Abstract
The noticeable trend away from autonomous professional decision making in social issues, including health, is attributable to diverse factors. First, there has been dissatisfaction with professional decisions, related in part to growing managerial control and distance of managers from clients, and in part to frustration with skewed distribution of products. Second, there has been growing recognition of the political nature of decision making, regardless of professional input. Third, consumer participation has been introduced into various other social models. The writer argues that consumer participation, and even control, will not damage the professional's role and may have positive values for the planning and implementation of health systems. Consumer participation at every level can offset the immobility of large systems, racism, unwieldy bureaucracies, and class discrimination.

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