Navigating Private and Public Healthcare : Experiences of Patients, Doctors and Policy-Makers

This edited collection focuses on the global growth of privatisation and private sector medicine in both developed and lesser developed countries, and the impact of this on patients, health workers, managers and policy-makers. Drawing upon sociological theories, concepts and insights, as well as experts from several countries with extensive experience in researching the field either nationally or internationally, the collection offers a unique perspective on healthcare services and healthcare systems: a view from those trying to access healthcare services, working inside health systems, or responsible for managing and organising services. Collectively, the chapters contribute an international perspective on the navigation of healthcare systems, and addresses the growing salience of ‘choice’ between public and private medicine in a variety of different national systems and contexts. Acknowledgements 5 Other Works by the Editors 6 Fran Collyer 6 Karen Willis 7 Contents 8 Notes on Contributors 11 List of Figures 20 List of Tables 21 Introduction 22 Neoliberalism, Privatisation, and the Trend Towards ‘the Market’ 23 Universal Healthcare Systems and the Role of the State 24 Private Health Insurance 26 Chapters in This Volume 27 References 30 Part I: About the System: Universalism and Privatisation 33 Chapter Two: Universalism in Healthcare and Social Citizenship in Chile, Uruguay and Costa Rica 34 Introduction 34 Welfare Regimes and Country Selection 37 Constitutive Dimensions of Healthcare Systems for Universalism and Social Citizenship 38 Chile, Uruguay and Costa Rica’s Healthcare Systems 40 Chile’s Healthcare System 40 Uruguay’s Healthcare System 45 Costa Rica’s Healthcare System 48 Comparison, Discussion and Conclusion 51 References 54 Chapter Three: Privatisation and Marketisation Within a Healthcare System: The Swedish Experience 59 Introduction 59 Universalism and the Nordic Healthcare Model 60 The Nordic Healthcare Model 63 The Shift from Statism to Privatisation in Swedish Healthcare 66 Critique and Reform After 1990 67 Private Care Providers and Universalism in Swedish Healthcare 71 Conclusions 74 References 76 Part II: Institutions of Health 79 Chapter Four: ‘Looking Outside Their Walls’: Exploring Community Health in Chicago Hospitals 80 Introduction 80 Profile of Chicago 83 First-Wave Reports 86 Conceptualising the ‘Community’ 89 Framing the Issue: Thinking of Causal Pathways or ‘Root Causes’ 90 Second-Wave Reports 93 Discussion 98 References 101 Chapter Five: Contracting-Out Care: Nursing Homes in Canada 104 Introduction 104 Forms of Privatisation 105 The Case of Nursing Homes 108 Contracting-Out Specific Services 109 Conclusions 114 References 117 Part III: Gatekeepers in the System 121 Chapter Six: Gatekeepers in a Mixed Private/Public System 122 Introduction 122 The Gatekeeper Study 128 The Healthcare Field and the Nation State 129 Gatekeepers in a Radically Altered Healthcare Field 132 Gatekeepers, Location and Social Space 134 Equity and Justice in the Healthcare System 136 Concluding Thoughts 139 References 142 Chapter Seven: Creeping Privatisation? Examining Procurement Choices in the ‘New’ NHS in England 146 Introduction 146 The Socio-Historical Context: NHS Commissioning 1991–2010 148 The Health and Social Care Act (2012): New Clinical Commissioning Decision-Makers 149 Developing a Conceptual Framework: Exploring New CCG Decision-Making Structures 151 The Ethnography 152 Decision-Making Within CCGs: What Shapes It? 154 The Salience of Financial Pressures 154 The Nature of the Provider Market-Place 155 The Use of the Market to Control Financial Pressure 158 Contextual Differences: Implications for Marketisation and Privatisation 160 Discussion: A Changing Private/Public Balance in the NHS? 161 Explanatory Power of the Conceptual Framework 162 Future Implications of the Health and Social Care Act (2012) 164 References 165 Part IV: Healthcare Professionals 170 Chapter Eight: Safeguarding Through Work Arounds: Socio-Materiality and the Organising of Care in a Private Hospital 171 Introduction 171 Practices and Objects: Theoretical Underpinnings 172 The Study 174 The Context of Private Hospital Care and Nursing 175 Working Around Staffing: Buddying-Up? 177 Working Around Staffing: ‘Holding the Baby’ 183 Discussion 187 Conclusion 191 References 192 Chapter Nine: Reducing Healthcare Costs in Portugal: Outcomes and Implications for Public and Private Medicine 195 Introduction 195 A Theoretical Approach to Healthcare Policy Analysis 197 The Portuguese Health System: An Overview 199 Survey of Physicians: Methods 202 Outcomes of Reducing Healthcare Costs 203 Healthcare Access 203 Quality of Care 204 Recessive Policies and the Implications for the Public-Private Relationship 205 Conclusion 208 References 210 Chapter Ten: Promoting Health as a Form of Capital: The Transformation of the Danish Healthcare Field as Experienced By Private Healthcare Professionals 214 Introduction 214 Recent Changes in the Danish Healthcare Field 216 A Changing Field of Employment 218 A Bourdieusian Perspective on the State and the Healthcare Field 219 This Study 222 Four Empirical Cases 223 Anne, Physiotherapist: Witnessing a Transition from Helping Others to Training the Individual 223 Marie, Occupational Therapist: Improving Unemployable Bodies 225 Birgitte, Dental Nurse: High-Class Clients and Low-Class Professions 226 Jonas, Physiotherapist: Knowing the Business 228 Discussion 230 Conclusion 232 References 234 Part V: Patients, Consumers and Citizens 237 Chapter Eleven: The Imperative of Choice in Australian Healthcare 238 Introduction 238 The Coexistence of Public and Private Healthcare in Australia 239 Our Study—Australians and Healthcare Choice 241 Field and the Promotion of Choice 241 Habitus and the Valuing of Choice 244 Capital and the Enactment of Choice 246 PHI and the Quality of Care 249 Coexisting Doxa? Public and Private Healthcare 253 Conclusions 255 References 258 Chapter Twelve: The Marketisation of Aged Care: The Impact of Aged Care Reform in Australia 260 Introduction 260 Aged Care in Australia 263 Deregulation of Ownership of Residential Aged Care and Privatisation 266 User Payments for Services 266 The Elderly and Consumer Choice 268 Privatisation, Regulation and Quality of Care 271 Conclusion 273 References 274 Part VI: Conclusion 279 Chapter Thirteen: Navigating Private and Public Healthcare 280 Health, Medicine and Sociology 280 The Growth of Private Medicine and the Changing Healthcare System 288 Privatisation, Private Medicine and the Professions 290 Governance 293 The Undermining of ‘Real’ Choice 296 A Final Word 297 References 297 Index 304 Front Matter ....Pages i-xxv Introduction (Karen Willis)....Pages 1-11 Front Matter ....Pages 13-13 Chapter Two: Universalism in Healthcare and Social Citizenship in Chile, Uruguay and Costa Rica (Monica Budowski)....Pages 15-39 Chapter Three: Privatisation and Marketisation Within a Healthcare System: The Swedish Experience (Paula Blomqvist)....Pages 41-60 Front Matter ....Pages 61-61 Chapter Four: ‘Looking Outside Their Walls’: Exploring Community Health in Chicago Hospitals (Fernando De Maio, Raj C. Shah, Kerianne Burke)....Pages 63-86 Chapter Five: Contracting-Out Care: Nursing Homes in Canada (Pat Armstrong, Hugh Armstrong)....Pages 87-103 Front Matter ....Pages 105-105 Chapter Six: Gatekeepers in a Mixed Private/Public System (Fran Collyer)....Pages 107-130 Chapter Seven: Creeping Privatisation? Examining Procurement Choices in the ‘New’ NHS in England (Vid Calovski, Michael Calnan)....Pages 131-154 Front Matter ....Pages 155-155 Chapter Eight: Safeguarding Through Work Arounds: Socio-Materiality and the Organising of Care in a Private Hospital (Trudy Rudge, Luisa Toffoli)....Pages 157-180 Chapter Nine: Reducing Healthcare Costs in Portugal: Outcomes and Implications for Public and Private Medicine (Tiago Correia)....Pages 181-199 Chapter Ten: Promoting Health as a Form of Capital: The Transformation of the Danish Healthcare Field as Experienced By Private Healthcare Professionals (Kristian Larsen, Ivan Harsløf)....Pages 201-223 Front Matter ....Pages 225-225 Chapter Eleven: The Imperative of Choice in Australian Healthcare (Karen Willis, Sophie Lewis)....Pages 227-248 Chapter Twelve: The Marketisation of Aged Care: The Impact of Aged Care Reform in Australia (Julie Henderson, Eileen Willis)....Pages 249-267 Front Matter ....Pages 269-269 Chapter Thirteen: Navigating Private and Public Healthcare (Fran Collyer)....Pages 271-294 Back Matter ....Pages 295-304