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Social Theory & Health

, Volume 16, Issue 4, pp 379–395 | Cite as

The private life of medicine: accounting for antibiotics in the ‘for-profit’ hospital setting

  • Alex Broom
  • Alexandra Gibson
  • Emma Kirby
  • Mark Davis
  • Jennifer Broom
Original Article
  • 42 Downloads

Abstract

The looming global antibiotic crisis, and the need to curtail over-use, has been positioned variously as a medical problem, an urgent public health concern, and an issue of governance and political will. But few questions have been raised in terms of its economic drivers. Specifically, how infection management—and the problematic of antimicrobial resistance—may be deeply embedded in economic imperatives and relations of labour. Drawing on interviews with 31 health professionals (doctors, nurses, pharmacists) from a private hospital in Australia, we explore their accounts of the dynamics of care and the economic imperatives in (and beyond) infection management. We argue that market-driven forces create a distinct set of obligations that could undermine the local and global antibiotic optimisation agenda. Given the increasingly privatised landscape of healthcare in Australia and internationally, exploring the nexus of economics and practice will be vital in retaining antibiotics for the future.

Keywords

Antibiotics Antimicrobial stewardship Australia Private hospital Qualitative research Sociology 

Notes

Acknowledgements

We would like to acknowledge the support from the Australasian Society of Infectious Diseases. This research was funded by an Australian Research Council Linkage Grant LP140100020.

References

  1. Australian Commission on Safety and Quality in Health Care (ACSQHC). 2015. Antimicrobial prescribing practice in Australian hospitals. https://www.safetyandquality.gov.au.
  2. Australian Institute of Health and Welfare (AIHW). 2016. Australia’s health 2016. Canberra: AIHW.Google Scholar
  3. Australian Prudential Regulation Authority (APRA). 2017. Private health insurance membership and coverage. http://www.apra.gov.au/PHI/Publications/Documents/1702-MemCov-20161231.pdf.
  4. Bishop, F.L., F. Barlow, B. Coghlan, P. Lee, and G.T. Lewith. 2011. Patients as healthcare consumers in the public and private sectors. BMC Health Services Research 11 (1): 1.CrossRefGoogle Scholar
  5. Bourdieu, P. 1990. The logic of practice. Cambridge: Polity Press.Google Scholar
  6. Bourdieu, P., and L. Wacquant. 1992. An invitation to reflexive sociology. Chicago: University of Chicago Press.Google Scholar
  7. Broom, A., J. Broom, and E. Kirby. 2014. Cultures of resistance? A Bourdieusian analysis of doctors’ antibiotic prescribing. Social Science and Medicine 110: 81–88.CrossRefGoogle Scholar
  8. Broom, A., J. Broom, E. Kirby, and G. Scambler. 2015. The path of least resistance? Jurisdictions, responsibility and professional asymmetries in pharmacists’ accounts of antibiotic decisions in hospitals. Social Science and Medicine 146: 95–103.CrossRefGoogle Scholar
  9. Broom, A., J. Broom, E. Kirby, and G. Scambler. 2016. Nurses as antibiotic brokers: Institutionalised praxis in the hospital. Qualitative Health Research 27 (3): 1924–1935.Google Scholar
  10. Broom, A., E. Kirby, A. Gibson, J. Post, and J. Broom. 2017a. Myth, manners, and medical ritual: Defensive medicine and the fetishisation of antibiotics. Qualitative Health Research 27 (13): 1994–2005.CrossRefGoogle Scholar
  11. Broom, A., J. Broom, E. Kirby, A. Gibson, and M. Davis. 2017b. Antibiotic optimisation in ‘the bush’: Local know-how and core-periphery relations. Health and Place 48: 56–62.CrossRefGoogle Scholar
  12. Brown, L., and J.R. Barnett. 2004. Is the corporate transformation of hospitals creating a new hybrid health care space? Social Science and Medicine 58 (2): 427–444.CrossRefGoogle Scholar
  13. Bury, M., and D. Taylor. 2008. Towards a theory of care transition. Social Theory and Health 6 (3): 201–219.CrossRefGoogle Scholar
  14. Callon, M. 1998. The laws of the markets. Oxford: Blackwell.Google Scholar
  15. Charani, E., E. Castro-Sanchez, N. Sevdalis, Y. Kyratsis, L. Drumright, N. Shah, and A. Holmes. 2013. Understanding the determinants of antimicrobial prescribing within hospitals. Clinical Infectious Diseases 57 (2): 188–196.CrossRefGoogle Scholar
  16. Charmaz, K. 1990. ‘Discovering’ chronic illness. Social Science and Medicine 30 (11): 1161–1172.CrossRefGoogle Scholar
  17. Collyer, F., and K. White. 1997. Enter the market. Journal of Sociology 33 (3): 344–363.CrossRefGoogle Scholar
  18. Collyer, F., and K. White. 2011. The privatisation of Medicare and the National Health Service, and the global marketisation of healthcare systems. Health Sociology Review 20 (3): 238–244.CrossRefGoogle Scholar
  19. Cotta, M.O., M.S. Robertson, C. Marshall, K.A. Thursky, D. Liew, and K.L. Buising. 2015. Implementing antimicrobial stewardship in the Australian private hospital system. Australian Health Review 39 (3): 315–322.CrossRefGoogle Scholar
  20. Cunningham, W., and H. Wilson. 2011. Complaints, shame and defensive medicine. BMJ Quality and Safety 20 (5): 449–452.CrossRefGoogle Scholar
  21. Fleming, N. 2016. Stewardship in the primary care and long-term care settings. In Antimicrobial stewardship, ed. M. Laundy, M. Gilchrist, and L. Whitney, 111–117. Oxford: Oxford University.Google Scholar
  22. Fraze, T., A. Elixhauser, L. Holmquist, and J. Johann. 2010. Public hospitals in the United States, 2008. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb95.jsp.
  23. Grant, M.C., D. Yang, C.L. Wu, M.A. Makary, and E.C. Wick. 2017. Impact of enhanced recovery after surgery and fast track surgery pathways on healthcare-associated infections. Annals of Surgery 265 (1): 68–79.CrossRefGoogle Scholar
  24. Greener, I., and M. Powell. 2008. The changing governance of the NHS: Reform in a post-Keynesian health service. Human Relations 61 (5): 617–636.CrossRefGoogle Scholar
  25. Harley, K., K. Willis, J. Gabe, S.D. Short, F. Collyer, K. Natalier, and M. Calnan. 2011. Constructing health consumers: Private health insurance discourses in Australia and the United Kingdom. Health Sociology Review 20 (3): 306–320.CrossRefGoogle Scholar
  26. Krachler, N., and I. Greer. 2015. When does marketisation lead to privatisation? Social Science and Medicine 124: 215–223.CrossRefGoogle Scholar
  27. Lane, R.E. 1991. The market experience. Cambridge: Cambridge University.CrossRefGoogle Scholar
  28. Maarse, H. 2006. The privatisation of health care in Europe. Journal of Health Politics, Policy and Law 31 (5): 981–1014.CrossRefGoogle Scholar
  29. Moreira, T. 2013. The transformation of contemporary health care. London: Routledge.CrossRefGoogle Scholar
  30. Murray, S.F., and M.A. Elston. 2005. The promotion of private health insurance and its implications for the social organisation of healthcare. Sociology of Health and Illness 27 (6): 701–721.CrossRefGoogle Scholar
  31. Powell, M., and R. Miller. 2014. Framing privatisation in the English National Health Service. Journal of Social Policy 43 (3): 575–594.CrossRefGoogle Scholar
  32. Quinn, C. 2002. The pasts and futures of private health insurance in Australia. https://openresearch-repository.anu.edu.au/bitstream/1885/41231/3/WP47.pdf.
  33. Timmermans, S., and H. Oh. 2010. The continued social transformation of the medical profession. Journal of Health and Social Behavior 51: S94–S106.CrossRefGoogle Scholar
  34. Toffoli, L., T. Rudge, and L. Barnes. 2011. The work of nurses in private health: Accounting for the intangibles in care delivery. Health Sociology Review 20 (3): 338–351.CrossRefGoogle Scholar
  35. UK Review on Antimicrobial Resistance. 2016. Tackling drug-resistant infections globally. https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf.
  36. UN General Assembly. 2016. Political declaration of the high-level meeting of the General Assembly on Antimicrobial Resistance, September 2016. www.un.org/pga/.
  37. World Health Organisation. 2015. Global action plan on antimicrobial resistance. www.who.int/drugresistance/global_action_plan/en/.
  38. Zarb, P., and H. Goossens. 2011. European surveillance of antimicrobial consumption. Drugs 71 (6): 745–755.CrossRefGoogle Scholar

Copyright information

© Macmillan Publishers Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Alex Broom
    • 1
  • Alexandra Gibson
    • 2
  • Emma Kirby
    • 1
  • Mark Davis
    • 3
  • Jennifer Broom
    • 4
    • 5
  1. 1.Faculty of Arts and Social Sciences, School of Social SciencesUniversity of New South WalesSydneyAustralia
  2. 2.School of Public Health and Community MedicineUniversity of New South WalesSydneyAustralia
  3. 3.School of Social SciencesMonash UniversityMelbourneAustralia
  4. 4.School of MedicineUniversity of QueenslandBrisbaneAustralia
  5. 5.Sunshine Coast Health and Hospital Service, Sunshine Coast University HospitalBirtinyaAustralia

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