The private life of medicine: accounting for antibiotics in the ‘for-profit’ hospital setting
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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.
KeywordsAntibiotics Antimicrobial stewardship Australia Private hospital Qualitative research Sociology
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.
- Australian Commission on Safety and Quality in Health Care (ACSQHC). 2015. Antimicrobial prescribing practice in Australian hospitals. https://www.safetyandquality.gov.au.
- Australian Institute of Health and Welfare (AIHW). 2016. Australia’s health 2016. Canberra: AIHW.Google Scholar
- Australian Prudential Regulation Authority (APRA). 2017. Private health insurance membership and coverage. http://www.apra.gov.au/PHI/Publications/Documents/1702-MemCov-20161231.pdf.
- Bourdieu, P. 1990. The logic of practice. Cambridge: Polity Press.Google Scholar
- Bourdieu, P., and L. Wacquant. 1992. An invitation to reflexive sociology. Chicago: University of Chicago Press.Google Scholar
- 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
- Callon, M. 1998. The laws of the markets. Oxford: Blackwell.Google Scholar
- 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
- 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.
- IHPA. 2017. Ministerial direction. www.ihpa.gov.au/media-releases/ministerial-directions/16-February-2017.
- Moreira, T. 2013. The transformation of contemporary health care. London: Routledge.Google Scholar
- 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.
- UK Review on Antimicrobial Resistance. 2016. Tackling drug-resistant infections globally. https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf.
- UN General Assembly. 2016. Political declaration of the high-level meeting of the General Assembly on Antimicrobial Resistance, September 2016. www.un.org/pga/.
- World Health Organisation. 2015. Global action plan on antimicrobial resistance. www.who.int/drugresistance/global_action_plan/en/.