Chapter Eleven: The Imperative of Choice in Australian Healthcare
Since the late 1990s, Australians have been encouraged to purchase private health insurance through a range of government policy incentives and an active private health insurance market. The notion that private health insurance will enable choice and facilitate control in the context of uncertain health and healthcare provides fertile ground for such encouragement. In this chapter, we explore the ‘imperative of choice’ that is now an integral part of the healthcare landscape. While the valuing of choice in healthcare reflects broader ideas about individual responsibility, it is also indicative of people’s dispositions towards, and strategies directed at, the attempt to control uncertainty. Our analysis of the imperative of choice draws on interviews with 78 Australians about how they navigate and make choices about healthcare, particularly the choice to purchase private health insurance. Drawing on Bourdieu’s concepts of field, capital and habitus, we examine how choice is constructed and how capacity to choose varies according to income and education, and we identify participants’ varying perceptions and experiences of public and private healthcare provision. Our analysis reveals that perceptions matter: while universal healthcare remains popular, the focus on, and valuing of, choice privileges private healthcare—which is perceived as enabling choice and as providing better quality care and control over uncertainty. This contrasts with perceptions of public healthcare, which is perceived as providing no choice and little control. The challenges of making choices in a complex healthcare system and the fact that the capacity to choose is unequally distributed become invisible, with choice promoted as desirable and available to all.
We acknowledge and thank the participants in this study for their time and thoughtful contribution to this project; the Australian Research Council, who funded the research (DP130103876); our colleague Fran Collyer, who provided supportive critique throughout the project; and research assistants Marika Franklin and Ian Flaherty, who provided research assistance support.
Approval for this study was obtained from the Human Ethics Committee (HEC) at the University of Sydney.
- Australian Competition and Consumer Commission (ACCC). (2015). ACCC Report on the Private Health Insurance Industry, 20 October. Available at: https://www.accc.gov.au/media-release/accc-report-on-the-private-health-insurance-industry [Accessed 8 May 2019].
- Beck, U. (1992). Risk Society. London: Sage.Google Scholar
- Bourdieu, P. (1984). Distinction: A Social Critique of the Judgement of Taste (translated by R. Nice). London: Routledge.Google Scholar
- Bourdieu, P. (1977). Outline of a Theory of Practice (translated by R. Nice). Cambridge: Cambridge University Press.Google Scholar
- Bourdieu, P. (1993). Sociology in Question (translated by R. Nice). London: Sage.Google Scholar
- Boxall, A.M. (2015). Private health insurance ‘carrot and stick’ reforms have failed – here’s why’. The Conversation, 31 March. Available at: https://theconversation.com/private-health-insurance-carrot-and-stick-reforms-have-failed-heres-why-38501.
- Cheng, T. (2018). Private health insurance rebates don’t serve their purpose. Let’s talk about scrapping them. The Conversation, 7 February. Available at: https://theconversation.com/private-health-insurance-rebates-dont-serve-their-purpose-lets-talk-about-scrapping-them-91061.
- Collyer, F., Willis, K. and Keleher, H. (2019, forthcoming). The private health sector and private health insurance. In: E. Willis, L. Reynolds and T. Rudge (eds.) Understanding the Australian Healthcare System. Australia: Elsevier.Google Scholar
- Coulter, A. (2010). Do patients want choice and does it work? BMJ, 341, pp. 973–975.Google Scholar
- Giddens, A. (1991). Modernity and Self Modernity: Self and Society in the Late Modern Age. Cambridge: Polity Press.Google Scholar
- McCauley, D. (2019). Labor will not rule out scrapping the $6billion health insurance rebate. The Sydney Morning Herald, 2nd May. Available at: https://www.smh.com.au/federal-election-2019/labor-will-not-rule-out-scrapping-6-billion-health-insurance-rebate-20190502-p51jgp.html [Accessed 6 May 2019].
- Mol, A. (2008). The Logic of Care: Health and the Problem of Patient Choice. London: Routledge.Google Scholar
- Petersen, A., Munsie, M., Tanner, C., Macgregor, C. and Brophy, J. (2017). Stem Cell Tourism and the Political Economy of Hope. Palgrave Macmillan.Google Scholar
- Thaler, R.H. and Sunstein, C.R. (2008). Nudge: Improving Decisions About Health, Wealth, and Happiness. New Haven, Conn.: Yale University Press.Google Scholar
- Van Natta, M., Burke, N.J., Yen, I.H., Rubin, S., Fleming, M.D., Thompson-Lastad, A. and Shim, J.K. (2018). Complex care and contradictions of choice in the safety net. Sociology of Health and Illness, 40(3), pp. 538–551.Google Scholar
- Willis, K. and Lewis, S. (2015). Confused about your private health insurance? You’re not alone. The Conversation, 23October. Available at: https://theconversation.com/confused-about-your-private-health-insurance-coverage-youre-not-alone-49493.