Chapter Six: Gatekeepers in a Mixed Private/Public System
The recent dramatic growth in private healthcare in Australia’s mixed public/private healthcare system has brought a new imperative to the investigation of decision-making and choice. This chapter draws on a study of key players in the healthcare system, the ‘gatekeepers’ who control access to resources and services and shape patients’ experiences of healthcare. The analysis draws on in-depth interviews with 43 gatekeepers (general practitioners [GPs], specialists, nurses, hospital administrators and policy-makers) in the private, public and not-for-profit sectors. Employing Bourdieu’s concepts of habitus, field, market and state, the study explores the impact of neoliberalism on the gatekeepers, finding connections between their perspectives on the state, the market and social justice, and their locations within the field. The analysis provides insight into differing perceptions of ‘public’, ‘private’, the role of the state and social justice across this key group of actors, and suggests neoliberalism has had both direct and indirect effects on their understandings and practices.
I would like to acknowledge the participants of the gatekeeper study for their time and thoughtful contribution to this project; the Australian Research Council and the University of Sydney for funding the field work; and colleagues, including Karen Willis and Sophie Lewis, without whom the project would not have been either successful or enjoyable; and Jon Gabe of Royal Holloway, University of London, for his thoughtful comments on the manuscript.
Note: Approval for the gatekeeper study was sought from a plethora of ethics committees at a variety of institutions. Primarily this was the Human Ethics Committee (HEC) at the University of Sydney, as well as the various authorities with responsibility for ethical conduct in the public hospital system in each state.
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