Navigating Healthcare in a Public/Private System – the Inequalities of Choice

The notion of choice in healthcare is now so ubiquitous that the potential problems of choice are rarely discussed. Underpinning a dominant rhetoric of choice, evident in health policy, popular, and marketing discourses, are notions that all individuals have the same capacity to choose, that they value choice, and, further, that they will make the ‘right' choices. However, our work, employing a Bourdieusian framework and drawing on concepts of capital, habitus and field, identifies choice as far from straightforward. In Australia and many other developed countries, the healthcare field comprises both public and private healthcare services, and there is significant contestation about what healthcare should be covered by public or private insurance. Moreover, individuals are unequally positioned in the social structure, and their beliefs, values, perceptions and knowledge intersect with their position. This makes for a complex set of processes through which individuals travel through, and navigate the healthcare system. In this paper we discuss the structuring of healthcare choice with a focus on the issue of private health insurance. Our Australian study, comprising interviews with 78 individuals who are, or have been, patients, examined the notion of health care choice – the choices that people perceive are available to them; and the choices they make. Our sample included participants with extensive resources to ensure that choice was available to them; as well as participants with few economic, social and cultural resources. We found that for those without the capacity to make choices, the dominance of a rhetoric of choice as desirable contributed to their perceptions of being marginalised within the healthcare system. Our research concludes that in systems where private options are privileged, there is an entrenchment of inequality.