The Unequal Structuring of Healthcare Choice: Perceptions of Australian Healthcare Consumers

The notion of choice in healthcare is a cornerstone of many western developed health policy settings. In the Australian context, choice has been integral to policy initiatives encouraging Australians to take out private health insurance (PHI). Promoted by policy makers and marketed by the health insurance industry, choice of specialist medical provider, hospital, and even complementary and alternative services has become highly valued. This private system coexists with a universal health insurance scheme for medical care and public hospital provision. However, despite the emphasis on healthcare choice, there has been little exploration about to the factors shaping, and unequal structuring of, healthcare choice.

Drawing on Bourdieu’s theoretical framework of intersecting forms of capital (cultural, social, symbolic, economic, and spatial) we explored the structuring of choice by Australian consumers using indepth interviews. Purposive sampling ensured a diversity of perceptions and experiences of healthcare choice, as well as in capacity to draw on healthcare capital when exercising choice. Interviews explored use of healthcare; purchase and use (or not) of PHI; social networks and information sources drawn upon when making healthcare choices. Interviews were thematically analysed.

We found that people have an unequal capacity to make choices in healthcare. Complex, interlinked forms of capital contribute to the unequal structuring of choice. While people’s choices are most clearly enabled or constrained by economic resources and position, economic capital is strongly shaped by social relationships and networks, geographic location and interactions with healthcare providers. Choice represents an individualised rather than communitarian approach to healthcare service provision. Therefore the prioritising of individual choice in healthcare policy and markets contributes to the maintenance of unequal health outcomes across the population.