Inequalities in Choice: Australian Accounts of Healthcare Preferences and Perceptions

Australia has a dual healthcare system with taxation based universal health insurance providing free public hospital care and a thriving private health insurance industry enabling healthcare provision in a private setting. The health policy context privileges healthcare as a consumer choice and there are policy incentives for individuals to choose private healthcare. We interviewed 78 individuals, and 41 healthcare gatekeepers (eg health professionals, administrators) to examine how preferences and perceptions about public and private care shapes the choices that they make for themselves or for others. Drawing on Bourdieu’s relational view of inequality, and using the conceptual triad of habitus, capital and field, we found the capacity to make healthcare choices is unequally distributed; and that this is exacerbated in a system where preferences for private care are privileged in public and popular discourses about healthcare. We find that because private healthcare is privileged in healthcare policy and the media, both individuals and their healthcare providers are more likely to view private healthcare as a necessity, rather than an option. Even in a healthcare system where there is a world class public health system, we observe emerging inequalities between those who feel confident in choosing health care (and usually state their preference is for private care) and those who perceive that their choices are limited (usually referring to the need to seek public care). Quality healthcare is increasingly viewed as requiring the use of capital resources (eg economic, social, cultural), as dispositions and preferences (habitus) are shaped through the dominant positioning of private over public in the healthcare field.