Chapter eleven: The imperative of choice in australian healthcare

Abstract

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.