Chapter thirteen: Navigating private and public

Abstract

The funding of healthcare services, the design and organisation of healthcare systems, and health policy have never been popular topics for sociologists, nor figured prominently in the discipline’s journals. Yet, without an understanding of the healthcare system, it is, we argue, difficult to envisage how healthcare behaviours, the inequalities of access to services or the experience of ill-health and treatment can be successfully explained. Enormous changes have spread through the healthcare systems of the world since the 1980s, with the growth of the private healthcare market and the widespread adoption of privatisation as solutions to the rising costs of care. Although many of the promises of privatisation have not been met, privatisation and state support for private medicine continue to grow without abatement, whether the focus is on Australia, Britain, Europe, the US, Korea, Argentina, Chile, or Mexico. This chapter draws from the literature, and from contributions to this volume, to offer a glimpse into a world of activity often overlooked: the challenges posed when private and public medicine meet. This world, we propose, is a microcosm encapsulating all the tensions and dramas that are played out in the broader social arena, where the ownership of resources matters, where the organisation and design of a system matters, where ‘surpluses’ or profits matter, and where it matters just who the major players are. In this world, patients, carers, health workers and taxpayers all are impacted by the subsequent consequences on cost, governance, working conditions, accessibility and equity.