Fran Collyer

Health Care Markets in Australia: Ownership of the Private Hospital Sector

Over the past decade, the Australian hospital sector has undergone a massive economic and administrative reorganization with ramifications for both the private and the public sectors. Changes such as privatization, deregulation, and the entry of foreign capital into the hospital sector are occurring in the hospital systems of many countries, including Australia, the United States, and the United Kingdom. These developments are radically transforming the hospital sector, altering established relationships between the state, the medical profession, the consumer, and the corporate investor, and raising important questions about the future of hospital services in regard to equity, accessibility, and quality.

Constructing health consumers: Private health insurance discourses in Australia and the United Kingdom

Abstract Significant transformations of the health care services sector over the past three decades have seen an increasing reliance on the private provision of health care services mediated through private health insurance. In countries such as Australia and the UK, private health insurance is promoted as providing a greater choice for individuals and easing the burden on the public system. While these claims, the policy contexts and the decision-making processes of individual consumers have attracted some sociological attention, little has been said about the role of private insurers. In this article we present a comparative analysis of the websites of private health insurers in Australia and the UK. Our analysis highlights adoption by private health insurers of neoliberal discourses of choice and individual responsibility, partnership and healthy lifestyles. In these respects, similarities between the discourses over-ride national differences which might otherwise be expected given their contrasting health care traditions and contexts.

Healthcare choice: Bourdieu’s capital, habitus and field

The promotion of choice is a common theme in both policy discourses and commercial marketing claims about healthcare. However, within the multiple potential pathways of the healthcare ‘maze’, how do healthcare ‘consumers’ or patients understand and experience choice? What is meant by ‘choice’ in the policy context, and, importantly from a sociological perspective, how are such choices socially produced and structured? In this theoretical article, the authors consider the interplay of Bourdieu’s three key, interlinked concepts – capital, habitus and field – in the structuring of healthcare choice. These are offered as an alternative to rational choice theory, where ‘choice’ is regarded uncritically as a fundamental ‘good’ and able to provide a solution to the problems of the healthcare system. The authors argue that sociological analyses of healthcare choice must take greater account of the ‘field’ in which choices are made in order to better explain the structuring of choice.

Sociology, sociologists and core–periphery reflections

This article reports on a citation-context analysis of journal articles from Australia, the United Kingdom and the United States of America. Examining publications from the sociology of health and medicine, the study draws a number of conclusions about the state of sociology, inter-country relationships between knowledge workers, and national systems of sociological knowledge production. It finds that core–periphery relations define significant features of sociological work, impacting on citation patterns, inter-country collaboration and the selection of reference materials. Core–periphery relations are also found to influence the sociological production of knowledge across the Australian university sector.

The Production of Scholarly Knowledge in the Global Market Arena: University Ranking Systems, Prestige and Power.

The relationships between disciplines and the institutions within which they are situated is a fertile area for researching the shaping of sociological knowledge. Applying theoretical insights from the sociology of knowledge, this article draws on an empirical study of research publications in the sociology of health and medicine to show which institutions in the Australian context are most likely to use sociological theory. When the institutions are positioned within the global university ranking system, an inverse association between sociological theory and the relative wealth and prestige of the originating institution becomes evident. Some of the implications of this finding are discussed with reference to the on-going viability of disciplines.

Vocational Rehabilitation of People with Mental Illness: The Need for a Broader Approach

Abstract This study examined the role of several factors in shaping the employment outcomes of people with mental illness who were interested in gaining open employment and participated in a community based vocational rehabilitation program to achieve this goal. The majority of the study respondents had a diagnosis of schizophrenia. The work history, work competence and social networks of the respondents were examined. While several aspects of work history and work competence were important for gaining employment, equally critical was the role of the social network, particularly family members and employers, in influencing employment outcomes. The study challenges existing assumptions about the social network characteristics of people with mental illness and proposes that supporting these networks is crucial for the success of rehabilitation programs.

Practices of conformity and resistance in the marketisation of the academy: Bourdieu, professionalism and academic capitalism

The paper reports on an empirical study based on qualitative interviews with staff from four Australian universities. These universities are shown to be undergoing significant social change as processes of marketisation impact on the everyday practices of academic workers. The universities are analysed as sites of contestation between the new professional managers and the established academic profession over the control of the conditions of work, the production of expert knowledge and the worksite itself. The theory of academic capitalism is examined, and the relevance of Bourdieu’s work for the analysis of a university sector in a context of marketisation is assessed. Bourdieu’s interlinked concepts of capital, habitus and the field are employed to investigate the nature of the contestation, revealing a dynamic process in which academics innovatively respond to threats to reduce their autonomy, to increased levels of surveillance and other constraints on practice. In addition, the study illustrates the processes through which actors within the sector, through acts of both conformity and resistance, contribute collectively to the growth of academic capitalism in the neoliberal university.

Origins and canons: medicine and the history of sociology.

Differing accounts are conventionally given of the origins of medical sociology and its parent discipline of sociology. These distinct ‘histories’ are justified on the basis that the sociological founders were uninterested in medicine, mortality and disease. This article challenges these ‘constructions’ of the past, proposing the theorization of health not as a ‘late development of sociology’ but an integral part of its formation. Drawing on a selection of key sociological texts, it is argued that evidence of the founders’ sustained interest in the infirmities of the individual, of mortality, and in medicine, have been expunged from the historical record through processes of ‘canonization’ and ‘medicalization’.

Knowledge Matters: Producing and Using Knowledge to Navigate Healthcare Systems

ABSTRACT In many contemporary healthcare systems, individuals are expected to be rational actors – weighing up available knowledge and making choices about their healthcare needs. In the policy context, this has been most explicitly applied to the financing of healthcare where there is encouragement for the purchase of private health insurance. However, perceptions of public and private healthcare provision, knowledge about healthcare needs, and the types of services people choose, are far from straightforward. Drawing on Bourdieu’s concepts of habitus, field, and capital, and a study of individual experiences of choice in Australian healthcare, we explore the knowledges used by people as they navigate through the healthcare system. Such navigation takes place in a milieu where authoritative medical knowledge intersects with knowledge from other sources, including the Internet and lived experience. However, our study reveals that navigation of healthcare is assisted most of all by the capacity to draw on ‘system knowledge’. System knowledge takes two, sometimes overlapping, forms. First, acquired system knowledge is produced through drawing on experience, formal knowledge and the capacity to undertake research (primarily cultural capital). Second, assumed system knowledge enables navigation of the healthcare system through accessing and utilising networks of privilege (primarily economic and social capital).

Toward a global sociology of knowledge: Post-colonial realities and intellectual practices

This article discusses changing social perspectives on knowledge, from the old sociology of knowledge to current post-colonial debates. The authors propose an approach that sees knowledge not as an abstract social construction but as the product of specific forms of social labour, showing the ontoformativity of social practice that creates reality through historical time. Research in three southern-tier countries examines knowledge workers and their labour process, knowledge institutions including workplaces and communication systems, economic strategies and the resourcing of knowledge work and workforces. This research shows in detail the contested hegemony of the global metropole in domains of knowledge. It reveals forms of negotiation that reshape knowledge production, and shows the importance for knowledge workers of the dynamics of global change.