J. Ross Barnett

To Boldly Go? Place, Metaphor, and the Marketing of Auckland's Starship Hospital

In this paper, we place the naming of the Starship Childrens Hospital in Auckland, New Zealand, within the context of increasingly consumer-oriented health care provision. This use of metaphor alludes to the hospitals distinctive design features and represents an attempt to de-emphasise connotations associated with institutionalised medicine, thus normalising the place for children. However, those naming the hospital had more than children in mind. Rather, there was a dual intent: to market the hospital as a distinctive place for monetary donors, as well as promoting a more therapeutic environment for youthful users. Through the vehicle of our case study, we raise questions concerning the competition by health care services for public and private funds. We conclude that there is a need to move beyond viewing hospitals as service entities and equating health care consumption with utilisation behaviour. Rather, a merging of insights from the political economy of health care and new cultural geography literatures can aid the development of more finely textured understandings of the meaning of contemporary health care, and the role of metaphor and marketing in selling places of health care consumption.

Declining professional dominance?: Trends in the proletarianisation of primary care in New Zealand

This paper explores the relevance of the proletarianisation thesis to the emergence of new forms of managed primary care in New Zealand. This concern is of particular interest because of primary care sector has persisted virtually unchanged, since the birth of the welfare state in 1938, despite numerous past state attempts at reform. Since 1993 collective action on the part of general practitioners has resulted in the formation of Independent Practice Associations (IPAs). In terms of Lights (1993) idea of countervailing trends to proletarianisation, IPA development represents a pre-emptive strategy designed to prevent the introduction of the kind of managerialism imposed on the secondary sector where some loss of autonomy has been sustained by health care professionals. At the macro-level, therefore, there has been little change in GP autonomy although at the micro-scale there has been some loss of freedom as the development of IPAs ironically has meant that the degree of control by GPs over the content of their work has changed. The results suggest that the notion of the profession acting as a countervailing force has been borne out. Furthermore, the proposition inherent in modern organisation-environment relations literature, that organisations not only adapt to their environment but may actively seek to change it receives some support.

Placing private health care: reading Ascot Hospital in the landscape of contemporary Auckland.

The closing years of the 20th century were a time in New Zealand dominated by health care reforms inspired by neo-liberal ideology. The result has been changing geographies of public and private health care providers and the evolution of a new discourse of health care. Ascot Integrated Hospital, situated in the affluent Auckland suburb of Remuera, opened in 1999, reflecting and projecting this new discourse. It is a pioneer, competing for patient patronage in a contracting market for surgical and medical providers. In this paper we survey the recent history of private hospital developments in New Zealand, then more closely consider the Ascot, a hospital that has deployed language to construct itself and its achievements in the public imagination. Given the context of an extremely competitive environment for private patients, this construction glamorises medicine and links healing with a contrived place. We conclude that texts associated with the Ascot provide a useful vehicle for advancing cultural geographies of health care and ideas of the place of hospitals in western capitalist countries.

Equity, access and resource allocation: Planning hospital services in New Zealand

The desire to limit the growth of expenditure in the Western world has seen increased attempts to reallocate resources in the name of equity and efficiency. This paper reviews recent moves in New Zealand to achieve an equitable financing and distribution of hospital resources. While a more equal distribution of resources is likely to result from the recent reforms, redistributive policies of the type being implemented in New Zealand, which leave the basic structure of the health care system intact, may have only a marginal impact on improvements in access to care and health status.

Influence of bed supply and health care organization on regional and local patterns of diabetes related hospitalization

This paper undertakes both a macro- and micro-scale analysis of the influences exerted by the health care system on patterns of hospitalization. The health disorder of diabetes mellitus is used as the case study and the analyses are based on New Zealand data sets. The article first examines the extent to which both the supply and organization of primary and secondary health care affect rates of hospitalization. The macro-scale analysis investigates the applicability of Roemers Law to regional variations in diabetes hospitalization. The organizational control of hospital utilization via doctor gatekeeping functions and interaction between health services are then examined at the local level. This analysis assumes a population based approach using the Canterbury Register of Insulin-treated diabetic persons as the study population. Diabetes discharge rates were found to be most highly correlated with hospital bed supply in 5 of the 8 years studied (1979-1986). Stepwise regression analysis indicated area rates of diabetes hospitalization were significantly influenced by resource factors even after controlling for differences in the socio-demographic characteristics of the area populations. This confirmed the presence of Roemers Law at the aggregate level with rates of diabetes hospitalization appearing to have more to do with the availability of medical resources than to population needs. At the local level, hospital admission patterns were found to vary by general practitioner age, practice type found to vary by general practitioner age, practice type and diabetic caseload. Overall, insulin-treated diabetic patients most likely to be hospitalized were those in the care of young doctors new to general practice, and those who attended doctors who had small diabetic caseloads. Solo practitioners had the lowest rates of patient hospitalization. There were marked disparities in patient access to specialist diabetes education and clinical outpatient services by patient age, duration of diabetes and attendance on primary care. Overall, no significant differences were found in the propensity for hospitalization between users and non-users of these specialist services. This does not imply however, service ineffectiveness but rather is indicative of the complexity of the local diabetes care organization and the differing needs of the insulin-treated diabetic population within the community as a whole.

Hospital resource allocation in New Zealand.

Abstract It has long been recognised that inequalities exist in the availability of primary medical care. Less well known, however, are the distributional inequalities that exist in the secondary sector. This paper examines the relationships between hospital resource allocation, the presence of medical resources and need in New Zealands 29 hospital boards in 1976. Although the relationship between resource allocation and need was positive, it was found to be tenuous, with bed numbers, political pressure and the systems inertia being the more important determinants of allocation levels.

Geographical implications of restricting foreign medical immigration: A New Zealand case study, 1976-1987

Foreign medical graduates (FMGs) have come to play an important role in providing primary care, especially in the more rural and poorer urban parts of New Zealand, locations which locally trained doctors have traditionally found unattractive. Since 1980, new immigration policies have enhanced this pattern, but are not the main cause of it. Rather, it is suggested that a set of informal constraints, arising from increased competition among greater numbers of GPs has caused a diffusion of foreign doctors into areas of need, although their presence in such areas, is for the most part, only temporary. Nevertheless, it is suggested that the success of market based policies in terms of improving the distribution of GPs is, to a large extent, dependent upon the presence of FMGs in the labour pool. Seen in this light, recent changes in immigration policy, which have reduced the inflow of FMGs into New Zealand, may well have been premature.

“Getting into Hospitals in a Big Way”: The Corporate Transformation of Hospital Care in Australia

In many countries the provision of hospital services has changed from a cottage industry with many small operators to an industry in which large corporate chains are now starting to predominate. Transnational corporations have increasingly invested in the provision of hospital services when traditional areas of investment have become no longer attractive. Although corporate involvement in the provision of hospital services has become an issue of considerable significance in recent years, geographers have paid little attention to such trends. Within Australia, changes in access to capital and shifts in investment, the role of the state regulatory environment, and, to a lesser extent, the emergence of corporate managerialism are the key factors underpinning corporate transformation. A case study of Mayne Health Ltd, formerly the largest corporate provider of hospital care, is used to illustrate such trends. The corporate transformation has been geographically uneven at both the state and local levels and reflects local variation especially in state regulatory environments and the extent to which corporate providers have entered into new public–private partnerships at the local level. We suggest that the implications of such trends are far from clear and that more research is needed on this fundamental restructuring of hospital services.