Kirsten Harley

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.

Theory Use in Introductory Sociology Textbooks

Introductory sociology textbooks are one of the disciplinary sites that illustrate both the prominent place, and many uses, of theory in sociology. This article examines the place of theory in a selection of introductory sociology textbooks published in Australia, Britain and the US. It identifies the emergence of theory as a separate topic warranting its own sections or chapters, and considers the historical changes in explicit advice provided about the nature and use of theory in sociology. It also illustrates some of the uses of theory exhibited there that go beyond those directly addressed in textbook advice.

Healthcare choice: Discourses, perceptions, experiences and practices

Policy discourse shaped by neoliberal ideology, with its emphasis on marketisation and competition, has highlighted the importance of choice in the context of healthcare and health systems globally. Yet, evidence about how so-called consumers perceive and experience healthcare choice is in short supply and limited to specific healthcare systems, primarily in the Global North. This special issue aims to explore how choice is perceived and utilised in the context of different systems of healthcare throughout the world, where choice, at least in policy and organisational terms, has been embedded for some time. The articles are divided into those emphasising: embodiment and the meaning of choice; social processes associated with choice; the uncertainties, risks and trust involved in making choices; and issues of access and inequality associated with enacting choice. These sociological studies reveal complexities not always captured in policy discourse and suggest that the commodification of healthcare is particularly problematic.

Sociology’s objects, objectivity and objectives Successes and failures in establishing the discipline in America, England and Australia before 1945

In the late 19th and early 20th century steps were taken to establish academic sociology in the USA, England and Australia. In America the project was a success and the discipline was well established by 1945, yet in England and Australia it made nothing like the same progress. In England it struggled against the influential extramural social research movement, while in Australia sociology’s case was so poorly managed and presented that it was swamped by other disciplines, especially economics, and did not officially join the university system until 1959. The article examines these three attempts to institutionalize sociology before 1945 in terms of three themes of disciplinary coherence: theorization of ‘society’ as a broad object, entailing an attempt to locate sociology as the integrative social science; the quest for ‘scientific’ objectivity; and the practical objective of social reform. While present in all three countries, it was only in America that these themes were organized and presented in such a way as to successfully institutionalize sociology in the academy.

Governance, transparency and alignment in the Council of Australian Governments (COAG) 2011 National Health Reform Agreement

OBJECTIVE This article provides a policy analysis of the Australian governments National Health Reform Agreement (NHRA) by bringing to the foreground the governance arrangements underpinning the two arms of the national reforms, to primary health care and hospital services. METHODS The article analyses the NHRA document and mandate, and contextualises the changes introduced vis-à-vis the complex characteristics of the Australian health care system. Specifically, it discusses the coherence of the agreement and its underlying objectives, and the consistency and logic of the governance arrangements introduced. RESULTS The policy analysis highlights the rationalisation of the responsibilities between the Commonwealth and states and territories, the commitment towards a funding arrangement based on uniform measures of performance and the troubled emergence of a more decentralised nation-wide homogenisation of governance arrangements, plus efforts to improve transparency, accountability and statutory support to increase the standards of quality of care and safety. CONCLUSIONS It is suggested that the NHRA falls short of adequately supporting integration between primary, secondary and tertiary health care provision and facilitating greater integration in chronic disease management in primary care. Successfully addressing this will unlock further value from the reforms.

Healthcare in the news media: The privileging of private over public:

This article reports on a discourse analysis of the representation of healthcare in the print news media, and the way this representation shapes perspectives of healthcare. We analysed news items from six major Australian newspapers over a three-year time period. We show how various framing devices promote ideas about a crisis in the current public healthcare system, the existence of a precarious balance between the public and private health sectors, and the benefits of private healthcare. We employ Bourdieu’s concepts of field and capital to demonstrate the processes through which these devices are employed to conceal the power relations operating in the healthcare sector, to obscure the identity of those who gain the most from the expansion of private sector medicine, and to indirectly increase health inequalities.

A Sketch of Australian Sociology, 1959–2014

This chapter presents a general overview of the discipline in Australia since 1959, with regular reference made to the important early developments. Among the matters covered are: the funding background; the growth of university sociology departments; the uneven growth of student enrolments in sociology; the uneven growth of staff numbers in sociology; the gender balance (a trend towards feminization); and the trials and tribulations of the professional sociology association. At its core this material speaks to the theme of survival, inasmuch as it provides evidence of an ongoing journey. Nonetheless, there are more than a few elements within it that highlight the fact that the ongoing journey is only a comfortable one in some places and possibly only for a limited amount of time.

Survival against the Odds: a Case Study of Sociology at the University of Sydney

This chapter offers a more thorough examination of just how sociology has survived in this country, despite that prospect often looking unlikely. The examination features a detailed case study of one institution, the University of Sydney. Here, we present a body of concentrated evidence towards our proposition that Australian sociology always gets up when it gets knocked down, even at a university where it was firmly rejected in the mid-twenties after an extremely unsuccessful trial. We show that at Sydney, in the years between its unsuccessful trial and its successful return in the early 1990s, sociology survived in the cracks, as it were, especially the cracks of those other disciplines which were sympathetic to its broader aims, in particular philosophy, anthropology, and social work/social studies.

Theory Use in Australian Sociology

The way theory is used by a discipline might seem a somewhat oblique aspect of its operation, perhaps not warranting its own chapter. But we think it to be a vital index of the way a discipline like sociology operates. In this chapter we consider the different ways in which theory is defined in Australian sociology, the way theory-in-sociology operates as both a means of disciplining the discipline and a supposedly special area of expertise, the way in which theory is taught within sociology, the way in which theory is situated in sociology textbooks, and the way in which the members of the Australian Sociological Association regard theory. The chapter shows theory to be a part of sociology’s fragility and rivalry, but also part of its survival.