Stephanie Short

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.

The Health Workforce

Policies concerning health personnel are of immediate significance to all employees in the health care system because they shape educational opportunities, registration requirements and employment prospects. Workforce policy influences both the supply of, and the demand for, health personnel. For example, the medical profession has expected the Commonwealth government to balance the supply and demand for medical practitioners in Australia. If the Australian Medical Association has decided that there are insufficient doctors to meet the demand for medical services it has requested that universities, with additional government funding, should produce more medical graduates. On the other hand, if the profession wishes to maintain its members’ incomes, in the face of a looming surplus of doctors, it has recommended that the government slow the growth in the doctor-to-population ratio by cutting back on medical education, and by limiting the licensing of medical practitioners with overseas qualifications. As we discuss below, the ability of governments to expand the numbers of medical specialists has been restricted in the past.

Source country perceptions, experiences, and recommendations regarding health workforce migration: a case study from the Philippines

BackgroundThe Philippines continues to overproduce nurses for export. Little first-hand evidence exists from leading organisations in the Philippines concerning their experiences and perceptions in relation to Filipino nurse migration. What are their views about health workforce migration? This paper addresses this research gap by providing a source country perspective on Filipino nurse migration to Australia.MethodsFocus-group interviews were conducted with key informants from nine Filipino organisations in the Philippines by an Australian-Filipino research team. The organisations were purposively selected and contacted in person, by phone, and/or email. Qualitative thematic analysis was performed using a coding framework.ResultsHealth workforce migration is perceived to have both positive and negative consequences. On the one hand, emigration offers a welcome opportunity for individual Filipino nurses to migrate abroad in order to achieve economic, professional, lifestyle, and social benefits. On the other, as senior and experienced nurses are attracted overseas, this results in the maldistribution of health workers particularly affecting rural health outcomes for people in developing countries. Problems such as ‘volunteerism’ also emerged in our study.ConclusionsIn the context of the WHO (2010) Code of Practice on the International Recruitment of Health Personnel it is to be hoped that, in the future, government recruiters, managers, and nursing leaders can utilise these insights in designing recruitment, orientation, and support programmes for migrant nurses that are more sensitive to the experience of the Philippines’ education and health sectors and their needs.

From headloading to the iron horse: the unequal health consequences of railway construction and expansion in the Gold Coast, 1898-1929.

This paper examines the health consequences of railway construction and expansion in the Gold Coast (present day Ghana) between 1898 and 1929. More specifically, it examines the differential effects of colonial railway development for the different socio-economic groups of the Gold Coast society. The case study utilizes sociological and historical perspectives to analyse primary historical data on the health of the three groups most affected by the Gold Coast railways: expatriate railway workers, African railway workers and African communities living both within and outside the immediate vicinity of the railways. The study unearths evidence of largely positive health consequences for expatriate workers and African elites, and considerable negative health consequences for the Africans employed as railway labourers, the newly created urban poor as well as those Africans living in the rural areas.

An exploration of the priority remote health personnel give to the development of the Indigenous Health Worker oral health role and why: Unexpected findings

Objective This research was undertaken to explore the priority given by remote area health personnel to the development of the oral health role of Indigenous Health Workers and the rationale for this prioritisation. Design Semistructured individual interviews and focus group interviews were undertaken with remote area health personnel working alongside Indigenous Health Workers. Setting Three Indigenous community clinics and two regional centres of remote northern Australia. Participants Interviews were conducted with 32 remote health personnel (11 dental, 14 nursing, 5 medical and 2 allied health personnel). Results The findings highlight the strong support found among remote health personnel for the development of the Indigenous Health Worker oral health role emphasising not only the perceived high impact of oral disease on the health of community members and community health resources, but also on the clinical practice of remote health personnel. Conclusion In identifying the high priority given to the development of this role, the study has also highlighted the impact of oral disease on the practice of remote health personnel and the need to develop training for remote health personnel to respond to oral disease.OBJECTIVE This research was undertaken to explore the priority given by remote area health personnel to the development of the oral health role of Indigenous Health Workers and the rationale for this prioritisation. DESIGN Semistructured individual interviews and focus group interviews were undertaken with remote area health personnel working alongside Indigenous Health Workers. SETTING Three Indigenous community clinics and two regional centres of remote northern Australia. PARTICIPANTS Interviews were conducted with 32 remote health personnel (11 dental, 14 nursing, 5 medical and 2 allied health personnel). RESULTS The findings highlight the strong support found among remote health personnel for the development of the Indigenous Health Worker oral health role emphasising not only the perceived high impact of oral disease on the health of community members and community health resources, but also on the clinical practice of remote health personnel. CONCLUSION In identifying the high priority given to the development of this role, the study has also highlighted the impact of oral disease on the practice of remote health personnel and the need to develop training for remote health personnel to respond to oral disease.

The Commonwealth as a custodian of dental migratory ethics: views of senior oral health leaders from India and Australia

OBJECTIVE The Commonwealth of Nations is a unique congregation of 53 countries providing a platform for realistic collaboration on several social and health care issues. Ethical migration of health professionals from developing to developed countries is a key priority of the Commonwealth and several ethical codes have been put into practice. However, these codes have been mainly developed in regard to the medical workforce (physicians and nurses), and can have some limitations when applied to the dental profession. The aim of this study was to understand the role of the Commonwealth in influencing ethical migration of dentists from developing to developed countries, by examining the case of Indian-trained dentists migrating to Australia. METHODS   The research design involved interviewing key health care or oral health leaders in India and Australia. A semi-structured interview process was designed. Grounded theory techniques were used in data collection and analysis. FINDINGS   Both the Indian and Australian participants expressed serious doubts on the Commonwealth or any of its Associations in influencing ethical migration of Indian trained dentists to Australia. Three reasons emerged: indifferent priorities, lack of funds and the rise of other international organisations. Bilateral cooperation between concerned countries was considered as a feasible alternative. CONCLUSION The role of the Commonwealth as a custodian of dental migratory ethics is limited. Further research is required as to how bilateral cooperation between India and Australia could be improved. There is also an urgent need for targeted funding allocations in oral health, especially in the form of international aid for research and development both in India and Australia.

Physiotherapy - a feminine profession.

The female-dominated professions in health care are not as powerful as the male-dominated medical profession. This paper suggests that the key factor in shaping the discrepancies in pay, status and power between medicine and the female-dominated professions is gender. It is argued that physiotherapy developed as a profession for middle-class women and that family responsibilities continue to take priority over professional responsibilities for the majority of physiotherapists. Physiotherapy enjoys higher occupational prestige than social work, speech therapy, occupational therapy and nursing and it is suggested that physiotherapy has achieved this status through recruitment of women from middle and upper middle class backgrounds. The history of physiotherapy is the history of a middle class feminine profession.

Listening to indigenous health workers Helping to explain the disconnect between policy and practice in oral health role development in remote Australia

Objective: This research was undertaken to explore factors operating at the level of the clinic and the community which influence the development of the oral health role of Indigenous Health Workers. The research is a significant aspect of a wider study of the disconnect between the strong national policy support for the development of the oral health role of Indigenous Health Workers and the limited development of the role. Design: Semi-structured interviews were conducted with Indigenous Health Workers to explore their perceptions of the priority of the development of an oral health role and to identify facilitators and barriers to sustainable role development. Setting: The study was conducted in three remote Indigenous communities and two regional centres of the Cape York region in far north Australia. Method: Interviews were conducted with 21 Indigenous Health Workers through five group interviews and eight individual interviews. Results: The findings highlight the high priority given by Indigenous Health Workers to the development of their oral health role while also identifying significant barriers to the sustainable development of this role. Conclusion: The identification of barriers to role development operating at the level of the clinic and the community helps to explain the disconnect between policy and practice in the development of the oral health role of these community health personnel.

Teaching Cultural Competence in Dental Education: A Systematic Review and Exploration of Implications for Indigenous Populations in Australia

Indigenous and other minority populations worldwide experience higher rates of disease including poor oral health than other populations. Cultural competence of practitioners is increasingly being recognized as fundamental to health care and quality of life in addressing these disparities. The aims of this study were to conduct a systematic review of the literature about teaching cultural competence in dental education and to explore the particular relevance of that teaching for the oral health care of Indigenous populations in Australia. A systematic review employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was conducted of published studies that explored cultural competency interventions in dental curricula. A total of 258 studies from 2004 to 2015 were identified; after removing duplications and applying criteria for exclusion, 12 were selected for analysis, involving 1,360 participants. The principal themes identified in the qualitative analysis of these studies were curriculum content, curriculum delivery, community service-learning, reflective writing, and evaluation. Students need knowledge of health disparities and community health to better understand the perspectives of culturally diverse populations and to communicate effectively with people from various cultures. The principal strategies that improved cultural competence in the articles examined in this study were educational seminars, community service-learning, and reflective writing. These findings suggest that integration of cultural competency curricula using a combination of didactic or online training, community engagement, and reflective writing may increase the cultural knowledge and skills of dental students.