Health Care

Health is a relative condition. Is an individual or population healthy? The answer depends on both the definition of health being applied by those undertaking an assessment and how health is understood by the people themselves. Health care is more tangible—a set of resources that are understood as having a particular relationship with health. The health care industry is the term often applied to the organization of these resources and their expression in terms of goods and services. Through the seeking of health care and commodities associated with advancing health, the users of medical services in Western capitalist countries have increasingly been regarded by policymakers as consumers. Whereas the term patient implies a relationship with a health care professional, the term consumer has more complex associations and implies a commodification of care. This reconceptualization has often occurred in tandem with changes in the spaces in which health care consultations take place. This entry considers the reasons for, as well as the characteristics and implications of, this transition toward health care consumption.

The historical roots of health care lie in the role of the traditional healer whose work was, like a priest, a vocation rather than occupation. This “calling” dimension is reflected in the Hippocratic [Page 706]oath, which, although still embraced by physicians today, has its integrity threatened by concerns relating to remuneration and liability. Doctors (and other health care professionals) are increasingly asked to be conveyors of a commodity (health care) and not the healers of their historical origins in contexts like ancient Greece.

The origins of the use of the term consumer and consumption in health care lie in the field of economics in which studies of demand constructed users as consumers. However, many such demand-based studies were in fact studies of utilization, because in health care, the practices of consumers are heavily influenced by the activities of suppliers such as doctors and insurance companies, notes Alistair McGuire and colleagues. Over recent decades, consumer culture has grown to mediate many aspects of political, economic, social, and cultural life. So, too, health care has become part of the set of resources that consumers use to satisfy their needs. Indeed, the convergence of changes in technology, advertising, and cultural acceptability has seen the medicalization of domains of everyday life previously shrouded in privacy and secrecy (e.g., Viagra and the commodification of sexual performance).

In the past, researchers have largely viewed the consumption of services in terms of utilization behavior. However, a strict focus on behavior can overlook a number of key elements of consumption: how providers shape practices, how spaces are crafted to be conducive to consumption, how the media is used to promote a culture of health care consumption, and how nonpatients (e.g., philanthropic donors, family members) can be complicit in creating consumer's world of health care.

Being a consumer implies having choice and (literally or metaphorically) shopping around. Although “doctor shopping” may exist, health care reforms based on the assumption that this is a widespread behavior appear to do little to improve the access to, or quality of, care for those who need it most, according to J. R. Barnett and R. A. Kearns. As E. D. Pellegrino states, the commodification of care raises the question of whether the marketplace is the right instrument for distributing health care. Access barriers are pervasive and, if health care is constructed as a consumption good, then distance, costs, language, cultural acceptability, and hours of opening can all mitigate against someone finding the care that they need.

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