ABSTRACT

Recent dramatic changes in health care in many contemporary societies, involving the deregulation and privatization of services and an emphasis on cost-effectiveness, ‘user-pays’, ‘self-care’, ‘community-based care’, and so on, pose important challenges for policy-makers, health care workers and recipients of health care. Increasingly, health is viewed as a ‘commodity’ and individuals are defined as health care ‘consumers’. The language of consumerism has become pervasive in health care, reflecting a changed relationship between citizens and the state from that which characterized many, if not most, liberal democratic societies in the past. The notion that the state should care for the health of its citizens, long seen as a fundamental principle of welfare states, is increasingly replaced by the expectation that citizens should play a more active role in caring for themselves as ‘clients’ or ‘consumers’. The view that citizens should be consumers of health and health care, and that they do indeed conduct themselves as such, however, is by no means uncontentious or uncontested. This book explores the diverse and often complex meanings and applications of the term ‘consumer’ in the arena of health care and assesses the implications for policy-making, health care delivery and people’s experiences of health care. It asks, who are the assumed ‘consumers’ of health care policy and practice, and what exactly is it that they are ‘consuming’? How relevant is the consumerism model in the field of health care? Is it valid and useful to view health and health care as ‘commodities’? What are the social, political and ethical implications of the consumerism in health care? How does the deployment of the philosophy and language of consumerism in the health care field affect people’s experience of illness and the nature and quality of care? And, how might the language and practices of consumerism be used to advance the interests of those who are ill, and promote change in health care systems?