Market reforms in English primary medical care: medicine, habitus and the public sphere.
Drawing on interviews with English primary care doctors (GPs), this paper examines GP responses to reforms intended to introduce a market in primary health care. GPs' reactions are conceptualised in terms of a GP habitus, which takes for granted the superiority of 'public' providers (i.e. GP partnerships) in the provision of care. GPs are actively involved in the defence of the public sphere, which is neither a neo-liberal minimalist market state, nor a wholly altruistic state, responding to consumers' wants. The public sphere they defend is one in which boundaries are drawn about entitlements and GPs are actively engaged in defining and policing these boundaries. The GP habitus can be seen as shaping responses in ways which serve GP interests. In the context of struggles involving various social actors (e.g. private providers, third-party payers, patients) with different stakes in the field of general medical practice; this public service orientation may enable GPs to reap cultural capital. At the same time, the habitus constrains action in a way which limits resistance to reforms threatening GPs' interests, with GPs responding by coping, rather than downing tools or engaging in active confrontation.
McDonald
Ruth
R
National Primary Care Research and Development Centre, University of Manchester, Manchester, UK. ruth.mcdonald@manchester.ac.uk
D000328:Adult; D001291:Attitude of Health Personnel; D004465:Economic Competition; D004739:England; D018166:Health Care Reform; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D010821:Physicians, Family / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D017149:Private Sector; D017150:Public Sector; D013222:State Medicine / Q000191:economics / Q000458:organization & administration*