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

Trust, regulatory processes and NICE decision-making: Appraising cost-effectiveness models through appraising people and systems.

This article presents an ethnographic study of regulatory decision-making regarding the cost-effectiveness of expensive medicines at the National Institute for Health and Care Excellence (NICE) in England. We explored trust as one important mechanism by which problems of complexity and uncertainty were resolved. Existing studies note the salience of trust for regulatory decisions, by which the appraisal of people becomes a proxy for appraising technologies themselves. Although such (dis)trust in manufacturers was one important influence, we describe a more intricate web of (dis)trust relations also involving various expert advisors, fellow committee members and committee Chairs. Within these complex chains of relations, we found examples of both more blind-acquiescent and more critical-investigative forms of trust as well as, at times, pronounced distrust. Difficulties in overcoming uncertainty through other means obliged trust in some contexts, although not in others. (Dis)trust was constructed through inferences involving abstract systems alongside actors’ oral and written presentations-of-self. Systemic features and ‘forced options’ to trust indicate potential insidious processes of regulatory capture

The Health and Social Care Act for England 2012: The extension of ‘new professionalism’

The 2012 Health and Social Care Act, introduced by the coalition government, has been seen as fundamentally changing the form and content of publicly funded health care provision in England. The legislation was hugely controversial and widely criticized. Much of this criticism pointed to the ways in which the reforms undermined the funding of the National Health Service, and challenged the founding principle of free universal provision. In this commentary we take issue with the argument that the Act represented a radical break with the past and instead suggest that it was an extension of the previous Labour government’s neo-liberal reforms of the public sector. In particular, the Act invoked the principles of ‘new professionalism’ to undermine professional dominance, and attract private providers into statutory health care at the expense of public providers. In turn, this extension of new professionalism may encourage public distrust in the medical profession and absolve the state of much of its statutory health care obligation. </jats:p

On Parr: The Use and Propriety of Appraisal Methods in Computing Fracking Awards

Parr v. Aruba Petroleum, Inc. made headlines in 2014 for being the first hydraulic fracturing (“fracking”) case to result in a jury verdict. In Parr, a Texas jury awarded $2.925 million to compensate the Parr family for injuries sustained as a result of Aruba Petroleum’s nearby fracking activities. Of the nearly$3 million verdict, the jury awarded $275,000 for diminution in property value. Thanks to the fiercely litigated and highly publicized trial and appeal, scholars, practitioners and academics received a rare glimpse into an area of litigation otherwise insulated from public view by out of court resolutions and confidential settlement agreements.In this interdisciplinary paper we will provide an overview of the valuation process, addressing issues specific to diminution in value in the context of fracking and similar incidences of environmental contamination. We will then explain the various appraisal methods within the context of real estate litigation, including the Sales Comparison Approach, Income Approach and Cost Approach. Using Parr as a test case, we will then analyze the unique appraisal challenges presented by the hydraulic fracturing and analogous toxic torts fact patterns, evaluating the probative value and persuasive necessity of each approach. Finally, we will make predictions about the rapidly evolving fracking litigation sphere, analyzing new challenges presented to homeowners, energy companies and the judiciary when faced with allegations of diminished property values.

Communication between family carers and health professionals about end-of-life care for older people in the acute hospital setting: a qualitative study

This paper focuses on communication between hospital staff and family carers of patients dying on acute hospital wards, with an emphasis on the family carers’ perspective. The age at which people in the UK die is increasing and many continue to die in the acute hospital setting. Concerns have been expressed about poor quality end of life care in hospitals, in particular regarding communication between staff and relatives. This research aimed to understand the factors and processes which affect the quality of care provided to frail older people who are dying in hospital and their family carers

Lung cancer diagnosed following an emergency admission: exploring patient and carer perspectives on delay in seeking help

Purpose Compared to others, patients diagnosed with lung cancer following an emergency, unplanned admission to hospital (DFEA) have more advanced disease and poorer prognosis. Little is known about DFEA patients’ beliefs about cancer and its symptoms or about their help-seeking behaviours prior to admission. Methods As part of a larger single-centre, prospective mixed-methods study conducted in one University hospital, we undertook qualitative interviews with patients DFEA and their carers to obtain their understanding of symptoms and experiences of trying to access healthcare services before admission to hospital. Interviews were recorded and transcribed. Framework analysis was employed. Results Thirteen patients and 10 carers plus 3 bereaved carers took part in interviews. Three patient/carer dyads were interviewed together. Participants spoke about their symptoms and why they did not seek help sooner. They described complex and nuanced experiences. Some (n = 12) had what they recalled as the wrong symptoms for lung cancer and attributed them either to a pre-existing condition or to ageing. In other cases (n = 9), patients or carers realised with hindsight that their symptoms were signs of lung cancer, but at the time had made other attributions to account for them. In some cases (n = 3), a sudden onset of symptoms was reported. Some GPs (n = 6) were also reported to have made incorrect attributions about cause. Conclusion Late diagnosis meant that patients DFEA needed palliative support sooner after diagnosis than patients not DFEA. Professionals and lay people interpret health and illness experiences differently

Are differential consumption patterns in health-related behaviours an explanation for persistent and widening social inequalities in health in England?

During the last two decades, differential consumption patterns in health-related behaviours have increasingly been highlighted as playing an important role in explaining persistent and widening health inequalities. This period has also seen government public health policies in England place a greater emphasis on changing ‘lifestyle’ behaviours, in an attempt to tackle social inequalities in health. The aim of this study was to empirically examine the variation in health-related behaviour in relation to socio-economic position, in the English adult population, to determine the nature of this relationship and whether it has changed over time