The caring commodity : transformations in the exchange character of medicine in New Zealand (1840-1985) : a thesis presented to the Dept. of Geography, Massey University in complete fulfilment of the requirements for the degree of Master of Arts

Abstract

Retrospective analysis of actions and interactions connected with health care makes evident their place as constituted and constitutive components of capitalist social relations. The contextually constrained activity of individuals to achieve certain ends has contributed to the production of outcomes which appear to be beyond individual control and which shape the social world. In explaining the main transformations in the character of medical services since the early days of European settlement emphasis is placed upon the multiple and differentiated emergence of various structures of relationships between, principally, doctors and patients, doctors and doctors, and those who, at various stages, have attempted to intervene in those relations. Over the period 1840-1985, medical practice has been transformed from a service provided on a user-pays basis, to one of collective provision, and back towards the "private" sector. In the six decades after 1840 medicine and the State became enmeshed. Some moves towards the State provision of health care services occurred. The period 1900-35 saw the supporters of both free enterprise and socialistic medicine inexorably drawn towards advocacy of some grand scheme of collective care, the character of which was extensively debated from 1935 until 1942. The outcome brought "free" provision of most medical care to those in need and also served the long term interests of capital. Since then, health care has been returning to the market. In part, the broad sweep from, and back to, commodity relations has arisen from actions to "solve" problems of health care provision and use. The solutions arrived at, however, have been compromises between conflicting demands. Although at times "solutions" may have facilitated the more humane allocation of medical services, the general tendency is for them to reproduce capitalist social relations