Positive Health Online

Abstract

BISHOP and COLLEAGUES, School of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK F.L.Bishop@southampton.ac.uk  compared patients' experiences of public and private sector healthcare, using acupuncture as an example.

Background

The aim of this study was to compare patients' experiences of public and private sector healthcare, using acupuncture as an example. In the UK, acupuncture is popular with patients, is recommended in official guidelines for low back pain, and is available in both the private sector and the public sector (NHS). Consumerism was used as a theoretical framework to explore patients' experiences.

Methodology

Semi-structured face-to-face interviews were conducted in 2007-8 with a purposive sample of 27 patients who had recently used acupuncture for painful conditions in the private sector and/or in the NHS. Inductive thematic analysis was used to develop themes that summarised the bulk of the data and provided insights into consumerism in NHS- and private practice-based acupuncture.

Results

Five main themes were identified: value for money and willingness to pay; free and fair access; individualized holistic care: feeling cared for; consequences of choice: empowerment and vulnerability; and ‘just added extras’: physical environment. Patients who had received acupuncture in the private sector constructed detailed accounts of the benefits of private care. Patients who had not received acupuncture in the private sector expected minimal differences from NHS care, and those differences were seen as not integral to treatment. The private sector facilitated consumerist behaviour to a greater extent than did the NHS, but private consumers appeared to base their decisions on unreliable and incomplete information.

Conclusion

Patients used and experienced acupuncture differently in the NHS compared to the private sector. Eight different faces of consumerist behaviour were identified, but six were dominant: consumer as chooser, consumer as pragmatist, consumer as patient, consumer as earnest explorer, consumer as victim, and consumer as citizen. The decision to use acupuncture in either the private sector or the NHS was rarely well-informed: NHS and private patients both had misconceptions about acupuncture in the other sector. Future research should evaluate whether the differences the authors identified in patients' experiences across private and public healthcare are common, whether they translate into significant differences in clinical outcomes, and whether similar faces of consumerism characterise patients' experiences of other interventions in the private and public sectors.

References

Bishop FL, Barlow F, Coghlan B, Lee P and Lewith GT. Patients as healthcare consumers in the public and private sectors: a qualitative study of acupuncture in the UK. BMC Health Services Research. 11:129. 2011. Other ID Source: NLM. PMC3127982. 2011.

Comment

This highly innovative research hugely informs values and attitudes of people toward health treatment approaches, reflecting upon the NHS experience, which combines a mixture of public and private healthcare options.