Autonomy, Choice and Treatment: Using Bourdieu's Theory of Practice to Explore Breast Cancer Patients' Preconceptions and Experiences of Public and Private Health Systems in New Zealand

Abstract

This thesis analyses 11 breast cancer patients’ preconceptions and experiences of public and private health sectors in New Zealand. Previous studies exploring breast cancer have analysed a range of issues including race, socio-economic and age inequalities, issues occuring between the public and private sectors, and the communication strategies patients preferred with health providers. In contrast, this thesis uses concepts from Pierre Bourdieu’s theory of practice to explore breast cancer patients’ accounts of the public and private sectors and how these accounts are shaped. For many of the women interviewed, cultural and social capital played an important role in the negotiation of the health system, whether public or private. This is because both sectors, at times, provided little information about the disease, treatment, side effects, and entitlements. In these circumstances, social and cultural capital were valuable resources providing alternative health assistance. Participants’ preconceptions when relating their choice of public or private health systems showed clear positive associations with the private health sector. When discussing their experiences, the women that used the public sector showed a positive turnaround in their opinions related to the public sector. In comparison, the women that used the private sector maintained their views regardless of some negative issues being experienced. Despite their personal experiences, both public and private participants maintained positive associations with the private sector. The reliance many of the participants had on social and cultural capital in both the public and private health sectors raises questions regarding processes related to patient information, access to services, and about whether case management of cancer services might be appropriate. The contrasts between participants’ preconceptions of the public sector in comparison to experiences highlights the need for a public campaign celebrating the successes of public cancer services.