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The private life of medicine: accounting for antibiotics in the ‘for-profit’ hospital setting

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Abstract

The looming global antibiotic crisis, and the need to curtail over-use, has been positioned variously as a medical problem, an urgent public health concern, and an issue of governance and political will. But few questions have been raised in terms of its economic drivers. Specifically, how infection management—and the problematic of antimicrobial resistance—may be deeply embedded in economic imperatives and relations of labour. Drawing on interviews with 31 health professionals (doctors, nurses, pharmacists) from a private hospital in Australia, we explore their accounts of the dynamics of care and the economic imperatives in (and beyond) infection management. We argue that market-driven forces create a distinct set of obligations that could undermine the local and global antibiotic optimisation agenda. Given the increasingly privatised landscape of healthcare in Australia and internationally, exploring the nexus of economics and practice will be vital in retaining antibiotics for the future.

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Notes

  1. To provide some comparative context, in the US, 21.1% of hospitals are private (for-profit), 57% are private (not-for-profit), and 21.9% are owned by state and local governments’ facilities (Fraze et al. 2010).

  2. Antimicrobial stewardship programmes are now required in Australian hospitals, and hospital accreditation is now reliant on having governance structures in place (ACSQHC 2015).

  3. In Australia, a sole trader is the simplest form of business structure. Sole traders are legally responsible for all aspects of their business.

  4. It is of note that nursing and allied health staff are employees, placing doctors in a distinct set of labour relations vis-à-vis other clinicians in the hospital.

  5. Antimicrobial stewardship programmes aim to increase correct prescribing of antibiotics, optimise the treatment of infections and reduce adverse events associated with antibiotic use.

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Acknowledgements

We would like to acknowledge the support from the Australasian Society of Infectious Diseases. This research was funded by an Australian Research Council Linkage Grant LP140100020.

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Authors and Affiliations

  1. Faculty of Arts and Social Sciences, School of Social Sciences, University of New South Wales, Sydney, NSW, 2052, Australia

    Alex Broom & Emma Kirby

  2. School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia

    Alexandra Gibson

  3. School of Social Sciences, Monash University, Melbourne, Australia

    Mark Davis

  4. School of Medicine, University of Queensland, Brisbane, Australia

    Jennifer Broom

  5. Sunshine Coast Health and Hospital Service, Sunshine Coast University Hospital, Birtinya, QLD, 4575, Australia

    Jennifer Broom

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  1. Alex Broom
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  2. Alexandra Gibson
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Correspondence to Alex Broom.

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Broom, A., Gibson, A., Kirby, E. et al. The private life of medicine: accounting for antibiotics in the ‘for-profit’ hospital setting. Soc Theory Health 16, 379–395 (2018). https://doi.org/10.1057/s41285-018-0063-8

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