Shopping around? Consumerism and the use of private accident and medical clinics in Auckland, New Zealand

In this paper we review the ideology of health care service users as consumerists within the context of the market-driven health care reforms of the New Right. We localise this discussion by examining the way in which the recent (since 1991) health reforms in New Zealand have incorporated this ideology and added impetus to earlier (unsuccessful) moves to bring corporate interests into the field of primary health care. We then test the contention that patients 'shop around' for doctors by examining the utilisation behaviour of patients at two recently developed private accident and medical clinics in Auckland, New Zealand. Our analysis of data from a sample of 205 patients suggests that, despite some price discounting by these clinics, patients appear to 'shop around' only modestly and largely use clinics because they are convenient and because of the perceived ambience of these new medical environments. We conclude that for those in more desperate financial circumstances, choices for health care continue to be made on the pragmatic basis of physical access. Although 'doctor shopping' may exist, health care reforms based on the assumption that this is widespread behaviour will do little to improve the access to, or quality of, care for those who need it most.