A case study of consumerism in healthcare: users and staff in two minor injury units

Background: Choice has become the defining characteristic of service users’ relationship with the National Health Service (NHS) in the UK. Decades of market-orientated policy have encouraged greater customer focus, and the NHS is now subject to the same consumer drivers that can be identified elsewhere in society.

Aim: The aim of this study is to understand whether the introduction to the NHS of market reforms designed to encourage and improve choice and experience have influenced the way in which service users access care and interact with service providers when receiving it.

Method: This study utilises an ethnographic approach to data collection combined with the structure, theoretical under-pinning and replication logic afforded by comparative case study. Both approaches allow for the inclusion of qualitative and quantitative data and use multiple data collection instruments in a triangulating fashion. Two minor injury units (MIUs) were selected as research sites/cases since they serve a large community with multiple and diverse needs and provide a crucial stepping-stone between primary and secondary care services.

Results: Although very few service users at either case identified themselves as ‘customers’ or ‘consumers’ of healthcare per se, there was general consensus that high standards of customer service were both important and desirable in a healthcare context. Similarly, regardless of whether service providers believed that service users should be viewed as ‘customers’ or ‘consumers’ of healthcare, they consistently demonstrated modes of behaviour that treated them as such.

Conclusions: Through careful analysis of the data, it is possible to identify five different healthcare consumer typologies: passive, reluctant, assertive, pragmatic and knowledgeable. The broad range of views and positions demonstrated by these typologies in relation to healthcare consumption seem to be the result of social values and practises that have developed in response to consumer culture and society as well as previous experience of healthcare services.