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The flaws of ‘consumer sovereignty’ in accessing the healthcare marketplace: A critical discourse analysis of subsistence consumers

This project examines the challenges to consumer sovereignty in both advanced and subsistence marketplaces, focusing on sectors like healthcare where limited choices and complex decisions often undermine the notion of consumer power.

Acknowledging the importance of good health, some countries provide free access to health care such as the United Kingdom and European counterparts. However, many countries, following the neoliberal paradigm of the inefficient allocation of public spending and the views of state interventions as the main trigger of bad public spending, have promoted free market policies in the sector. This has allowed a growing private sector and the culture of marketisation in health services (Slater, 1997). These decisions have put considerable pressure to subsistence consumers promoting social inequalities and segregation to access such fundamental service. In effect, when exploring the ideology underpinning the self-regulation of markets, Polanyi (1944, 2001) contended that marketisation is a complex phenomenon, with consequences that extend beyond the economic realm, affecting social, political, and even environmental aspects when a sector lacks regulation.

In line with Polanyi’s views, social inequalities and segregation can be attributed to the extensive marketisation of a market economy, becoming socially divisive. Furthermore, when market-driven policies, as seen in highly privatised health care systems, have been stretched to their limits, societies will endeavour to reconfigure these market-oriented policies, leading societies to advocate for increased government involvement in the sector.

The context for this study is the Sri Lankan health care system formed by a hybrid system of public and private healthcare providers. While there is a public national health system in the country (free for low income citizens and paid with tax payers money), the sector has not been able to meet health service demand. For example, in the state sector hospitals, beds per 1,000 people is 4.7, which is well below developed countries, and the number of patients per doctor is recorded as 1,203 (Central Bank of Sri Lanka 2019). Given the inability of the public health system in Sri Lanka to meet demand, the private sector has stepped in to provide healthcare services.

To examine the ‘sovereignty’ of the subsistence consumer in their decisions for healthcare, we followed Fairclough’s (1992, 2003) three-dimensional approach to CDA which involves (1) the analysis of text, (2) the analysis of discursive practice and (3) the analysis of social practice. The corpus consisted of in depth interviews to 10 subsistence consumers and 5 health care specialist in Sri Lanka.