Abstract
BackgroundThe formation of domestic and global marketplaces during the past 50 years has opened up new commercial opportunities for third-party activity in healthcare systems. Commercial mediation of access to healthcare is one recent area of activity that sees companies and individuals offering to organise healthcare and travel in return for payment. With varying degrees of control over the location, type, cost and experiences of healthcare provisioning, these intermediaries occupy potentially influential positions in healthcare systems and yet much of their work is poorly understood.MethodsDrawing on social science theories of brokerage, this article presents a novel analysis of commercial healthcare facilitation. It focuses on facilitation companies and their workers as central, intermediating actors for people to access healthcare in markets characterised by complexity. Semi-structured interviews were conducted with people working in domestic and international healthcare facilitation in London and Delhi, and data were analysed using a framework approach that emphasises the structural features and personal agencies for this area of work.ResultsFindings point to an institutional environment for commercial healthcare facilitation marked by competition and the threat of obsolescence. The activities of rivals, and the risk that users and providers will bypass intermediaries, compels facilitation companies to respond strategically and to continuously pursue new populations and activities to mediate – to go for broke. These pressures percolate into the lives of people who perform facilitation work and who describe a physical and mental burden of labour incurred by onerous processes for generating and completing facilitation work. The need for language interpretation services introduces an additional set of relations and has created further points of tension. It is an environment that engenders mistrust and anxiety, and which incentivises exploitation and a commodification of users whose associated commissions are highly prized.ConclusionBrokerage analysis provides valuable insights into the strategies and strains for commercial mediation of access to healthcare, and the findings indicate opportunities for further research on the contributions of interpreters, diplomatic and business networks, and new technologies, and on the growth of new forms of mediation in domestic and overseas settings.
Highlights
The formation of domestic and global marketplaces during the past 50 years has opened up new commercial opportunities for third-party activity in healthcare systems
Often the focus of these activities has been to cater to the growing number of people who cross borders to search of care: one study identified 208 web-based facilitation companies globally [8], and many more operate on an informal basis in countries such as Mexico [9], Malaysia [10] and India [11]; while some focus on global markets for specific services such as assisted reproduction [12,13,14] or cosmetic surgery [15]
London is a destination for advanced treatments, for wealthy users travelling to London from countries in the MiddleEast [43], but healthcare providers offer private services to people living in the UK and there has been a trend for people living in the UK to travel to other countries to seek services that are unavailable, or considered over-priced, in the UK healthcare system
Summary
The formation of domestic and global marketplaces during the past 50 years has opened up new commercial opportunities for third-party activity in healthcare systems. It is a trend that has been accompanied by growth in cross-border travel for healthcare, as people seek care in global healthcare markets for services unavailable to them in their country of origin [3,4,5,6]. The expansion of these domestic and global markets for healthcare pose new sets of choices, and with them new bureaucratic and informational barriers and needs for accessing care [7], and this has opened up commercial opportunities for third-parties to operate as intermediaries in healthcare markets. There are small but growing markets for facilitation services in a domestic context, for example the high-end ‘concierge’ services being offered in some countries [16]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
