Från patient till kund : intåget av marknadstänkande i sjukvården och förskjutningen av patientens position

Marketization of society has gradually transformed health care at the end of the 20th century. The conditions of possibility for this transformation have been the social impact of the market discourse and the discourse on patient rights. These discourses brought about a displacement of the discursive order in health care. One effect of this discursive break was that the view of the sick person was gradually displaced from the passive patient to the active customer. This thesis identifies and illustrates this displacement of the position of the patient in health care, in Sweden, over the period of 1970 - 2000. The methodological framework has been inspired by Michel Foucault’s understanding of discourse. The notion of perceiving the sick person as a customer was preceded by a discursive formation, which according to Foucault is defined as a process for spreading and formation of statements into disourse. In this process several influential voices are talking about objects referring to certain concepts and themes. While referring to and using a market theme like freedom of choice, operationalised in the Swedish context by health care guarantee and voucher for care, the influential voices gradually legitimise the market discourse. By applying Foucault’s theory of how discursive formations appear, it is possible to understand how concepts like freedom of choice and voucher for care circulate in various texts, reappear with new words like customer choice, are reorganized in statements and used in new contexts. Through formation of new discourses in health care the attitude towards how operational and economic issues are managed in health care is changing. The conclusion drawn is that the market discourse, based on the discourse on personal rights for patients, despite resistance, constitutes a customer position, which is evident in an increasing degree of participation, freedom of choice, care guarantee and patient rights in health care. The constitution of the customer position does not entail, however, that the patient concept is being replaced but rather completed by the customer concept.