Table of Contents

• Introduction
• Historical Context: From Welfare to Market Logics
• Key Mechanisms of Marketisation
• Sociological Critiques of Marketisation
• Marketisation and Organisational Change
• Patient Experience and the Culture of Health Care
• Resistance and Alternatives
• Conclusion

Introduction

In recent decades, the health care sector has undergone a profound and far-reaching transformation, shaped by the broader global processes of neoliberal reform, economic restructuring, and the growing dominance of capitalist logics in public services. Central to this transformation is the phenomenon known as the marketisation of health care. Marketisation refers to the introduction, extension, or intensification of market principles—such as competition, profit orientation, consumer choice, and commodification—into domains that were traditionally governed by public, solidaristic, or welfare-oriented logics.

The marketisation of health care is not merely an economic shift. It represents a deeply social, cultural, and political transformation that reconfigures how health is understood, how care is accessed and delivered, and how both providers and recipients of care are socially positioned. This article draws on sociological perspectives to explore the complex dimensions of marketised health care. It considers the historical development of this shift, its institutional and discursive mechanisms, and the implications for social inequality, professional practice, patient identity, and health system governance.

Historical Context: From Welfare to Market Logics

The Rise of the Welfare Model

In the post-World War II era, many industrialised societies embraced the welfare state as a mechanism to ensure universal access to essential services, including health care. This model was underpinned by social democratic values such as equity, collective responsibility, and the belief that health care is a public good rather than a commodity. In countries such as the United Kingdom, Sweden, and Canada, the welfare model ensured that health services were publicly funded, largely free at the point of use, and governed by state or publicly accountable institutions.

Health care under the welfare model was integrated, universally accessible, and oriented around professional ethics rather than profit. Medical professionals were seen as stewards of public trust, and patients were regarded as citizens with rights rather than consumers.

The Neoliberal Turn

From the late 1970s and into the 1980s and 1990s, a major ideological and policy shift occurred. Neoliberalism—emphasising deregulation, privatisation, market discipline, and the retreat of the welfare state—became the dominant paradigm in many Western democracies. In health care, this ideological turn led to a wide range of reforms that introduced or intensified market mechanisms:

• Public hospitals were encouraged or required to operate as independent, self-financing trusts or corporations.
• Health services were increasingly outsourced to private providers, including multinational health corporations.
• Patients were redefined as consumers with the responsibility to choose between competing providers.
• Medical professionals were reframed as service providers, subject to performance management and competitive pressures.

Key Mechanisms of Marketisation

Marketisation is operationalised through a series of interrelated mechanisms that reshape how health care systems function and how care is conceptualised.

Commodification

Commodification involves the transformation of health care into a marketable good or service. Under commodification:

• Insurance schemes—whether private or public-private hybrids—determine the scope and cost of services.
• Treatment decisions are increasingly subject to economic evaluation, such as cost-effectiveness ratios or return-on-investment assessments.
• Health care encounters become transactions, subject to billing codes, itemised pricing, and financial performance targets.

This reorientation frames patients as clients purchasing a service, and it reframes illnesses as disruptions to be efficiently resolved rather than complex lived experiences.

Competition

Health care marketisation introduces competition between providers under the assumption that competition drives innovation, efficiency, and responsiveness. However, competition also produces challenges:

• Health providers may compete for profitable services (e.g., elective surgeries) while avoiding unprofitable ones (e.g., chronic care).
• Fragmentation of care may increase, undermining integrated service delivery.
• Duplication of infrastructure may result, especially when providers compete rather than collaborate.

Competition also affects public trust, as services are no longer perceived as equally available to all but subject to selective availability.

Consumer Choice

One of the key narratives driving marketisation is the empowerment of patients as consumers. This narrative assumes:

• That patients can and should exercise choice among providers, treatments, and coverage options.
• That choice fosters accountability, as dissatisfied consumers can “exit” to superior alternatives.
• That health services can be standardised and evaluated using performance indicators (e.g., mortality rates, satisfaction scores).

Yet from a sociological perspective, this model obscures structural inequalities:

• Not all patients possess the cultural capital, health literacy, or economic resources needed to exercise meaningful choice.
• The illusion of choice often masks limited options, especially in underfunded or rural settings.
• Choice discourses transfer responsibility onto patients for outcomes that may be shaped by systemic failings.

Sociological Critiques of Marketisation