Receiving money for medicine: some tensions and resolutions for community-based private complementary therapists
Corresponding Author
Gavin J. Andrews PhD
Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
Gavin J. Andrews Faculty of Nursing University of Toronto 50 St George Street Toronto Ontario M5S 3H4 Canada E-mail: [email protected]Search for more papers by this authorElizabeth Peter PhD RN
Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorRobin Hammond BA
Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorCorresponding Author
Gavin J. Andrews PhD
Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
Gavin J. Andrews Faculty of Nursing University of Toronto 50 St George Street Toronto Ontario M5S 3H4 Canada E-mail: [email protected]Search for more papers by this authorElizabeth Peter PhD RN
Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorRobin Hammond BA
Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorAbstract
During recent years, private complementary medicine has grown as a significant provider of healthcare in the UK and much of this provision is through small private businesses financed by out-of-pocket payments made by privately paying clients. Using a combined questionnaire (n = 426) and interview survey (n = 49), the present paper considers the potential tensions and dilemmas which therapists face and the resolutions which they come to in being carers, but in market terms, also profit makers. Therapists generally identified with being carers first and business people second, and this was reflected in their caring decisions. Indeed, under circumstances where the roles potentially conflicted (e.g. when clients could no longer afford to pay for their treatments), most therapists claimed that they continued to provide care, either by providing their services free-of-charge, at a reduced rate, by deferring payment or by accepting alternative forms of compensation. There is a relative lack of dedicated research literature on complementary therapists, their attitudes and actions, and this paper provides some important data on their specific management and caring decisions. At the same time, the evidence also provides some initial food-for-thought and indicates some potential research directions for exploring ethical issues in the private practice of complementary medicine.
References
- Andrews G.J. (2002a) Complementary medicine and older people: service use and user empowerment. Ageing Society 22, 343–368.
- Andrews G.J. (2002b) Placing the consumption of private complementary medicine: everyday geographies of older people's use. Health and Place (in press).
- Andrews G.J. (2002c) Nurses who left the NHS to practice private complementary medicine: Why did they leave? Would they return? Journal of Advanced Nursing (in press).
- Andrews G.J. & Phillips D.R. (2000) Moral dilemmas and the management of private residential homes: the impact of care in the community reforms in the UK. Ageing Society 20 (5), 599–623.
- Andrews G.J. & Phillips D.R. (2002) Changing local geographies of private residential care for older people, 1983–1999: lessons for social policy in England and Wales. Social Science and Medicine 55, 63–78.
- Asch D., Jedrziewski K. & Christakis N. (1997) Response rates to mail surveys published in medical journals. Journal of Clinical Epidemiology 50 (10), 1129–1136.
- Asenso-Okyere W.K. (1995) Financing health care in Ghana. World Health Forum 16 (1), 86.
- Astin J. (1998) Why patients use alternative medicine: results of a national study. Journal of the American Medical Association 279 (19), 1548–1553.
- Barnhill K.E., Beitsch L.M. & Brooks R.G. (2001) Improving access to care for the underserved: state-supported volunteerism as a successful component. Archives of Internal Medicine 161 (18), 2177–2181.
- Burstall M.L. (1994) Co-payments for medicines – how much should patients pay? Pharmacoeconomics 6, 187–192.
- Burton (1977) A Work-Study of the Osteopathic Association of Great Britain. Part 1: The Structure of Practices. Osteopathic Association of Great Britain, London.
- Cant S. & Calnan M. (1991) On the margins of the medical marketplace? An exploratory study of alternative practitioners’ perceptions. Sociology of Health and Illness 13, 34–51.
- Charmaz K. (2000) Grounded theory: objectivist and constructivist methods. In: N. Denzin & Y. Lincoln (Eds) Handbook of Qualitative Research, pp. 509–537 . Sage, London.
- Davies P. (1984) Report on Trends in Complementary Medicine. ICM, London.
- Downer S., Cody M., McCluskey P., Wilson P.D., Arnott S., Lister T.A. & Slevin M. (1994) Pursuit and practice of complementary therapies by cancer patients receiving conventional treatment. British Medical Journal 309, 86–89.
- Eisenberg O., Kessler R. & Foster C. (1993) Unconventional medicine in the United Kingdom: patients, practitioners and consultants. Lancet ii, 542–545.
- Ernst E. (Ed.) (1996) Complementary Medicine: An Objective Appraisal. Butterworth Heinemann, Oxford.
- Ernst E. & White A. (2000) The BBC survey of complementary medicine use in the UK. Complementary Therapies in Medicine 8, 32–36.
- Fox C.M., Robinson K.R. & Broadley D. (1998) Cost-effectiveness of follow-up strategies in improving the response rate of mail surveys. Industrial Marketing Management 27, 127–133.
-
Friedson E. (1983) The theory of professions: state of the art. In: R. Dingwall & P. Lewis (Eds)
The Sociology of the Professions, pp. 19–37. Macmillan, London.
10.1007/978-1-349-16979-5_2 Google Scholar
- Fulder S. (1996) The Handbook of Alternative and Complementary Medicine. Oxford University Press, Oxford.
-
Fulder S. &
Monro R. (1985) complementary medicine in the United Kingdom: patients, practitioners and consultants.
Lancet
ii, 542–545.
10.1016/S0140-6736(85)90473-8 Google Scholar
- Furnham A. (1996) Why do people choose and use complementary therapies? In: E. Ernst (Ed.) Complementary Medicine: An Objective Appraisal, pp. 71–89 . Butterworth Heinmann, Oxford.
-
Furnham A. &
Forey J. (1994) The attitudes, behaviors and beliefs of patients of conventional vs complementary (alternative) medicine.
Journal of Clinical Psychology
50, 458–469.
10.1002/1097-4679(199405)50:3<458::AID-JCLP2270500318>3.0.CO;2-V CAS PubMed Web of Science® Google Scholar
- Furnham A. & Kirkcaldy B. (1996) The health beliefs and behaviors of orthodox and complementary medicine clients. British Journal of Clinical Psychology 35, 49–61.
- Furnham A., Vincent C. & Wood R. (1995) The health beliefs and behaviors of three groups of complementary medicine and a general practice group of patients. Journal of Alternative Complementary Medicine 1, 347–359.
- Furnham A. & Smith C. (1988) Choosing alternative medicine: a comparison of the beliefs of patients visiting a GP and a homeopath. Social Science and Medicine 26, 685–687.
- Glaser B.G. (1978) Theoretical Sensitivity. Sociology Press, Mill Valley, CA.
- Glaser B.G. & Strauss A.L. (1967) The Discovery of Grounded Theory: Strategies for Qualitative Research. Aldine, Chicago, IL.
- Gray R., Finch M., Saunders P., Wilkison A., Ross C., Franssen E. & Caverhill K. (1999) complementary health practitioners attitudes, practices and knowledge related to women's cancers. Cancer Prevention and Control 3 (1), 77–82.
- Greene J. (1998) Melatonin for the masses. Antiaging entrepreneurs peddle therapies that promise to cheat the clock. Hospital Health Network 72 (22), 32–34.
- Haddad S. & Fournier P. (1995) Quality, cost and utilisation of health services in developing countries. A longitudinal study in Zaïre. Social Science and Medicine 40 (6), 743–753.
- House of Lords Select Committee on Science and Technology (2000) Complementary and Alternative Medicine. HL Paper 123, November. HMSO, London.
- Hughes D. & McGuire A. (1995) Patient charges and the utilisation of NHS prescription medicines: some estimates using a co-integration procedure. Health Economics 4, 213–220.
- Huttin C. (1994) The use of prescription charges. Health Policy 27, 53–73.
- Kelner M. & Wellman B. (1997a) Who seeks alternative health care? A profile of users of five modes of treatment. Journal of Alternative and Complementary Medicine 3 (2), 127–140.
- Kelner M. & Wellman B. (1997b) Health care and consumer choice: medical and alternative therapies. Social Science and Medicine 45 (2), 203–212.
- Kelner M. & Wellman B. (2001) The therapeutic relationships of older adults: comparing medical and alternative patients. Health and Canadian Society 6 (1), 87–109.
- Lo B. (1999) The patient-provider relationship: opportunities as well as problems. Journal of General Internal Medicine 14 (Suppl. 1), S41–S44.
- Lundberg G. (1997) The business and professionalism of medicine: a pendulum swings and a rocking horse rocks. Journal of the American Medical Association 278 (20), 1704–1705.
- May W.F. (1997) Money and the medical profession. Kennedy Institute of Ethics Journal 7 (1), 1–13.
- Mbugua J.K., Bloom G.H. & Segall M.M. (1995) Impact of user charges on vulnerable groups: the case of Kibwezi in rural Kenya. Social Science and Medicine 41 (6), 829–835.
- McGregor K. & Peay E. (1996) The choice of alternative therapy for health care: testing some propositions. Social Science and Medicine 43 (9), 1317–1327.
- Market and Opinion Research International (1989) Research on Alternative Medicine. Market and Opinion Research International, London.
- Noyce P., Huttin C., Atella V., Brenner G. & Haaijer-Ruskamp F. (2000) The cost of prescription medicines to patients. Health Policy 52 (2), 129–145.
- Ooijendijk W., Mackenbach J. & Limberger H. (1981) What Is Better? The Threshold Foundation, London.
- Pawluch D., Cain R. & Gillet J. (1994) Ideology and alternative therapy use among people living with HIV/AIDS. Health and Canadian Society 2 (1), 63–84.
- Peters (1997) Clinical supervision for potent practice. Complementary Therapies in Nursing and Midwifery 3, 38–41.
- Rodwin M.A. (1993) Medicine, Money, and Morals: Physicians’ Conflicts of Interests. Oxford University Press, Oxford.
- Schroeder S.A. (2001) Prospects for expanding health insurance coverage. New England Journal of Medicine 344 (11), 847–852.
- Sharma U. (1991) Complementary practitioners in a midlands locality. Complementary Medical Research 5, 12–16.
- Sharma U. (1995) Complementary Medicine Today: Practitioners and Patients. Routledge, London.
- Siahpush M. (1999a) Why do people favour alternative medicine? Australian and New Zealand Journal of Public Health 23 (3), 266–271.
- Siapush M. (1999b) Postmodern attitudes about health: a population-based exploratory study. Complementary Therapies in Medicine 7, 164–169.
- Smith T. (1983) Alternative medicine. (Editorial.) British Medical Journal 287, 307.
- Sridhar M.K. (2002) Prescription charges for tuberculosis drugs. Lancet 359 (9003), 360.
- Strauss A. & Corbin J. (1998) Grounded theory methodology: an overview. In: N. Denzin & Y. Lincoln (Eds) Strategies of Qualitative Inquiry, pp. 158–184 . Sage, London.
- Sullivan W.M. (1999) What is left of professionalism after managed care? Hastings Center Report 29 (2), 7–13.
- Thomas K., Fall M., Nicholl J. & Williams B. (1993) Methodological Study to Investigate the Feasibility of Conducting a Population-Based Survey of the Use of Complementary Health Care. RCCM, London.
- Thomas K., Fall M., Parry G. & Nichol J. (1995) National Survey of Access to Complementary Health Care Via General Practice: Report of Department of Health. SCHARR, Sheffield.
- Varstag B. (2001) Report on uninsured tries to reverse myths. Journal of the American Medical Association 286 (18), 2223–2224.
- Vaughan D. (1992) Theory elaboration: the heuristics of case analysis. In: H. Becker & C. Ragin (Eds) What is a Case?, pp. 65–83 . Cambridge University Press, Cambridge.
- Verhoef M., Scott C. & Hilsden R. (1998) A multimethod research study on the use of complementary therapies among patients with inflammatory bowel disease. Alternative Therapies in Health and Medicine 4, 68–71.
- Vickers A.J. (1994) Use of complementary therapies. (Letter.) British Medical Journal 309, 1161.
- Vickers A.J., Rees R.W. & Robin A. (1998) Advice given by health food shops. Is it clinically safe? Journal of the Royal College of Physicians 32 (5), 26–28.
- Vincent C. & Furnham A. (1996) Why do patients turn to complementary medicine? An empirical study. British Journal of Clinical Psychology 35, 37–48.
- Weaver M., Wong H., Sako A., Simon R. & Lee F. (1994) Prospects for reform of hospital fees in sub-Saharan Africa: a case study of Niamey National hospital in Niger. Social Science and Medicine 38 (4), 565–574.
- Wellman B., Kelner M. & Wigdor B. (2001) Older adults’ use of medical and alternative care. Journal of Applied Gerontology 20 (1), 3–23.
- Which (1986) Magic or medicine? Which October , 443–447.
- White A. (1996) Do complementary therapists offer value for money? In: E. Ernst (Ed.) Complementary Medicine: An Objective Appraisal, pp. 89–106 . Butterworth Heinmann, Oxford.
-
White A.,
Resch K. &
Ernst E. (1997) A survey of complementary practitioners’ fees, practice and attitudes to working within the National Health Service.
Complementary Therapies in Medicine
5, 210–214.
10.1016/S0965-2299(97)80031-3 Google Scholar
- Wysong P. (1998) Many asthma patients using alternative medicine: conventional medicine seen as not treating the whole person. Medical Post, 6–7.
- Zollman C. & Vickers A. (1999b) The ABC of complementary medicine: users and practitioners of complementary medicine. British Medical Journal 319, 836–838.