Commodification of Healthcare—Patient Perspective: A Cultural-Class Inquiry of Patients’ Experience in Public–Private Systems in Israel

This study discusses subjective aspects of the commodification of healthcare from an ethno-class perspective using narrative analysis of patient stories. We hypothesize that the objective social hierarchy of resources, together with a certain degree of individual agency, structure the patients' strategies of coping with the public-private "maze" of the healthcare system. The findings show different coping strategies indicating three different ethno-class 'patient-selves': The dominant 'Neo-Liberal Self', prevalent among the upper middle-class (mostly Ashkenazi Jews) that expresses contempt of the public system, and an individual hero-quest story maneuvering between the private and the public. The 'troubled' patient-self of the low-middle and working classes (mainly Mizrahi Jews and Arabs) also expresses negative impressions of the public system, but it is drawn to sadness, fear of being lost, and a longing for a lost 'logic of care'. Finally, a 'communal alternative self' among the Arab lower classes seeks personal solutions through social networks that include local health providers while crossing barriers between private and public sectors. All selves show some degree of neoliberal values, but the first 'patient-self' implies a sense of social mastery while the other two attest to the agency and even resistance of patients facing structural barriers and scarce resources.