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

## TL;DR

This paper explores how patients in Israel's healthcare system experience and cope with the shift toward privatization, highlighting differences based on cultural and class backgrounds.

## Contribution

The study introduces a novel ethno-class framework to analyze patient narratives and coping strategies in public-private healthcare systems.

## Key findings

- Three distinct ethno-class 'patient-selves' were identified based on coping strategies in navigating healthcare systems.
- The 'Neo-Liberal Self' reflects upper-middle-class mastery, while the 'troubled' and 'communal alternative' selves reflect struggles and resistance among lower classes.
- All patient-selves exhibit neoliberal values, but to varying degrees of agency and resistance.

## Abstract

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.