Australian news media framing of medical tourism in low- and middle-income countries: A content review

© 2013 Imison and Schweinsberg; licensee BioMed Central Ltd. Background: Medical tourism - travel across international borders for health care - appears to be growing globally, with patients from high-income nations increasingly visiting low- and middle-income countries to access such services. This paper analyses Australian television and newspaper news and current affairs coverage to examine how medical tourism and these destinations for the practice are represented to media audiences. Methods: Electronic copies of Australian television (n = 66) and newspaper (n = 65) items from 2005-2011 about medical care overseas were coded for patterns of reporting (year, format and type) and story characteristics (geographic and medical foci in the coverage, news actors featured and appeals, credibility and risks of the practice mentioned). Results: Australian media coverage of medical tourism was largely focused on Asia, featuring cosmetic surgery procedures and therapies unavailable domestically. Experts were the most frequently-appearing news actors, followed by patients. Common among the types of appeals mentioned were access to services and low cost. Factors lending credibility included personal testimony, while uncertainty and ethical dilemmas featured strongly among potential risks mentioned from medical tourism. Conclusions: The Australian media coverage of medical tourism was characterised by a narrow range of medical, geographic and ethical concerns, a focus on individual Australian patients and on content presented as being personally relevant for domestic audiences. Medical tourism was portrayed as an exercise of economically-rational consumer choice, but with no attention given to its consequences for the commodification of health or broader political, medical and ethical implications. In this picture, LMICs were no longer passive recipients of aid but providers of a beneficial service to Australian patients

‘Disease, disaster and despair’? health stories from low- and middle-income countries in the Australian news media

The mass media in high-income nations remain a crucial source of news and information. In relation to health, coverage is dominated by a medical perspective and an individualised view of illness that neglects public health. With regard to foreign news, previous research has shown that reporting tends to be narrow in scope, focused on nations that are significant to the country for which coverage is being produced and usually has an aspect of domestic relevance. These patterns are especially pronounced in relation to news from low- and middle-income countries (LMICs), the coverage of which has long been criticised as limited, negative and stereotyped. However, little is known about the coverage of health stories from these nations. This thesis uses a uniquely large database of Australian television coverage about health to examine how health stories from LMICs are covered in the Australian news media. It provides an overview of mass-media reporting on the subject, examining what locations and health conditions feature in coverage of LMIC health and the extent to which a ‘local Australian angle’ is often key to their newsworthiness. Several case studies from this dataset are also analysed. One, an exemplary story about the transport to Australia and surgical separation of infant conjoined twin girls from Bangladesh – a nation that is otherwise little-covered in the Australian media – is considered from the three key angles for media studies: production (journalism), representation (content) and reception (audience). The medical tourism narrative in the Australian news media is also considered for the way in which it reverses the usual expectations of LMICs as passive and dependent on high-income nations. Finally, the relationship among international development agencies and the news media in Australian in relation to LMIC health is examined. The thesis concludes with general reflections and suggestions for further research

Perceptions of healthcare professionals and managers regarding the effectiveness of GP-led walk-in centres in the UK.

OBJECTIVES: This study aimed to identify the perceptions of healthcare professionals regarding the effectiveness and the impact of a new general practitioner-led (GP-led) walk-in centre in the UK. SETTING: This qualitative study was conducted in a large city in the North of England. In the past few years, there has been particular concern about an increase in the use of emergency department (ED) services provided by the National Health Service and part of the rationale for introducing the new GP-led walk-in centres has been to stem this increase. The five institutes included in the study were EDs, a minor injuries unit, a primary care trust, a GP-led walk-in centre and GP surgeries. PARTICIPANTS: Semistructured interviews were conducted with healthcare providers at an adult ED, an ED at a children's hospital, a minor injuries unit, a GP-led walk-in centre, GPs from surrounding surgeries and GPs. RESULTS: 11 healthcare professionals and managers were interviewed. Seven key themes were identified within the data: the clinical model of the GP-led walk-in centre; public awareness of the services; appropriate use of the centre; the impact of the centre on other services; demand for healthcare services; choice and confusion and mixed views (positive and negative) of the walk-in services. There were discrepancies between the managers and healthcare professionals regarding the usefulness of the GP-led walk-in centre in the current urgent care system. CONCLUSIONS: Participants did not notice declines in the demand for EDs after the GP-led walk-in centre. Most of the healthcare professionals believed that the GP-led walk-in centre duplicated existing healthcare services. There is a need to have a better communication system between the GP-led walk-in centres and other healthcare providers to have an integrated system of urgent care delivery

'...a story that's got all the right elements': Australian media audiences talk about the coverage of a health-related story from the developing world

Australian news coverage of low- and middle-income countries (LMICs) generally, and of their health contexts specifically, has long been criticised as problematic. This paper considers an exemplary LMIC health story and presents findings of an audience reception study that examined how different groups of Australian participants responded to it, the possible implications for future LMIC health coverage and for domestic perceptions of global public health. In particular, the paper examines how audiences talked about three of the story’s principal themes and suggests that greater audience engagement with LMIC health news may be possible as the mass-media landscape continues to evolve.National Health and Medical Research Council Capacity Building Grant 571376 (2009-2013)

Media Miracles: The Separation of Conjoined Twins, and Reflections on Minimal Television News Coverage of Health from Low- and Middle-Income Countries

Australian television news and current affairs remain an important source of information for domestic audiences about both health and low- and middle-income countries. In November 2009, the successful surgical separation in Australia of conjoined infant twins from Bangladesh generated large-scale domestic media interest. In the 66 months to October 2010, only 75 health-related stories about Bangladesh were broadcast on Sydney television, 70 of them (93%) about these twins. Drawing on the television database of the Australian Health News Research Collaboration, this paper presents a thematic analysis of the Australian television news and current affairs coverage of the twins and why their case attained such a profile relative to other coverage of health from this nation. In addition to the predictable newsworthiness of a rare and bizarre medical condition and the made-for-television tension inherent in the saga of their arrival, preparation and eventual lengthy operation, prominent themes centred around the story’s opportunities to praise Australian individuals, medical skill and national character. The focus in this story on identified individuals with an uncommon condition requiring tertiary medical intervention only available in a high-income nation contrasts with a lack of coverage of, or critical consideration for, the well-being of anonymous individuals or less culturally-favoured groups, more long-term and mundane health considerations or any broader social or financial context to health issues in low- and middle-income countries. Reportage of foreign health issues appears contingent on the availability of populist ‘rule of rescue’ news frames, arresting footage and dramatic narratives that resonate with audiences’ expectations of such nations. The analysis offered in this paper illuminates the potential implications of such reporting for the wider news space available to health stories from low- and middle-income countries.This work was supported by a Capacity Building Grant from the National Health and Medical Research Council (http://www.nhmrc.gov.au) to the Australian Health News Research Collaboration (2009–2013) [571376]

Australian journalists’ reflections on local coverage of a health-related story from the developing world

Given the limited Australian media coverage of health news from low- and middle-income countries (LMICs), the 2009 story of conjoined Bangladeshi twins Trishna and Krishna was conspicuous for its scale. This paper draws on interviews with journalists who reported the story and considers what those seeking to increase the news exposure given to LMIC health issues might learn from this coverage. It considers, in particular, the extent to which the twins’ story fitted with prevailing journalistic norms and beliefs about both health and news, and suited professional expectations and routines, especially in relation to choice of sources and access to material. Finally, the paper surveys opportunities for broader and deeper coverage of such news in the future

Clinical leadership in service redesign using Clinical Commissioning Groups: a mixed-methods study

Background: A core component of the Health and Social Care Act 2012 (Great Britain. Health and Social Care Act 2012. London: HMSO; 2012) was the idea of devolving to general practitioners (GPs) a health service leadership role for service redesign. For this purpose, new Clinical Commissioning Groups (CCGs) were formed in the English NHS.Objectives: This research examined the extent to which, and the methods by which, clinicians stepped forward to take up a leadership role in service redesign using CCGs as a platform.Design: The project proceeded in five phases: (1) a scoping study across 15 CCGs, (2) the design and administration of a national survey of all members of CCG governing bodies in 2014, (3) six main in-depth case studies, (4) a second national survey of governing body members in 2016, which allowed longitudinal comparisons, and (5) international comparisons.Participants: In addition to GPs serving in clinical lead roles for CCGs, the research included insights from accountable officers and other managers and perspectives from secondary care and other provider organisations (local authority councillors and staff, patients and the public, and other relevant bodies).Results: Instances of the exercise of clinical leadership utilising the mechanism of the CCGs were strikingly varied. Some CCG teams had made little of the opportunity. However, we found other examples of clinicians stepping forward to bring about meaningful improvements in services. The most notable cases involved the design of integrated care for frail elderly patients and others with long-term conditions. The leadership of these service redesigns required cross-boundary working with primary care, secondary care, community care and social work. The processes enabling such breakthroughs required interlocking processes of leadership across three arenas: (1) strategy-level work at CCG board level, (2) mid-range operational planning and negotiation at programme board level and (3) the arena of practical implementation leadership at the point of delivery. The arena of the CCG board provided the legitimacy for strategic change; the programme boards worked through the competing logics of markets, hierarchy and networks; and the practice arena allowed the exercise of clinical leadership in practical problemsolving, detailed learning and routinisation of new ways of working at a common-sense everyday level.Limitations: Although the research was conducted over a 3-year period, it could be argued that a much longer period is required for CCGs to mature and realise their potential.Conclusions: Despite the variation in practice, we found significant examples of clinical leaders forging new modes of service design and delivery. A great deal of the service redesign effort was directed at compensating for the fragmented nature of the NHS – part of which had been created by the 2012 reforms. This is the first study to reveal details of such work in a systematic way

‘Disease, Disaster and Despair’? The Presentation of Health in Low- and Middle-Income Countries on Australian Television

In high-income nations mainstream television news remains an important source of information about both general health issues and low- and middle-income countries (LMICs). However, research on news coverage of health in LMICs is scarce. The present paper examines the general features of Australian television coverage of LMIC health issues, testing the hypotheses that this coverage conforms to the general patterns of foreign news reporting in high-income countries and, in particular, that LMIC health coverage will largely reflect Australian interests. We analysed relevant items from May 2005 – December 2009 from the largest health-related television dataset of its kind, classifying each story on the basis of the region(s) it covered, principal content relating to health in LMICs and the presence of an Australian reference point. LMICs that are culturally proximate and politically significant to Australia had higher levels of reportage than more distant and unengaged nations. Items concerning communicable diseases, injury and aspects of child health generally consonant with ‘disease, disaster and despair’ news frames predominated, with relatively little emphasis given to chronic diseases which are increasingly prevalent in many LMICs. Forty-two percent of LMIC stories had explicit Australian content, such as imported medical expertise or health risk to Australians in LMICs. Media consumers’ perceptions of disease burdens in LMICs and of these nations’ capacity to identify and manage their own health priorities may be distorted by the major news emphasis on exotic disease, disaster and despair stories. Such perceptions may inhibit the development of appropriate policy emphases in high-income countries. In this context, non-government organisations concerned with international development may find it more difficult to strike a balance between crises and enduring issues in their health programming and fundraising efforts.This work was supported by a Capacity Building Grant from the National Health and Medical Research Council (http://www.nhmrc.gov.au) to the Australian Health News Research Collaboration (2009–2013) [571376]

Room for one more? A review of the literature on ‘inappropriate’ admissions to hospital for older people in the English NHS

This paper reports the findings of a review of the literature on emergency admissions to hospital for older people in the UK, undertaken between May and June 2014 at the Health Services Management Centre, University of Birmingham. This review sought to explore: the rate of in/appropriate emergency admissions of older people in the UK; the way this is defined in the literature; solutions proposed to reduce the rate of inappropriate admissions; and the methodological issues which particular definitions of ‘inappropriateness’ raise. The extent to which a patient perspective is included in these definitions of inappropriateness was also noted, given patient involvement is such a key policy priority in other areas of health policy. Despite long-standing policy debates, relatively little research has been published on formal rates of ‘inappropriate’ emergency hospital admissions for older people in the UK NHS in recent years. What has been produced indicates varying rates of in/appropriateness, inconsistent ways of defining appropriateness and a lack of focus on the possible solutions to address the problem. Significantly, patient perspectives are lacking, and we would suggest that this is a key factor in fully understanding how to prevent avoidable admissions. With an ageing population, significant financial challenges and a potentially fragmented health and social care system, the issue of the appropriateness of emergency admission is a pressing one which requires further research, greater focus on the experiences of older people and their families, and more nuanced contextual and evidence-based responses