The formation of domestic and global marketplaces during the past 50 years has opened up new commercial opportunities for third-party activity in healthcare systems. Commercial mediation of access to healthcare is one recent area of activity that sees companies and individuals offering to organise healthcare and travel in return for payment. With varying degrees of control over the location, type, cost and experiences of healthcare provisioning, these intermediaries occupy potentially influential positions in healthcare systems and yet much of their work is poorly understood. Drawing on social science theories of brokerage, this article presents a novel analysis of commercial healthcare facilitation. It focuses on facilitation companies and their workers as central, intermediating actors for people to access healthcare in markets characterised by complexity. Semi-structured interviews were conducted with people working in domestic and international healthcare facilitation in London and Delhi, and data were analysed using a framework approach that emphasises the structural features and personal agencies for this area of work. Findings point to an institutional environment for commercial healthcare facilitation marked by competition and the threat of obsolescence. The activities of rivals, and the risk that users and providers will bypass intermediaries, compels facilitation companies to respond strategically and to continuously pursue new populations and activities to mediate – to go for broke. These pressures percolate into the lives of people who perform facilitation work and who describe a physical and mental burden of labour incurred by onerous processes for generating and completing facilitation work. The need for language interpretation services introduces an additional set of relations and has created further points of tension. It is an environment that engenders mistrust and anxiety, and which incentivises exploitation and a commodification of users whose associated commissions are highly prized. Brokerage analysis provides valuable insights into the strategies and strains for commercial mediation of access to healthcare, and the findings indicate opportunities for further research on the contributions of interpreters, diplomatic and business networks, and new technologies, and on the growth of new forms of mediation in domestic and overseas settings.

中文翻译：

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走向经纪业：商业医疗便利化的策略和压力。


过去 50 年国内和全球市场的形成为医疗保健系统中的第三方活动开辟了新的商业机会。获得医疗保健的商业中介是最近的活动领域之一，公司和个人愿意组织医疗保健和旅行以换取报酬。这些中介机构对医疗保健提供的地点、类型、成本和体验有着不同程度的控制，在医疗保健系统中占据着潜在的影响力位置，但他们的大部分工作却鲜为人知。本文借鉴经纪业的社会科学理论，对商业医疗便利化进行了新颖的分析。它侧重于便利公司及其员工作为人们在复杂市场中获得医疗保健的核心中介参与者。对伦敦和德里国内和国际医疗保健机构的工作人员进行了半结构化访谈，并使用强调该工作领域的结构特征和个人机构的框架方法对数据进行了分析。调查结果表明，商业医疗便利化的制度环境充满了竞争和过时的威胁。竞争对手的活动，以及用户和提供商绕过中介机构的风险，迫使便利服务公司做出战略性反应，并不断寻求新的人群和活动来进行调解——孤注一掷。这些压力渗透到执行便利工作的人们的生活中，他们描述了由于生成和完成便利工作的繁重过程而造成的身体和精神负担。 对语言口译服务的需求引入了一组额外的关系，并造成了进一步的紧张点。这是一个会产生不信任和焦虑的环境，会刺激用户的剥削和商品化，而这些用户的相关佣金会受到高度重视。经纪分析为获得医疗保健的商业调解的策略和压力提供了宝贵的见解，研究结果表明有机会进一步研究口译员、外交和商业网络、新技术的贡献以及新调解形式的发展在国内和海外环境中。