Year: 2016
Working paper number: 383
Author: Kelly, Gabrielle
Unit: CSSR General
Abstract:
Problems in fairly allocating welfare and health resources or targeting social programmes are very often located in the spaces where citizens interact directly with state workers. This study draws on observations of doctor-patient encounters in disability assessments for the South African disability grant (DG), to examine how doctor-patient interactions shape social welfare allocation. I show that interactions between doctors and patients are sites of negotiation and contestation over rights to social assistance. Claimants' understanding of disability differed from biomedical conceptions of disability. Doctors carrying out DG assessments faced both direct and indirect pressure from claimants, who aimed to influence their decisions through narratives of suffering and performances of disability. Frustrated by communication barriers, as well as the perceived unfairness and arbitrary nature of assessments, some claimants used verbal or physical abuse as a form of protest against the system. In order to defend themselves from these pressures and maintain authority in these interactions, doctors employed coping strategies that distanced and objectified claimants, minimising opportunities for patients to bully them or affect their judgment. These strategies strained already tense doctor-patient relationships and made the DG system illegible to the public. This demonstrates the importance of considering trust, power dynamics and the exercise of agency by both patients and providers in understanding policy implementation.
Publication file: WP 383 Kelly.pdf
Working paper number: 383
Author: Kelly, Gabrielle
Unit: CSSR General
Abstract:
Problems in fairly allocating welfare and health resources or targeting social programmes are very often located in the spaces where citizens interact directly with state workers. This study draws on observations of doctor-patient encounters in disability assessments for the South African disability grant (DG), to examine how doctor-patient interactions shape social welfare allocation. I show that interactions between doctors and patients are sites of negotiation and contestation over rights to social assistance. Claimants' understanding of disability differed from biomedical conceptions of disability. Doctors carrying out DG assessments faced both direct and indirect pressure from claimants, who aimed to influence their decisions through narratives of suffering and performances of disability. Frustrated by communication barriers, as well as the perceived unfairness and arbitrary nature of assessments, some claimants used verbal or physical abuse as a form of protest against the system. In order to defend themselves from these pressures and maintain authority in these interactions, doctors employed coping strategies that distanced and objectified claimants, minimising opportunities for patients to bully them or affect their judgment. These strategies strained already tense doctor-patient relationships and made the DG system illegible to the public. This demonstrates the importance of considering trust, power dynamics and the exercise of agency by both patients and providers in understanding policy implementation.
Publication file: WP 383 Kelly.pdf