Paper short abstract:

As taxpayers, New Zealand citizens who become patients are credited with moral capital which can be paid forward as they engage with the healthcare system. We examine the ways in which moral capital was paid forward within the moral economy of a community long-term conditions management team.

Paper long abstract:

This New Zealand study used ethnography to explore the activities of communities of clinical practice (CoCP) in a community based long-term conditions management program within a large primary healthcare clinic. CoCP are the informal vehicles by which patient care was delivered within the program. Here, we describe the CoCP as a micro level moral economy within which values such as trust, respect, authenticity, reciprocity and obligation circulate as a kind of moral capital. As taxpayers, citizens who become patients are credited with moral capital because the public health system is funded by taxes. This moral capital can be paid forward; accrued, banked, redeemed, exchanged and forfeited by patients and their healthcare professionals during the course of a patient's journey. The concept of moral capital offers another route into the 'black box' of clinical work by providing an alternative theoretic for explaining the relational aspects of patient care.