The body of a patient and rational treatment in the managed care era Public Deposited

http://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/f1881p984

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  • This study aims to identify conceptions of the body, as well as "rational" treatment among primary care practitioners (PCPs) and emergency medicine practitioners (EMPs) dealing with managed care plans. I conducted ethnographic study throughout 1996, and interviewed six PCPs and four EMPs. In the course of my interviews, I discovered that EMPs' and PCPs' perceived meaning and power in regards to treatment of their patients has been increasingly resituated by the power of scientific discourse as utilized by technocrats (such as consumer, provider, and insurance organizations who formulate managed care plans). Technocrats have developed scientific measurements to monitor physicians' performances, quantifiably or scientifically. Technocrats conceptualize ideal treatment as a cost effective care. They guide PCPs to supervise ideal treatment of the managed care delivery networks, providing care without referring patients to specialists and administrating to hospitals. Consequently, PCPs' power to pursue the newly conceptualized ideal treatment influences other arenas of specialty, such as EMPs. On the other hand, EMPs develop preferred treatment which is formulated through their medical school education and clinical experiences. The preferred treatment is associated with time because EMPs have to treat acute conditions of their patients within a limited amount of time. However, EMPs sometimes cannot complete their preferred treatment because they have to send their patient back to the patients' contracted PCPs in order to save health care expenditure. Technocrats implemented the engineering concept of quality control, and the concept is incorporated into the principle of managed care plans, and preventive medicine. As a result, the managed care plan networks become like production lines of large manufacturing factories, and PCPs work as laborers to maintain the bodies of enrollees in healthy conditions.
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  • File scanned at 300 ppi (Monochrome) using ScandAll PRO 1.8.1 on a Fi-6770A in PDF format. CVista PdfCompressor 4.0 was used for pdf compression and textual OCR.
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