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Unmanageable CareAn Ethnography of Health Care Privatization in Puerto Rico$
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Jessica M. Mulligan

Print publication date: 2014

Print ISBN-13: 9780814724910

Published to NYU Press Scholarship Online: March 2016

DOI: 10.18574/nyu/9780814724910.001.0001

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Managing by Numbers

(p.125) 4 Quality
Unmanageable Care

Jessica M. Mulligan

NYU Press

This chapter examines the role of quality measurement within market-based health policies. Quantifying quality is supposed to unite regulators, health plans, and health care consumers in a circuit of constant improvement. Additionally, the production of quality data is important in the Medicare program as patients are supposed to use quality statistics to make informed plan choices. The chapter first analyzes policy documents that define the methods and administrative rationale for conducting quality measurement. It draws on the ethnographic research conducted at Acme. Much of the observation done was targeted at maximizing revenue and complying with regulatory requirements. The chapter concludes with interview excerpts from health plan members regarding how they imagine quality health care, thereby demonstrating some of the disconnects between the quality-measurement efforts of policy makers and health maintenance organizations (HMOs), and the kinds of quality concerns raised by consumers.

Keywords:   quality measurement, market-based health policies, regulators, health plans, health care consumers, Medicare, Acme, health maintenance organizations

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