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Unmanageable Care: An Ethnography Of Health Care Privatization In Puerto Rico,Used
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In Unmanageable Care, anthropologist Jessica M. Mulligan goes to work at an HMO and records what its really like to manage care. Set at a health insurance company dubbed Acme, this book chronicles how the privatization of the health care system in Puerto Rico transformed the experience of accessing and providing care on the island. Through interviews and participant observation, the book explores the everyday contexts in which market reforms were enacted. It follows privatization into the compliance department of a managed care organization, through the visits of federal auditors to a health plan, and into the homes of health plan members who recount their experiences navigating the new managed care system.In the 1990s and early 2000s, policymakers in Puerto Rico sold off most of the islands public health facilities and enrolled the poor, elderly and disabled into forprofit managed care plans. These reforms were supposed to promote efficiency, costeffectiveness, and high quality care. Despite the optimistic promises of marketbased reforms, the system became more expensive, not more efficient; patients rarely behaved as the expected healthmaximizing information processing consumers; and care became more chaotic and difficult to access. Citizens continued to look to the state to provide health services for the poor, disabled, and elderly. This book argues that promarket reforms failed to deliver on many of their promises. The health care system in Puerto Rico was dramatically transformed, just not according to plan.
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