Unmanageable Care: An Ethnography of Health Care Privatization in Puerto Rico PDF
Preview Unmanageable Care: An Ethnography of Health Care Privatization in Puerto Rico
Unmanageable Care This page intentionally left blank Unmanageable Care An Ethnography of Health Care Privatization in Puerto Rico Jessica M. Mulligan a NEW YORK UNIVERSITY PRESS New York and London NEW YORK UNIVERSITY PRESS New York and London www.nyupress.org © 2014 by New York University All rights reserved References to Internet websites (URLs) were accurate at the time of writing. Neither the author nor New York University Press is responsible for URLs that may have expired or changed since the manuscript was prepared. Library of Congress Cataloging-in-Publication Data Mulligan, Jessica M. Unmanageable care : an ethnography of health care privatization in Puerto Rico / Jessica M. Mulligan. pages cm Includes bibliographical references and index. ISBN 978-0-8147-2491-0 (hardback) — ISBN 978-0-8147-7031-3 (paper) 1. Medical care—Puerto Rico. 2. Medical policy—Puerto Rico. 3. Health care reform—Puerto Rico. 4. Privatization—Puerto Rico. I. Title. RA395.P7M85 2014 362.1097295—dc 3 2014002840 New York University Press books are printed on acid-free paper, and their binding materials are chosen for strength and durability. We strive to use environmentally responsible suppliers and materials to the greatest extent possible in publishing our books. Manufactured in the United States of America 10 9 8 7 6 5 4 3 2 1 Also available as an ebook I dedicate this book to my parents—I am lucky that a large number of people play that role. To Gerry Mulligan, Janet Mulligan, Sarah Baker Sultenfuss, and Tom Dooley. Thank you. This page intentionally left blank Contents Acknowledgments ix Introduction: Learning to Manage 1 Part I: Elements of a System 1. A History of Reform: Colonialism, Public Health, 31 and Privatized Care 2. Regulating a Runaway Train: Everyone Is Replaceable 61 3. New Consumer Citizens: Life Histories 89 Part II: The Business of Care: Market Values and Management Strategies 4. Quality: Managing by Numbers 125 5. Complaints: The Wrong Glucometer . . . Again! 151 6. Market Values: Partnering and Choice 179 Conclusion: Ungovernability as Market Rule 209 Appendix 1: A Methodological Appendix 231 Appendix 2: Interview Descriptions 241 Notes 253 Works Cited 277 Index 295 About the Author 299 >> vii This page intentionally left blank Acknowledgments Ten years is a long time, a decade during which I have benefited from many acts of generosity, care, and support. The time has also been marked by loss. To my stepfather, Tom Dooley, I am so sorry that I cannot share this book with you. I wish you could have seen how much of you is in it. This book began at Harvard University where the Department of Anthropology, the Hemenway Fellowship of American Ethnology, the David Rockefeller Center for Latin American Studies, and the Salton- stall Population Studies Center provided generous financial support. The Department of Anthropology and the Watson Institute for Interna- tional Studies at Brown University provided write-up funding and new intellectual connections. Without my advisors and mentors—Arthur Kleinman, Joanne Rap- paport, and Kay Warren—this project never would have materialized. Thank you for the years of continued support; I never realized that advising was such a long-term commitment. I am grateful to Arthur Kleinman for taking me on as an advisee post-fieldwork and then turn- ing me into a medical anthropologist. His engagement with my work and sharp critical reading have made this book possible. Joanne Rap- paport started me on this path. Being a student in her classes made me want to be an anthropologist. Kay Warren provided crucial support at key moments in this project and was always convinced that there was an interesting project here, even when I wasn’t. Charles Rosenberg and Mary Steedly provided valuable support and intellectual guidance at early points in the project. Michael Her- zfeld helped me muddle through that excruciatingly difficult learning process that is figuring out how to write an academic article. Margarita Alegría was extraordinarily generous with her time and expertise. >> ix
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