Institutions, Interest Groups, and Ideology

Abstract

A central sociological premise is that health care systems are organizations that are embedded within larger institutions, which have been shaped by historical precedents and operate within a specific cultural context. Although bound by policy legacies, embedded constituencies, and path dependent processes, health care systems are not rigid, static, and impervious to change. The success of health care reform in 2010 has shown that existing regimes do have the capacity to respond to new needs in ways that transcend their institutional and ideological limits. For the United States the question is how health care reform will reconfigure the existing network of public and private benefits and the power relationships between the numerous constituencies surrounding them. This article considers how institutions, interest groups, and ideology have affected the organization of the health care system in the United States as well as in other nations. It then discusses issues for future research in the aftermath of the 2009-10 health care reform debate.

Healthcare Systems in Comparative Perspective: Classification, Convergence, Institutions, Inequalities, and Five Missed Turns

“…Quadagno (2010) sees it as “organizations that both deliver care and medical services (hospitals, physicians’ practices, clinics) and that arrange for the financing of care (governments, agencies, states, local communities, and private insurance companies).” Many configurations are possible, and the goals of comparative typological research are to reduce the massive amount of data that is available on any given healthcare system, and to identify a reasonably small set of common configurations. Recently, comparative health care researchers have taken this notion seriously and not only attempted to classify nations, but to consider how that can be done in a way that is analytically meaningful and can move our understanding of health care systems across countries forward.…”

“…A recent review of the literature on inequalities in access to curative care gives some empirical support for this view, finding more class inequality in specialist care, and less class inequality in primary/GP care (Hanratty et al 2007), across several healthcare systems. In the US, the UK, and the Netherlands, recent reforms of healthcare systems raise a host of new questions about distributional conflicts over healthcare, including unequal relations among stakeholders and other organized interests (Quadagno 2010; Tuohy 2012). …”

The Affordable Care Act: Implications for African Americans Living with HIV

“…America lags behind in health care access compared to other developed nations (Reid, 2009;Quadagno, 2010). The ACA addresses this insufficiency by expanding Medicaid coverage to include persons with annual incomes up to 133% of the federal poverty level, approximately $30,000 annually (Beeuwkes-Buntin, 2010; Kaiser Family Foundation, 2011a; U.S. Department of Health and Human Services, 2010a).…”

“…A central social work premise is that everyone deserves to live in a just community, which is why many social workers support health care reform legislation (Gorin, 2011;Quadagno, 2010). The health care reform legislation makes clear the interconnection between the U.S. health care system and the social welfare system.…”

Sociology and Studies of Gender, Caregiving, and Inequality

“…The underlying structural conflict between expanding care and rewarding caregivers, identified by England and Folbre (2002), is evident in these accounts. Jill Quadagno (2010) offers an analysis applicable to the macro‐institutional field confronted by anyone who would reform low‐tier care work. In an article about health care reform, but applicable to imagining any broad movement of care reform, Quadagno draws our attention to the relations among care organizations, those that finance them, and their embedment in the “institutional logics and distributional principles that restructure class relations in specific ways” (126).…”