The pharmaceutical regulation of chronic disease among the U.S. urban poor: an ethnographic study of accountability

Research output: Contribution to journalArticle

Abstract

The Massachusetts experience of health care reform before the Affordable Care Act of 2010 reveals a moral economy of care in which expanded access was met by neoliberal demands for accountability and cost control. Publicly subsidized health insurance programs in the U.S. are deeply concerned with managing and regulating low-income residents’ access to and coverage for medications. By focusing our attention on the new forms of social relations invoked by specific techniques of governing, analyses of accountability can help us understand the ways in which subjectivities are shaped through their encounters with overarching social and economic structures. This paper presents qualitative findings from a four-year, prospective study that combined two waves of survey and chart-based data collection with four qualitative methods. Medicaid patients are made accountable to their medication regimens as they must track their supply and obtain refills promptly; regular blood tests carried out by health care providers verify their adherence. Both patients and their physicians are subject to cost savings measures such as changing lists of covered medications. Finally, patients struggle to pay ever-increasing out-of-pocket costs for their medications, expenses which may keep patients from taking their medications as prescribed. The fraught relationship between trust, accountability, and verification finds emphatic expression in the moral economy of health care, where the vulnerability of the sick and their hope for a cure confront policies designed to hold down costs.

Original languageEnglish (US)
Pages (from-to)1-12
Number of pages12
JournalCritical Public Health
DOIs
StateAccepted/In press - May 28 2017
Externally publishedYes

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Social Responsibility
Chronic Disease
Pharmaceutical Preparations
Hope
Patient Protection and Affordable Care Act
Costs and Cost Analysis
Health Care Reform
Cost Control
Cost Savings
Medicaid
Hematologic Tests
Health Insurance
Health Expenditures
Health Personnel
Economics
Prospective Studies
Delivery of Health Care
Physicians

Keywords

  • access to health care
  • Accountability
  • chronic disease
  • costs of care
  • health disparities
  • medically underserved groups
  • pharmaceuticals
  • United States

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

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