The pharmaceutical regulation of chronic disease among the U.S. urban poor: an ethnographic study of accountability.
The pharmaceutical regulation of chronic disease among the U.S. urban poor: an ethnographic study of accountability.
复制标题
美国城市贫民慢性病的药物监管：责任的人种学研究。
DOI：
10.1080/09581596.2017.1332338
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发表时间：
2018
影响因子：
2.8
通讯作者：
Shaw,SusanJ
中科院分区：
文献类型：
--
作者：
Shaw,SusanJ
2010年《平价医疗法案》出台之前，马萨诸塞州的医疗保健改革经验揭示了一种医疗保健的道德经济，在这种经济中，新自由主义对问责制和成本控制的要求满足了扩大可及性的要求。美国的公共补贴医疗保险计划非常关注管理和调节低收入居民获得药物的机会和覆盖范围。通过将我们的注意力集中在特定的治理技术所引发的新形式的社会关系上，对问责制的分析可以帮助我们理解主体性是如何通过与总体社会和经济结构的接触而形成的。本文介绍了一项为期四年的前瞻性研究的定性结果，该研究将两波调查和基于图表的数据收集与四种定性方法相结合。医疗补助患者对他们的药物治疗方案负责，因为他们必须跟踪他们的供应并迅速获得补充;医疗保健提供者进行的定期血液检查验证他们的依从性。病人和他们的医生都受到节省成本的措施，如改变名单的覆盖药物。最后，患者努力为他们的药物支付不断增加的自付费用，这些费用可能会使患者无法按照规定服用药物。信任、责任和验证之间的关系在医疗保健的道德经济中得到了生动的表达，病人的脆弱性和他们对治愈的希望与旨在降低成本的政策相对抗。
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.