Dissertation Research: An Ethnographic Study of Information and Technology in Transnational Healthcare Markets

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This dissertation proposes ethnographic fieldwork in the strategic arena of "informatics and biology" within contemporary international healthcare. In particular the researcher will investigate the sciences and technologies driving or facilitating the changing transnational medical care markets, as a crucible for analyzing and re-mapping the changing structures and ever-present dilemmas of health care, the welfare state, decision-making in clinical practice, and the display, manipulation and transformation of information within and across healthcare systems. The project is divided into three sections-Macro, Micro, and Margin-which are supported by empirical fieldwork in several sites. The 'Macro' section outlines the theoretical dimensions of the shift from the national welfare-state provision of healthcare to the international market-oriented welfare capitalism of the emerging healthcare market. These empirical changes will be yoked to the theories of Ulrich Beck and Francois Ewald on risk, responsibility, and rights, requiring a theoretical synthesis of political economy, history and anthropology. The 'Micro' section includes detailed empirical fieldwork (first phase, completed) on the sciences and technologies that facilitate and exacerbate the changes outlined in the Macro section. This research focuses on the design and implementation of information and communication technologies by both large and small organizations within an Academic Medical Center; in particular, the studies focus on technologies for the manipulation and communication of visual images on the internet. The researcher has explored and will continue to study the tension between contingent design and standardization, and among academic, medical and industry research strategies. The 'Margin' section will follow the technologies in 'Micro' to several international and national remote sites. Under the assumption that the unevenly porous boundaries of nations produce global centralizations of capital and expertise, the researcher intends to study how a new international geography of center and periphery is built up around the marketing and use of networked healthcare; in particular how the technologies designed in Boston are used and understood by the doctors, technicians, and administrators away from the center. The potential sites for extended fieldwork (based on the existing connections established by the field sites I am currently working in) include Istanbul, Jerusalem, Tel Aviv, Central Maine, and Roxbury, Massachusetts. The research funds applied for here are primarily for the international fieldwork component of the dissertation: for travel and living expenses, and for the audio-visual equipment used for interviews and participant observation.