Doctoral Dissertation Research: Cancer, Citizenship, and Scarcity in the Land of Opportunity

亚利桑那大学博士生朱莉·阿明，由马克·A博士指导。尼希特将对有资格获得国家资助的医疗服务的无保险患者进行癌症治疗的现场体验的民族志研究。由于癌症是一种依赖于高科技医疗干预的疾病，它为研究医疗保健体验如何受到支付能力的影响提供了一个特别丰富的场所。随着美国通过提供免费或低成本检查的计划改善癌症筛查的可及性，低收入和无保险的个人也随之需要治疗。这项对患者、家庭和医疗保健提供者的人种学研究将研究这些新的“医疗公民”的经历，他们对各种医疗保健资源提出要求，包括医院、医学专家、外行专业人员、慈善机构和国家计划。这项研究将在亚利桑那州图森市进行，这是一个距离美国和墨西哥边境不到一小时的城市，那里的人口经常向墨西哥寻求更便宜的医疗保健。研究人员将使用民族志研究方法的组合，包括深入访谈，结构化观察和参与观察。研究目标是：1）从个人、家庭和医疗保健提供者的角度记录经济治疗政策的经验; 2）检查邀请或限制获得医疗保健的临床官僚做法; 3）探索个人、家庭和负责癌症护理的提供者所做的工作，特别注意性别。这项研究很重要，因为它将有助于解释为什么社会不平等持续存在的理论，即使在促进平等的民主国家。这项研究还将有助于阐明严重疾病所带来的工作和成本是如何分配的。此外，研究结果可以为公共政策分析提供信息，这些分析试图确定政策如何既能促进又能限制个人，并可能造成健康差距。支持这项研究也支持社会科学家的教育。

University of Arizona doctoral student, Julie Armin, supervised by Dr. Mark A. Nichter, will undertake ethnographic research on the lived-experience of cancer treatment for uninsured patients who qualify for state-funded care. Because cancer is a disease dependent upon high-tech medical interventions, it offers a particularly rich locus for examining how the experience of health care is affected by ability to pay. As the United States improves access to cancer screenings through programs that offer free or reduced-cost exams, there is an accompanying need for treatment among low-income and uninsured individuals. This ethnographic study of patients, families, and health care providers will examine the experiences of these new "medical citizens," who make claims on various health care resources, including hospitals, medical experts, lay professionals, charities, and state programs. The research will be conducted in Tucson, Arizona, a city less than an hour from the United States-Mexico border, with a population that often looks to Mexico for less expensive health care. The researcher will use a combination of ethnographic research methods, including in-depth interviews, structured observations, and participant-observation. The research goals are: 1) to document the experience of financial treatment policies from the individual, household, and health care provider perspectives; 2) to examine the clinical bureaucratic practices that invite or restrict access to health care; and 3) to explore the work done by individuals, families and providers who take responsibility for cancer care, with particular attention to gender. The research is important because it will contribute to theories that seek to explain why social inequalities persist, even in equality-promoting democracies. The research also will help to illuminate how the work as well as the costs occasioned by serious illness are distributed. In addition, research findings may inform the public policy analyses that seek to determine how policy may both enable and constrain individuals, and possibly contribute to health disparities. Supporting this research also supports the education of a social scientist.