Doctoral Dissertation Research: The Public Provision of Healthcare Under Changing Conditions in North and South America

博士论文研究：北美和南美不断变化的条件下的公共医疗服务

• 批准号: 1519292
• 负责人: Janet Shim
• 金额: $ 1.2万
• 依托单位: University of California-San Francisco
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1519292&HistoricalAwards=false
• 关键词: Doctoral; Dissertation; Research; Public; Provision

Contested forms of health care or diagnosis inevitably involve deliberations about proper definition and treatment, and these debates are all the more polarized where public funding is concerned. Activists and health care providers comprise two central groups with a stake in how certain forms of care are included or excluded from public coverage. Taking a comparative approach, this dissertation examines how health care providers and social movement activists in the U.S. and Argentina conceptualize the public provision of contested forms of health care. Addressing the example of transgender health care (a highly contested and emergent field of practice) it asks how two different approaches to public coverage for transgender health care have unfolded in New York City and in Buenos Aires. Both cities are host to health care providers and social movement activists who characterize themselves as leaders in transgender health.The project will examine how health care providers and social movement activists in these places work to define or redefine diagnoses and how they navigate systems of public coverage for transgender health care. The data collection involves interviews with 60 to 90 healthcare providers, patients, and social movement actors in New York City and Buenos Aires, combined with a content analysis of relvant documents and legislation associated with transgender healthcare at both sites. A secondary analysis will also examine the current revision of the World Health Organization's International Classification of Diseases, in which a number of older diagnoses are being reworked, replaced, and redefined. A working group of global experts, including individuals from Argentina and the U.S., are proposing major changes to diagnoses associated with transgender health care, and transnational activist networks are also providing ongoing feedback. In analyzing these processes, this dissertation also asks how multiple transnational actors with ranging expertise coordinate or conflict in the process of diagnostic revision. This project stands to improve the well-being of individuals in society by revealing how health care providers and activists shape public policy and definitions of diagnostic classifications.

有争议的医疗保健或诊断形式不可避免地涉及对正确定义和治疗的审议，而在涉及公共资金时，这些争论更加两极分化。活动家和医疗保健提供者组成两个核心群体，他们在如何将某些形式的护理纳入或排除在公共覆盖范围之外利害攸关。本文采用比较方法，研究了美国和阿根廷的医疗保健提供者和社会运动活动家如何概念化公共提供有争议的医疗保健形式。以跨性别医疗保健（一个备受争议和新兴的实践领域）为例，它询问了纽约市和布宜诺斯艾利斯如何展现两种不同的跨性别医疗保健公共覆盖方法。这两个城市都有医疗保健提供者和社会运动活动家，他们将自己视为跨性别健康领域的领导者。该项目将研究这些地方的医疗保健提供者和社会运动活动家如何定义或重新定义诊断，以及他们如何操纵跨性别医疗保健的公共覆盖系统。数据收集涉及对纽约市和布宜诺斯艾利斯的 60 至 90 名医疗保健提供者、患者和社会运动参与者的采访，并结合对两个地点与跨性别医疗保健相关的相关文件和立法的内容分析。二次分析还将检查世界卫生组织国际疾病分类的当前修订版，其中一些旧的诊断正在被重新设计、替换和重新定义。一个由包括来自阿根廷和美国的个人在内的全球专家组成的工作组正在提议对与跨性别医疗保健相关的诊断进行重大改变，跨国活动家网络也正在提供持续的反馈。在分析这些过程时，本文还提出了具有不同专业知识的多个跨国参与者在诊断修订过程中如何协调或冲突的问题。该项目旨在通过揭示医疗保健提供者和活动家如何制定公共政策和诊断分类的定义来改善社会中个人的福祉。