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This chapter examines a paradox of GroupCare Hospital's palliative care program. On the one hand, GroupCare created a space for intimacy, honesty, and personal connection that has become exceedingly rare in the U.S. medical system. On the other hand, GroupCare considered the palliative care program to be consistent with its goal of “appropriate utilization” and likely would not have invested such resources in the program had it not been seen as economically efficient. This chapter shows that the staff at GroupCare tended to believe that through evidence-based medicine, technical savvy, and systems integration, it could make the mission of health care and the market for health care consistent with and supportive of one another. It also considers how GroupCare seemed to have succeeded in taming the market for hospital care and aligning the health of its membership with the economic interests of the organization and the practitioners within it.

This chapter examines GroupCare Hospital's disciplinary program for its doctors. Just as GroupCare worked to convince patients that each member's well-being was consistent with the optimization of the membership's health, so it sought to convince physicians that their submission to the organization's disciplinary authority was in the interests both of patients and of physicians themselves and that an efficient, rationalized delivery of care was synonymous with health care quality. Doctors were encouraged to treat individuals while at the same time keeping an eye on the interests of the membership in the aggregate. The chapter first considers doctors' understandings of their work at GroupCare, with particular emphasis on the notion of autonomy, before discussing two technologies through which GroupCare sought to bring doctors into line with the prerogatives of the organization as a whole: electronic medical records and patient satisfaction surveys.

This chapter examines how GroupCare Hospital expressed its commitment to reducing uncertainty in health care not only in the way that it managed its doctors but also in the partnerships it worked to establish among different constituencies within the organization. Thoughout GroupCare, the language of partnership abounded—patients “partnered” with the organization, physicians “partnered” with one another, and nurses and ancillary workers “partnered” with doctors and managers. The logic—at least according to administrators—was that the mitigation of status distinctions allowed the organization to evolve into a “culture of continuous improvement.” The chapter also considers the limits of rationalization at GroupCare as well as the labor-management partnership at the hospital. Finally, it explains how GroupCare used the language and practices of “partnership” as a strategy for securing a compliant workforce, noting that there was a certain egalitarianism among different constituencies within the organization.

This book explores the contradictions between the mission of hospital care and the market for it. It shows how market forces and market actors have become increasingly important to contemporary hospital practice, and yet the commodification of hospital care in the United States remains uneven and incomplete. While they compete in a competitive marketplace, many hospitals—and the people within them—work to sustain social values that sit in uneasy tension with this market. In order to understand these contradictions, the book examines not only the broad sets of rules and regulations through which the market for hospital care is structured, but also the meanings, practices, and people that make up the hospital itself. The focus is on three hospitals located in Las Lomas, California—PubliCare Hospital, HolyCare Hospital, and GroupCare Hospital—and their ongoing struggle with the contradictory nature of the commodification of hospital care.

This book has examined the commodification of hospital care in the United States. It has looked at PubliCare Hospital, HolyCare Hospital, and GroupCare Hospital to highlight the contradictions between the mission of hospital care and the market for it. If PubliCare is reminiscent of the hospital's past, and HolyCare is indicative of health care's present, then GroupCare seems to anticipate health care's future. This concluding chapter considers some of the changes in the U.S. health care market and cites the impact of the Patient Protection and Affordable Care Act (PPACA, 2010). For example, the law imposes important new regulations on the insurance industry and promotes and incentivizes “evidence-based” medicine. The chapter argues that while PPACA certainly changes the market for hospital care, it does not resolve the market's contradictions. It also reflects on future prospects for hospitals and hospital care.