The problem of choice: From the voluntary way to Affordable Care Act health insurance exchanges.
This article takes a genealogical and ethnographic approach to the problem of choice, arguing that what choice means has been reworked several times since health insurance first figured prominently in national debates about health reform. Whereas voluntary choice of doctor and hospital used to be fr...
| Publicado en: | Social Science & Medicine Vol. 181; pp. 34 - 43 |
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| Formato: | Artículo |
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Elsevier B.V.
May2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=122588571&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 122588571 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 02779536 SMD jtl: Social Science & Medicine issn: 02779536 maglogo: N pubinfo: dt: May2017 vid: 181 pid: 2410 pub: Elsevier B.V. artinfo: ui: 122588571 10.1016/j.socscimed.2017.03.055 ppf: 34 ppct: 9 formats: tig: atl: The problem of choice: From the voluntary way to Affordable Care Act health insurance exchanges. aug: au: Mulligan, Jessica affil: Providence College, 1 Cunningham Square, Providence, RI 02918-0001, USA su: Rhode Island Consumers Ethnology research Health insurance exchanges sug: subj: Consumers Ethnology research Rhode Island Health insurance exchanges keyword: Access to coverage Affordable Care Act Choice Ethnography Insurance Medical anthropology Risk United States Access to coverage Affordable Care Act Choice Ethnography Insurance Medical anthropology Risk United States ab: This article takes a genealogical and ethnographic approach to the problem of choice, arguing that what choice means has been reworked several times since health insurance first figured prominently in national debates about health reform. Whereas voluntary choice of doctor and hospital used to be framed as an American right, contemporary choice rhetoric includes consumer choice of insurance plan. Understanding who has deployed choice rhetoric and to what ends helps explain how offering choices has become the common sense justification for defending and preserving the exclusionary health care system in the United States. Four case studies derived from 180 enrollment observations at the Rhode Island health insurance exchange conducted from March 2014–January 2017 and interviews with enrollees show how choice is experienced in this latest iteration of health reform. The Affordable Care Act (ACA) of 2010 created new pathways to insurance coverage in the United States. Insurance exchanges were supposed to unleash the power of consumer decision-making through marketplaces where health plans compete on quality, coverage, and price. Consumers, however, contended with confusing insurance terminology and difficult to navigate websites. The ethnography shows that consumers experienced choice as confusing and overwhelming and did not feel “in charge” of their decisions. Instead, unstable employment, changes in income, existing health needs, and bureaucratic barriers shaped their “choices.” pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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