Health Care Restructuring

Competitive health care markets are unable to produce the health status goals Americans have set for themselves. Market-driven health care replaces health status goals with profitability goals. Competitive markets can only respond to the biomedical model of health care services. They can't alter structural characteristics of poverty, disease, and injury that are the root sources of health care costs and health status outcomes. Civic community, a variation of civil society, offers a third way (as opposed to markets and government command systems) of restructuring health care by addressing the root causes of the current system's shortcomings.

When given space to act, civic community is able to set new rules and guidelines that mediate and redirect excessive competitive markets and an intrusive government. Civic community is a conscious undertaking by individuals within and across multiple organizations to, through dialogue and actions, shape the function of society, in this case, the restructuring of the health care function. In civic community, organizations set aside self-interest to achieve a common interest: allocation of scarce resources for the public good. Dr. Morton, an assistant professor of sociology, examines large-scale processes and regionalized response to changing health care environments. Empirical findings, case studies, and archival documents support her contention that the civic community model can provide governments with a road map for setting regulations, monitoring, and enforcing practices relating to baseline health care, and provider and insurer behaviors. When the automatic behavior of health care markets is directed and channeled by civic community, there is emerging evidence that preferred health outcomes at affordable prices are possible.

LOIS WRIGHT MORTON is Assistant Professor in the Department of Sociology at Iowa State University./e Morton is a former faculty member of the Department of Policy Analysis and Management at Cornell University in Ithaca, New York.