ABSTRACT
This chapter aims to put the policy developments Harrington has described in the context of a sociological framework, focusing on the uneasy interface between families and the formal health care system. It examines this uneasy interface in search of a more refined answer to the question of to what problem is the Social Health Maintenance Organization (SHMO) a potential solution. The chapter introduces another aspect of social structure, bureaucracy, as it affects elder care. There are four aspects of bureaucracy pertinent: formalization, objectivity, standardization, and the hierarchical division of labor. If SHMOs and other forms of case managed care systems are to serve as remedies to bureaucratization, the effectiveness of the case managers who provide interface between elders, their families and the system are all-important. Managed care is becoming pervasive as a structural choice of public and private payers for health care.
