ABSTRACT
The health care system in the United States has changed dramatically in the last 30 years. Health organizations are under pressure from patients for access to high quality, affordable care. Employers, insurance companies, and federal agencies want lower costs, accountability, and safety. Hospitals and medical groups, as well as insurance companies and government agencies, are adopting management methods that emphasize effi ciency, predictability, calculability, and control (Ritzer, 2004). Despite the efforts to more tightly manage health care in the United States, however, medical expenses continue to rise (Strunk, Ginsburg, & Gabel, 2002), and patients and payers are not alone in their expressions of dissatisfaction. Both nurses and physicians also have expressed concern about working conditions and quality of care in managed care arrangements (Harvard School of Public Health, 2000). The concerns of so many involved in the health care system at multiple levels (patients as well as providers, organizations as well as government agencies) present an opportunity to health services researchers in the form of research of keen interest to a broad audience. The changes in health care also present a mandate to address our fi eld’s lack of theoretical models that explain developments at both personal and organizational levels in health services.
