First Advisor

Heather Hartley

Term of Graduation

Spring 2001

Date of Publication

5-11-2001

Document Type

Thesis

Degree Name

Master of Science (M.S.) in Sociology

Department

Sociology

Language

English

Subjects

Childbirth at home -- Washington (State), Health insurance -- Washington (State), Midwives -- Washington (State)

Physical Description

1 online resource (vii, 108 pages)

Abstract

The expansion of managed care, which is premised on containing costs while maintaining market share, represents a radical transformation of the U.S. health care system. A central question for medical sociologists is to determine how the changes brought by managed care influence health insurance and health care options. In evaluating the impacts of managed care, obstetrics is a particularly important site of study. Part of this agenda involves gathering baseline data on a specific transformation in obstetrics practice new to the managed care scene: the emergence of health insurance coverage for the option of home birth. The research project detailed in this thesis is a focused case study analysis of this topic in the state of Washington, widely recognized as a leader in this movement. My key objective was to analyze how different forces are working together to change Washington's policies, and to examine what this means for physician power, control and dominance. Data were gathered through fourteen interviews with key informants in relevant agencies and organizations in Washington State (i.e., state offices; midwife and other professional associations; and an HMO). Results of this research suggest that consumer demand is an important precipitating factor without which changes to health insurance coverage would have been mute. Though the primary importance of consumer demand is not in its numbers but rather in its strategic and temporal value. State policies and professional mobilization, which have the most evidence as to their impact in securing reimbursement of homebirth, were critical factors. Cost containment appears to have had the least importance in Washington's move to cover homebirth. This research further suggests that the true strength of these forces appears to lie not in their individual influence but rather in their interaction.

Rights

In Copyright. URI: http://rightsstatements.org/vocab/InC/1.0/

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Persistent Identifier

https://archives.pdx.edu/ds/psu/44865

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