The Transformation of Caring in the Light and Shadow of "Managed Care"

This article addresses the transformation of caring under managed care in the United States. Managed care, driven by the economic concerns of governments' and large employers' health and welfare benefit costs, has transformed care. In so doing, it sheds light on significant issues and leaves in the shadows other important issues. This article examines six ways that managed care has transformed caring: (a) it transforms patients from those who suffer into quasi-consumers with limited choice; (b) it transforms the medical care facility into a factory; (c) it transforms the patient into a population member; (d) it shifts cost risks from a third party to the patient and the provider; (e) it limits the reach of caring; and (f) it transforms providers into bureaucrats. We discuss two contradictions that arise through these changes, substitutability versus relationships and biotechnological knowledge versus humanistic knowledge. The implications for patient care and health communication studies are also discussed.