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The U.S. healthcare system is in crisis, marked by soaring costs, inefficiencies, and stark disparities in health outcomes. Or at least, this is how U.S. policy makers have predominantly narrated and justified healthcare policy interventions since the 1970s. This dissertation examines how, starting in the 2010s, U.S. policymakers and politicians have turned towards data infrastructures – including new protocols and standards for exchanging clinical, billing, and administrative health data – as the newest site for reforming healthcare markets. Drawing on 24 months of multi-sited ethnographic research in the U.S. healthcare industry, I trace how federal regulations, particularly the 21st Century Cures Act (2016), position data interoperability, or standardized data sharing, as a means to realign a fragmented, profit-driven healthcare market with the efficient production of population health outcomes. I describe this mode of governance, which merges market-solutionism and techno-solutionism, as “computing care.” Through a close examination of “value-based care” policies, social determinants of health data, and the automation of prior authorization, I show how computing care helps to depoliticize the failures of for-profit healthcare markets to produce equitable, accessible, affordable care. The failures of healthcare markets are instead narrated by policymakers as technical problems - of insufficient information and sub-optimal market design. I argue that intensified computation and continually evolving capacities to collect, analyze, and store data help reproduce this depoliticized, market-solutionist mode of governance. Through this project, I interrogate the banal violence of computing care as a mode of governance and point towards the possibility of alternative modes of governance beyond market- and techno-solutionism. I also reflect specifically on the potential role of data infrastructures in advancing alternative modes of care governance. This project contributes to the fields of critical data studies, science and technology studies, and feminist political economy, highlighting the reconfigurations of data and governance necessary to achieve an equitable and just future of healthcare.
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Designing markets, governing data: Engineering value in the American healthcare system
In crucial sectors like healthcare, education, and housing, policymakers are turning to the tools ofmarket designto incentivize public and private actors to more efficiently and effectively produce the public good. Although market design has been a key policymaking tool for decades, datafication is increasingly central to this technocratic tinkering. This article explores a project of datafied market redesign in the U.S. healthcare industry, demonstrating that emerging federal health data regulations are designed to enable the state to more precisely quantify, and thereby incentivize, the production of “valuable” care. This case study demonstrates how both the public good and crucial data infrastructures are constrained through their enactment within market-based modes of governance. As this data-solutionism for extractive markets becomes a more prevalent mode of governance—particularly in areas like climate change—we must find alternative mechanisms for collectively defining the public good, and for achieving corporate accountability beyond financial incentive structures.
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- Award ID(s):
- 1901171
- PAR ID:
- 10657721
- Publisher / Repository:
- SAGE Publications
- Date Published:
- Journal Name:
- Big Data & Society
- Volume:
- 12
- Issue:
- 3
- ISSN:
- 2053-9517
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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