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Power, Blame, and Accountability: Medicaid Managed Care for Mental Health Services in New Mexico
Author(s) -
WILLGING CATHLEEN E.
Publication year - 2005
Publication title -
medical anthropology quarterly
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.855
H-Index - 55
eISSN - 1548-1387
pISSN - 0745-5194
DOI - 10.1525/maq.2005.19.1.084
Subject(s) - accountability , medicaid , general partnership , medicaid managed care , blame , managed care , mental health , business , power (physics) , public administration , public relations , state (computer science) , health care , medicine , economics , political science , economic growth , finance , psychiatry , law , physics , algorithm , quantum mechanics , computer science
I examine the provision of mental health services to Medicaid recipients in New Mexico to illustrate how managed care accountability models subvert the allocation of responsibility for delivering, monitoring, and improving care for the poor. The downward transfer of responsibility is a phenomenon emergent in this hierarchically organized system. I offer three examples to clarify the implications of accountability discourse. First, I problematize the public–private “partnership” between the state and its managed care contractors to illuminate the complexities of exacting state oversight in a medically underserved, rural setting. Second, I discuss the strategic deployment of accountability discourse by members of this partnership to limit use of expensive services by Medicaid recipients. Third, I focus on transportation for Medicaid recipients to show how market triumphalism drives patient care decisions. Providers and patients with the least amount of formal authority and power are typically blamed for system deficiencies.