Socio-cultural implications of changing organizational technologies in the provision of care.

Technology refers to inputs (machines, bureaucratic procedures, management strategies) organized to achieve specified outcomes. Such inputs and how they are used arise from socio-cultural conditions and in turn influence social behavior and values. Advances in medical technology are due to the high value populations place on health, emerging developments in science (also a cultural product). and from the opportunities and incentives the society gives to varying stakeholders. In the United States for example, the development and uses of medical technology are shaped by faith in marketplace competition, technological progress, activism, choice and consumerism. This constellation of values has resulted in very rapid growth and dissemination of hardware and related procedures whose costs pose significant financial dilemmas. In response, a range of management technologies have been developed to restrain the excesses of intervention but, because they are counter to many prevailing values and interests, they have led to much tension and a social backlash. Resolving these rationing tensions--which are rarely acknowledged as such--is a major challenge in American medical care and in much of the world. In the context of American social values, once new preventive or treatment technologies are introduced, they take patients on treatment trajectories that are difficult to control and which result in many being labeled with diagnoses they do not have and receiving interventions they do not need. Major efforts are under way to increase the sophistication of consumers of health care in a manner consistent with evidence-based medicine but these face significant barriers. Underlying what at first appears as simply technical barriers are the particular social and cultural influences on how people acquire and use information, the sources they trust and distrust, and the types of information they find credible and relevant to their situations. In short, the competition between new preventive and treatment technologies and managed care technologies is at its heart a culture war.