Consumer-based boards of health centers: structural problems in achieving effective control.

The fact that consumers have problems in utilizing their formal power as board members is usually attributed to individual deficiencies or cultural differences. The position argued here is that such views need to be questioned and amended. Thus, the ties between a health center and the larger health care system, the relations of consumers to their community environments, and the internal organization of health centers are examined as structural factors which limit the effectiveness of consumer board members. Despite the magnitude and durability of such factors, suggestions are made for increasing the effectiveness of consumer-based boards.