Quality as Quantity: Medicare Reform and the Quiet Politics of Measurement

• In Event: Privatizing Policy Feedback

Abstract

Abstract: In the last decade, Congress has made significant changes to the Medicare program that aim to control spending and reduce the prevalence of medical errors. At the heart of these reforms is a regime for measuring the quality of health care services. Research on the sociology of quantification suggests that measurement regimes often undercut the power of incumbent professionals. Yet recent work in political science has shown that, even in the face of quantification, organized medicine continues to dominate decision making in the Medicare policy arena. This paper investigates the extent to which new institutions for the development and certification of quality measures have reversed this dynamic. I present a novel theoretical framework for analyzing the internal governance of measurement regimes by investigating their independence from incumbent professions; their openness to cross-cutting stakeholders; and their capacity for institutionalizing new measurement practices. I then use this framework to analyze a combination of quantitative and qualitative data on the development and implementation of quality measures in the United States between 2001 and 2017.

Author

• Philip B. Rocco, Marquette University