The Growth of Medical Technology and Bureaucracy: Implications for Medical Care

Despite significant differences in ideology, values, and social organization, most Western developed countries-and probably most countries in the world-face common problems of financing, organizing, and providing health care services. As populations increasingly demand medical care, there is growing concern among the governments of most nations to provide a minimal level of service to all and to decrease obvious inequalities in care. To use available technology and knowledge efficiently and effectively, certain organizational options are most desirable. Thus, there is a general tendency throughout the world to link existing services to defined population groups, to develop new and more economic ways to provide primary services to the population without too great an emphasis on technological efforts, to integrate services increasingly fragmented by specialization or a more elaborate division of labor, and to seek ways to improve the output of the delivery system with fixed inputs. Although all of these concerns to some extent characterize national planning in underdeveloped countries, they particularly describe tendencies among developed countries as they attempt to control the enormous costs of available technologies. Throughout the world there is increasing movement away from medicine as a solitary entrepreneurial activity and more emphasis on the effective development of health delivery systems. Having discussed these trends elsewhere in detail (Mechanic, 1974, 1976), what I will do here is examine how changing technology and organization affect not only the provision of medical care, but also the underlying assumptions of practitioners and patients. My thesis is that medical care constitutes a complex