UCSF

Over the past two decades, numerous political actors have called for greater accountability from health care providers on the “value” of the care they provide. Against the backdrop of variation in health outcomes, rising medical expenditures, and persistent health inequities, these actors have mobilized behind the use of quantified quality measures to hold providers to account. Through new mechanisms of public accountability, quantified knowledge has emerged as a central node in the reconfiguration of medical-social relations in the twenty-first century. I examine this widespread phenomenon of “reform by numbers” through a three-pronged analysis. First, I trace the historical drivers of contemporary delivery system reform efforts, highlighting the role of public critique in making sense of the origin of quantification. Second, I analyze the deliberation process of three institutionalized quality measures via a national public-private forum, identifying the values and priorities that inform the design of quantification. Third, I examine the local politics within new “data-driven care” strategies, emphasizing the emerging consequences of quantification. In our current era of cultural anxiety over the value of prominent social institutions, this turn to quantified knowledge, data, and technology is widely expected to address longstanding social problems. However, I argue that this phenomenon merely displaces old conflicts onto emerging technical domains while creating new sources of contention across the rapidly evolving social landscape. This results in the widespread expansion of the institution itself as well as an intensification of the political nature of its activity, ushering in what I term the sociotechnical transformation of American medicine.