A Critical Discourse Study: Dominant Discourse and Medical Resource Procurement
Open AccessAbstract of the DissertationA Critical Discourse Study: Dominant Discourse and Medical Resource ProcurementHealthcare delivery is extraordinarily expensive, with healthcare systems focusing cost reduction efforts on expenses for medical resources. A multitude of healthcare professionals engage in conversations to decide which pharmaceuticals, supplies, and implants to purchase. However, professionals have different foci, and these conversations are not just an exchange of information but are situated in the practices of language and power relations—in other words, in discourse. This case study explored the social and historical processes, power relations, and knowledge that frames discourse during the formulary process to answer the research question—How does a dominant discourse emerge during the procurement of medical resources?—and two subquestions: What are the influences on the procurement of medical resources? How do the influences on medical resource procurement occur? Three types of data were collected and analyzed: semi-structured interviews, documents, and nonparticipant observations. Six major themes emerged during the data analysis in answering the research question: (1) insurance and site of care frame the conversations; (2) corporate practices establish conversational boundaries; (3) the approval structure and process limit what is discussed; (4) discussions are continuously characterized in terms of financial implications; (5) power is dispersed; and (6) decisions are not always final. These six themes informed the interpretations and conclusions that a dominant discourse emerges during the formulary process in a recursive manner, with the healthcare sector structuring the conversations and power exercised at differing points along the process through corporate practices and by different professionals.
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