Colin Garon

I propose a 12-month ethnographic research program exploring how clinical actions become invested with economic value in Chicago primary care. Building upon a year of archival research, my ethnography will center upon the clinical ‘revenue cycle’–a managerial gloss linking the processes for delivery, documentation, coding, billing, and collection of payment for medical services–to understand how monetary transfers are configured with clinical encounters, asking: How are artifacts of clinical interaction constituted as value-bearing units, with what effects on therapeutic relationships? How do medical billing processes create venues for the contestation or standardization of economic value in healthcare? I will conduct participant observation in three primary care clinics, constructing a controlled comparison to theorize how revenue cycles shape therapeutic encounters. Interviewing interlocutors across the expanding medical billing industry, I will develop an account of the revenue cycle as an object of intervention and innovation. Finally, I will trace the development of the coding system that identifies clinical actions and assigns them standardized values. This research will contribute to social-scientific research on healthcare economies by developing a conceptual apparatus for analyzing the relationship between clinical action and monetary transfers, capable of scaling from interactional ‘micropolitics’ to the transaction systems structuring healthcare markets.