Unequal Care: A Case Study of Interorganizational Relations in Health Care, New York: Columbia University Press, 1980
By Murray Milner, Jr.
Organizations, not individuals, have increasingly become the key actors in modern society. Broadening our understanding of this phenomenon, Unequal Care focuses on the interorganizational relationships between a group of health care institutions in one of America's largest cities.
Murray Milner's study proceeds from the evidence that urban health care systems have been characterized by three recurrent social problems: inequality, with low status institutions for the poor and superior facilities for the affluent; lack of coordination; and continually ineffective reform efforts. Milner analyzes these problems in terms of the sources of inequality, the coordination of efforts of collectivities, and the sources of social conflict and stalemate -- three basic concerns of sociological theory.
In contrast to the survey research of most studies of interorganizational relations, this analysis is based on multiple data sources, including an ethnographic account. To a large extent, the people involved tell their own stories in their own words. Unequal Care thus reveals the complex web of interorganizational and interpersonal relationships that are used both to maintain the present systems of urban health care and to mitigate its worst features.
Milner illustrates that a key feature of metropolitan health care systems is symbiotic inequality; if there are high quality hospitals and clinics, there must also be low quality ones to provide for low-income patients and unwanted cases. The dilemma of the high quality institutions is how both monopolize the more rewarding activities and to ensure the continued existence of low quality institutions to carry out the less rewarding activities. Unequal Care makes it clear that the dynamics of such a local system can only be understood within the context of the larger institutional structures of the society. In accordance with this premise, Milner locates his analysis within a provocative examination of the welfare state and the dilemmas and contradictions which encumber it.
While focusing on the subjects of health care and social problems, Milner's study incorporates pertinent issues in sociological theory. The result is a unique contribution to our general understanding of social inequality, coordination, and social conflict.
"Milner looks behind the current concepts of interorganizational relations at some facinating real-life cases, and proposes some strong revisions of accepted theory. He links this to larger societal issues in a clear and forceful manner...A welcome contribution to a field that is abandoning case studies for remote indicators of vague concepts."
-- Charles Perrow, State University of New York at Stony Brook.