Social Ontology and the Dynamics of Organizational Forms: Creating Market Actors in the Healthcare Field, 1966-1994

Abstract

Social scientists have evidenced a long-standing interest in the cultural construction of ontologies - symbolic systems of categorization and meaning - but have yet to develop a widely recognized method for the empirical analysis of this process. Analyzing textual data from the area of health services research, this article illustrates a general framework that can be employed to isolate the tacit rules used to structure an ontology and identify changes in those rules over time. Focusing on the process of market reform in U.S. healthcare during the last thirty years, this study finds systematic variation in the dimensions used to differentiate discourse on organizational forms such as hospitals, health maintenance organizations, and nursing homes. Discourse in the sector suggests that the symbolic integration of forms along the dimension of accessibility during the heyday of welfare state policies has given way to symbolic integration along clinical and functional dimensions with the rise of neoliberal ideologies. These segregating and blending processes are discussed as a general response to uncertainty and the desire for ontological security among organizational actors.