How organizations shape medical technology allocation: Insulin pumps and pediatric patients with type 1 diabetes

• Authors: Cassidy Puckett, Emory University; Jenise C Wong, University of California San Francisco; Tanicia C Daley, Emory University; Kristina Cossen, Emory University
• Journal Title: SOCIAL SCIENCE & MEDICINE
• Volume: Volume 249
• Publisher: PERGAMON-ELSEVIER SCIENCE LTD | 2020-03-01, Pages 112825-112825
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.socscimed.2020.112825
• Subjects: Sociology, General
• Keywords: Science & Technology; Social Sciences; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; Social Sciences, Biomedical; Biomedical Social Sciences; Medical technology; Diabetes; Health disparities; Organizations; Gatekeeping; Decision-making; Culture; Sociology; HEALTH-CARE; DECISION-MAKING; FUNDAMENTAL CAUSE; DISPARITIES; INEQUALITY; MANAGEMENT; THERAPY; CONTEXT; ADOLESCENTS; CHILDREN

Abstract

Although guidelines for prescribing insulin pumps to patients with type 1 diabetes (T1D) focus on patient assessment, sociological research shows decision-making is influenced by the organizations within which actors are embedded. However, how organizational context shapes unequal resource allocation by race and class is less well understood. To investigate this, we compare two pediatric endocrinology centers differing in racial and socio-economic equity in pump use. Using over 400 h of observations and 16 provider interviews, we find allocation is shaped by how organizations use patient cultural health capital to determine pump eligibility, frame technology use, and structure decision-making processes. Overall, findings extend health inequalities research by describing how organizations shape technology resource allocation by race and class.