Biopolitics, Risk and Organization in Health Care

Abstract

The study and analysis of the organization in health care, depends on some aspects that include the observation of social phenomena, law categories, and political strategies as well as the administrative behaviors. All these as-pects have led to the overcoming of the traditional concept of bureaucracy, which finds a solid theoretical foun-dation in the studies undertaken by Weber. In the Weber's vi-sion, bureaucracy is the organization of people and resources for a collective purpose, public, ac-cording to any criteria of rationality, impartiality and impersonality. The assumption is that it is hard to perceive organizations oriented towards an end in a rational way, unless as bureaucracies, even considering that there may be non-bureaucratic organizational forms, not rationally oriented to a purpose (Weber 1922). One of the most original contributions of the late twentieth century comes from Luhmann's theory of social systems that is applied to the concept of organization. It provides an understanding of the object that goes beyond tautological assumptions (e.g. the organization is composed of men) and that permits to talk about organization as autopoietic system, not "closed" but "operationally closed" and therefore independent on the structural and operational plan (Luhmann 2000, 29-30). In the theory of systems - although the organizations may arise freely – what is defined as "complex" organizations, are formed within functions sys-tems distinguished in economic organizations, political organizations, trade union organizations, health care or-ganizations, etc. Main features include the possibility that they have to communicate with other systems in their environment (Luhmann and De Giorgi 1994, 328) and the reduction of uncertainty and risk. The absorption of uncertainty occurs when an organization elaborates some decisions that are a pre-requisite for other decisions. In the social systems theory, all the organization activities are classified as decisions, take place at a given time, and are always documented. However, the evolutionary path that is used to trace the organizational profiles of com-plex apparatus cannot ignore the im-portance of Kuhn's theory, according to which scientific revolutions are characterized by the transi-tion from one paradigm to another (Kuhn, 1999). The application of this latter model to the public organizations, permits to understand that even these organizations are subjected to the dynamics of cultural paradigms, according to which the transition from one paradigm - that no longer recognizes the organi-zations themselves - to another one, that rather includes new models, methods and prac-tices, definitely involves a revolution (Limone 2008, 17). In order to properly talk about organiza-tion and e-government, especially in the health and medical sector, we first need to verify the most suitable organizational context able to manage innova-tion solutions and, therefore, analyze the or-ganizational conditions as a prerequisite for the technological condi-tions. In fact, if the organiza-tional environment does not respond to concrete parameters such as transparency, efficiency and economy, even the same e-government process is likely to fail. That is the only viable way to ra-tionalizing and improving the public organizational system, such as health care systems, that tend to have high level of complexity and risk due to their nature.