Modernization, Rationality and Continuity of Care: Theoretical Concepts and Empirical Findings

Abstract

Modernization theories of Weber, Parsons, Mannheim, Elias and Habermas are used to analyze continuity of care. Discontinuities are considered unintended consequences of formal rationality and differentiation in health care, leading to a fragmented, disease-oriented health care system. It is argued that value conflicts exist between instrumental values like efficiency, effectiveness and justice — and expressive values like continuity, solidarity, well-being and meaningfulness. This is especially the case in the care of chronically ill patients, who are in need not only of rational, systems-oriented professional interventions, but also of activities that help them establish their identities and live meaningful lives. A paradigm is presented of patient problems, strategies of care givers, ideal patient outcomes and criteria to evaluate these. Also, a research model is presented based on a continuity of care research program.