Temporal patient trajectories: long stories in short admissions

Coordinating illness and insurance trajectories: Evidence from a post-acute care unit

This article examines how healthcare practitioners incorporate patients' insurance coverage and financial situation into their professional judgment. It does so by introducing the concept of an "insurance trajectory" that healthcare workers must coordinate with their medical management of illness and recovery. Drawing on 15 months of ethnography and 16 in-depth interviews at a post-acute care unit in New York City, this article argues that providers engage in anticipation work to align the tempo of recovery with the timeline of insurance coverage, in order to maximize revenue for the organization and minimize costs for patients. It identifies three modalities of anticipation work from intake to discharge: the creation of roadmaps on which illness and insurance trajectories intersect to predict an ideal discharge date, the synchronization of trajectories to avoid denials of coverage during rehabilitation, and the projection of futures to prevent illness and insurance trajectories from decoupling once patients are discharged. These findings expand our understanding of the effects of managed care on healthcare workers' practices and decision-making.