Ivanova, D., MSc.

Care and place. The governance of spatial arrangements in health care

Department of Health Policy and Management, Erasmus University Rotterdam, ivanova@bmg.eur.nl

Supervisor(s): Professor Roland Bal, Dr. Iris Wallenburg


Bachelor of Arts in Social Sciences, University College Roosevelt, 2008-2011
Research Master of Science in Cultural Anthropology, Utrecht University, 2011-2013
Fieldwork: BA level: 6 weeks in Italy, 2010
MSc level: 5 months in Italy and Bulgaria, 2012-2013
MSc thesis: Agency at Work: Bulgarian badanti migrant women in Italy, 2013
The thesis explores gender and agency in the case of Bulgarian care-giver migrants in Italy.


Care is often defined by place. We distinguish, for example, home care from hospital care. In addition, displacing care is seen as a solution for better care. Cancer care needs to be centralized; youth care needs to be decentralized, etc. Defining care by place and improving care by displacing care conflicts with the lives of patients. As long as care is defined by place, patients have to move. Moreover, as patients move, they become—or are made—responsible to coordinate the care they get at different places. Despite the clear connection between place and governance, the place and displacement of care is hardly studied empirically. Place is an obvious but hidden element of the governance of care.
This project focuses on the interaction between governance, care and place. Governance is defined as the coordination of collective behavior and expressed in different modes of coordination: compliance to rules, inclusion and exclusion of communities, negotiation with associations of organizations and optimizing demand and supply. All four coordination mechanisms—the state, the market, the professional and the association—undergo changes in the new spatial arrangements: the dissolution of the state into smaller (communities) and larger (international organizations) arrangements is most apparent, but so is the market, that comes to operate loose from state boundaries, but is also embedded in new governmental (local and international) arrangements. Hence, reshufflings of care leads to questions about who is governing, what is being governed and to what effects.
The concept of place is moreover in transition. Technologies, such as robotics and information technology promise an era of ‘placeless’ care, where radiologists in India can interpret digital scans for Western European patients, or surgeons in Boston can operate on patients all over the developed world. At the same time increased mobility of patients, professionals, knowledge, money and equipment has made it possible for specialized centres to arise all over the world. Sociological analyses of such development have shown however that ‘place’ is still important even in instances of ‘placeless care’. In fact, place multiplies as the place of health services and their use becomes detached, making it necessary to make new connections between disparate places. Place in such new phenomena becomes much more of an accomplishment rather than a given (Mort, Finch, and May 2009; Mort, May, and Williams 2003).

In this project we focus on place and displacement of care as a key property of good governance. The aim of the project is to examine the relation between ‘place’ and governance by describing (a) the ways in which place is used as an instrument for governance, and (b) the consequences of the displacement of care for governance.
The central question is: In what ways does place—especially relating to the displacement of care—matter for who is governing, what is being governed and to what effects?
We specify this question by the following sub questions:
• How do new spatial arrangements affect the ways in which incentives work out?
• How do new spatial arrangements set limits to the compliance to rules?
• How do new spatial arrangements enable values that include or exclude groups?
• How do new spatial arrangements affect the interdependencies within organizational networks and thereby change their negotiations?