Liberators, innovators, and experts: Struggles for the telemedical future in the shadow of neoliberal reform

This dissertation examines how medical specialists in publicly funded academic medical centers in North Carolina sought during the mid-1990s to develop and promote the use of interactive-video and internet technology for extending their expertise into rural and minority communities. Situating these demonstration projects within the context of the changing relationships between the biomedical professions, capitalist economics, and the welfare state, I show how these health professionals used telemedicine as a means of refashioning their authority and agency in ways that adapted to the contradictory demands of dominant neoliberal ideologies of health reform which have joined together the ideals of public service with imperatives of market competition.; Three telemedicine projects are examined. The first was a state-wide prototypical health care delivery system for older adults led by a geriatrician who envisioned telecommunications enabling more open and deliberative forms of interaction and communication between health care providers and their patients. The second was directed by a pediatric cardiologist who attempted to coordinate and publicize emerging applications of telemedicine at a public academic medical center through the creation of an Office of Telemedicine. The third was initiated by a pediatric psychiatrist who attempted to create a statewide video-conferencing network that would coordinate medical and therapeutic services for young children with physical disabilities.; Forming partnerships with state/federal government, community hospitals, health centers, and private day care centers, I show how these projects sought to extend and diversify the specialty services offered to these populations. I illuminate the role played by the federal government in creating markets for telemedicine as part of it's broader effort to promote information and communication technologies as technologies of neoliberal reform.