UNCOVERING MORE KNOWLEDGE about the communication between health care providers and health care insurers may help to explain how physicians and insurers make decisions about patient care. Hence, the written communicative practices may work, or not, as a vital link in patient care. The genres that occur in medical/insurance communication provide opportunities for examination: some of these genres are written by doctors and medical staff for an audience about whom many doctors have little real knowledge; the genres can function as highly persuasive documents when they attempt to negotiate payment from the insurance company for medical procedures; some genres, like letters of appeal or pre-authorization, are relatively new genres of medical writing as insurance companies have acquired more control and power in recent decades; and many of these genres function in a business world presently in the midst of much change. Further, many doctors and claims managers have little experience or expertise in communicating w ith and appealing to health insurance companies.
In my study, I start by questioning the communications between two discourse communities, medical practices and health insurance companies: What is the process by which these two communities communicate with each other in order to get the work done in their respective communities? How do genres mediate power struggles between two different, sometimes competing communities? To answer these questions, I look mainly at the interactions at three medical practices: the interactions between insurance letters and other genres of the workplaces, the interactions between the genres and other forces, like motives, values, and writer agency, of the workplaces, and finally the interactions between the activities of the medical workplace and the activities of insurance companies.
Activity system theory provides a holistic theory for examining the discourses of power--essentially the power struggles between medical practices, health insurance companies, and patients. I argue that these two business communities--medical practices and health insurance companies--are activity systems. And all three elements of activity systems--communicative tools, agents, and objectives--must be studied in concert to develop a more comprehensive understanding of how genres mediate power between competing systems. Activity system theory identifies tensions also known as "contradictions" (Russell, …