Virtual health care infrastructures: Markets and hierarchies

The objective of this review is to develop a conceptual framework for analyzing the evolution of large scale virtual infrastructures in ideologically diverse health care systems. Market dynamics and system control mechanisms define the logic of system structures, processes and ideologies. Ideology, defined as the integrated theories and values that constitute a coherent socio-political system, is expressed in patterns of stakeholders' participation in the financing, administration, and regulation of health care, including the roles of government and health care enterprise, both public and private. Large scale grid and cloud computing systems are considered as well as the emerging influence of global social networks. The analysis suggests alternative paths to health care service delivery motivated by professional, citizenship, consumer and managerial values expressing ideological diversity among institutional systems.