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This chapter develops a productivity analysis of the New Jersey PPO Health Insurance Industry for 2018. The chapter concerns five New Jersey PPO insurance companies. The two output variables are claims paid and loss ratio. The two input variables include premiums collected and assets.

Whereas many researchers have examined the way in which health institutions have been transformed through funding modalities, and particularly through prospective payment systems (PPS), few have investigated the architecture of these systems, that is, costs and cost variance. Focusing on the study of costs and on the production of hospital rates, this chapter shows that the French PPS, called “rate per activity” made possible what we call a policy of variance. For health policymakers, the aim was to make the different accounting figures between hospitals, and between ways of practising healthcare, visible, in order to reduce these variances. This policy was attended by uncertainty in the processes of quantification, which led to metrological controversies. As a consequence of the issues around the way of calculating costs, some accounts and calculations were redone. In this chapter, we consider the case of metrological controversy over the remuneration of costs for cystic fibrosis patients’ hospital stays, and over the action of a patient organization that criticized the costs calculated officially. It leads to the analysis of the way calculative infrastructures, as cost accounting and rates, are challenged, and how some actors try to stabilize them.

My story is one of becoming a sociologist by accident. Throughout this story, I emphasize the turning points I took and those thrust upon me during my sociological journey. The turning points in my path to becoming a sociologist began during my childhood, although I could not have foreseen them. Both of my parents had experienced downward social mobility yet had managed to receive university degrees despite enduring hardships and living through the Great Depression. Gender roles circumscribed opportunities for girls who grew up in the 1950s. Thus, I entered a women's profession, occupational therapy. After a few years, my interest in teaching occupational therapy students led me back to graduate school to seek a master's degree in sociology at San Francisco State College. I gained a new worldview, although I soon learned that quantification and esoteric theorizing, not social issues, commanded the attention of most mid-1960s sociologists. I also learned that women sociologists had scant opportunities despite their qualifications but decided to seek a doctoral degree in sociology anyway. Eventually the University of California, San Francisco, accepted me in their first cohort of doctoral students and subsequently I worked closely with Anselm Strauss, my dissertation chair, and Barney Glaser, from whom I learned grounded theory. After finishing my dissertation, a temporary appointment at Sonoma State College turned into a tenure-track appointment. Although many years at Sonoma have been tumultuous, I have also had the privilege of developing a writing program to assist the faculty in their research and writing.

Kathy Charmaz, who survived against all odds and eventually to become an internationally acclaimed qualitative researcher, demonstrated extraordinary resilience and intellect. In this chapter, I describe the ways she lived through her early life, her beginning research as a student, and how she managed the trials of academic life while making an international contribution to understanding the experiences of the chronically ill. In the process she developed Constructivist Grounded Theory, refining her qualitative methods, making them accessible to all, and producing findings that changed the course of qualitive health research.