The performance of consumers or laypersons in government programs has been studied extensively, usually from the standpoint of the control exercised by providers or other professionals, or correlative, what consumers need in order to be on an equal footing with the experts. At stake is lay control -i.e., democracy. This case study of one Health Systems Agency (HSA) in contrast, focuses attention on the crucial role of the HSA staff in the democratization of health care. Outcomes, such as cost-containment and allocation of resources, can be examined in terms of the staff's interests and the constraints of its multi-leveled environment. From this perspective, the recruitment, selection, socialization, promotion, training and control of consumers are seen as important factors in the decisions made by the HSA, and these factors are seen as being greatly influenced by staff members as they seek to achieve a balance of outcomes. The balance of outcomes may include certain material and professional interests of the staff itself. In this process, lay control becomes subordinated.

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