This dissertation argues that there are three basic types of health care systems used in industrial nations: free market (private insurance and provision), universal (public insurance and private provision), and socialized (public insurance and provision). It examines the role of market forces (supply and demand) within the health care systems and their effects on health outcomes by constructing an integrative model of health care markets and policies that is lacking within the scientific and academic literature. The results show that, free market systems have decreased access to care, good quality of care, and are economically inefficient resulting in 2.7 years of life expectancy lost and wasted expenditures (expenditures that do not increase life expectancy) of $3474 per capita ($1.12 trillion per year in the U.S.). Socialized systems are the most economically efficient systems but have decreased access to care compared to universal systems, increased access to care compared to free market systems and have the lowest quality of care of all three systems resulting in 3 months of life expectancy lost per capita and a saving of $335 per capita. Universal systems perform better than either of the other 2 systems based on quality and access to care. The models show that health insurance is a Giffen Good; a good that defies the law of demand. This study is the first fully demonstrated case of a Giffen good. This investigation shows how the theoretically informed integrative model behaves as predicted and influences health outcomes contingent upon the system type. To test and substantiate this integrative model, regression analysis, Time-Series-Cross-Section analysis, and structural equation modeling were performed using longitudinal data provided and standardized by the Organization for Economic Cooperation and Development (OECD). The results demonstrate that universal health care systems are superior to the other two systems.
Doctor of Philosophy (Ph.D.)
College of Community Innovation and Education
Public Affairs; Goverance and Policy Reseach
Length of Campus-only Access
Doctoral Dissertation (Open Access)
Helligso, Jesse, "Constructing and Validating an Integrative Economic Model of Health Care Systems and Health Care Markets: A Comparative Analysis of OECD Countries" (2018). Electronic Theses and Dissertations, 2004-2019. 6177.