Title: Universal healthcare: key behavioural factors affecting providers' and recipients' value propositions: a structural causal model of the Puerto Rico experience

Authors: Valerie Quiñones-Avila; Alexandra Medina-Borja

Addresses: International Service Systems Engineering Research Lab, ISSER, University of Puerto Rico at Mayaguez, MSC 308 Suite 112, 100 Grand BLVD Paseos, San Juan, 00926-4262, Puerto Rico. ' International Service Systems Engineering Research Lab, ISSER, Industrial Engineering Department, University of Puerto Rico at Mayaguez, II-205 Industrial Engineering Building, Mayaguez, PR 00680, Puerto Rico

Abstract: In 1993, Puerto Rico became a pioneer amongst the USA and its territories for instituting a public health insurance funded by the state and provided by private insurance companies. This health reform plan was aimed at providing coverage particularly to the medically indigent sector of society and ensuring universal access to healthcare. However, today this system is still struggling with sustaining the goals that originated it. Thus, the purpose of this study is to understand how universal access affects physicians' and patients' attitudes, in turn affecting the effectiveness of health reform implementation. A causal model was created to depict the structural form of the physician and patient value system influenced by different actors as a result of the implementation of the Government Health Reform from 1993-2010 in Puerto Rico.

Keywords: causal models; healthcare systems engineering; service effectiveness; qualitative research; behavioural factors; Puerto Rico; public health insurance; universal healthcare; health reform; value systems; healthcare services.

DOI: 10.1504/IJBHR.2012.045618

International Journal of Behavioural and Healthcare Research, 2012 Vol.3 No.1, pp.25 - 45

Published online: 20 Aug 2014 *

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