Abstract
Background
Numerous academic inquiries have set out to study the healthcare systems of Germany, New Zealand, and the United States to identify inequalities, system-inherent problems, and to analyze other aspects of health and healthcare. A much smaller number of studies have looked at healthcare systems as moral economies that fulfill a moral duty to ensure the health and wellbeing of a country’s population. However, the academic literature does not yet provide comprehensive insights into healthcare systems as moral economies in which forms of moral capital are traded; and, so far, no study has compared forms of moral capital in healthcare between countries. This thesis strives to address that gap by identifying the forms of moral capital that circulate in the healthcare systems of Germany, New Zealand, and the United States.
Aims
The goal of this thesis is to answer the following research questions:
1. What are the forms of moral capital that circulate and/or are dominant in the healthcare systems of Germany, New Zealand, and the U.S.?
2. Does the type of healthcare system – market-driven vs. government-controlled – affect the forms and exchanges of moral capital in healthcare?
3. What are the points of alignment, misalignment, and conflict between expectations in healthcare and reality, from a moral capital perspective?
Methodology
This exploratory, qualitative research is based on documentary data, traditional and social media analysis, and 48 semi-structured interviews with patients and healthcare providers in Germany, New Zealand, and the United States. The theoretical framework is social constructionism, with a Foucauldian lens. It is an inductive, cross-sectional, and non-probabilistic research project that offers cross-sectional, maximum-variation insights into the moral economy of healthcare and the forms of moral capital that circulate in the healthcare systems of the three countries.
Results
This thesis provides an inventory of 41 forms of moral capital that circulate in the healthcare systems of Germany, New Zealand, and the United States. It identifies the forms of moral capital that dominate in the three countries: access, affordability, equality, neoliberalism, and timeliness. In addition, it elaborates on outlier forms that arise from particularities of the respective healthcare systems as well as societal values and historical developments: freedom and navigability in the U.S., solidarity and satisfaction in Germany, and quality of care in New Zealand. This thesis also offers categories of moral capital – negative vs. positive; macro vs. micro level of healthcare, patients vs. providers, among others – as well as concrete examples of how moral capital is conferred, gained, lost, and traded.
Conclusion
The findings emphasize the importance and validity of moral capital in the moral economy of healthcare. The dominance of certain forms of moral capital in the healthcare systems of Germany, New Zealand and the U.S. hint at a relationship between the healthcare system type, funding mechanisms, and system structure and the forms of moral capital that circulate in these systems. The negative expression and/or depletion of moral capital points to a dissonance between expectations and reality in healthcare. This, in turn, makes moral capital a useful tool or lens when healthcare reforms are pursued.