Thesis advisor: Peter Gottschalk / Thesis advisor: Thomas McGuire / Thesis advisor: Donald Cox / Does managed care send expectant mothers to hospitals they would choose even if their choice of hospital was not limited? I find that Medicaid managed care patients are redirected to hospitals that enrollees of more generous insurance payers with the same personal characteristics do not go to. However, Medicare managed care enrollees do not face an increased risk of having a cesarean delivery at the hospital they attend, which is interpreted as evidence that they are redirected to high quality hospitals. / Thesis (PhD) — Boston College, 2003. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Economics.

This dissertation aims to determine what should be the appropriate base ethical limits of health care markets in the United States. I argue that because we do not value health care goods and services as commodities, treating them as commodities available for market sale can only be ethical when health care markets accord with at least the principles of honesty, respect for autonomy, and increased access to essential health care goods and services. I begin by establishing the theoretical foundation of my argument by expositing three theories of commodification and ethical markets that critically examine the relationship of goods to the market. Each theory shows how commodification often fails to account for the non-market value(s) we attribute to many goods. I then apply these theories to health care goods and services to show how they are not properly valued merely as commodities, and to lay the foundation of my argument regarding the ethical limits of health care markets. I then argue why honesty, respect for autonomy, and increased access to essential health care goods and services should be considered the base ethical limits of health care markets by examining how each ideally applies to both health care and the market. Lastly, I apply my argument to two health care markets: the pharmaceutical industry and a possible legal organ market. For the former, I show how many of the practices of the pharmaceutical industry violate what I argue should be the base ethical limits of health care markets. For the latter, I show the extent to which a legal organ market in the United States could or would violate these limits.