Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Industrial and Management Systems Engineering

Major Professor

José Zayas-Castro, Ph.D.

Committee Member

Hadi Charkhgard, Ph.D.

Committee Member

Alex Savachkin, Ph.D.

Committee Member

Robert Frisina, Ph.D.

Committee Member

Jay Wolfson, Dr.P.H.


Game Theory, Health Insurance, Operations Research, Public Policy, Waiting Time


Affordable health care access that provides well-coordinated and high-quality services on time is a goal that governments and health organizations strive for. Regrettably, most countries deal with access problems that affect the population's health, such as long waiting lists for specialized medical services, overcrowding of emergency departments, and high health prices. In the present doctoral dissertation, I model and analyze the strategic interactions that inhabit the health system machinery to uncover possible structural problems that led to the aforementioned issues. The study involves operation research, data science, and game theory techniques to address the health care access predicament.

Each research topic in this document targets a single access problem; however, taken together, the findings highlight the need for better coordination and supervision in health systems. The first topic studies the waiting lists for specialized medical services considering local and regional interactions among public hospitals and governing institutions and the possible roles of private providers. The second topic focuses on the overcrowding of emergency departments considering the interactions among ambulance allocation decisions, waiting times to treatment, fairness, and efficiency. Finally, the last topic explores hospital consolidation as a factor determining high prices in health care markets where patients, insurers, and hospitals interact with each other.

Several insights to increase health care access were obtained through this dissertation. The results of the first research topic indicate that an increase in cooperation among hospitals can significantly reduce waiting lists for medical services due to the heterogeneity of demand and resources of each institution. Furthermore, the cooperation should not be limited to local negotiations; instead, it should be expanded to regional contexts to mitigate the negative effect of selfish behaviors. The second study shows that implementing centralized decision systems for ambulance allocation can significantly reduce emergency department overcrowding. However, patient-centered models need to be considered to deliver increases in system efficiency that are fair to everyone. The last research topic indicates that increasing competition (or reducing consolidations) in health care markets reduces health prices and insurance premiums. Furthermore, expanding insurers' networks generate similar outcomes and even better results in oligopolistic scenarios. Finally, hospital consolidations do not imply an increase in quality of care, and changes in the demand (e.g., due to SARS-Cov-2) should reflect adjustments in the health policy prices.

The insights of this work can influence policy modifications to enhance health care access in developing and developed countries. Implementing the proposed frameworks will reduce mortality rates and increase the quality of life for patients.