Abstract
Using theoretical perspectives of several literatures (e.g., human capital investment, state theory, mortality, and professional dominance), this study explains variation in the performance of national medical systems. Using an unique data set, it assesses the consequences of human capital investments by analyzing the impact that investments in the number of doctors and in the proportion of doctors who were specialists have on reductions in mortality (social effectiveness) and mortality reductions relative to costs (social efficiency) in Britain, France, Sweden, and the U.S. between 1890 and 1970. Net of other effects, investments in both doctors and specialists lead to mortality reductions, but increases in specialists are not socially efficient. The role of the state influences the impact human capital investments have on system performance. More than one configuration of the key variables can lead to the same outcomes. The study analyzes pooled time series and cross-sectional data with regression and Boolean methods
Published Version
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