Date of Award

Spring 2024

Document Type


Degree Name

Doctor of Public Administration (DPA)


Public Policy and Administration

Committee Chairperson

Mark Davis, Ph.D.

Committee Member

Kristen Crossney, Ph.D.

Committee Member

Allison Turner, Ph.D.


This study presents a critical analysis of the relationship between the market concentration of private health insurance companies and per capita healthcare costs in the United States. It explores the hypothesis that consolidation within the private health insurance sector, driven by frequent mergers and acquisitions, contributes to a dysfunctional healthcare system characterized by high consumer costs. The study investigates the degree of market concentration in the health insurance sector from 2017 to 2020, focusing on healthcare costs per capita as the dependent variable, and employing independent variables such as market data of health insurers, the Herfindahl-Hirschman Index (HHI), and the C-5 Concentration Ratio.

A significant finding is that the top five health insurance firms now account for 55% of the private market, indicating substantial market concentration. Moreover, the national health insurance market presents an HHI score of 639 out of 10,000, suggesting a seemingly competitive national landscape. This contrast between national and regional market dynamics raises concerns about the balance between insurers' fiduciary duties and healthcare delivery commitments, particularly in the context of Principal-Agent Theory.

The study also evaluates the macroeconomic impacts of these market conditions, such as increased healthcare costs and socio-economic disparities. It advocates for policy reforms, including transitioning to a single-payer system and deconsolidating private insurers, to better align healthcare provision with public welfare. This study contributes to the discourse on healthcare policy reform in the United States, offering insights into the complexities of the healthcare system and suggesting pathways for future policy development.