Date of Award

4-6-2026

Document Type

Thesis

First Advisor

Dr. Francesca Seaman

Second Advisor

Dr. Daniel Gurnon

Third Advisor

Dr. Michael Scanlon

Abstract

This thesis presents a comparative study of the Italian and the American healthcare systems, using Total Knee Replacements (TKRs) as a standardized metric to evaluate the health policy, financing, and patient outcomes. Despite the United States spending over $10,000 more per capita on healthcare than Italy, American life expectancy is 5 years shorter than Italian life expectancy. Through a mixed-methods analysis of data from the American Joint Replacement Registry (AJRR), the Programma Nazionale Esiti (PNE), the Registri Italiani di ArtoProtesi (RIAP), and the HCUPnet (AHRQ) database, this research identifies multiple disparities throughout the system. Key findings in this thesis include a “negotiating margin” between hospitals and private insurance companies, where 2023 inpatient TKR charges exceeded the actual production cost of an inpatient TKR by over $85,000, which is absent from Italy's SSN’s standardized tariff reimbursement model. Additionally, health policies, such as the Comprehensive Care Joint Replacement (CJR) model, affect hospitalization lengths and marginalized procedures, such as the Partial Knee Replacement (PKR). The PKR accounts for only 3.5% of knee surgeries in the United States, whereas it accounts for approximately 20% of knee surgeries in Italy. Additional findings include that the TKR 30-day readmission rate in America was twice that in Italy, further implying structural differences, as the readmission rate was likely due to decreased hospitalization and a lack of inpatient rehabilitation. The thesis concludes with a discussion of potential healthcare policy reform, including proposals for American standardized reimbursement for elective procedures and for reform supporting professional, inpatient rehabilitation treatments rather than the swift, home-based care.

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