Honors Theses

Date of Award

Spring 5-10-2025

Document Type

Undergraduate Thesis

Department

Croft Institute for International Studies

First Advisor

Kate Centellas

Second Advisor

Joshua First

Third Advisor

Kenneth Negy

Relational Format

Dissertation/Thesis

Abstract

This thesis examines how regional economic histories and national healthcare policies interact to shape cancer care delivery in Mississippi (United States) and Andalusia (Spain)—two regions with parallel histories of agricultural dominance followed by economic decline, yet operating under fundamentally different healthcare systems. Through comparative policy analysis focused on the Affordable Care Act (2010) and Spain's Royal Decree Law 16/2012, this research challenges conventional fixation on healthcare system type as the primary determinant of patient outcomes. Instead, it reveals a “rural cancer paradox” where historically impoverished regions face similar barriers to effective cancer care despite their contrasting funding models. The research identifies policy incoherence—the systematic misalignment between national healthcare objectives and regional implementation—as the critical mechanism that transcends both system type and economic situation in shaping health outcomes. This incoherence manifests through three key patterns: the Regional Autonomy Paradox, where regions exercise independence in ways that undermine healthcare outcomes; System Inertia, where healthcare frameworks intensify existing characteristics rather than adapting to emerging needs; and the Illusion of Access, where theoretical coverage guarantees mask practical barriers for rural cancer patients. Cancer care provides a uniquely powerful analytical window into these governance tensions because it requires coordination across multiple healthcare levels, depends on specialist availability, and demands sustained resources over time. The findings demonstrate that when poverty meets policy incoherence, patients face similar consequences regardless of whether their healthcare system is market-driven or universal. This research offers insights for policymakers seeking to bridge the gap between theoretical healthcare access and meaningful care delivery in economically struggling regions.

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