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Cost-effectiveness models for health care interventions generally make the assumption that all resources are available, as required, without capacity constraints. This assumption may be a reasonable approximation of the truth for a range of questions faced by decision makers in health care. However, in some health care settings, capacity constraints predominate leading to queue development. In these situations the use of a modelling technique that can accommodate these constraints would appear advisable to allow the efficiency of competing healthcare interventions to be determined. Nevertheless, there have been no empirical comparisons of economic modelling techniques that capture capacity constraints and those that do not. Further, there are only a few cost-effectiveness analyses (CEA) of health care that capture the effect of capacity constraints at all. This research seeks to explore these gaps in the literature in an applied manner.

This thesis focuses on how reproductive health is made meaningful in the context of a Planned Parenthood clinic in Kentucky. Using ethnographic field methods, including participant observation and semi-structured interviews, the paper explores how staff members negotiate definitions of reproductive health as employees of Planned Parenthood health center. The analysis addresses reproductive health discourse among the clinic staff and how reproductive health is used as a site of intervention. It also explores the sociocultural processes and interactions the staff members engage in at the national and local levels and the role these play in shaping the conceptualization of reproductive health and how it is deployed at the clinic level. This analysis illuminates the fluid nature of reproductive health meanings and the ways in which health care delivery is contextually and socially mediated.