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Published: 25 January 2024

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1

Fauquert, Élisabeth. "L'entrepreneuriat politique des présidents des Etats-Unis sur les réformes de l'assurance maladie : une histoire politique du Patient Protection and Affordable Care Act (2010)." Thesis, Lyon, 2017. http://www.theses.fr/2017LYSE2094.

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Cette thèse inscrite dans la tradition intellectuelle de l’American Political Development analyse les liens dialectiques entre l’entrepreneuriat des présidents des États-Unis sur la question de l’assurance maladie, l’essor du système de santé américain contemporain et son produit le plus récent, le Patient Protection and Affordable Care Act (2010). Il s’agit d’analyser les influences réciproques entre un exécutif qui subit de très fortes contraintes institutionnelles dans ce champ précis des politiques publiques et un système de santé dont les fondements et les contours sont en perpétuelle mutation. Les réformes de santé, de par leur nature transversale et polémique, leur complexité mais aussi leur poids dans l'économie américaine, agissent directement sur les équilibres de la gouvernance publique. Elles doivent être considérées comme un laboratoire et un accélérateur d’innovations pour la présidence, dans un système politique où sa sphère d’action est limitée, tant par les freins et des contre-pouvoirs que par l’influence d’autres entrepreneurs politiques dotés d’une légitimité d’action égale voir supérieure à se saisir de la question épineuse de la santé. L’adoption du PPACA, sa promulgation par un président démocrate après un siècle de rendez-vous manqués avec les réformes ambitieuses de l’assurance maladie, ainsi que sa mise en œuvre compliquée, offrent un cas d’étude de premier plan sur les évolutions de l'exécutif étasunien et sur la normalisation d’un entrepreneuriat présidentiel hétérodoxe
This dissertation which falls within the intellectual tradition of American Political Development explores the dialectical links between the entrepreneurship of US presidents on health care reform, the development of the American health care system and its latest product, the Patient Protection and Affordable Care Act (PPACA), which was signed into law in 2010. This work analyses the mutual forces of influence at work between a deeply constrained executive in this particular field of public policy and a health care system whose foundations and contours are in constant mutation. Given its controversial nature, its complexity and its weight in the US economy, health care reform directly affects the dynamics of public governance. Health care reform must therefore be considered as a laboratory and an accelerator of innovations for the presidency, in a political system in which its sphere of action is limited, as much by checks and balances as by the influence of other entrepreneurs who enjoy equivalent if not greater legitimacy than the executive branch to take action on the thorny issue of health care. The passage of the PPACA, the fact that it was signed into law by a democratic president after a century of failed attempts at ambitious reform as well as its arduous implementation, are a picture perfect case study on the evolutions of the presidential institution and on the routinization of heterodox presidential entrepreneurship
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2

Tuttle, Chiquita Theresa. "The Association between Demographic Factors and Use of California's Health Insurance." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2016.

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The Patient Protection and Affordability Act of 2010 (PPACA) addressed the access to healthcare in the United States. One of the problems of this healthcare access was rooted in disproportionally lower access among minority populations. The purpose of this quantitative study, guided by the consumer behavior theory, was to examine the association between race/ethnicity and enrollment within the Covered California-?¢ (CoveredCA) Insurance Exchange. A cross-sectional study design was used to investigate the association between race/ethnicity and the use of Covered CA health benefit exchange. Logistic regression analysis was used to examine the relationship between enrollment and race/ethnicity, having adjusted for covariates of age, gender, and literacy. The results revealed that, while all other race/ethnicity groups were less likely to purchase Bronze level versus Silver and above coverage compared to the Hispanic race/ethnicity, Asians (OR =1.16, 95% CI: 1.11, 1.20) and Whites (OR = 1.12, 95% CI: 1.02, 1.14) were more likely to purchase Bronze level versus Silver and above coverage compared to the Hispanic group. Chi-square test results indicated a statistically significant difference in the proportion of individuals selecting the Bronze level coverage compared to the Silver and above among the various race/ethnicity groups ï?£2 (13, N= 763,531), 1922.083, p < 0.0001. The Hispanic race/ethnicity was more likely to enroll in the Bronze versus Silver and above compared to other race/ethnicities. The results of this study may contribute to positive social change by informing policy that besides income and age, race/ethnicity is an important determinant of the likelihood of enrollment in the Covered CA health exchange.
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3

Hosseinzadeh, Sereshki Shaghayegh. "Droit à la protection de la santé et Constitution : étude comparée en droit français et en droit américain." Electronic Thesis or Diss., Université Paris Cité, 2020. http://www.theses.fr/2020UNIP5212.

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Le droit à la protection de la santé est essentiel au bien-être de tous. Le droit à la protection de la santé implique en principe de garantir à toute personne un accès égalitaire aux soins nécessités par son état de santé, sans discrimination. Il existe un lien inhérent entre la Constitution d'une nation et la protection de la santé des individus au sein de cette nation. Une personne en mauvaise santé ne pourra pas profiter pleinement de sa vie et de développer son potentiel. Le droit constitutionnel français proclame le droit à la protection de la santé à la différence de la Constitution américaine qui ne reconnais pas ce droit expressément. L'auteur tente de démontrer que les législateurs fédéraux et fédérés ainsi que la Cour suprême prennent un compte l'existence d'un droit à la protection de la santé aux Etats-Unis. Par ailleurs, le droit constitutionnel français en matière de protection de la santé a fait l'objet d'une lente évolution en fonction du temps. Il s'agit en réalité d'une préoccupation ancienne des premiers constituants et il est, pour la première fois, reconnu en tant que tel par la Constitution de la seconde République. Pour ce qui est du système constitutionnel des Etats-Unis d'Amérique, la Constitution fédérale de 1887 ne reconnait pas de droit à la protection de la santé. Cette reconnaissance aurait pu avoir lieu en 1944 avec la proposition de Franklin Roosevelt de modifier la constitution mais celle-ci n'a pas été menée à son terme. Les deux seules ouvertures qui existent sont celles créées par la Cour suprême au profit des détenus et des femmes lorsqu'elles décident de recourir à une interruption volontaire de grossesse, et encore dans ce dernier cas, dans des conditions très précises. Toutefois, au niveau des Etats fédérés, certains reconnaissent un droit à la santé. Cette reconnaissance est expliquée par les différents cultures politiques des Etats fédérés. Le but de cette étude comparative est de démontrer que le droit à la protection de la santé est un droit fondamental, intimement lié à l'épanouissement et au bonheur de chacun, ainsi qu'au bien-être collectif, de l'humanité. C'est aussi reconnaître qu'une protection constitutionnelle de ce droit est nécessaire et de la plus haute importance pour qu'il puisse être efficacement appliqué
The right to protection of health is essential for the well-being of all. It implies guaranteeing everyone equal access to the health care necessary to their health, without discrimination. There is an inherent link between the constitution of a nation and the protection of the health of individuals within that nation. An individual with poor health will not be able to fully enjoy his life and develop his or her full potential. In the French constitution, the right to health is proclaimed unlike the American Constitution which does not recognize this right expressly. The author attempts to demonstrate that federal and state legislators, as well as the Supreme Court, take into account the existence of a right to health protection in the United States. Moreover, French constitutional law on health protection has evolved slowly over time. The protection of health was a long-standing concern of the first constituents and is, for the first time recognized as such by the Constitution of the Second Republic. With respect to the constitutional system of the United States of America, the Federal Constitution of 1887 does not recognize a right to protection of health. This recognition could have taken place in 1944 with Franklin Roosevelt's proposal for a Second Bill of rights recognized social and economic rights such as the right to have access to medical care. Franklin Roosevelt died before he was able to amend the constitution. Even though health care is not a constitutional right, it has been protected by the Supreme Court for the benefit of prisoners and women when they decide to resort to abortion. However, at the State level, some States recognize a right to health. This recognition is explained by the different political cultures of each State. The aim of this comparative study is to demonstrate that the right to protection of health is a fundamental right, intimately linked to the development and happiness of each individual, as well as to the collective well-being of humanity. It also recognizes that constitutional protection of this right is necessary and of the utmost importance for it to be effectively applied
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4

Gallman, Sean. "Influence of the Patient Protection and Affordable Care Act on Small Businesses." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2029.

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Business leaders lack strategies to implement the employer shared responsibility provision of the Patient Protection and Affordable Care Act (ACA). Small businesses pay approximately 18% more than larger companies for the same health coverage. Within a conceptual framework of management by objectives, the purpose of this qualitative multiple case study was to explore the strategies small business leaders use to implement the employer shared responsibility provision of the ACA. Data were gathered from the review of company documents, observations, and semistructured interviews with 5 senior business leaders from small business organizations in the Mid-Atlantic region of the United States. Data were coded via Atlas.ti to identify themes from the narative segments. Key themes that emerged from the study included business cost, lack of transparency, and consultation. Recommendations include examining alternative health providers to reduce company health premiums to improve business costs, network with other small businesses for ACA clarity, and work with health consultants for new business processes. Implications for social change include contributing to the effective implementation of the employer shared responsibility provision of the ACA that can improve the economic well-being of small businesses.
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5

Oshegbo, Godwin. "Effects of Patient Protection and Affordable Care Act on Behavioral Health Access." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4978.

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About 50% of adults in the United States suffer from at least 1 mental health challenge in their lifetime. Annually, mental health and substance use disorders cost the United States about $800 billion, leaving individuals with unaffordable cost of care and the nation with diminished productivity and revenue. With the Essential Health Benefits and Medicaid expansion under the Patient Protection and Affordable Care Act (PPACA), healthcare resources were created to address gaps in behavioral healthcare. There is a need to understand how the healthcare law has influenced the availability of behavioral health services and access to needed care. This study explored the lived experiences of 10 behavioral health service recipients to identify the benefits and challenges of the PPACA on behavioral health services. Participants from Anne Arundel County, Maryland, were purposefully selected and interviewed face-to-face. Relative advantage, compatibility, and complexity were characteristics of the diffusion of innovation theory used for the exploration of this research. Based on the interpretive phenomenological approach, Nvivo 11 Pro was used for data coding, management, organization, and analysis. There was the shared belief among participants that the PPACA improved their access to adequate and affordable behavioral healthcare. Effective network of care and having health insurance seemed to have improved health outcomes. Findings from this study highlight issues of common interest to healthcare stakeholders while providing reasonable platforms for objectively addressing complex challenges, which tend to undermine the possibility of adopting policies that could yield positive dividends for all parties involved.
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6

Nix, Tanya J. "Evolution of Physician-Centric Business Models Under Patient Protection and Affordable Care Act." ScholarWorks, 2014. http://scholarworks.waldenu.edu/dissertations/123.

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For several decades, the cost of medical care in the United States has increased exponentially. Congress enacted the Patient Protection and Affordable Care Act (PPACA) of 2010 to ensure affordable healthcare to the citizens of the United States. The purpose of this case study was to explore physicians' perspectives regarding physician-centric business models evolving under the requirements of PPACA legislation. Complex adaptive systems formed the conceptual framework for this study. Data were gathered through face-to-face, semistructured interviews and e-mail questionnaires with a purposeful sample of 20 participants across 14 medical specialties within Northeast Texas. Participant perceptions were elicited regarding opinions of PPACA legislation and the viability of business models under the PPACA. In addition, a word cloud was used to identify 3 prevalent or universal themes that emerged from participant interviews and questionnaires, including (a) use of mid-level practitioners, (b) changes to provider practices, and (c) lack of business education. The implications for positive social change include the potential to develop innovative models for the delivery of medical care that will improve the health of the aggregate population. Healthcare leaders may use the findings to advance the evolution of physician business models that meet the needs of healthcare stakeholders. These findings may also inform healthcare leaders of the need to develop cost-effective and innovative organizational models that are distinct to individual patient populations.
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7

Nix, Tanya. "Evolution of Physician-Centric Business Models Under Patient Protection and Affordable Care Act." Thesis, Walden University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3641824.

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For several decades, the cost of medical care in the United States has increased exponentially. Congress enacted the Patient Protection and Affordable Care Act (PPACA) of 2010 to ensure affordable healthcare to the citizens of the United States. The purpose of this case study was to explore physicians' perspectives regarding physician-centric business models evolving under the requirements of PPACA legislation. Complex adaptive systems formed the conceptual framework for this study. Data were gathered through face-to-face, semistructured interviews and e-mail questionnaires with a purposeful sample of 20 participants across 14 medical specialties within Northeast Texas. Participant perceptions were elicited regarding opinions of PPACA legislation and the viability of business models under the PPACA. In addition, a word cloud was used to identify 3 prevalent or universal themes that emerged from participant interviews and questionnaires, including (a) use of mid-level practitioners, (b) changes to provider practices, and (c) lack of business education. The implications for positive social change include the potential to develop innovative models for the delivery of medical care that will improve the health of the aggregate population. Healthcare leaders may use the findings to advance the evolution of physician business models that meet the needs of healthcare stakeholders. These findings may also inform healthcare leaders of the need to develop cost-effective and innovative organizational models that are distinct to individual patient populations.

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8

Nix, Tanya. "Evolution of Physician-Centric Business Models Under Patient Protection and Affordable Care Act." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/1157.

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For several decades, the cost of medical care in the United States has increased exponentially. Congress enacted the Patient Protection and Affordable Care Act (PPACA) of 2010 to ensure affordable healthcare to the citizens of the United States. The purpose of this case study was to explore physicians' perspectives regarding physician-centric business models evolving under the requirements of PPACA legislation. Complex adaptive systems formed the conceptual framework for this study. Data were gathered through face-to-face, semistructured interviews and e-mail questionnaires with a purposeful sample of 20 participants across 14 medical specialties within Northeast Texas. Participant perceptions were elicited regarding opinions of PPACA legislation and the viability of business models under the PPACA. In addition, a word cloud was used to identify 3 prevalent or universal themes that emerged from participant interviews and questionnaires, including (a) use of mid-level practitioners, (b) changes to provider practices, and (c) lack of business education. The implications for positive social change include the potential to develop innovative models for the delivery of medical care that will improve the health of the aggregate population. Healthcare leaders may use the findings to advance the evolution of physician business models that meet the needs of healthcare stakeholders. These findings may also inform healthcare leaders of the need to develop cost-effective and innovative organizational models that are distinct to individual patient populations.
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9

Hall, Bradley A. "Independent Retail Business Owners' Perceptions of the Patient Protection and Affordable Care Act." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1537.

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Passage of the Patient Protection and Affordable Care Act (PPACA) in 2010 prompted the question of how independent businesses may react to the employer mandate in the PPACA. The law is based on the theory of managed competition and it is more likely to affect businesses with fewer employees than to affect larger businesses that already offer health insurance. The purpose of this quantitative, pre-experimental study was to examine the strategic responses of independent retail business owners in Hillsborough County, Florida, regarding their perceptions of the employer mandate in the PPACA. Before 2014, there was a great deal of non-peer-reviewed literature in which researchers made predictions about the PPACA and independent business perceptions regarding the new law. To determine independent business owners' perceptions of and strategies for addressing the PPACA, a random sample of 309 independent retail businesses in Hillsborough County was invited by e-mail to participate in an online survey. The quantitative data were analyzed using descriptive statistics, t tests for hypothesis testing, and chi-square goodness-of-fit analyses to confirm the results without using means. None of the alternative hypotheses were supported, indicating that the PPACA may not have an adverse effect on job creation for independent retail businesses in Hillsborough County. The findings of this study can indirectly promote positive social change by communicating to independent business owners and individuals that healthcare insurance options exist. This question was important to academics and business professionals, because the strategies employed by business owners may affect job creation.
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10

Driscoll, Ryan. "Opting Into Medicaid Expansion under the Patient Protection and Affordable Care Act and Hospital Performance." Scholarship @ Claremont, 2016. http://scholarship.claremont.edu/cmc_theses/1324.

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Healthcare has had a storied past in the United States, and to say that the two have had a complicated relationship would be an egregious understatement. Intertwined in the narrative of our healthcare system is the narrative of United States hospitals, both how they came to be and the nature of their structures. Over time, legislation at local, state, and federal levels has shaped hospital organization and cost-structure. Here, I aim to better understand the effect of the Patient Protection and Affordable Care Act (PPACA), and more specifically Medicaid expansion, on hospitals in a handful of Southern states.
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11

Brom, Heather. "The Changing Landscape of Ambulatory Care: Provision and Utilization as Influenced by the Patient Protection and Affordable Care Act." The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1491814890562107.

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12

Gautreaux, Ryan J. "Framing the Patient Protection and Affordable Care Act| A Content Analysis of Democratic and Republican Twitter Feeds." Thesis, University of Louisiana at Lafayette, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10163326.

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This study examines the portrayal of the Patient Protection and Affordable Health Care Act (PPACA) based on the Twitter feeds of Democratic and Republican leaders. This innovative thesis provides a clear depiction of how divisive and unprecedented political cyberwarfare has unfolded within the realm of computer-mediated communications. This study also uses an original approach in its capability of identifying the political combatants of a divisive topic. This is also the first content analysis of its kind by bringing data analysis to the concepts of Entman and Kuypers, focusing on problem/solution and cause/effect rhetoric that confirms framing as a powerful political weapon. This research combines all of the above concepts and applies them to one of the most popular and current social media sites as a basis of analysis. This research also proves the value of politicians’ personal Twitter accounts when studying the general framing strategies of the respective parties.

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13

Nieves, Rafael. "Perceptions of Senior Citizens in Central Florida Regarding Quality of Care Under the Patient Protection and Affordable Care Act (ACA)." Honors in the Major Thesis, University of Central Florida, 2013. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/958.

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On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. This reform, it is argued, is projected to increase insurance coverage of pre-existing conditions, to expand access to insurance for more than 30 million Americans, and to increase estimated National medical spending while lowering projected Medicare spending. This thesis sought to investigate and analyze the perceptions of senior citizens in Central Florida about PPACA and their perceived effects on the healthcare quality provided to them under this law. Four sections of PPACA bill, thought to specifically pertain to the elderly, were selected for this study; respondents were asked their opinions regarding PPACA's aspects of: (1) the reform on preventive healthcare services; (2) Medicare Part D (prescription drugs); (3) Medicare; and (4) Medicaid. This thesis employed both qualitative and quantitative methodologies; data were collected and analyzed with findings presented and discussed.
B.S.
Bachelors
Health and Public Affairs
Health Management and Informatics
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14

Lorish, Kathryn. "The Tax Exclusion for Employer-Sponsored Insurance and the Debate Over the Patient Protection and Affordable Care Act." Scholarship @ Claremont, 2012. http://scholarship.claremont.edu/cmc_theses/514.

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On March 23rd 2010, President Obama signed the Patient Protection and Affordable Care Act, setting in motion the most comprehensive health reform in the United States since 1965. Among many provisions within the near-3,000-page law, the Affordable Care Act (ACA) amends the Internal Revenue Code to include an excise tax on high cost employer-provided health plans. Starting in 2018, the new provision will levy a 40 percent tax on every dollar of health benefits received in excess of $10,200 for individuals and $27,500 for families. This provision alters tax policy dating back to 1954, and will significantly change employer-sponsored insurance in the United States.This thesis will analyze how the ACA came to include the excise tax for high cost health insurance, and discuss the political forces motivating this decision.
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15

Ricciardi, Lynda M. "The Perception and Reported Impact of the Patient Protection and Affordable Care Act on Participation in Health Care and Health Maintenance by Caucasian Males." Youngstown State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ysu149565209581924.

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16

Sawyer, Ashlee. "ARE YOU COVERED? EXAMINING HOW KNOWLEDGE OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT INFLUENCES USE OF PREVENTIVE REPRODUCTIVE HEALTH SERVICES." VCU Scholars Compass, 2016. http://scholarscompass.vcu.edu/etd/4265.

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The Patient Protection and Affordable Care Act (PPACA) expanded access to insurance coverage and health care services for many citizens, and has increased access for women in particular by including preventive reproductive health services as essential health benefits. The current national rates of sexually transmitted infections (STIs), reproductive cancer diagnoses, and unintended pregnancy serve as major areas of concern for women’s health and public health. The present study examined how knowledge of the PPACA influences receipt of preventive reproductive health services among women. Results indicate that higher levels of knowledge of the PPACA are associated with a greater likelihood of receiving cancer and STI screenings, as well as contraceptive counseling, and that increasing contraceptive knowledge, rates of contraceptive counseling, and pap screenings are related to greater use of highly effective contraception. The present study offers support for increased outreach and education efforts, along with additional policy and provider involvement.
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17

Hamel, Michael Graham. "RESISTANCE TO MANDATED HEALTHCARE CHANGE: USING PSYCHOLOGICAL REACTANCE TO PREDICT RESPONSES TO THE PATIENT PROTECTION AND AFFORDABLE CARE ACT INSURANCE COVERAGE REQUIREMENT." OpenSIUC, 2015. https://opensiuc.lib.siu.edu/dissertations/1139.

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The Affordable Care Act (ACA), passed on March 23rd, 2010, contains widesweeping legislation aimed at reforming the current U.S. healthcare system. The ACA has been lauded by its proponents and deeply criticized by its opponents. The current paper included two experimental studies designed to test if the individual insurance mandate requirement is a specific source of the psychological and behavioral resistance displayed toward the ACA. In study 1 the individual insurance mandate requirement did not produce greater negative attitudes towards the ACA or the current Presidential administration and it did not predict attitudes towards the longevity of the ACA. Democrats were found to have significantly less negative attitudes towards the ACA and towards the longevity of the ACA and Democrats also reported a lower likelihood of the ACA being repealed in comparison to Independents, Republicans or Libertarians. In study 2, the non-significant individual insurance mandate findings from study 1, were replicated in study 2. However, Democrats again were found to have significantly less negative attitudes towards the ACA and towards the longevity of the ACA in comparison to Independents, Republicans and those with no political affiliation. Democrats also indicated that they were less likely to vote for a political candidate who supports the repeal of the ACA in comparison to Independents, Republicans and those with no political affiliation. Implications and future research directions are discussed.
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18

Reimer, Denise M. "The effect of workload formulas to measure part-time faculty work in response to the Patient Protection and Affordable Care Act." Thesis, Edgewood College, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3705734.

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The Patient Protection and Affordable Care Act (PPACA, ACA) stipulates a full-time employee, defined as one who works an average at least 30 hours per week, merits a prescribed set of insurance benefits. Higher education institutions must determine whether a part-time employee meets the ACA definition of a full-time employee by calculating the average weekly working hours. Although challenges exist when defining and measuring academic instructional work, the purpose of this quantitative study was to examine the effect of various workload formulas as a means to measure the average weekly working hours of part-time faculty and to compare the results to the ACA definition of a full-time employee. The results, grounded in the Parametric Estimating Model framework, indicated that if the ACA was in effect in FY2013 several part-time faculty members met the ACA definition of full-time employee at one institution when utilizing workload formulas as a means to measure instructional work. The three common salient characteristics of these part-time faculty members include that they were either potentially loaded greater than 50% of a full-time faculty workload, reported excessive hourly-compensated work, or worked during the summer term. An organization risks the potential financial penalty of $2,000 annually for each full-time employee employed when an ACA defined full-time employee is not offered healthcare benefits. Therefore, the study recommends that the organization create methods to control and monitor hourly work and course assignments particularly of those offered in the summer term in order to avoid the risk of the ACA penalty or alternatively, provide access to healthcare coverage that meets the ACA requirements to its part-time employees. Part-time employees, including part-time faculty play a critical and important role for institutions of higher education.

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Leimbigler, Betsy. "Mixed Frames of Obamacare: a Critical Discourse Analysis of the Intertwining of Rights and Market Framing Discourse Surrounding the Patient Protection and Affordable Care Act." Thesis, Université d'Ottawa / University of Ottawa, 2014. http://hdl.handle.net/10393/31780.

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This thesis investigates the complex relationship between political institutions and health care policy through framing techniques employed in political discourse in the Patient Protection and Affordable Care Act (PPACA). It addresses how rights and market framing interact in the development, passage and further discourses on the PPACA. President Obama’s discourses are analyzed using qualitative critical discourse analysis of five remarks and addresses given between 2009-2013. These speeches are unpacked and catego-rized to illustrate the change in framing techniques over time. Three main findings are presented after the analysis portion: market framing is used more frequently in the developmental stages of the PPACA, mixed rights and market framing are largely conveyed through anecdotes, and the “right to affordable health care” is forwarded as an argument. These findings support the main argument that rights and market frames have a high level of interaction in the development of the PPACA.
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20

Smith, Lawrence Russell. "A case study: the executive leadership response at a community hospital to the value-based purchasing requirements of the Patient Protection and Affordable Care Act." UNF Digital Commons, 2017. http://digitalcommons.unf.edu/etd/747.

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This qualitative case study examined the perceived effectiveness of executive leadership team processes at a community hospital in the southeastern U.S. in relation to the Value-Based Purchasing (VBP) requirements of the Patient Protection and Affordable Care Act (PPACA) through an analysis of documents and a repository database (http:www.hospitalcompare.hhs.gov) relating to service quality, patient satisfaction, and governmental reimbursements; and, structured interviews. Today, the PPACA or “Obamacare” continues to challenge the executive leadership teams at U.S. hospitals to effectively navigate the intricacies of the legislation in order to remain solvent in a volatile healthcare arena. The Plan-Do-Check-Act (PDCA) model was utilized to guide the theoretical framework for this qualitative case study in terms of process improvement. Hill’s (2010) team leadership model was also applied to examine the perceived effectiveness of the executive leadership team processes in terms of analyzing any change in core measures and patient satisfaction scores from the federal fiscal year (FFY) 2013 and 2014, respectively. The VBP data reflected consistent core measure scores in the 48th percentile and an increase in patient satisfaction scores from the 20th to 33rd percentile. The results revealed that the executive leadership team processes were perceived by the researcher as effective as evidenced by a strong collaboration among administration, the bord, and medical staff in implementing several strategies via a team oriented approach that impacted Medicare patients during the FFY of 2013-2014. This study offers a starting point in terms of generating more understanding of the importance of executive leadership team processes at a community hospital in relation to the VBP requirements of the PPACA which can be studied on a broader scale in the future.
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Hamdy, Ronald C., J. V. Lewis, Rebecca Copeland, Audrey Depelteau, Amber E. Kinser, T. Kendall-Wilson, and Kathleen Whalen. "Patients With Dementia Are Easy Victims to Predators." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/1236.

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Patients with dementia, especially Alzheimer’s disease and particularly those in early stages, are susceptible to become victims of predators: Their agnosia (see Case 1) prevents them from detecting and accurately interpreting subtle signals that otherwise would have alerted them that they are about to fall for a scam. Furthermore, their judgment is impaired very early in the disease process, often before other symptoms manifest themselves and usually before a diagnosis is made. Patients with early stages of dementia are therefore prime targets for unscrupulous predators, and it behooves caregivers and health care professionals to ensure the integrity of these patients. In this case study, we discuss how a man with mild Alzheimer’s disease was about to fall for a scam were it not for his vigilant wife. We discuss what went wrong in the patient/caregiver interaction and how the catastrophic ending could have been avoided or averted.
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Pham, Tan Phu. "Differences in Access to Care and Healthcare Utilization Among Sexual Minorities: A Master's Thesis." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/719.

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BACKGROUND: The barriers in accessing healthcare for gay, lesbian and bisexuals individuals are not well explored. These challenges as well as a lack of knowledge concerning this understudied group has prompted the Institute of Medicine to create a research agenda to build a foundational understanding of gay, lesbian and bisexual health and the barriers they encounter.1 the primary aim of this study will be to compare the differences in health care access and utilization between gay/lesbian, bisexual and heterosexual individuals using a large, nationally representative dataset of the U.S. population. METHODS: Data from 2001 to 2012 from the National Health and Nutrition Examination Survey was pooled. Using logistic regression, we calculated the unadjusted and adjusted odds ratios of having health insurance, having a routine place and seeing a provider at least one in the past year. RESULTS: We found that gay men were more likely to have health insurance coverage (ORadj:2.13 95%CI: 1.15,3.92), while bisexual men were at a small disadvantage in having health insurance coverage (ORadj:0.82 95%CI: 0.46,1.46). Bisexual men were more likely to have received health care in the past 12 months (ORadj:3.11 95%CI: 1.74,5.55). Lesbian women were less likely to have health insurance coverage (ORadj-lesbian:0.58 95%CI: 0.34,0.97). CONCLUSION: This study contributed to the limited knowledge on understanding the health care access and utilization among gay, lesbian and bisexual individuals, which was classified as a high priority by the Institute of Medicine. Expanding health insurance coverage through the Affordable Care Act and Universal Partnership Coverage may reduce the disparities among gay, lesbian and bisexual individuals.
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Pham, Tan Phu. "Differences in Access to Care and Healthcare Utilization Among Sexual Minorities: A Master's Thesis." eScholarship@UMMS, 2006. http://escholarship.umassmed.edu/gsbs_diss/719.

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BACKGROUND: The barriers in accessing healthcare for gay, lesbian and bisexuals individuals are not well explored. These challenges as well as a lack of knowledge concerning this understudied group has prompted the Institute of Medicine to create a research agenda to build a foundational understanding of gay, lesbian and bisexual health and the barriers they encounter.1 the primary aim of this study will be to compare the differences in health care access and utilization between gay/lesbian, bisexual and heterosexual individuals using a large, nationally representative dataset of the U.S. population. METHODS: Data from 2001 to 2012 from the National Health and Nutrition Examination Survey was pooled. Using logistic regression, we calculated the unadjusted and adjusted odds ratios of having health insurance, having a routine place and seeing a provider at least one in the past year. RESULTS: We found that gay men were more likely to have health insurance coverage (ORadj:2.13 95%CI: 1.15,3.92), while bisexual men were at a small disadvantage in having health insurance coverage (ORadj:0.82 95%CI: 0.46,1.46). Bisexual men were more likely to have received health care in the past 12 months (ORadj:3.11 95%CI: 1.74,5.55). Lesbian women were less likely to have health insurance coverage (ORadj-lesbian:0.58 95%CI: 0.34,0.97). CONCLUSION: This study contributed to the limited knowledge on understanding the health care access and utilization among gay, lesbian and bisexual individuals, which was classified as a high priority by the Institute of Medicine. Expanding health insurance coverage through the Affordable Care Act and Universal Partnership Coverage may reduce the disparities among gay, lesbian and bisexual individuals.
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Medling, Nicholas. "The Individual Mandate, Commerce Clause, and Supreme Court: Predicting the Court's Ruling in HHS v. Florida." Scholarship @ Claremont, 2012. http://scholarship.claremont.edu/cmc_theses/345.

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An analysis of the evolution of the Commerce Clause, the Justices on the Supreme Court, and the arguments presented in this case indicate that the minimum coverage provision of the Patient Protection and Affordable Care Act will be struck down. Although the Court will likely be split 5 to 4 along ideological lines, each of the justices will have a unique rationale behind their decision. Chief Justice Roberts, Justice Scalia, and Justice Kennedy were heavily targeted by both parties’ oral and written arguments because there was speculation that any one of these traditionally conservative justices could be the fifth vote to uphold the individual mandate. However, it does not appear likely that the federal government supported their claims well enough to yield such a result. Instead, the Court will respond in the negative to the issue of "Whether Congress had the power under Article I of the Constitution to enact the minimum coverage provision." The Court’s interpretation of the Congress' commerce power has undergone two major expansions since the Constitution was ratified, and both of these expansions were met with a contractionary response to prevent the commerce clause’s growth into an unchecked power. This Court will not open a new frontier of power for the Congress, but rather it will respect the limits on Congressional power established by the Rehnquist Court.
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Alvarez, Cea Camila. "Verklighet eller en politisk illusion? : En studie av den svenska pressens syn på sjukförsäkringsreformen i USA." Thesis, Karlstad University, Division for Social Sciences, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-6091.

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Essay in Political Science, C-level, by Camila Alvarez Cea, spring semester 2010.

 

Tutor: Alf Sundin

“Reality or a Political Mirage? – A Study of the Swedish Press Views on the Health Insurance Reform in the USA”

 

The purpose of this essay is partly to examine whether the picture that Swedish press presents of the health insurance reform in the US, which is part of the Patient Protection and Affordable Act bill, will be of crucial importance to the possibilities that the American population has to receive health insurance. The main research question is accordingly: “Does the picture that Swedish press presents of the health insurance reform in the USA, seem like something that will be of radical importance to the possibilities of the population to receive healthcare?” The purpose is also to examine in which model (demand or market) the opinions of the Swedish press fits. This purpose will be answered by using three specific questions asking whether their opinions differ when it comes to three criterions: organization, financing/resources and delivery systems. These criterions come from a model from Milton I. Roemer’s book “National health systems of the world,” which also is the theoretical foundation of this essay.

 

The methodological approach of this essay is a qualitative text analysis along with an analysis chart, where the three criterions have been examined from the reporting of the four Swedish newspapers chosen for this essay. The conclusions that have been reached from the analysis chart are that the opinions differ greatly within Swedish press, and that the picture that Swedish press presents of the health insurance reform is that it will become easier for the American population to receive health care.

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Horáková, Kateřina. "Reforma systému zdravotní péče ve Spojených státech amerických." Master's thesis, Vysoká škola ekonomická v Praze, 2011. http://www.nusl.cz/ntk/nusl-97142.

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The Diploma work "Health care reform in the United States of America" is the sequel of the Bachelor work of 2008 called "The liberal health care system of the United States of America". The work is focused on the financial means and changes which has been effective since singing The Patient Protection and Affordable Care Act (acronym PPACA) into the United States law on 23rd March 2010 by the democratic president Barack Obama. The special attention is drawn to permanently increasing health care costs and defrauding of money within the social heath care program Medicare that is designated for seniors 65 and over as well as handicapped people. This work deals with Massachusetts Mandatory Health Insurance Program of 2006, which has been used like a model for the new federal law PPACA. The practical part presents the particular changes brought by the new law, including their impact on the chosen social groups -- the uninsured, the employers, the families and their kids, the seniors and the people with "pre-existing conditions". Since the Health care reform is the political issue as well, at the end there are mentioned some pros and cons opinions.
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Onukogu, Dr Claret. "Streamlining Hospital Administrative Procedures to Reduce Costs." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4810.

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Americans spent nearly $2.6 trillion, or $8,000 per person for medical and administrative costs in 2010. By 2015, healthcare spending in the United States increased to 5.8% reaching $3.2 trillion or $9,990 per individual. By tackling healthcare administrative costs, it is estimated that healthcare providers could reduce these costs by $20 billion yearly. This case study explored strategies for streamlining hospital administrative procedures to reduce costs. The business process reengineering model formed the conceptual framework for this study. Data were gathered through semistructured face-to-face interviews guided by open-ended questions with a purposeful sample of 4 hospital managers in Atlanta, Georgia. This study identifies important themes regarding cost reduction and hospital administration based on participant interviews. Themes included participants' unfavorable perspectives of the Spell out PPACA (PPACA) legislation, employment of physicians, PPACA reimbursement method, follow-up services, hospital administrative governance, and lack of business education. The themes comprised steps hospital managers could take to streamline administrative procedures to reduce costs. The implications for positive social change included the potential to provide strategies for streamlined processes that could lead to savings passed on to patients from low socio-economic backgrounds through accessibility to affordable healthcare services.
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Stephan, Lea. "Social policies and racial questions : from the Great Society to Obamacare." Thesis, Toulouse 2, 2017. http://www.theses.fr/2017TOU20120/document.

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Cette thèse propose un éclairage inédit sur la stratégie politique employée par le président Barack Obama pour réduire les inégalités raciales ; ceci dans un contexte dominé par le fort ressentiment de la population blanche envers les politiques sociales en général et les mesures dites « raciales » en particulier. La présente analyse s’appuie sur l’exemple spécifique de la réforme de santé Obamacare, fruit d’une stratégie politique soigneusement et prudemment choisie, mais qui a vu le jour au terme d’une bataille houleuse. La réforme fut élaborée dans un contexte d’extrême polarisation partisane en matière de politique sociale et de questions raciales, mais aussi au sujet de l’intervention de l’État. Ayant pour but la création d’une législation significative quoique politiquement acceptable, Obama a opté pour une stratégie politique de neutralité raciale en ciblant toutefois des problèmes spécifiques aux Afro-Américains. Ainsi, cette thèse démontre en quoi cette tactique s’est basée sur des considérations tant de faisabilité politique que d’efficacité afin de répondre aux besoins économiques spécifiques à la population noire. Il s’est également agit d’analyser comment l’administration Obama a réussi, après presque un siècle de tentatives infructueuses, à promulguer une loi mettant en place un système de couverture de santé universelle ; loi que les attaques répétées du Parti républicain ont profondément mutilé. Nous démontrons enfin qu’à l’instar de la non-extension de Medicaid qui a particulièrement nuit à la population noire, la réforme d’Obama, puisque basée sur un système préexistant, a finalement ravivé les problèmes de stratification raciale
This dissertation examines the political strategy used by President Barack Obama to address racial inequalities in a context dominated by a rejection of social policies in general, and race-specific initiatives in particular. This analysis is based on the example of health care reform. The legislation known as Obamacare, passed in 2010, which is composed of two Acts, the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act, was the result of a careful political strategy and a heated political battle. Obamacare was enacted in a context of strong partisan polarization around issues of social policies, racial inequalities, and the scope of government intervention. To achieve meaningful, yet politically acceptable, legislation, Obama chose a race-neutral, but issue-focused approach. This approach was mainly based on considerations of political feasibility, but also on considerations of efficiency in furthering black economic interests. Thus, this dissertation examines the foundation, application, and outcome of Obama’s political strategy as applied to health care reform. On the one hand, his administration managed to enact comprehensive health care reform after almost a hundred years of frustrated attempts. On the other hand, subsequent Republican attacks maimed the reform. Moreover, as the reform was built on the existing system, previous issues of racial stratification resurfaced. The non-extension of Medicaid was particularly detrimental to African-Americans. Yet, despite its imperfections, Obamacare, by creating for the first time a system of universal health care coverage in the US, has contributed to make public opinion more favorable to a single-payer system, in other words, a fully government-run health care system
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Ro, Myungsun. "The expanding role of the pharmacist under the Patient Protection and Affordable Care Act of 2010." Thesis, 2016. https://hdl.handle.net/2144/17693.

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The Patient Protection and Affordable Care Act (PPACA) represents one of the most significant pieces of legislation in the history of United States healthcare. The PPACA has two main goals: to increase the insured patient population in the US and to reduce the overall cost while improving the quality of healthcare in the US. To accomplish the latter goal, healthcare providers are experiencing a movement toward integrated, team-oriented models that place increasing accountability on the providers and institutions. At the same time, these integrative models emphasize effective preventive care, which is critical in reducing the country’s overall healthcare costs. As more health care institutions and providers across the country adopt the healthcare reform models of the Patient-Centered Medical Homes (PCMH) and Accountable Care Organizations (ACOs) directly under the PPACA, the demand for pharmacists is increasing. In addition, the role of the pharmacist through Medication Therapy Management (MTM) is growing as more public and private sectors adopt MTM and its standards are being used as the medication-related cornerstone for the ACOs. There is a call for lower costs and higher quality outcomes in healthcare, and the pharmacists are increasingly integrated into direct patient care and medication management. The newly integrated responsibilities of the pharmacist are numerous and almost limitless. The roleof pharmacists is expanding, and as many studies suggest, their contributions produce auspicious results.
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Rolle, Mary Joy. "Health care for homeless individuals : implications of the patient protection and Affordable Care Act." Thesis, 2011. http://hdl.handle.net/2152/ETD-UT-2011-05-3618.

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This professional report explores the unique health needs of homeless individuals, how homeless individuals access medical and mental health services, and the impact that the Patient Protection and Affordable Care Act (ACA) may have on medical services for homeless individuals. Homeless individuals are more likely to experience physical and mental health problems and earlier mortality rates than the general population. Common access points for homeless medical services include clinics, such as Community Health Centers, and emergency care centers, such as hospital emergency rooms. Homeless individuals often face barriers of access to medical services, including competing priorities to sustain life, strained relationships with medical providers, and an inability to pay for high health care costs. Through the expansion of Medicaid and the Community Health Center network, the ACA has the potential to increase access to medical services for homeless individuals. This report concludes by offering recommendations to ensure that homeless individuals benefit from health care reform through the ACA.
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Lavelle, Tanya Josée Holland. "Texas primary care and the Affordable Care Act : implications for the primary care physician workforce." Thesis, 2012. http://hdl.handle.net/2152/ETD-UT-2012-05-5809.

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Primary care physicians are the first point of contact for patients entering the formal health care system. A shortage of primary care physicians in the United States has left approximately 60 million people without adequate access to a physician, resulting in lowered health care outcomes and excess stress on the health care safety net. Texas has one of the most severe shortages of primary care physicians with more than 5.7 million people living in rural and urban areas considered to be underserved. The state’s rapid population growth, as well as the wide geographic distribution of its residents, makes it particularly vulnerable to health care disparities. Although there is a decisive need, factors like high medical school debt and low anticipated salaries are leading more students to specialize instead of pursue a primary care career. A variety of solutions have been proposed to address this problem including: rethinking the physician reimbursement structure; expanding graduate medical education opportunities for primary care students; and incentivizing primary care with loan repayment. In 2014, the new insurance exchanges created by the Patient Protection and Affordable Care Act will begin operating, giving millions more Texans access to health insurance. The current Texas primary care physician workforce shortage will be exacerbated once the major components of the Patient Protection and Affordable Care Act are fully enacted; therefore, state policymakers must take steps to increase Texas’ primary care physician workforce by making primary care a more attractive and accessible career path for medical students.
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Edwards, Lauren Jean. "RediClinic : an evaluation of a convenient care clinic in a shifting medical landscape." Thesis, 2010. http://hdl.handle.net/2152/ETD-UT-2010-12-2461.

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This paper offers in-depth look at the convenient care/retail clinic industry in the context of today’s changing medical landscape with specific focus on Texas-based RediClinic. In addition to a detailed analysis of RediClinic, this paper proposes detailed advertising, marketing and social media recommendations that will aid RediClinic in bolstering its brand image and expanding its client base. Every suggested tactic is framed within the rapidly changing healthcare environment present in America, and specific focus is given to the recent passing of the Patient Protection and Affordable Care Act. This paper attempts to aid RediClinic in understanding and leveraging its most important strengths: its strong position within the Texas market, and its service to those who are currently uninsured.
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Libet, Dean. "The Patient Protection and Affordable Care Act: a new dedication to primary care." Thesis, 2014. https://hdl.handle.net/2144/14376.

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The Patient Protection and Affordable Care Act drastically transforms the United States healthcare infrastructure. This law, passed in 2008, will shift financial incentives, payment methods, policies, and, in fact, the very way our physicians practice medicine. Currently, the US ranks 1st in healthcare costs, but 37th in healthcare service in the world. It is estimated that there are between 35-42 million uninsured Americans that ultimately cost 50 billion in taxpayer dollars annually. The 4,033 behemoth of a law sets the groundwork to provide high quality healthcare to all Americans with either insufficient or no insurance. Although it will affect every aspect of healthcare and medicine, this paper will assess the changes being made in primary care. The renewed dedication to family medicine provides the foundation to create a more cost efficient healthcare system and a healthier America. We will review the current state of primary care, assess the provisions enacted by the Patient Protection and Affordable Care Act, and evaluate future goals of family medicine. Ultimately the Affordable Care Act attempts to boost primary care, focus on prevention, and use research-based policies in order to lower healthcare costs and provide accessible healthcare. In order to do so, the United States needs to address the insufficiencies of the previous healthcare system and re-evaluate our healthcare expenditures.
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Gastmyer, Christine 1987. "The Impact of the Patient Protection and Affordable Care Act on the Health Education Profession as Perceived by the Leaders of the Profession: An Exploratory Study." Thesis, 2012. http://hdl.handle.net/1969.1/148308.

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The major legislation, the Patient Protection and Affordable Care Act, is attempting to overhaul the health care system in the United States. Health educators need to understand how this health care policy will impact the profession. Forecasted with change, this study’s goal was to provide preliminary insights into the perceived impact of the Affordable Care Act and changes that could occur within the health education profession as a result of this major health care reform legislation. Seven knowledgeable, experienced, and well-respected leaders of the health education profession participated in this qualitative research study. Semi-structured, exploratory interviews were conducted with six participants and one participant provided written responses to the interview protocol questions. After each interview, a thematic analysis was conducted on the participants’ responses. Five themes emerged from the interviews: (1) a fragmented sick-care system, (2) ACA becomes law: the participants’ reactions, (3) ACA becomes law: the profession’s reactions, (4) impact on the profession, and (5) health education in 2020. The changes the Affordable Care Act is attempting to make to the health care system are no secret. There is potential for health educators to do something they have never been able to do before because of the Affordable Care Act, but action must be taken by these professionals. The positive elements of this legislation need to be protected, strengthened and verified, and further action needs to be taken to assure all critical components for creating a truly reformed health care system are incorporated into future legislation. Future research focused on investigating the impact the Affordable Care Act has on the health education profession should be conducted on a regular basis. As more mandates within the law are enacted over time, the impact on the profession, more than likely, will shift. It is also recommended future research seek to quantify the impact the legislation has on the profession.
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Srinivasan, Ram active 21st century. "Policy goals, political reality, and IT problems : the influence of politics and policy-making on the launch of Healthcare.gov." Thesis, 2014. http://hdl.handle.net/2152/28664.

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Successfully designing and delivering a large-scale information technology (IT) system to meet new organizational objectives is a difficult undertaking in any context. The failure of the federally-facilitated online health insurance exchanges – known most commonly by their website address Healthcare.gov – to properly function when they opened for operations in 2013 provides a case study in how politics and policy-making can uniquely complicate IT projects in the public sector. Analysis reveals several instances where the legislative and regulatory process contributed to the project’s initial failure: from the project’s inception, elected representatives oversold the familiarity and simplicity of the site; statutory and regulatory law amplified the underlying technological complexity of the exchanges; partisan tensions extended the uncertainties around project scope until much too late in the process; legal and political concerns for maintaining stated delivery deadlines came at the cost of adequate testing and site functionality when it first opened; and the team appointed to oversee the project was more sensitive to political challenges then technological ones. Based on these findings, several recommendations are provided to help future representatives and government administrators minimize the negative toll that politics and policy-making can exact on a public sector IT project’s success. These include actively managing expectations, increasing information flow, simplifying functionality, providing fluid but reasonable delivery timelines, and appointing independent and technically savvy project leadership. Using Healthcare.gov as a case study on the effects politics and policy can have on developing IT systems can better prepare legislators and the public for future challenges of developing and implementing technology solutions in the public sector.
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McKell, Dawn C. "Does Merger and Acquisition Activity Play a Role in The Pre-Existing Healthcare Initiatives of Improved Quality and Decreased Costs Highlighted by The Affordable Care Act?" 2016. http://scholarworks.gsu.edu/bus_admin_diss/74.

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This is a quantitative study of archival data that examines Merger and Acquisition (M&A) activity using currently established healthcare quality and financial performance metrics. The research seeks to explicate the relationship between M&A activity and M&A experience in the healthcare industry as it relates to initiatives aimed at improving the quality and decreasing the cost of healthcare. The Affordable Care Act (ACA) legislation appears to be contributing to a trend toward M&A consolidation; by illuminating how this trend potentially impacts healthcare quality and cost reduction initiatives, this study’s contribution is both useful and practical. The units of analysis are Medicare reporting hospitals, hospital systems, and related healthcare providers that have or have not experienced an M&A or multiple M&As. The study shows a statistically significant improvement in quality each year from 2006–2014, which is reflected in higher scores for the four quality metrics measured. M&A activity, as measured by acquisition status and acquirer experience, did not appear to influence these quality metrics, with the exception of the heart failure measure, which showed a statistically significant positive influence of acquirer experience across all specifications. M&A activity’s possible effects on hospital financial performance was assessed through operating-cost-to-charge and capital-cost-to-charge ratios (CCRs). The operating CCR appears to be positively influenced by both acquisition status and acquirer experience, while the capital CCR was positively influenced only by acquirer experience. A positive influence is reflected in a decreasing ratio. Results on quality improvement over time, both before and after the ACA, suggest that the ACA itself may not be the driver for quality improvement. Similarly, decreases in OCCR occurred consistently and statistically significantly over time, both pre- and post-ACA, while CCCR showed statistically significant decreases in 2006–2008, 2013, and 2014. These results appear to support the notion that the trend was ongoing before the ACA was enacted and gave these measures high-profile exposure. This is a quantitative study of archival data that examines Merger and Acquisition (M&A) activity using currently established healthcare quality and financial performance metrics. The research seeks to explicate the relationship between M&A activity and M&A experience in the healthcare industry as it relates to initiatives aimed at improving the quality and decreasing the cost of healthcare. The Affordable Care Act (ACA) legislation appears to be contributing to a trend toward M&A consolidation; by illuminating how this trend potentially impacts healthcare quality and cost reduction initiatives, this study’s contribution is both useful and practical. The units of analysis are Medicare reporting hospitals, hospital systems, and related healthcare providers that have or have not experienced an M&A or multiple M&As. The study shows a statistically significant improvement in quality each year from 2006–2014, which is reflected in higher scores for the four quality metrics measured. M&A activity, as measured by acquisition status and acquirer experience, did not appear to influence these quality metrics, with the exception of the heart failure measure, which showed a statistically significant positive influence of acquirer experience across all specifications. M&A activity’s possible effects on hospital financial performance was assessed through operating-cost-to-charge and capital-cost-to-charge ratios (CCRs). The operating CCR appears to be positively influenced by both acquisition status and acquirer experience, while the capital CCR was positively influenced only by acquirer experience. A positive influence is reflected in a decreasing ratio. Results on quality improvement over time, both before and after the ACA, suggest that the ACA itself may not be the driver for quality improvement. Similarly, decreases in OCCR occurred consistently and statistically significantly over time, both pre- and post-ACA, while CCCR showed statistically significant decreases in 2006–2008, 2013, and 2014. These results appear to support the notion that the trend was ongoing before the ACA was enacted and gave these measures high-profile exposure.
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Howard, Steven W. "Medicare managed care : market penetration and the resulting health outcomes." Thesis, 2011. http://hdl.handle.net/1957/26133.

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Managed care plans purport to improve the health of their members with chronic diseases. How has the growing adoption of Medicare Advantage (MA), the managed care program for Medicare beneficiaries, affected the progression of chronic disease? The literature is rich with articles focusing on managed care organizations' impacts on quality of care, access, patient satisfaction, and costs. However, few studies have analyzed these impacts with respect to market penetration of Medicare managed care. The objective of this research has been to analyze the relationships between the market penetration of MA plans and the progression of chronic diseases among Medicare beneficiaries. The Chronic Disease Severity Index scale (CDSI) was constructed to represent beneficiaries' overall chronic disease states for survey or claims-based data, when more direct clinical measures of disease progression are not available. Using the CDSI on the MEPS survey dataset from AHRQ, we sought to assess the impacts of MA market penetration and other covariates on the overall chronic disease state of Medicare beneficiaries from 2004 through 2008. Though the model explains much of the variation in CDSI change, the author expected the multilevel model would show that MA penetration explains a significant level of variation in CDSI change. However, this hypothesis was not substantiated, and the findings suggest that unmeasured factors may be contributing to additional unexplained heterogeneity. Policymakers should explore opportunities to refine the current MA program. The MA program costs the federal government more than the Traditional Fee-for-Service Medicare program, and there is no definitive evidence that outcomes differ. Within both programs, there is opportunity to experiment with different models of payment, healthcare service delivery and care coordination. The Patient Protection and Affordable Care Act (ACA) contains provisions for innovative demonstration projects in delivery and payment. The effectiveness of these ACA initiatives must be monitored, both for impacts on health outcomes and for economic effects. This research can inform future approaches to outcomes assessment using the CDSI, and multilevel modeling methodologies similar to those employed here. Firms offering MA health plans would be prudent to proactively demonstrate their value to beneficiaries and taxpayers. They should explore means of better monitoring and reporting the longitudinal outcomes of their enrolled beneficiaries. Demonstrating that they can bring value in terms of improved health outcomes will help insure their long-term survival, both in the marketplace and in the political arena.
Graduation date: 2012
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Eliason, Erica Linn. "The Effects of Health Insurance Eligibility Policies on Maternal Care Access and Childbirth Outcomes." Thesis, 2021. https://doi.org/10.7916/d8-bwaq-kf37.

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This dissertation examines three health insurance eligibility policies and their impact on reproductive health outcomes for low-income women of reproductive age. The first paper examines the effects of expanded eligibility for Medicaid under the Affordable Care Act (ACA), on fertility among low-income women of childbearing age. The second paper explores the effect of presumptive eligibility policies in Medicaid for pregnant women on access to prenatal care and health insurance coverage. Finally, the third paper exploits state-level differences in eligibility for public versus private insurance under the ACA, and the effects on perinatal coverage patterns, childbirth outcomes, and access to care.
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BALLONI, MATTEO. "Strategie sanitarie comparate. Inghilterra e Stati Uniti, prove di convergenza tra modelli antitetici." Doctoral thesis, 2018. http://hdl.handle.net/2158/1137778.

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McCaslin, Brianna Jean. "Thou Shalt Not: Experiences of Contraceptive Use and Religious Identity Negotiation Among Married Catholic Women." Thesis, 2015. http://hdl.handle.net/1805/8363.

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Indiana University-Purdue University Indianapolis (IUPUI)
The Catholic Church is widely known for its opposition to birth control. Yet statistics show that the vast majority of American Catholics use birth control. While multiple studies have been conducted on a larger quantitative scale about the use or attitudes of American Catholics toward birth control, there have not been qualitative studies to understand the experiences of Catholics who use contraception. This study is particularly timely given the recent Catholic opposition to the Affordable Care Act’s mandate of employee healthcare provided birth control as well as, the extraordinary synod of bishops to discuss pastoral challenges to family life in October 2015. Fourteen married Catholic women were interviewed about their religious identities and experiences using contraception. Analysis demonstrated how these women constructed a religious identity by maximizing certain aspects, such as prayer and service, while minimizing other aspects, such as individual autonomy and denominational distinctions, of their religious identity. However in order to cope with the tension between their salient religious identity and their contraceptive decision making women utilizing multiple mechanisms. Specifically, they made boundaries around which types of contraception were acceptable and limits to church or individual authority; they justified their decisions based on medical necessity or betrayal they felt from the church; they legitimated their decisions by discussing God’s control and their husband’s perceptions of NFP; and they normalized their decisions through their desire to care for their children and be sexually intimate with their husbands. This research illuminates unique challenges that religious women face in their sexual decision making and sexual health practices that can help sex educators and health care providers care for women. Additionally, the Catholic Church and American Catholics make up huge forces in education, health care, charity, politics, and employment. However, not all Catholics follow the rules of the church. Those members who remain an active part of the Catholic Church, such as the practicing Catholics in this study can influence the way the church changes. By better understanding the experience of these dissenters, social researchers may be able to better understand the future of the Catholic Church.
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