A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / While it is known that over 266,000 Arizonans enrolled in health coverage through the federal Marketplace and Medicaid from October 2013 through May 2014, little analysis has been performed to examine whether enrollment by diverse racial and ethnic groups sufficiently reduced disparities in coverage. We obtained publicly available data from the Census Bureau comparing rates of uninsured by race/ethnicity from 2013 to 2014 in Arizona from the American Community Survey. The uninsured rate in Arizona for the total civilian no institutionalized population dropped from 17% in 2013 to 13.6% in 2014. The uninsured rate in Arizona for whites declined from 15.7% to 12.2%, for African Americans declined from 17.4% to 11.1%, for American Indian/Alaskan Natives declined from 26.9% to 24.1%, for Asian Americans declined from 15.1% to 11.0% and for Hispanic/Latino declined from 27.5% to 22.2%. We conducted interviews with nine community organizations in order to identify barriers that must be addressed moving forward to lessen insurance coverage disparities among various minority groups. Technological literacy and functionality, lack of funding, lack of personnel, physical vastness of many populations, language, and cultural differences were commonly identified as barriers to enrollment. Mistrust of government and confusion regarding the specific provisions within the ACA pertaining to Native individuals were also cited.

People living with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS; PLWHA) are at increased risk of insufficient medical care due to lack of insurance. Inadequate medical care for PLWHA contributes to increases in HIV transmission rates. The U.S. Surveillance Report noted that in 2015, over 1.2 million people were living with HIV infection, and there were approximately 50,000 new infections every year. The report further stated that about 675,000 people have died from HIV-related illnesses since its discovery in 1981. The implementation of the Affordable Care Act (ACA) in 2014 was intended to provide Americans, including people at risk of or living with HIV, options for health insurance coverage and better access to health care. It was also designed to allow people with existing health conditions such as HIV to reach for optimal health, irrespective of the severity of their condition. Andersen's behavioral model and economic theory provided the theoretical framework and conceptual foundation for this study's assessment of the impact of the ACA on the HIV care continuum. This quantitative study used secondary data with a retrospective correlational design. Data from the Health Resources Service Administration and the Behavioral Risk Factor Surveillance System were analyzed. Overall, chi-square tests indicated a steady increase in the number of PLWHA who achieved viral suppression (Ï?2 (1) = 105, p < .001) between 2010 and 2015. Future research should include the general American population to assess the impact of the ACA. This study could lead to positive social change as PLWHA are made more aware of the benefits of comprehensive health care coverage and increase healthcare utilization, leading to improved health for those infected and less transmission of the virus.

acase@tulane.edu / 1 / Yongkang Zhang

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Since the Affordable Care Act (ACA) was signed into law in March of 2010, there have been multiple large survey studies focusing on physicians’ thoughts towards health care policy issues. 1‐6 Unfortunately, there has not been adequate attention paid to medical students’ feelings on reform in the literature. Today’s medical students will enter their practice at a vital time in the ACA’s implementation and will play an integral role in health care reform throughout their careers.7,8 This study is a national project that used a survey tool to demonstrate how well medical students know the details of the ACA and what their feelings are on the legislation. The survey was sent to eight different medical institutions across the country with ten total medical school campuses, using SurveyMonkey to collect results. The institutions were chosen based on their geographic location, mix between private and public institutions, and available investigators at each institution. The survey tool was developed by Tyler Winkelman, MD, from the University of Minnesota after a comprehensive literature review, adaptation of items from his previous survey of medical students in Minnesota performed in 2012, and consultation with physicians and policy experts.9 The survey focuses on student’s opinion of the ACA, knowledge of nine key provisions in the ACA, level of support of key health care policies, feelings towards health care policy education in medical schools, and socio‐demographic information, including political ideology, debt amount and intended specialty. Data analysis was performed using Pearson’s Chi‐square tests and multiple logistic regression models at The University of Minnesota to test for associations between students’ opinion of the ACA and five key predictors: debt, medical school year, political ideology, ACA knowledge, and intended specialty. A total of 2,761 out of 5,340 medical students (52%) responded to the survey, with 63% of students indicating support for the ACA, 75% agreeing that they understand the key ACA provisions, and 56% indicating professional obligation to assist in implementation of the ACA. Students intending to enter surgery or a surgical subspecialty and students who identified themselves as conservative were found to have less support and professional obligation of the ACA when compared to students entering primary care (Internal medicine, family medicine, pediatrics, internal medicine/pediatrics, or emergency medicine) or identifying themselves as liberal or moderate. Students that were most knowledgeable of the ACA were found to more likely support the ACA and indicate professional obligation towards the legislation. In conclusion, our study found that the majority of medical students indicate support for the ACA and feel they have a professional obligation in assisting implementation. The views of the ACA differ based on student’s political ideology, anticipated specialty, and knowledge of key ACA provisions, but overall, there is optimism that this high level of support can lead to advocacy and successful health care reform down the road.

I estimate two models of consumer health insurance choices where individual attributes and e.g., income, age, gender, cost, etc. affect qualification for specific programs e.g., Medicaid and Medicare, but also affect the choices individuals make. From these results, I assess how these attributes affect health insurance choices using the 2008 Medical Expenditure Panel Survey. I then use these results to predict how individual health insurance choices change with the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014. My predictions estimate that more 50 percent of those who become eligible for Medicaid under ACA will switch to Medicaid or choose to have both Private and Medicaid insurance.

No description available.

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.

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.

Thesis advisor: Marvin Kraus / Thesis advisor: Matt Rutledge / The state of Massachusetts implemented a health care reform in 2006 that induced a number of changes to its health care system. Studies regarding this reform bear a certain degree of predictive power on the national scale because the reform was used as a model for the Affordable Care Act, the highly controversial national health care reform law passed in 2010. Most of the research on health care reform focuses on the costs, not the quality, of health care. I utilized a difference-in-differences statistical design to isolate the impact of the Massachusetts reform on the state's asthma mortality rate, a health care quality indicator. Given certain assumptions, my empirical results indicate that the reform led to a 45.38% reduction in asthma mortality in Massachusetts. Due to the similarity between the Massachusetts and the national health care reform laws, I drew the conclusion that national asthma mortality rates will decrease after 2014 when certain key provisions of the national reform come into play. / Thesis (BA) — Boston College, 2013. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Economics Honors Program. / Discipline: Economics.

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. / text