Applied Biostatistics



Applied Biostatistics

Health Reforms and Controversies

Health Reforms代写 Health care in America has become better and accessible by millions of people who could not have accessed it previously.


The main question that has been raised for years regarding healthcare is whether the Affordable Care Act has improved health care in the United States. The supporters argue that the Affordable Care Act is a landmark that has provided affordable health care insurance coverage to millions of people in America that they could not have accessed in previous years. The opponents argue that ACA has been a failure that has increased not only the cost of health care but also limited choices of Americans. Health care in America has become better and accessible by millions of people who could not have accessed it previously. Health Reforms代写**格式

However, some of the issues it seeks to address have remained unsolved and have continued to be debated as modifications are proposed amid controversies. As such, it is vital to research the health care reforms and disputes, which has impacted the sector to offer recommendations. Although the Affordable Care Act was introduced to solve health care access issues, it has continuously been reformed to make it better and controversies in equal measure.

Background Health Reforms代写

i. Health Care Sector in U.S.

Americans spent more than $3.65 trillion on health care in 2018. The expenditure rose by 4.4 percent from 2017 (Herman, 2019). The $3.65 trillion spendings on health care translate to $11,212 per person. More than 55 percent of the spending goes to hospitals, doctors, and clinical services. The health insurance has increased the expenditure per person to 4.5 percent between 2017 and 2018, and still, the number of enrollment has remained the same. Health Reforms代写**格式

Also, people still face difficulty in accessing medical care. The cost of health care has continued to rise and has continued to consume a large proportion of the federal budget (Amaded, 2019; Sobel, 2014). The cost of preventive care has become unaffordable. The various reforms aim to make the sector better and efficient.

ii. Health Care Reforms Health Reforms代写

The question that arises is the logic behind the implementation of health care reforms. Publicly available data from government agencies and published research between 1963 and 2016 reveals the need for health care reforms (Sobel, 2014). It has been found that ACA has made a significant stride towards attaining universal health care in terms of affordability, access, and quality. ACA has increased the number of insured by 43 percent, which is tremendous progress compared to 16 percent in 2010 and 9.1 percent in 2015. Health Reforms代写**格式

The study found that there has been an improvement in access to quality care, financial security, and health. The central reform is the health care payment system a shift from Medicare payment to bundled payment or accountable care organizations.

iii. Health Care Controversies Health Reforms代写

Affordable Care Act is dogged with various controversies, including the individual mandate, Medicaid, exchanges, insurance regulations, and cost. Although they have led to sustained slow growth in enrollment, there is an increase in the quality of health care. There are rooms for improvement in the health care system despite the progress made with the introduction of the ACA. Health Reforms代写**格式

Policymakers should, therefore, build on the progress made to ACA better in care delivery, public financing, implement Health Insurance Marketplace, and regulation of the cost of prescription drugs. Regardless of the opposition, ACA has a positive indication of better health care in the future.

iv. Health Care Benefits

Americans now have convenient access to insurance coverage through the ACA. The reform extend coverage to the poor citizens and their dependants. Also, health care consumers have the chance to understand all the jargons used in insurance as the are required to be available in plain language.

Literature Review Health Reforms代写

i. Research Design

The research used a systematic literature review and analysis to investigate the issues of reforms and controversies in health care. The population of the research is various quantitative studies which have been conducted on healthcare reforms and controversies and that have biostatistics analysis.

ii. Literature Review Health Reforms代写

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Health Reforms代写
Health Care Reforms

In this section, various quantitative literature will be reviewed regarding the issues of health reforms and controversies. The evaluation of the literatures will be used to derive the findings for the research and hence facilitate in offering recommendations.

The article by Courtemanche, Marton, Ukert, Yelowitz, and Zapata (2017) focus on the causal impact of the Affordable Care Act on health insurance coverage. Health Reforms代写

The survey used the differences-in-differences-in-differences model that analyze disparities in access to health care regarding states participation in Medicaid and the changes in the rate of uninsured rates. The approach used allowed the researchers to study the effect of ACA. The research used data from the American Community Survey. The Census Bureau collected the data on the features of population and housing. Health Reforms代写**格式

The population was all U.S. The samples of the census represented 1% of the whole U.S. population. Participation was not optional. Participants were conducted online or via a questionnaire mailed to the agency. ACS surveyed more than 3,000,000 participants.

The critical variable of the study was the uninsured rate in the participants in 2013. Health Reforms代写

It identified 630 local areas around all states, and each of them contained more than 78,000 participants in 2013 (2017). The sample size was considered large enough for all areas. The various control variables use demographics in terms of age, sex, race, and citizens and non-citizens. The other control variable was family structure and economic categories. The main was to get correlation in the effects of ACA in various states. Health Reforms代写**格式

The dependent variable included insurance covers, which can be private, employer-sponsored, individually purchased, Medicaid, and any other cover available. The dependent variable was the Medicaid expansion or non-expansion to either above or below the median baseline uninsured.

The study used baseline multivariable DD model represented by Health Reforms代写

yiast=β0+β1 POS Tt+β2( MEDICAL Ds× POS Tt)+β3Xiast+αas+εiast, where;

“Yiast is results of respondent i in local areas in a state s in year t,

POSTt is an indicator period t, that is 2014,

MEDICAIDs is an indicator that shows whether state s took part in 2014 ACA expansion,

Xias is a vector of control variables,

∞as is a local area fixed effect, and

Ƹiast is the error term.

Β1 is the impact of the non-Medicaid, Β1 represent the Medicaid expansion.

The research also used DDD model Health Reforms代写

yiast=γ0+γ1 UNINSURE Das× POS Tt+γ2(MEDICAI Ds× POS Tt)+γ3 UNINSURE Das× MEDICAL Ds× POS Tt+γ4Xiast+ττ+αas+εiast, where;”

“where UNINSURE Das is the 2013 uninsured rate in the local area an in state s, and ττ is a year fixed effect. …. MEDICAIDs, UNINSUREDs, and UNINSURE Ds× MEDICAL Ds are not separately included since they are perfectly collinear with the area fixed effects.” Health Reforms代写**格式

The results having a respondent with insurance cover were acquired using baseline DD and DDD models of regression analysis. The tests for inferences were conducted using randomization. The test looked to prove that the statistical error was as a result of underestimation of standard errors. There were 51 clusters grouped as control and treatment.

The researchers used 27 states with Medicaid expansion to implement the method of inference test. Health Reforms代写

DDD was re-estimated with a repeat of 1000 times to obtain the distribution of the results of the model (2017). An extreme DDD estimate will decline the null hypothesis. Then the p-value was calculated on the proportion of the results from the null distribution that are larger than the DDD baseline coefficient estimates. The same process was repeated for the non-Medicaid expansion. The overall results from local areas show that Medicaid expansion reduced uninsured rate by 3.1 percent in 2014. The results are essential to inform the comparison of the impact of Medicaid expansion and non-expansion states. Health Reforms代写**格式

Recent research by Daw and Sommers, (2019) focused on the health care reform brought about by the ACA and how it has impacted on the access to care for the women. The research used the National Health Interview Survey of 2010-2013 and 2015 -2016 to determine expansion. The data collected was based on the sociodemographic, health insurance status, care access, and care utilization. The target population was all American women. Sampling was done randomly. Health Reforms代写**格式

The sample represented women at the reproductive stage or those pregnant. The number of women covered and accessibility of ACA were the dependent and independent variables, respectively. The data were statistically analyzed for interpretation.

Daw and Sommers used a logistics regression model were used to estimate the relationship between the ACA and the data results. Health Reforms代写

The difference in the predicted probability of results between the two periods of research was compared. The control variables included age, race, marital status, region, and economic status.

They found that the first phase of ACA implementation showed an adjusted 3.9 percent decline in uninsured women while the second phase of research recorded a 7.4 percent decrease in uninsured. The number of insured women increased with an increase in Medicaid coverage. The confidence interval for both survey periods was 95% confidence interval [CI] = −4.8, 2.9, and 95% CI = −8.6, −6.2, respectively. Health Reforms代写**格式

Therefore, according to Daw and Sommers, there was a decrease in uninsured and increased in nongroup private insurance in women population. There was also an increase in access to care. The ACA reform reversed uninsurance among reproductive-age women for both periods. Health Reforms代写**格式

Research by Bhatt and Beck-Sagué (2018) investigated how ACA reforms has contributed reduction or increase in infant mortality. The study utilized the data set of infant mortality rate from all the states for the year 2010 to 2016. The dependent and independent variables were children mortality and Medicaid coverage, respectively.

The data were tested using Bartlett for homogeneity of variances. Health Reforms代写

The research used T-test to assess the appropriateness and make comparisons of infant mortality in after Medicaid implementation.

After the introduction of ACA Medicaid, the national infant mortality rates decreased by 11.9 percent. The difference in mortality rates between those states that accepted expansion and those that declined rose from 0.573 (P = .08) in 2014 to 0.599 (P = .037) in 2015 and 0.838 (P = .006) in 2016. A similar phenomenon of infant mortality was observed regarding race/ethnic comparisons. There was a decline in infant mortality in the African Americas from 12.2 in 2010 to 10.7 in 2015. The decline was attributed to the expansion of Medicaid.

Health Reforms代写
Health Reforms代写
Health Care Controversies Health Reforms代写
Sobel (2014) researched on the reason some states refused to expand Medicaid.

Almost half of the states have not expanded Medicaid, citing high cost and strain on the state budget. The controversy is mainly politically instigated with researcher stating that the ruling political party is likely to control the decision for expansion regardless of the cost. Health Reforms代写**格式

The study used probit and logit binary choice models to determine the yes and no decision of the state to expand Medicaid. The aim was to find out factors that correlated with states decision to either expand or decline Medicaid as per the call by ACA. The model of probability was used to predict whether undecided states will expand or not. As such, the primary dependent variable is whether the state has the ruling party dominance at the lower legislative chamber. The independent variable is the state decided that is logit and probit. Health Reforms代写**格式

The research found that it is easy to predict the probability that a state that has not decided on Medicaid expansion. The state which had a higher number of Republican control at both legislative chambers had a higher likelihood of expanding ACA.

Another controversy that has hit health care reform is the access to Opioid as a prescriptive drug that has a prevalence for abuse. Health Reforms代写

Research by Sharp, Jones, Sherwood, Kutsa, Honermann, and Millett (2018) aimed to establish the impact of Medicaid expansion and Opioid crisis in the United States. The article argues that health care reform has increased access to Opioid analgesic medications. The research used data available in all states about Medicaid enrollment and reimbursement between 2011-2016 to analyze Opioid prescription trends. Health Reforms代写**格式

The dependent and independent variables were Opioid use and Medicaid expansion of non-expansion, respectively. The Medicaid took the forms of post-expansion, medicated assisted treatment and expansion and non-expansion. They used difference-in-difference and interpreted time series models to calculate prescription rates in the periods before and after ACA reform. Hypotheses tests for DD model looked into the significant of the b2 coefficient while that of the time series model evaluate the effect of expansion b5 and b6. Health Reforms代写**格式

The research found that the rate of opioid prescription increased with the expansion of Medicaid. As such, there was fewer number of units prescribed in non-expansion areas. Similarly, the rate of use of opioid increased over the years after introduction ACA’s Medicaid reform.

Recommendations Health Reforms代写

Policymakers should weigh options it has such as expanding coverage versus reducing costs; quality care to the sick and expensive care versus choice of citizens who might not need the cover as well as lowering federal government cost liability versus reducing shifting cost to the citizens and states. Thus, to decide for opposing objective or creating balance in them will need political and value considerations of the required health care system in the United States.

Conclusion Health Reforms代写

The growth in the health care system did not come the easy way. The U.S. health care sector has undergone numerous changes in the bid to make care delivery effective and efficient. Some of these reforms include Medicaid expansion, which offered health insurance coverage to the poor citizens. However, the improvements did not happen without opposition due to controversies. People were divided, especially along political lines on the implementation of Medicaid. Health Reforms代写**格式

Most of the opposing groups or states cited the high cost of implementation and unsustainability, among other things. Therefore, reforms in health care should be continuous to factor in the changes and needs occurring over time.

References Health Reforms代写

Bhatt, C. B., & Beck-Sagué, C. M. (2018). Medicaid expansion and infant mortality in the United States. American journal of public health, 108(4), 565-567.

Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2017). Early impacts of the Affordable Care Act on health insurance coverage in Medicaid expansion and non‐expansion states. Journal of Policy Analysis and Management, 36(1), 178-210.

Daw, J. R., & Sommers, B. D. (2019). The Affordable Care Act and Access to Care for Reproductive-Aged and Pregnant Women in the United States, 2010–2016. American journal of public health, 109(4), 565-571.

Sobel, R. S. (2014). The elephant in the room: why some states are refusing to expand Medicaid. Applied Economics Letters, 21(17), 1226-1229.

Sharp, A., Jones, A., Sherwood, J., Kutsa, O., Honermann, B., & Millett, G. (2018). Impact of Medicaid expansion on access to opioid analgesic medications and medication-assisted treatment. American journal of public health, 108(5), 642-648.


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