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Is health care a right or an entitlement? This question persists in the ongoing political, legal, and social turbulence surrounding efforts toward accessible and affordable health care in the United States.

The analysis is drawn from a review of the literature and interviewing a subject matter expert employed by a health maintenance organization in Michigan.

Since the early 1900s, federal legislation has been proposed to establish some type of health care structure that could sufficiently address the varying health care needs of Americans. These multiple attempts toward national health care reform invoke the inquiry of the federal government’s role and function to facilitate access to and management of health care. The passage of the Patient Protection and Affordable Care Act (PPACA) amplifies the conditions and consequences of implementing health care reform effectively.

For college students, the complexities of both the health care and higher education systems can be overwhelming, especially for those students who may already be struggling to pay for and/or finance their schooling and satisfy academic requirements to matriculate while simultaneously striving to maintain a reasonable level of health to complete their education. College students are but one of many vulnerable populations in the United States impacted by the complicated policies and procedures of accessing, delivering, funding, and paying for health care.

This study aims to examine the effect of the Patient Protection and Affordable Care Act (PPACA) on for-profit hospitals in the USA.

The study uses the event study methodology to examine the stock market’s reaction to the passage of the PPACA.

The results of the analysis do not show a negative effect; on the contrary, the stock prices of for-profit hospitals increased, on average, by 6%. The cumulative abnormal returns were 5.64% with a generalized z-value of 3.851 with a significance level of 0.001 (two-tailed test). This translates into an average gain of $230,537,096 for the four days (dates) that a positive step was taken in making the Affordable Care Act (ACA) a law of the country.

Because the study suggests that for-profit hospitals will be profitable under the PPACA, one could expect to see growth or, at the minimum, expansion in for-profit hospitals under the Act. Furthermore, and consistent with the principles of marketing, one would expect all the for-profit hospitals, at this nascent stage of the ACA, to pull resources together to promote the benefits of having the ACA.

To the best of the author’s knowledge, this is the first study to examine the effect of the PPACA on the operations of for-profit hospitals.

This paper aims to explore the perspectives of Ohio physicians on the Patient Protection and Affordable Care Act (ACA) of 2010. While much has been debated about ACA, relatively few studies have focused on how ACA will impact on physicians' practice behavior.

The research data came from a mailed survey of ninety physicians randomly selected from the Cigna Directory of Physicians practicing in Ohio. Study examined how informed were physicians about ACA, and explored how much the effect of ACA has been discussed in their practice, how they think ACA will impact their practice, and whether or not they are in favor of the provisions under the Act.

Overwhelmingly, while the physicians surveyed were familiar with the specific provisions of ACA, almost half of them opposed it. Primary care physicians reported generally favorable opinions about ACA. All but one of the physicians concluded that ACA, much like managed care provisions, has undermined and will continue to reduce the autonomy and professional independence of physicians.

This study is limited by its small sample and reliance on a small set of physicians.

This study has practical implications for examining how Ohio physicians are responding to the new health care reform in the United States. It has broader implications for addressing the problem of the uninsured and the role of the federal government in health care provision.

If physicians are opposed to this reform as the study seems to suggest, it might have broader implications for future career aspirations for physicians.

So far as we can tell, there has not been any exploratory study in Ohio examining the perspectives of physicians on ACA.

Procedures can be categorized as certain surgeries based on their necessity and outcomes while others are classified as uncertain surgeries based on these areas. To account for this variance, policies such as the Affordable Care Act (ACA) call for health care providers to engage in shared decision making (SDM) with patients to ensure they are informed of treatment options and asked their preferences. Yet, gender may influence the decision-making process. Thus, this project examines the decision process and how gender impacts patients’ participation in decisions to undergo certain surgeries compared to uncertain surgeries.

This research project analyzed data from the National Survey of Medical Decisions 2006–2007 which surveyed the medical decisions of US residents 40 and older.

First, the data reveals that women felt more informed having uncertain surgeries compared to men. Second, patients were less likely asked their preference for surgery when undergoing certain surgeries compared to uncertain surgeries. Third, compared to men, women having uncertain surgeries were less likely to make the final decision to have surgery, compared to sharing the final decision with health care providers.

Due to the sample size, this project could not perform three-way interactions between gender, race, and surgery type.

Gender influences the level patients feel informed having uncertain surgeries. Though policy calls for SDM, health care providers are less likely to ask patients their preference for surgery regarding certain surgeries, relative to uncertain surgeries. Gender impacts the final decision-making process regarding whether patients should have uncertain surgeries.

This chapter problematizes the body politics of American liberalism, as viewed through the lens of health policy. The author suggests that American efforts to pursue basic health goals are undercut by the particular way in which American liberals – and their state – conceptualize bodies. To understand the theoretical basis of this body politics, the chapter examines policy preoccupations such as the institution of informed consent, malpractice reform, and efforts to establish a Patients’ Bill of Rights. Finally, considering the ideological contexts that have given rise to the Patient Protection and Affordable Care Act, the author gestures toward the establishment of a stronger liberal – and possibly post-liberal – health care system that takes the embodiment of its subjects seriously.

The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics (RHCs) are responding to the ACO model. This research examines RHC managers’ perceived benefits and barriers for implementing ACOs from an organizational ecology perspective.

A survey was conducted in spring of 2012 covering the present RHC network working infrastructures – (1) Organizational social network; (2) organizational care delivery structure; (3) ACO knowledge, perceived benefits, and perceived barriers; (4) quality and disease management programs; and (5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of 91 responses were received.

RHC managers’ personal perceptions on ACO’s benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis.

The study is primarily focused in the Southeastern region of the United States. The generalizability is limited to this region. The predictors of RHCs’ participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act.

RHCs are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform in the United States.

The purpose of this paper is to examine whether the timing associated with the implementation of the health insurance-related provisions of the Patient Protection and Affordable Care Act (ACA) altered the presence and distribution of medical/non-medical debts accumulated by different types of bankruptcy filers.

Data were drawn from the US Bankruptcy Court’s Eastern Washington District over the years 2009, 2011 and 2014 using interval random sampling. Binary probit and Tobit analyses were used to model the existence, and distribution, of medical debts and total debts, respectively, at the time of filing. The impact of the time frame associated with the ACA was operationalized via a Chow test for structural dynamic change.

Chapter 13 filers in 2014 (post-ACA-based health exchange implementation) were more likely to report medical debts than Chapter 7 filers in the pre-intervention period, and were also more likely to report a larger proportion of outstanding debts owed to a single creditor. Filers claiming health insurance premium expenses in 2011 were (at the 10 percent significance level) more likely to report a more skewed distribution of medical debts.

The time frame associated with the implementation of the ACA impacts the distribution of medical debts among filers who have sufficient net disposable income to fund a Chapter 13 plan. The polarization of outstanding medical debts may indicate coverage gaps in existing health insurance policies, whose costs would be disproportionately borne by patients operating on thin financial margins.

At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public health) and other industry sectors, began to recognize the limitations of the current fragmented healthcare system paradigm. Primary stakeholders, including employers, insurance companies, and healthcare professional organizations, also voiced dissatisfaction with unacceptable health outcomes and rising costs. Grand challenges and wicked problems threatened the viability of the health sector. American health systems responded with innovations and advances in healthcare delivery frameworks that encouraged shifts from intra- and inter-sector arrangements to multi-sector, lasting relationships that emphasized patient centrality along with long-term commitments to sustainability and accountability. This pathway, leading to a population health approach, also generated the need for transformative business models. The coproduction of health framework, with its emphasis on cross-sector alignments, nontraditional partner relationships, sustainable missions, and accountability capable of yielding return on investments, has emerged as a unique strategy for facing disruptive threats and challenges from nonhealth sector corporations. This chapter presents a coproduction of health framework, goals and criteria, examples of boundary spanning network alliance models, and operational (integrator, convener, aggregator) strategies. A comparison of important organizational science theories, including institutional theory, network/network analysis theory, and resource dependency theory, provides suggestions for future research directions necessary to validate the utility of the coproduction of health framework as a precursor for paradigm change.

This paper aims to study the post-patent ethical drug market and simulate the impact of Patient Protection and Affordable Care Act (ACA) on individuals, health-care providers and pharmaceutical firms. US policymakers have been looking at various ways to curb rising health-care costs in USA, including ways to promote the use of generic drugs in lieu of brand drugs. In this broader context, the implementation of ACA in December 2013 will introduce major changes in the pharmaceutical market.

To fully understand the impact of such policy changes, we develop a structural model to study consumers’ buying behavior and firm competition in the post-patent ethical drug markets. We use the estimated model parameters to conduct four policy simulations to illustrate the effect of Obamacare on increasing the relative size of price-insensitive segment, reducing price sensitivity in the price-sensitive segment, providing brand price discount to Medicare patients previously in the “donut hole” and the effect of change in people’s attitude toward generics.

Our model estimation reveals two classes of consumers with different price sensitivities. This heterogeneity explains the increase in the brand price after generic entry. We identify consumers’ switching costs between generic and brand drugs, as well as among different generics. From the policy simulation, we find that except the closure of Medicare donut hole, all other policy changes lead to increased usage of the focal molecule, and the efforts to increase insurance coverage and reduce the out of pocket payment for prescription drugs lead to increase in firm profit.

This paper is the first to illustrate the potential policy effect of Obamacare through a structural model on post-patent ethical drug market.

As the new Patient Protection and Affordable Care Act (ACA) achieves full implementation in 2014–2015, public perceptions regarding improvement in access and quality of care due to the ACA provide a fertile area for sociological research. The aim of this chapter is to determine if race is independently associated with perceptions of quality of care and access to care after ACA implementation. And, secondarily, we examined if such a relationship remained stable after considering SES (education and income) alone and SES with other relevant individual characteristics.

Data come from a telephone survey of a representative sample of Georgia residents aged 18 years or older. For each domain of the dependent variables (quality of care and access to care), three models were fitted with a nested design. The first model included only race. The second model included only race and SES. Model 3 included race, SES, and the following individual characteristics: (1) self-rated health status; (2) sense of coherence (SOC; a construct used to explain why some people are more disposed than others to illness after stressful situations); (3) travel time to doctor’s office; (4) importance of short wait times as doctor’s office; (5) political affiliation; and (6) geographic location (rural/non-rural).

Race was significantly associated with both the quality of care and the access to care. Non-White respondents were more likely to perceive improvements to both as a result of the ACA. Likewise, respondents with either higher education or income were also more likely to perceive improvements in quality and access as a result of the ACA. However, these associations were partly explained by respondents’ self-reported political affiliations.

Results of this study show that public perceptions toward the ACA and its impact on quality and access to care seem to differ based on an individuals’ race, income level and political affiliation. This may be a reflection of the media blitzkrieg that surrounds the ACA rather than a direct consequence of the policy itself. A concerted effort to develop communication strategies and outreach efforts by race and SES that can better educate the general population on the ACA may alleviate some of the reservations that are inherent to any major policy implementation, especially in terms of healthcare quality and access.