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Relationship Between Health Care Costs and Type of Insurance Macey Buker Walden University

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Relationship Between Health Care Costs and Type of Insurance Macey Buker Walden University Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2017 Relationship Between Health Care Costs and Type of Insurance Macey Buker Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Health and Medical Administration Commons, and the Public Policy Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Macey Buker has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. James Goes, Committee Chairperson, Health Services Faculty Dr. Stephanie Hsieh, Committee Member, Health Services Faculty Dr. Simone Salandy, University Reviewer, Health Services Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2017 Abstract Relationship Between Health Care Costs and Type of Insurance by Macey Buker MHA, Weber State University, 2014 MAcc, Utah State University, 1995 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Health Sciences, Health Administration Walden University November 2017 Abstract Continued escalation in health care expenditures in the United States has led to an unsustainable model that consumes almost 20% of GDP. Policymakers have recognized the need for industry reform and have taken action through the passage of the Affordable Care Act (ACA). The purpose of this quantitative, longitudinal study was to examine the relationship between the type of health insurance and health care costs. Mechanism theory and game theory provided the theoretical framework. The analysis of secondary data from the Healthcare Cost and Utilization Project included a sample of 1,956,790- inpatient hospital stays from 2007 to 2014. Results of one-way ANOVAs indicated that between 2% and 9% of health care costs could be attributed to type of health insurance, a statistically significant finding. Results also supported the effectiveness of the ACA in stabilizing health care costs. The average annual rate of health care cost increase was 38.6% from 2007 until 2010, decreasing to an average annual increase of 4.3% from 2011 until 2014. Results provide important information to generate positive social change for consumers, providers, and policymakers. This includes improving decisions related to health care costs, improved understanding of the costs of health care services, increased transparency, increased patient engagement, maximizing consumer utility, facilitation of reduction of waste within the industry, and increased understanding of the impact of health policy on health care costs and efficiencies within newly created health policies. Results may also improve transparency of health care costs, which allows consumers, providers, and policymakers to take specific action to reduce health care costs, resulting in a more just and sustainable health care model. Relationship Between Health Care Costs and Type of Insurance by Macey Buker MHA, Weber State University, 2014 MAcc, Utah State University, 1995 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Health Sciences, Health Administration Walden University November 2017 Dedication I dedicate my dissertation work to my family, friends, and colleagues who have supported me throughout the process. A special thanks to my wife, Leeshel, for her unwavering support and words of encouragement throughout the process. Acknowledgments I wish to thank my committee members who were always generous with their expertise and time. A special thanks to Dr. James Goes, my committee chair, for his never-ending support, encouragement, reading, reflection, and most of all patience in guiding me through the process. Table of Contents List of Tables .......................................................................................................................v List of Figures ................................................................................................................... xii Chapter 1: Introduction to the Study ....................................................................................1 Background ....................................................................................................................2 Lack of Transparency ............................................................................................. 3 Type of Health Insurance ........................................................................................ 4 Problem Statement .........................................................................................................6 Purpose ...........................................................................................................................7 Significance ....................................................................................................................8 Nature of the Study ........................................................................................................9 Theoretical Foundation ................................................................................................11 Research Questions and Hypotheses ...........................................................................14 Limitations ...................................................................................................................15 Scope and Delimitations ..............................................................................................17 Operational Definitions ................................................................................................19 Assumptions .................................................................................................................20 Summary ......................................................................................................................21 Chapter 2: Literature Review .............................................................................................23 Problem Statement .......................................................................................................24 Purpose .........................................................................................................................25 Literature Search Strategy ............................................................................................25 i Theoretical Foundation ................................................................................................26 Development of the Health Care Industry ...................................................................29 Current Industry Practices ............................................................................................40 Role of Consumers ................................................................................................ 41 Role of Third-Party Payers ................................................................................... 43 Type of Health Insurance ...................................................................................... 45 Role of Health Care Service Providers ................................................................. 51 Complexity in the Health Care System ................................................................. 57 Summary ......................................................................................................................58 Chapter 3: Research Method ..............................................................................................62 Research Methodology and Design .............................................................................62 Setting and Sample ......................................................................................................64 Data Collection ............................................................................................................67 Instrumentation and Materials .....................................................................................69 Data Collection and Analysis .......................................................................................69 Measures for Protection ...............................................................................................71 Summary ......................................................................................................................73 Chapter 4: Results ..............................................................................................................74 Data Collection ............................................................................................................77 Results. .........................................................................................................................84 Assumptions .......................................................................................................... 84 ANOVA Analysis ................................................................................................. 88 ii Post Hoc Analysis of Statistical Tests .................................................................
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