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Comparison of Affordable Care Act and Ryan White Coverage on Treatment Compliance, Engagement, Affordability, and Health Status for People Living with HIV/AIDS

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Comparison of Affordable Care Act and Ryan White Coverage on Treatment Compliance, Engagement, Affordability, and Health Status for People Living with HIV/AIDS Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2020 Comparison of Affordable Care Act and Ryan White Coverage on Treatment Compliance, Engagement, Affordability, and Health Status for People Living with HIV/AIDS Todd Blum Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Medicine and Health Sciences 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 Todd Blum 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. David Segal, Committee Chairperson, Health Services Faculty Dr. Shari Jorissen, Committee Member, Health Services Faculty Dr. Simone Salandy, University Reviewer, Health Services Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2020 Abstract Comparison of Affordable Care Act and Ryan White Coverage on Treatment Compliance, Engagement, Affordability, and Health Status for People Living with HIV/AIDS by Todd Blum MHA, Georgia State University, 1996 MBA, Georgia State University, 1995 BSM, Tulane University, 1993 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Health Sciences Walden University August 2020 Abstract The Ryan White HIV/AIDS Program (RWHAP) provides HIV care to uninsured people living with HIV/AIDS (PLWHA). Although the RWHAP has helped PLWHA achieve a viral suppression rate of 84%, this does not meet the 90% target goals under the U.N. 90- 90-90 plan to end the AIDS epidemic. The Affordable Care Act (ACA) was enacted to enhance access and health status, but outcomes have not been measured for PLWHA. The purpose of this quantitative correlational cross-sectional study was to determine whether PLWHA enrolled in an ACA qualified health plan (ACAQHP) achieved improved health status compared to PLWHA enrolled in the RWHAP. Andersen’s behavioral model of health services use provided the theoretical framework for this study. Research questions addressed variables such as demographic factors, difficulty in paying out-of-pocket medical expenses, health status, coverage status, treatment compliance, and engagement in care. A purposeful convenience sample of weighted secondary data from 30,670 PLWHA residing in Florida who participated in the 2015-2017 Medical Monitoring Project survey was used. Multiple linear regression only showed a statistically significant relationship between engagement in care and health status. Mann- Whitney U tests indicated a statistically significant difference in treatment compliance and engagement in care, but not in health status between RWHAP and ACAQHP enrollees. Findings also showed that those enrolled in the ACAQHP had less difficulty in paying their health care expenses than those in the RWHAP. Study results may be used to encourage enrollment in an ACAQHP and improve health outcomes due to access to more affordable comprehensive services. Comparison of Affordable Care Act and Ryan White Coverage on Treatment Compliance, Engagement, Affordability, and Health Status for People Living with HIV/AIDS by Todd Blum MHA, Georgia State University, 1996 MBA, Georgia State University, 1995 BSM, Tulane University, 1993 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Health Sciences Walden University August 2020 Dedication This dissertation is dedicated to my family. To my wife, Hope, and my children, Brian, Carly, and Kailee, thank you for your patience and support, which allowed me to dedicate the time needed to complete my research. To my parents, Roz and Steve Blum, thanks for instilling in me the passion to pursue my dreams. Acknowledgments Completing my dissertation would not have been possible without the support of my team. First and foremost, thank you to Dr. David Segal, my committee chair. I am grateful for the significant amount of time and effort you invested in my research, and I have appreciated your encouragement and guidance throughout my dissertation journey. To my professor and committee member, Dr. Shari Jorissen, thank you for helping me with the statistical analysis portion of my research. I appreciate your demand for excellence and for helping me elevate the overall quality of my work. To my university research reviewer, Dr. Simone Salandy, thank you for reviewing my work and providing suggested improvements. I also want to thank Dr. Zin Htway and Dr. Deirdre Rogers for helping me to increase my grasp of doctoral-level statistical theory. I also wish to express my sincere gratitude to the Florida Department of Health and Dr. Emma Spencer, Ph.D., MPH, HIV/Hepatitis Surveillance Program Manager, HIV/AIDS Section, Bureau of Communicable Diseases and Shana Geary, MPH, CPH, Supplementary Surveillance Program Manager, HIV/AIDS Section, Bureau of Communicable Diseases for sharing the data set I used in this study. Finally, to Dr. Alan Whiteman, Associate Director, Executive Masters Health Management Programs at Florida Atlantic University, thank you for suggesting I pursue my doctoral degree and for your continued mentorship and friendship. Table of Contents List of Tables .......................................................................................................................v List of Figures .................................................................................................................... vi Chapter 1: Introduction to the Study ....................................................................................1 Introduction ....................................................................................................................1 Background ....................................................................................................................3 Problem Statement .........................................................................................................7 Purpose of the Study ......................................................................................................8 Research Questions and Hypotheses .............................................................................9 Theoretical Framework ................................................................................................12 Nature of Study ............................................................................................................13 Definitions....................................................................................................................17 Assumptions .................................................................................................................21 Scope and Delimitations ..............................................................................................22 Limitations ...................................................................................................................23 Significance of the Study .............................................................................................25 Summary ......................................................................................................................27 Chapter 2: Literature Review .............................................................................................28 Introduction ..................................................................................................................28 Literature Search Strategy............................................................................................30 Theoretical Foundation ................................................................................................31 Behavioral Model of Health Services Use ............................................................ 31 i Model Use in Research ......................................................................................... 35 Appropriateness to Current Study ......................................................................... 37 Literature Review Related to Key Variables and/or Concepts ....................................39 Affordable Care Act .............................................................................................. 39 HIV/AIDS ............................................................................................................. 48 Ryan White HIV/AIDS Program .......................................................................... 59 Relationships Between Health Coverage and Outcomes for PLWHA ................. 66 Summary and Conclusions ..........................................................................................72 Chapter 3: Research Method ..............................................................................................75 Introduction ..................................................................................................................75 Research Design and Rationale ...................................................................................76 Methodology ................................................................................................................79
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