Beruflich Dokumente
Kultur Dokumente
Results.p.17
Quantitative Findings.p.17
Designp.11
Discussion ......p.12
Interpretation of Findings...p.14
Limitations.p.14
Recommendations for Use.....p.14
Recommendations for Further Research....p.14
Conclusion..p.22
References...........p.23
Literature Review
The number of families in America without health insurance is on the rise. According to a CNN
Money Magazine article, 16.3% of the nations population did not have health insurance in 2010
(Christie, 2011). The article also stated that in 2009, the U.S. Census Bureau reported over 49 million
people did not have health insurance, and this number increased to 49.9 million in 2010. As mentioned
above, most of the people without insurance are families that are unemployed or from low income, young
adults between the ages of 19 to 25, and from foreign born, non U.S. citizens. Furthermore, a lot of
employers cannot afford to offer health insurance to their employees due to the high premiums and
budget cuts. Some of the companies that do offer health insurance have to pass along more of the cost to
the employees causing some of the employees to opt out of their employers healthcare plans. Nearly
one-in-four working-age adults are uninsured (Christie, 2011). With more people not having any health
insurance, government programs such as Medicaid, Medicare, and children health plans try to pick up
some of the slack. According to CNN Money, in 2010, 31% of Americans relied on the government for
health insurance, up from 24.2% in 1999 (Christie, 2011). Even with these government health plans, the
Census Bureau reported that 9.8% of children under age 18 are uninsured despite the government
programs targeting them like CHIPS and Medicaid, which is also open to their parents (Christie, 2011).
In most states, Medicaid is not offered to adults without children.
The graphical representation below is from the US Census Bureau showing the national statistics on
the number of people in America without health insurance (Christie, 2011).
Health insurance is a major concern for our country. According to an article written in 2012, the
presidential electoral issues include:
The Electoral Issue: Health care is expensive and getting more so, squeezing private
enterprise and driving up the deficit. Millions of Americans are uninsured which leads to
bankruptcies and anxiety.
The Challenge: How to lower costs and expand coverage without a drop in quality (Miller, 2012).
Healthcare concerns are a major issue for the 2012 election since the rising cost of health care is the
number one cause of increased deficits (Miller, 2012). A lot of people rely on government programs to
help them pay their medical expenses:
Federal health care programs, including Medicare, Medicaid, and the Childrens' Health Insurance
Program (CHIP), comprised 21 percent of the 2011 federal budget, totaling $769 billion dollars.
Nearly two thirds of this amount went to Medicare, the health-insurance program that covers
approximately 48 million disabled and elderly Americans. The remainder went to Medicaid and
CHIP which provide health care to 60 million low-income children and families and are co-funded
by the states (Miller, 2012).
The Medicare and Medicaid programs put a lot of strain on the Governments budget. Some people feel
that the Americans fee-for-service insurance program is the cause of this added expense. They believe
that some physicians just order unnecessary exams and test to pad their pockets without explaining to
their patient the option to decline these procedures. According to CBS news, Among the 34 OECD
countries, only Mexico, Turkey, and the United States do not have universal health care coverage, and:
almost 50 million Americans did not have health insurance in 2010 - 16.3 percent of the
population The healthcare costs incurred by those without insurance are eventually shifted to
those with insurance in the form of higher premiums. A 2008 study from Families USA, an
advocacy group that supports coverage expansion, determined that the average family pays $1017
per year in higher premiums to help cover the cost of the uninsured (Miller, 2012).
In 2010, about 55.3 percent of Americans receive their health insurance from their employers compared
to 64.1 percent in 2000 (Miller, 2012). This percentage has been decreasing due to the high cost of
offering medical insurance benefits, especially for the smaller businesses. Americans not having any
type of health insurance is a big problem. In 2009, a study by the American Journal of Medicine reported
that medical debt was the number one reason behind bankruptcy filings in the U.S., accounting for 62
percent of personal bankruptcies (Miller, 2012).
Hypothesis
During this 6 month study, April 2012 through October 2012, over 35% of the population coming
into Bronson Battle Creek, Emergency Department (ED), for medical treatment will not have any type of
health insurance. The confidence interval for this study is only 90% due to the delimitations and the
limitations. The null hypothesis for this study -- 35% of the patients coming into the ED will not have
health insurance. The alternative hypothesis-- a different percentage, (maybe higher or maybe lower than
35%), of the population will not have health insurance. Example: null hypothesis: H: = 35 %.
Alternative hypotheses: H: 35%.
Delimitations, limitations, and assumptions
This study does not include the whole population of Calhoun County. It only includes the people
that seek treatment for medical conditions at Bronson Battle Creek Emergency Department between a six
month time frame starting April 2012 and October 2012. This study is limited, since it only is surveying
the population that needs medical treatment. It does not include the healthy population who do not need
any medical treatment. It also excludes the percent of the population that have Medicaid or use charity to
pay for their medical care. The assumption for this study is that the percentage of the population living in
Calhoun County, that does not have health insurance, is 35 percent.
Method
This research study collected raw data by using a convenience sample on the number of patients
that came into the Emergency Department for medical treatment. It also kept track if the patients that
came into the hospital had health insurance or not. The information collected for this study was from
April 2012 through October 2012. In addition, data was collected from literature review on the
percentage of the population in the United States that do not have health insurance.
Participants
The participants for this study are the patients that come into Bronson Battle Creek Emergency
Department for medical treatment over a six months period of time, (April 2012 through October 2012).
Instrument
The raw data for this study was collected by a software program called Business Objects. All the
data entered by hospitals registration department is dumped into this data warehouse. The data collected
by this program is divided up and stored in different files on the hospitals computer system, in the P
drive.
Procedure
The first step in collecting data for this study was to log onto the hospitals computer system. After
starting up the computer, the P Drive had to be accessed. The P Drive stores all the files obtained through
Business Objects. Once in the P Drive, the file containing information for the 2012 fiscal year was located
and opened. From the 2012 file, data was copied on the number of patients that came into the emergency
department (ED) during the time frame of April 2012 through October 2012. After all the number of
patients where extracted, they were pasted on an excel sheet. The next step was to cross reference the
dates and number of patients to find the columns that contained the insurance information for these
patients. The column which showed self-pay/per day was copied and then pasted on an excel sheet,
adjacent to the number of patients per day. After all the raw data was collected and aligned side by side,
it was reviewed and interpreted. Pivot charts, grafts, and percentages were made to help decipher all the
data, and then the information was compared to the hypothesis to see if there were similarities or
differences.
10
The raw data, copied from the fiscal year 2012 in the p drive of the hospitals computer, on the
number of patients coming into ER from April 2012 through October, 2012 is listed below:
Emergency Room/April 2012
Adm
O/P
Total
Adm
O/P
Total
Adm
O/P
Total
22
107
129
14
105
119
15
106
121
15
127
142
11
125
136
12
117
129
14
93
107
12
108
120
122
131
14
108
122
16
118
134
22
114
136
24
100
124
11
112
123
18
105
123
14
89
103
12
114
126
14
106
120
114
121
21
124
145
113
121
17
97
114
25
130
155
14
114
128
17
106
123
17
126
143
16
119
135
22
119
141
19
113
132
14
114
128
15
117
132
16
95
111
21
132
153
12
121
133
14
106
120
15
100
115
20
115
135
18
111
129
21
108
129
13
114
127
22
121
143
16
100
116
19
126
145
20
111
131
17
114
131
12
128
140
18
125
143
15
116
131
14
98
112
15
91
106
15
97
112
12
113
125
15
96
111
15
113
128
15
114
129
18
111
129
17
112
129
14
101
115
15
108
123
18
97
115
22
117
139
13
120
133
17
117
134
12
124
136
13
102
115
11
127
138
22
122
144
31
106
137
13
124
137
16
129
145
15
100
115
21
134
155
95
104
12
120
132
16
133
149
10
124
134
11
128
139
17
108
125
18
108
126
10
113
123
13
116
129
12
101
113
20
118
138
23
105
128
10
127
137
17
136
153
14
106
120
21
96
117
41
48
12
67
79
7
469
3,356
3,825
485
3,334
3,819
464
3,350
3,814
Adm
O/P
Total
Adm
O/P
Total
Adm
O/P
Total
10
132
142
11
100
111
15
127
142
30
112
142
17
102
119
13
152
165
16
120
136
16
119
135
12
132
144
11
13
103
116
13
127
140
23
109
132
14
132
146
13
106
119
19
120
139
131
140
18
137
155
20
129
149
13
137
150
19
125
144
13
133
146
13
122
135
15
120
135
14
143
157
22
123
145
109
118
18
129
147
16
121
137
119
128
12
133
145
16
130
146
13
99
112
15
124
139
12
104
116
110
119
15
126
141
16
113
129
20
119
139
12
108
120
132
140
23
114
137
12
126
138
19
109
128
23
96
119
129
136
21
118
139
18
125
143
15
130
145
21
99
120
17
101
118
19
127
146
21
121
142
13
129
142
23
126
149
14
122
136
20
121
141
122
129
21
96
117
19
134
153
17
125
142
129
138
15
118
133
14
105
119
25
133
158
16
123
139
15
127
142
23
131
154
12
143
155
14
112
126
12
130
142
19
107
126
15
137
152
17
120
137
12
110
122
16
132
148
19
117
136
17
118
135
16
112
128
11
106
117
18
116
134
10
121
131
10
113
123
14
137
151
13
123
136
13
115
128
14
120
134
20
123
143
13
120
133
16
115
131
11
117
128
18
104
122
20
98
118
445
3,759
4,204
495
3,695
4,190
488
3,617
4,105
The raw data: Comparing/aligning the total number of patients coming into the ED with the number of
patients with no health insurance by day.
Abbreviations: Adm= admission into the hospital
Total ER patients
Month
4
4
4
O/P = Outpatient
Adm
O/P
Total
22
107
129
19
15
127
142
4/2/2012
16
14
93
107
4/3/2012
14
12
14
108
122
4/4/2012
19
24
100
124
4/5/2012
20
14
89
103
4/6/2012
11
114
121
4/7/2012
24
17
97
114
4/8/2012
25
17
106
123
4/9/2012
19
22
119
141
4/10/2012
17
15
117
132
4/11/2012
23
12
121
133
4/12/2012
14
20
115
135
4/13/2012
23
13
114
127
4/14/2012
24
19
126
145
4/15/2012
19
12
128
140
4/16/2012
18
14
98
112
4/17/2012
22
12
113
125
4/18/2012
15
15
114
129
4/19/2012
20
14
101
115
4/20/2012
19
22
117
139
4/21/2012
19
12
124
136
4/22/2012
17
22
122
144
4/23/2012
27
16
129
145
4/24/2012
21
9
95
104
4/25/2012
10
124
134
4/26/2012
18
108
126
4/27/2012
16
12
101
113
4/28/2012
22
10
127
137
4/29/2012
12
21
96
117
4/30/2012
22
14
105
119
5/1/2012
11
11
125
136
5/2/2012
22
12
108
120
5/3/2012
16
16
118
134
5/4/2012
17
11
112
123
5/5/2012
23
12
114
126
5/6/2012
15
21
124
145
5/7/2012
22
25
130
155
5/8/2012
25
17
126
143
5/9/2012
26
19
113
132
5/10/2012
30
16
95
111
5/11/2012
17
14
106
120
5/12/2012
17
18
111
129
5/13/2012
16
22
121
143
5/14/2012
25
20
111
131
5/15/2012
20
18
125
143
5/16/2012
29
15
91
106
5/17/2012
12
15
96
111
5/18/2012
11
18
111
129
5/19/2012
14
15
108
123
5/20/2012
15
13
120
133
5/21/2012
21
13
13
102
115
5/22/2012
14
31
106
137
5/23/2012
22
15
100
115
5/24/2012
18
12
120
132
5/25/2012
27
11
128
139
5/26/2012
21
10
113
123
5/27/2012
18
20
118
138
5/28/2012
28
17
136
153
5/29/2012
28
41
48
5/30/2012
19
5/31/2012
11
15
106
121
6/1/2012
15
12
117
129
6/2/2012
28
122
131
6/3/2012
18
22
114
136
6/4/2012
23
18
105
123
6/5/2012
22
14
106
120
6/6/2012
23
113
121
6/7/2012
22
14
114
128
6/8/2012
15
16
119
135
6/9/2012
21
14
114
128
6/10/2012
15
21
132
153
6/11/2012
19
15
100
115
6/12/2012
16
21
108
129
6/13/2012
20
16
100
116
6/14/2012
17
17
114
131
6/15/2012
24
15
116
131
6/16/2012
24
15
97
112
6/17/2012
16
15
113
128
6/18/2012
28
17
112
129
6/19/2012
17
18
97
115
6/20/2012
19
17
117
134
6/21/2012
20
11
127
138
6/22/2012
16
13
124
137
6/23/2012
17
21
134
155
6/24/2012
29
16
133
149
6/25/2012
24
17
108
125
6/26/2012
14
13
116
129
6/27/2012
20
23
105
128
6/28/2012
21
14
106
120
6/29/2012
23
12
67
79
6/30/2012
16
10
132
142
7/1/2012
23
30
112
142
7/2/2012
28
16
120
136
7/3/2012
22
13
103
116
7/4/2012
27
14
132
146
7/5/2012
31
131
140
7/6/2012
18
13
137
150
7/7/2012
25
13
122
135
7/8/2012
23
22
123
145
7/9/2012
32
14
16
121
137
7/10/2012
19
16
130
146
7/11/2012
24
12
104
116
7/12/2012
23
16
113
129
7/13/2012
25
132
140
7/14/2012
27
19
109
128
7/15/2012
26
21
118
139
7/16/2012
17
21
99
120
7/17/2012
14
21
121
142
7/18/2012
20
14
122
136
7/19/2012
25
21
96
117
7/20/2012
17
129
138
7/21/2012
17
25
133
158
7/22/2012
14
23
131
154
7/23/2012
30
12
130
142
7/24/2012
25
17
120
137
7/25/2012
27
19
117
136
7/26/2012
20
11
106
117
7/27/2012
20
10
113
123
7/28/2012
20
13
115
128
7/29/2012
15
13
120
133
7/30/2012
23
18
104
122
7/31/2012
14
11
100
111
8/1/2012
23
17
102
119
8/2/2012
24
16
119
135
8/3/2012
27
13
127
140
8/4/2012
33
13
106
119
8/5/2012
18
18
137
155
8/6/2012
27
19
125
144
8/7/2012
18
15
120
135
8/8/2012
19
109
118
8/9/2012
119
128
8/10/2012
14
13
99
112
8/11/2012
13
110
119
8/12/2012
18
20
119
139
8/13/2012
21
23
114
137
8/14/2012
17
23
96
119
8/15/2012
13
18
125
143
8/16/2012
14
17
101
118
8/17/2012
12
13
129
142
8/18/2012
15
20
121
141
8/19/2012
20
19
134
153
8/20/2012
21
15
118
133
8/21/2012
27
16
123
139
8/22/2012
20
12
143
155
8/23/2012
18
19
107
126
8/24/2012
15
12
110
122
8/25/2012
16
17
118
135
8/26/2012
14
18
116
134
8/27/2012
17
15
14
137
151
8/28/2012
17
14
120
134
8/29/2012
13
16
115
131
8/30/2012
15
20
98
118
8/31/2012
15
15
127
142
9/1/2012
23
13
152
165
9/2/2012
15
12
132
144
9/3/2012
14
23
109
132
9/4/2012
19
120
139
9/5/2012
14
20
129
149
9/6/2012
13
133
146
9/7/2012
16
14
143
157
9/8/2012
14
18
129
147
9/9/2012
11
12
133
145
9/10/2012
15
124
139
9/11/2012
15
126
141
9/12/2012
12
12
108
120
9/13/2012
13
12
126
138
9/14/2012
10
129
136
9/15/2012
16
15
130
145
9/16/2012
13
19
127
146
9/17/2012
14
23
126
149
9/18/2012
122
129
9/19/2012
17
125
142
9/20/2012
14
14
105
119
9/21/2012
10
15
127
142
9/22/2012
10
14
112
126
9/23/2012
13
15
137
152
9/24/2012
16
132
148
9/25/2012
16
112
128
9/26/2012
10
121
131
9/27/2012
13
123
136
9/28/2012
10
20
123
143
9/29/2012
16
11
117
128
9/30/2012
12
23957
3355
A Pivot graft that was made to help organizing all the monthly raw data is listed below:
Month
Data
Total patients No Insurance
4
3814
555
5
3819
610
6
3825
602
7
4190
691
4105
4204
23957
16
562
335
3355
Results
The purpose of this study was to determine the percentage of people living around Calhoun County
that do not have any type of health insurance. During a six month period, April 2012 through October
2012, the hypothesis estimated around 35 percent of the population coming into Bronson Battle Creek,
Emergency Department (ED) for medical treatment would not have any type of medical insurance.
Quantitative Findings
The quantitative findings for this study showed that 23,957 patients came into the hospitals
emergency department over the six month period, (April October, 2012), and 3,355 of them did not have
any health insurance: only 14 percent.
The Graphical representation below shows the number of patients coming into the hospital inbetween the time period of April, 2012 through October, 2012; and it includes the number of those
patients that did not have any health insurance.
17
The Pie graft below summarizes the quantitative findings collected over the 6 months:
Design
The design of this study used the quantitative method for the collection of the data to help answer the
research problem. Quantitative data was obtained from the hospitals computer system to obtain actuate
data on the number of patients that came to the emergency department (ED) between the time periods of
18
April, 2012 through October, 2012. Included in this data, was the actual number of patients who did not
have any type of medical insurance.
The hypothesis for this study, with a confidence level of 90%, is that 35% of the patients coming into
the ED would not have health insurance. To calculate the confidence interval, and to find the margin of
error, the p-hat formula is used. The first step in calculating the p-hat formula for the proportion of 35%
is to find all the numbers that will be needed for the equation. For example: the sample size (n), the p
(sample proportion or probability), the q (the proportion not wanted), and the zza (margin of error). For
this study: the sample size is the number of days the data was collect183. The p is the
hypothesis/percentage of patients without health insurance -- 14% or 0.14. The q is the percentage of
patients with health insurance 86% or 0.86. And finally the zza (margin of error) for this study is 90%,
which is equal to 1.65. The p-hat equation to calculate the confidence interval lower number is: p
minus zza times the square root of (p times q divided by n), and then the equation to calculate the phat higher number is: p plus zza times the square root of (p times q divided by n). For example:
pp - z/2 x
(p*q)
< p<
pp + z/2 x
< p<
(0.120)
n
0.14 + 165(.0007)
(p*q)
0 .14 + .165*0.026
0 .14 + 0.042
19
The results for this p- hat equation, with a confidence interval of 90 percent, should be somewhere inbetween 9.3% to 18.2%.
Discussion
This study only showed that 14 percent of the patients that came into Bronson Battle Creek
Emergency Department were without any medical insurance. The hypothesis was 35 percent. This study
is not a true picture of the areas population, since it did not include the healthy people that did not seek
medical treatment during the six month time period.
Interpretation of Findings
As stated above, the percentage of people seeking treatment at Bronson Battle Creek was only 14
percent which is less than the national average of 16.3 percent. The month of September had the lowest
percentage of patients without health insurance7.96%, while July had the highest percentage at
16.49%. The results of the P hat for a 90% confidence level showed that the hypothesis for this study
should have been somewhere in-between 9.3% to 18.2%. After calculating the confidence level, the
hypothesis for this study should be rejected or changed.
The table below shows the percentages per month, and the percentage obtained over the six month
period, (April, 2012 through October, 2012), on the number of patients that came into the ED without
health insurance:
Month
Percentage with
no insurance
April
14.55%
May
15.97%
June
15.73%
July
16.49%
August
13.69%
September
7.96%
Total six months14.00%
Number
of patients per
month.
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Average/Mean
Average/mean
without insurance
3993
559
The average number of patients that came into the hospital per month was 3993, which included the
average number of patient that did not have insurance of 559 per month.
Limitations
As mentioned above, this study is limited, since it only is surveying the population that needs medical
treatment. It does not include the healthy population who do not need any medical treatment. It also does
not include the percent of the population that have Medicaid or use Charity to pay for their medical care.
Recommendations for Use
This study was intended just to bring awareness to the problem of how many people are uninsured.
More research needs to be done to plan for the future, and to help make health insurance affordable to
everyone.
Recommendations for Further Research
For a more accurate percentage of the Calhoun County population that does not have any type of
health insurance, future research should be done by doing phone surveys, or door to door using random
samples. . A lot of people that do not have health insurance do no come to the hospital unless they have
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an accident or are really sick. A lot a people with children were not captured in this research study. A
random sample of the population should be done on people with no health insurance, and the ones that
require assistance from other government agencies; such as: Medicare, Medicaid, CHIP, and Charity pay.
Conclusion
The hypothesis for this study, that 35% of the population in Calhoun County does not have health
insurance, was way out of the ball park and should be rejected. The result of 14% for six months was
closer to the national average of 16.3%. If the study included some of the limitations that were
mentioned: such as Medicaid, Medicare, and Charity pay patients, the results from this research project
could have come closer to the hypothesis.
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References
Christie, L. (2011, September 13). Number of people without health insurance climbs. CNN Money.
Retrieved October 16, 2012, from
http://money.cnn.com/2011/09/13/news/economy/census_bureau_health_insurance/index.htm
Miller, J. (2012, October 1). Issue brief: Health care. CBS News. Retrieved October 27, 2012, from
http://www.cbsnews.com/8301-505103_162-57522437/issue-brief-health-care/