Health Sciences Program Student Theses, Dissertations and Capstones

Document Type


Degree Name

Doctor of Philosophy (PhD)

Copyright Statement

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College of Health Care Sciences – Health Science Department

First Advisor

Rose Colon

Publication Date / Copyright Date



Nova Southeastern University


Affordable Care Act (ACA) was passed and implemented to expand insurance coverage, reduce health care cost, and improve the quality of care. The purpose of this dissertation study was to investigate whether the ACA insurance expansion correlates with the number of visits made to emergency departments (EDs). The quasi-experimental design interrupted time series was utilized in the analysis. The ED visits were compared using MANOVA to determine the relationship between ED visits and ACA and canonical correlation analysis to assess the strength of the relationship and the extent to which independent variables could predict the dependent variable. The hypothesis was that the ACA will reduce the uninsured, increase the insured, and reduce the ED visits. The relationship between number of ED visits and the ACA will present whether the uninsured patients contributed significantly to the ED overcrowding. Analysis of secondary data from four EDs (H1, H2, H3, and H4) in the Chicago area showed that 484,742 visits were made, and 2,801 were excluded due to unknown payer type. Medicaid patients recorded the largest number of visits (181,226) while the uninsured patients recorded the least number of visits (56,572). The ED visits decreased by 6% from 2012 to 2013 (pre-ACA) and increased by 4% from 2013 to 2105 (post-ACA). The ACA implementation increased the people with insurance who visited the EDs by 11%. The results demonstrated a strong relationship between ACA and ED visits. The correlation of the variables (hospital and year) and ED visits demonstrated that the hospital could explain 97% of the Medicaid visits and 87% of uninsured while the year could predict 82.6% of the uninsured visits and 52.5% of Medicaid visits.


Medicine and Health Sciences


Health and environmental sciences, Affordable Care Act, Emergency department, Insured, Medicaid, Overcrowding, Uninsured

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