AP News. (n.d.). Majority of the world’s population breathes dirty air, report says. Retrieved from https://apnews.com/article/air-pollution-climate-change-asia-diseases-cancer-lungs-dc623f24dfab652ef06eca51cd4211e8

This article from AP News discusses a report indicating that 83% of cities worldwide exceed established clean air standards, thereby exposing residents to pollutants that contribute to chronic respiratory diseases. The report highlights the widespread impact of urban air pollution on public health, emphasizing the urgency of implementing stricter air quality regulations and sustainable urban policies. This source is instrumental in our analysis as it provides a global perspective on environmental health risks, underscoring the link between poor air quality and chronic respiratory conditions.

Apergis, Nicholas, et al. (2017). Convergence of Health Care Expenditures Across the US States: A Reconsideration. Social Indicators Research, vol. 133, no. 1, pp. 303–316. https://doi.org/10.1007/s11205-016-1357-7

Apergis et al. examine the convergence of healthcare expenditures across U.S. states while highlighting persistent income-based disparities in healthcare access and quality. Their study reveals that while spending levels may be aligning, wealthier individuals continue to have superior access to medical services, leading to better healthcare experiences and outcomes. This research was instrumental in shaping our website’s discussion of economic disparities in Medicare, particularly how income influences patient satisfaction and healthcare accessibility. Additionally, the study underscores how policy decisions, including potential Medicare budget cuts, may further exacerbate inequities, disproportionately affecting lower-income populations who rely more heavily on federally funded healthcare services.

Centers for Medicare and Medicaid Services (CMS): Usagov. Centers for Medicare and Medicaid Services (CMS) | USAGov. (n.d.). https://www.usa.gov/agencies/centers-for-medicare-and-medicaid-services

This official government source serves as a foundational reference for understanding Medicare, detailing its purpose, coverage, and role in the U.S. healthcare system. As part of our website, we used this resource to define Medicare and highlight its significance in providing healthcare access to millions of Americans, particularly older adults and individuals with disabilities. Beyond offering a basic definition, the CMS page provides insight into how Medicare operates within the larger healthcare landscape, including its influence on medical costs, reimbursement models, and healthcare policies. Its credibility as an authoritative government publication makes it a vital reference for exploring Medicare’s evolving impact on healthcare accessibility and equity.

Centers for Medicare & Medicaid Services (CMS). (2023). Medicare in U.S. Territories. https://www.cms.gov/medicare/us-territories

This source from the Centers for Medicare & Medicaid Services highlights the significant funding disparities faced by U.S. territories in Medicare and Medicaid reimbursements. Despite residents paying into Medicare through payroll taxes, these territories receive substantially lower Medicaid funding—less than 15% of what they would if they were states. Additionally, healthcare providers in these regions are reimbursed at lower rates, making it increasingly difficult to provide quality care. This information was crucial for our website’s discussion on healthcare inequities, illustrating how systemic funding gaps create barriers to healthcare access and quality for Medicare beneficiaries in U.S. territories.

Cooper, Lisa A., et al. (2012). The Associations of Clinicians’ Implicit Attitudes About Race With Medical Visit Communication and Patient Ratings of Interpersonal Care. American Journal of Public Health (1971), vol. 102, no. 5, pp. 979–987. https://doi.org/10.2105/AJPH.2011.300558

Cooper et al. explore the impact of implicit racial bias among healthcare providers on medical communication and patient perceptions of care. Their research reveals that Black Medicare patients may receive lower-quality treatment compared to their White counterparts due to unconscious biases that influence provider decision-making and patient interactions. This study is critical to our website’s discussion of healthcare disparities under Medicare, demonstrating how racial bias contributes to inequities in medical treatment and patient satisfaction. By highlighting the intersection of race and healthcare quality, Cooper et al. provide essential context for understanding broader systemic issues within the U.S. healthcare system.

Daaleman, Timothy P. (2006). Reorganizing Medicare for Older Adults with Chronic Illness. The Journal of the American Board of Family Medicine, vol. 19, no. 3, pp. 303–309. https://doi.org/10.3122/jabfm.19.3.303

Daaleman examines the challenges Medicare faces in effectively serving older adults with chronic illnesses, emphasizing the limitations of the traditional fee-for-service model in addressing long-term care needs. His analysis underscores the necessity of healthcare reforms that integrate medical, social, and policy-driven solutions to improve patient outcomes. This source was instrumental in our website’s discussion on chronic respiratory illness outcomes and the broader systemic changes required to enhance Medicare’s ability to support chronic disease management. By highlighting gaps in current healthcare delivery models, Daaleman’s work provides valuable insights into the future direction of Medicare and its role in shaping long-term care strategies.

Heredia-Rizo, Alberto Marcos, et al. (2024). Effectiveness of Mind-Body Exercises in Chronic Respiratory Diseases: An Overview of Systematic Reviews with Meta-Analyses. Disability and Rehabilitation, vol. ahead-of-print, no. ahead-of-print, pp. 1–16. https://doi.org/10.1080/09638288.2023.2233899

Heredia-Rizo et al. explore the role of mind-body exercises in improving lung function, stamina, and overall well-being for patients with chronic respiratory diseases. Their findings emphasize that tackling chronic illnesses requires more than conventional medical interventions, highlighting the importance of holistic approaches alongside standard treatments like vaccinations and healthcare access improvements. This study reinforces our website’s discussion on chronic disease management under Medicare, illustrating how integrated care strategies can enhance patient outcomes, particularly in states with high rates of chronic respiratory conditions.

Institute of Medicine, et al. (2011). Living Well with Chronic Illness: A Call for Public Health Action. 1st ed., National Academies Press. https://doi.org/10.17226/13272

This report underscores the need for a comprehensive approach to managing chronic illnesses, emphasizing that effective care extends beyond clinical treatments to include social, economic, and policy-driven strategies. The Institute of Medicine highlights the importance of public health interventions, systemic healthcare reforms, and interdisciplinary collaboration in improving long-term health outcomes. This source was particularly valuable in our website’s discussion of Medicare’s role in chronic disease management, reinforcing the argument that traditional fee-for-service models are insufficient for addressing the complex needs of chronically ill patients. By integrating these broader considerations, the report contributes to an evolving conversation on healthcare policy and patient-centered care.

Konerding, Uwe. (2020). Is a Ratio Scale Assumption for Physician Ratings Justified? Comment on ‘What Patients Value in Physicians: Analyzing Drivers of Patient Satisfaction Using Physician-Rating Website Data’. Journal of Medical Internet Research, 22(10), e18289. https://doi.org/10.2196/18289

Konerding (2020) critically examines the validity of ratio-scale assumptions in physician ratings, arguing that the lack of an empirically determined zero-point compromises the reliability of comparisons. This perspective is particularly relevant to our analysis of patient satisfaction as a measure of healthcare quality. Since satisfaction ratings are based on subjective experiences and influenced by regional disparities, they may not fully capture true healthcare effectiveness. This source underscores the importance of refining measurement methodologies to ensure more accurate assessments of healthcare quality, reinforcing the need for a nuanced interpretation of patient satisfaction data in our research.

Kurpas, Donata, et al. “Importance of Social Relationships in Patients with Chronic Respiratory Diseases.” Advances in Experimental Medicine and Biology, vol. 935, Springer International Publishing AG, 2016, pp. 63–73, https://doi.org/10.1007/5584_2016_35.

Kurpas et al. (2016) focus on how social relationships affect the quality of life (QoL) for patients with chronic respiratory diseases (CRDs) in primary care. The researchers studied 582 patients with CRDs and other chronic diseases from 199 primary care centers. They found that patients with stronger social relationships had more medical visits, needed fewer nurse visits, were hospitalized less often, and had fewer chronic diseases. Strong social relationships were linked to better psychological, environmental, and physical QoL, as well as higher overall life satisfaction. The study suggests that programs to prevent a decline in social relationships should focus on patients with low QoL in these areas, poor mental or physical health, negative attitudes, unhealthy habits, and unmet needs. It also highlights the need to help older widows/widowers, people with little education, those living far from healthcare centers, and those who visit for non-medical reasons. This research is important for our project because it shows how social relationships impact patient satisfaction and health outcomes, especially for vulnerable groups. It also helps us understand how social and psychological factors can improve care for CRD patients, which may differ across states due to variations in income, education, and healthcare access. This connects to our goal of exploring how demographics and environmental factors shape healthcare experiences and disparities.

Marmor, Theodore R. (1988). Reflections on Medicare. The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, vol. 13, no. 1, pp. 5–29. https://doi.org/10.1093/jmp/13.1.5

Marmor’s work provides an in-depth analysis of Medicare’s evolution from a program designed to integrate older adults into the healthcare system to a broader mechanism for shaping medical costs and healthcare policy in the United States. His reflections highlight the significant role Medicare plays in regulating hospital reimbursements, physician payment structures, and overall healthcare expenditures. This source was particularly valuable in our website’s discussion of how Medicare’s influence extends beyond direct patient care, affecting systemic healthcare trends and economic policies. By examining the program’s historical shifts and policy implications, Marmor provides critical insight into Medicare’s long-term impact on the U.S. healthcare system.

“Medicare Timeline.” The Henry J. Kaiser Family Foundation, 24 Mar. 2015, www.kff.org/medicare/timeline/medicare-timeline/.  

The comprehensive timeline from the Kaiser Family Foundation provides a detailed chronological overview of Medicare’s legislative and policy milestones. The source is used as the reference for key policy milestones for our project. It includes key events such as the establishment of Medicare Parts A and B, introduction of Medicare Advantage (Part C) and Part D prescription drug coverage, and significant reforms under the Affordable Care Act (ACA). The source is used to structure and verify the accuracy of the Medicare timeline presented in our project. It helped identify critical legislative milestones and provided context for understanding the connection between healthcare and patients’ outcome and experience. 

Orsini, Chiara. “The Mortality Effects of Changing Public Funding for Home Health Care: An Empirical Analysis of Medicare Home Health Care in the United States.” Health Economics, vol. 28, no. 7, 2019, pp. 921–36, https://doi.org/10.1002/hec.3896.(Tara)

In this piece, Orsini addresses how cuts to Medicare home health care funding have impacted elderly mortality in the United States. Specifically, she focuses on how changes that were introduced by the 1997 Interim Payment System (IPS), influenced health outcomes among the elderly. Throughout the study, a difference-in-differences methodology is leveraged to analyze such variations in mortality rates across states both before and after these cuts in funding. Ultimately, the study concluded that such reductions in public funding for home health care led to a statistically significant increase in mortality among men aged 65-74, despite no significant effects found for women or older men. Additionally, the study emphasized that Medicare cost restrictions actually led to ‘cream skimming’, where home health agencies were actually incentivized to avoid high-cost patients with chronic conditions. In the context of our research, this resource guides us in directly examining how changes in healthcare funding influence patient outcomes. It equips us with the necessary empirical evidence to link policy decisions with real-world health impacts, especially in the context of elderly people who receive medicare benefits. Additionally, the resource analyzes outcomes and funding cuts through a state-level lens, reinforcing our investigation into how healthcare policies affect patient outcomes at the state-level. Additionally, similar to our dataset addressing chronic illnesses, this piece addresses chronic obstructive pulmonary disease, which provides, though indirectly, critical insights on state-level disparities in respiratory disease prevalence and care. Orsini writes, “the IPS was associated with an increase equal to 0.6% in the overall mortality rate for men aged between 65 and 74” (Orsini, 2019), further reinforcing the notion that public funding is both integral and necessary in mitigating health risks, particularly for vulnerable and disadvantaged populations. 

For our project, this source provides insight into the relationship between public healthcare funding and health outcomes, furthering us in our goal to assess how healthcare spending contributes to patient satisfaction and mortality across states.

Patel, Minal R., et al. “Improving the Affordability of Prescription Medications for People with Chronic Respiratory Disease: An Official American Thoracic Society Policy Statement.” American Journal of Respiratory and Critical Care Medicine, vol. 198, no. 11, 2018, pp. 1367–74, https://doi.org/10.1164/rccm.201810-1865ST.

This resource is effectively a policy statement from the American Thoracic Society which addresses how prescription medications serve as increasing financial burdens for individuals who suffer from chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). The authors argue that such high costs result in a reduction in patients’ adherence to their medications, ultimately leading to worsened health outcomes and more hospitalizations. Additionally, the authors explain how a lack of generic alternatives for respiratory treatments that are widespread and holistically applicable and the role that the pharmaceutical market places in driving up costs exacerbates this accessibility-centered problem. The report essentially argues for a publicly funded, but independent advisory entity to develop evidence-based pharmaceutical policies that focus on actually expanding access to medication, promoting generic drugs to make them more readily available, as opposed to equipping profit-centered pharmaceutical companies with the task of promoting access and welfare in this particular domain of medicine. Furthermore, the study presents evidence from various national healthcare databases, economic research, and international policy comparisons, ultimately highlighting the disparities, inequalities, and problematicality in pharmaceutical pricing. The authors write, “rising healthcare costs are passed on to patients through higher out-of-pocket expenses, resulting in one-quarter of families reporting a significant financial burden” (Patel et al., 2018). Additionally, the report addresses the particular policy measures that have been adopted by other nations beyond just the United States and compares them with the incredibly inconsistent and fragmented approach carried out by the United States. For the purpose of our research, this source is imperative in our examination of how both economic and policy factors play a role in chronic respiratory disease treatment and patient satisfaction. On the topic of how public health policies impact such health outcomes, this piece provides us with the necessary insight to wholly understand the financial and affordability aspect of respiratory treatments across various states. In identifying gaps in current pharmaceutical regulations, this particular report reinforces our ideas about healthcare funding, patient-reported satisfaction, and the relationship between economic barriers and managing chronic diseases, especially in the context of respiratory diseases and the elderly population that relies on medicare benefits. 

The Guardian. (2025). GOP Budget Proposes Significant Cuts to Medicare and Medicaid. https://www.theguardian.com/us-news/2025/mar/06/gop-budget-medicare-medicaid-cuts

This article discusses recent budget proposals from the Trump administration that include significant cuts to Medicare, aiming to reduce federal spending by $880 billion over the next decade. The proposed reductions could disproportionately impact lower-income states where residents are more reliant on Medicare services. By limiting access to care, these cuts risk exacerbating existing income-based health disparities and further straining an already burdened healthcare system. This source was crucial in our website’s discussion of policy-driven healthcare inequities, highlighting the real-world consequences of financial decisions on Medicare beneficiaries and the broader healthcare landscape.

The Guardian. (2025, March 7). How cooking with gas releases harmful air pollution in the home. Retrieved from https://www.theguardian.com/environment/2025/mar/07/how-cooking-with-gas-releases-harmful-air-pollution-in-the-home

This article from The Guardian explores how targeted policy interventions can significantly improve air quality and public health. It highlights London’s expansion of its Ultra Low Emission Zone (ULEZ), which resulted in a measurable reduction of harmful pollutants, thereby demonstrating the effectiveness of environmental regulations in enhancing lung health. In addition, the article addresses indoor air pollution by examining how cooking with gas emits pollutants that are linked to respiratory issues. It underscores the importance of proper ventilation and the adoption of alternative cooking methods to mitigate these health risks. This source is invaluable for understanding the multifaceted approaches needed—from policy changes to everyday practices—to reduce air pollution and improve respiratory health outcomes.

Vogus, Timothy J., and Laura E. McClelland. “When the Customer Is the Patient: Lessons from Healthcare Research on Patient Satisfaction and Service Quality Ratings.” Human Resource Management Review, vol. 26, no. 1, 2016, pp. 37–49, https://doi.org/10.1016/j.hrmr.2015.09.005.

Vogus, Timothy J., and Laura E. McClelland (2016) discuss the value of healthcare research and how this research can  provide insights for broader management research on customer satisfaction, particularly in high-stakes, emotionally charged, and complex service environments. Healthcare is naturally complex and consequences of low patient satisfaction can lead to detrimental health outcomes. Because of this the authors discuss the importance of cultural competency, relational work systems, compassion, and patient-centered care. This research is important because it highlights the consumer assessment of healthcare providers and systems (CAHPS), which is standardized, patient-mix adjusted, and publicly reported, influencing hospital rankings and reimbursement through programs like Value-Based Purchasing (VBP). By understanding this, we can understand motives for why hospitals and health care systems may want to improve their patient satisfaction and overall understand the role that healthcare systems have on patients. 

Zhang, Yili, and Güneş Koru. “A Comparative Study of Home Healthcare Quality in Urban and Rural Home Health Agencies throughout the USA (2010–22).” International Journal for Quality in Health Care, vol. 36, no. 3, 2024, https://doi.org/10.1093/intqhc/mzae080.

This resource argues that there’s big disparities between the quality of home healthcare in urban areas and rural areas in the US, with rural areas experiencing higher rates of ER visits and hospital visits. It performs a longitudinal panel data analysis of home health agency records from 2010 to 2022, and it compares the hospital visit and ER visit rates across urban vs. rural medical centers. It could provide insight into how patient satisfaction varied by region in the US could be affected by population density. It mentions how rural areas tend to have higher rates of uninsured patients and greater portions of elderly populations, and higher shortage of healthcare providers. The disparity in healthcare between rural and urban areas could be seen as a significant factor for patient outcomes and satisfaction, and this paper reinforces the importance of addressing geographic disparities to improve healthcare equity. 

Images Used

Bernstein, Aaron P. “Medicare For All”, The New York Times, https://www.nytimes.com/2019/04/21/health/medicare-for-all-hospitals.html. Accessed 19 Mar. 2025.

Cuputo. “Lung Icon.” The Noun Project, https://thenounproject.com/icon/lung-4303915/. Accessed 20 Mar. 2025.

Diaz, Al.. Miami Herald/Tribune News Service, Getty Images, https://www.vox.com/identities/2020/2/27/21150176/puerto-rico-health-care-hospital-access-hurricane-maria.

“Historical Image of Racial Segregation in Hospitals.” LSU Health New Orleans School of Medicine, Louisiana State University, www.medschool.lsuhsc.edu/ortho/history_of_racial_segregation_in_hospitals_dr_arjmand.asp.

Pedal Chile. “English PR.” Pedal Chile, https://pedalchile.com/blog/english-pr. Accessed 19 Mar. 2025.

Pan American Health Organization. “Coronavirus Disease (COVID-19) Pandemic.” PAHO, https://www.paho.org/en/topics/coronavirus-infections/coronavirus-disease-covid-19-pandemic. Accessed 19 Mar. 2025.

“Photograph of Medicare.” Total Benefits Integrated Insurance Services, https://totalbenefits.net/the-history-of-medicare/. Accessed 20 Mar. 2025.

Rohman, Ali Nur. “Health Advocacy Icon.” The Noun Project, https://thenounproject.com/icon/health-advocacy-7059081/. Accessed 20 Mar. 2025.

Videos Used

AP Archive. “Medicare Bill Signed – 1965 | Today In History | 30 July 17.” YouTube, 30 July 2017, https://www.youtube.com/watch?v=d8hxO3XFm4Q

This archival footage from AP Archive captures the historic signing of the Medicare Bill in 1965 by President Lyndon B. Johnson. The video provides valuable insights into the origins of Medicare, a program that transformed healthcare access for older Americans. By featuring this video on our website, we aim to highlight the significance of this legislation and its lasting impact on U.S. healthcare policy.