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Association and Bias in Observational Studies Discussion

Association and Bias in Observational Studies Discussion


Analysis of Lifestyle Choices on Group Health Insurance Premiums:

  1. Smoking: One lifestyle choice that can significantly affect group health insurance premiums is smoking. Employees who smoke are at a higher risk of developing various health conditions such as lung cancer, heart disease, and respiratory problems. These health issues can lead to increased healthcare utilization and costs for the insurance provider. As a result, insurance premiums for a company with a higher percentage of smokers in its employee population are likely to be higher. This is an example of adverse selection, where individuals with riskier behaviors (smoking in this case) are more likely to opt for insurance, leading to increased costs for the insurer.
  2. Physical Activity: Another lifestyle choice that can impact group health insurance premiums is the level of physical activity among employees. Employees who engage in regular physical activity and maintain a healthy lifestyle are generally at a lower risk of developing chronic diseases. This can result in lower healthcare costs and fewer claims for the insurance provider. In this case, the insurance company might offer lower premiums to organizations whose employees are more physically active. This is an example of favorable selection, where healthier individuals opt for insurance, leading to reduced costs for the insurer.

Debate on the Affordable Care Act (ACA):

Position: The full implementation of the Affordable Care Act (ACA) in 2014 will not create a market failure for insurance companies.


  1. Increased Market Access: The ACA aimed to expand access to healthcare coverage for millions of previously uninsured individuals. By requiring individuals to have health insurance and offering subsidies for low-income individuals, the ACA increased the customer base for insurance companies. This expanded market can lead to increased revenue opportunities for insurance companies, rather than market failure.
  2. Risk Mitigation Mechanisms: The ACA introduced risk mitigation mechanisms such as risk corridors, reinsurance, and risk adjustment. These mechanisms help stabilize the insurance market by redistributing funds among insurers based on the risk profile of their enrollees. This reduces the potential for insurance companies to face overwhelming financial losses due to high-risk enrollees.
  3. Preventive Care Emphasis: The ACA emphasized preventive care and wellness programs. By promoting early detection and intervention, insurance companies can potentially reduce long-term healthcare costs. This aligns with their interests in minimizing claims and overall expenses.
  4. Market Competition: The ACA’s health insurance marketplace promotes competition among insurers by offering consumers a variety of plans to choose from. This competition incentivizes insurance companies to innovate, tailor their offerings, and manage costs efficiently to attract customers.
  5. Gradual Implementation and Adaptation: The ACA was implemented over time, allowing insurance companies to adjust their strategies, pricing models, and networks. This gradual approach allowed insurers to adapt to the changing landscape without sudden market disruptions.

In conclusion, while there have been debates about the impact of the ACA on insurance companies, evidence suggests that the mechanisms and changes introduced by the ACA are designed to mitigate potential market failures and create a more stable and accessible healthcare insurance market.

Association and Bias in Observational Studies Discussion


This week you will review different types of bias, present an example of a study, and discuss whether bias was a factor in the study outcome. You will also discuss how the study design could have been altered to minimize or eliminate the risk of invalidating the results.

To prepare for this Discussion:

Review the types of bias listed below.

Non-differential recall bias

Differential recall bias

  • Publication bias

Loss to follow-up

  • Refusal to participate
  • Interviewer bias
  • Confounding
  • Select one type of bias from the list above, and consider the ways that bias could impact a study.
  • To complete this Discussion, post a real or hypothetical example of one study. You can use one of the studies you designed during Weeks 3 or 4 or search for a different study.
  • How could bias be introduced in the study?
  • Would the bias be considered a selection bias or an information bias? Why?

Name two or three variables that might be possible confounders in your study.

Describe at least one method of controlling those confounding variables.


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