Effect of Same-Sex Marriage Laws on Healthcare - Article Example

?Running head: ARTICLE CRITIQUE Effect of Same-Sex Marriage Laws on Health Care Use and Expenditures in Sexual Minority Men: A Quasi-Natural Experiment Name Institution Professor Subject Research Problem The study aimed to investigate the impact of same-sex marriage policies on the physical and mental health conditions of gays, bisexuals, and lesbians in the U.S. It mentioned substantial number of related studies, which concern constitutional amendments about same-sex marriage and pro-gay marriage policies, and mental health problems among gays, bisexuals, and lesbians. The authors satisfactorily provided a clear background on how policy-level interventions could cause psychological stress among gays, bisexuals, and lesbians, particularly in the U.S. states where same-sex marriage is prohibited. Research Objective The authors aimed to examine the impact of pro-gay marriage policies, enacted in 2003 in Massachusetts, on health care use and expenditures among gays and bisexuals. They postulated that if same-sex marriage policies can reduce health problems among gays, bisexuals, and lesbians, then such policies may have implications on the health care use and expenditures of sexual minority men. It was clear that the authors were only interested in examining the effect of pro-gay marriage policies on the health care use and expenditures among gay and bisexual men. Theory/Framework Although the theoretical framework was not explicitly presented, it is apparent that the study was anchored on the notion that same-sex marriage policies could improve the physical and mental health conditions of gays, bisexuals, and lesbians. They postulated that same-sex marriage policies reduce structural forms of discrimination against gays, bisexuals, and lesbians, resulting in the reduction of health care use by such groups of individuals. Methods The authors employed quasi-natural experiment method to examine the impact of the legalization of same-sex marriage in Massachusetts on the health care use and expenditures among sexual minority men. This research design lacks random assignment of participants to comparison groups. Similar to a true experiment, a quasi-experiment has a control group and a treatment group, but the members of these groups are not explicitly or randomly chosen by researchers. Rather, these groups naturally arise from an exogenous event. Through random selection, research participants have an equal chance of being assigned to either control group or treatment group. Thus, the resulting groups are statistically identical at baseline, on both observed and unobserved characteristics. Any changes in such characteristics can be attributed to the intervention made. However, this is not the case for quasi-experiments. Since the control and treatment groups are not randomly selected, the quasi-experiment method faces threats to internal validity. That is, a causal link between the treatment and outcomes may not clearly establish. Independent and Dependent Variables The independent variable is the same-sex marriage policies while the dependent variable is the health care use and costs. The factors measured were sexual orientation, partnership status, and health care use and costs. However, the measures or instruments used were not properly referenced and their reliability was not even mentioned. Study Design The authors employed a quasi-experiment design, which has threats to internal validity because the participants were not randomly selected to be assigned in either control group or treatment group. Hence, the participants’ groups in the study may not statistically comparable at baseline. Consequently, any changes in the observed and unobserved characteristics of the participants may not absolutely be attributed to same-sex marriage policies. Quasi-experiments can be utilized in studies where many variables are involved because this research design can control extraneous variables and may infer cause-and-effect relationships. However, if there are differences between the control and treatment groups that cannot be controlled, predicting cause-and-effect relationships cannot accurately be done. Thus, the causal link between same-sex policies and health care use and costs may not accurately be predicted. On the other hand, the authors claimed that the legalization of same-sex marriage in Massachusetts occurred outside the control of the participants and was not confounded with the participant-level factors that can affect health care use. Sampling/ Data collection The authors used the data of sexual minority male patients in a large community-based clinic in Massachusetts. Of the 1,309 male patients surveyed, only 1,211 were chosen because the 98 patients did not directly indicate their sexual orientation. Based on the clinic’s electronic medical records, the sample was composed of representative of all patients, who visited the clinic during the target time period, with respect to various demographic variables. The authors examined the changes in the patients’ health care use and expenditures 12 months before and after the legalization of same-sex marriage. The participants’ responses were linked to their outpatient billing records for medical and mental health visits. Since the sample was a representative sample, sampling bias was avoided. The sample could be generalizable to a population possessing sociodemographic traits similar to those of the participants. Results Twelve months after the legalization of same-sex marriage, the mean of medical care visits dropped from 2.61 to 2.26. The mean difference was statistically significant at p Read More