PH 7160 – Introduction to Health Care System

(CRN: 86057)

Bruce C. Perry MD MPH

Health Management and Policy

Fall Semester2014

Course Basics / Class Day/Time: / Wednesday 4:30 – 7:00 PM
Class Location: / Rm. 516, 34 Peachtree Street Building
Prerequisite(s): / No prerequisites are required for the course.
Required Course Materials / Shi, Leiyu, and Singh, Douglas A. (2012). Delivering Health Care in America: A Systems Approach. Fifth or Sixth Edition. Sudbury, Massachusetts: Jones and Bartlett Publishers.
Faculty Accessibility / Instructor(s) of Record: / Bruce C. Perry, MD MPH
Office Location: / Rm. 662D One Park Place
Phone Number(s): / 404-413-1139
Email: /
Office Hours/Availability: / Office hours by appointment
  1. Course Description:

This course introduces and describes the health delivery system and the resources that comprise it. The theoretical basis for the system as well as the principal means of system organization and evaluation are discussed.

More specifically, this course introduces and describes the U.S. health care system, addressing its components and complexities. The historical basis for the system’s organization will be discussed, as well as the various modes of health care delivery and the ways health care is organized, financed and delivered in the United States. In addition to presenting the foundations of health care organization, the course will include an overview of health care delivery, health insurance, public health, health care finance and purchasing, and current challenges to the system. Policy options on organization, financing and delivery will be discussed. Students who complete the course will gain a basic understanding of the organization, functions, and delivery of health care by the many components of the U.S. system.

  1. Course Objectives / Competency / Assessment of Student Learning:

Students in the Master of Public Health programs will be expected to demonstrate competence in the following areas after completion of this course, as indicated in the GSU School of Public Health Graduate Student Handbook (see MPH Competencies):

  • Identify and critically discuss the organization and financing of the health services and public health systems in the United States, with emphasis on the consequences for vulnerable populations. (MPH Core Competency #11)
  • Apply evidence-based principles to critically evaluate current policies and practices in healthcare delivery and in public health systems including present and future healthcare reform proposals to address the quality, accessibility and cost of our health systems. (MPH Core Competency #12)

Course Objectives / Program Competency / Assessment Method(s)
Demonstrate ability to use library resources. / N/A / Issue paper #1 and #2
Write critically and cogently. / N/A / Issue paper #1 and #2
Critique the various components of the U.S. health care systems. / MPH Core 11 & 12 / Oral presentation and take home final examination
Analyze the history and current state of financing, insurance, payment and delivery functions. / MPH Core 11 / In class activity and take home final examination
Analyze the basic methods of how health care is purchased and paid for in the United States / N/A / In-class activity
List and describe the major players in the delivery system such as hospitals and physicians with attention to organization, payment, manpower issues and challenges. / MPH Core 11 / Oral presentation and take home final examination
Express cogent and critical comment on the consequences of the current health care delivery structure of the United States on health status of vulnerable populations. / MPH Core 12 / Oral presentation
Synthesize the perceived issues in the U.S. health care that are driving reform. / MPH Core 11 / Oral presentation and take home final examination
Apply public health theory, principles and knowledge in analysis of the Patient Protection and Affordable Care act of 2010. / MPH Core 12 / In-class activity and take home final examination
Describe the major principals and themes of Public Health in America. / MPH Core 11 / Discussion and take home final examination
  1. Course Assignments and Requirements

Course requirements will contribute to grade as follows:

Issue Paper #1 / 30%
Issue paper #2 / 30%
Final Examination / 30%
Class Attendance, Participation and Homework / 10%

Issue Papers: Each student will individually submit a paper that is to be 6-10 pages in length (excluding bibliography), double spaced, 12 point font with 1 inch margins left, right, top and bottom. The paper should be supported by research published in 6 strong sources (see below) from peer-reviewed sources.

Issue paper # 1: You may choose one of two topics for your paper. Please see Appendix A for more specific information. The Literature Review is due at noon on the day of Class 4 via the Desire2Learn dropbox (see Step 3 of Appendix A}. The paper isdue at noon on the day of Class 7 via the Desire2Learn dropbox in Word format.

Issue Paper #2 (Intervention Paper): The student shall pick a topic dealing with an issue or problem in health care delivery or public health and perform an analysis of an intervention that addresses the issue. Please see Appendix B for more specific information.

The one page summary is to be submitted by noon on the Class 11 via Desire2Learn dropbox (see Step 2 of Appendix B). The paper #2 is due at noon on the day of the Class 13 via the Desire2Learn assignment dropbox in Word format.

Final Examination: The final examination is cumulative and will be a take home test. The finalisdue noon on 7/24/14 via the Desire2Learn dropbox.

IV Grading Policy

Grading Scale:

94 – 100 A

90 – 93A-

87 – 89B+

83 – 86B

80 – 82B-

77 – 79C+

73 – 76C

70 – 72C-

60 – 69D

Below 60 F

Withdrawals: A student who withdrawals at any time up to the mid-point of the quarter will be assigned a W or WF depending upon whether he/she is doing satisfactory work at the time of withdrawal. An average grade of D or F at the time of withdrawal will be assigned a grade of WF. After the mid-point of the quarter, the Registrar’s Office will assign an automatic WF to any student who withdraws from the course without a hardship withdrawal. If a student receives permission to withdraw under hardship, the Instructor will assign a W or WF grade depending upon the student’s work up to the point of time that the student withdrew.

The following is the formal policy at Georgia State University:

Effective Fall 2001, Instructors must on a date after the mid-point of the course to be set by the Provost (or his designee),

  1. give a WF to all those students who are on their rolls but no longer taking the class and
  2. report the last day the student attended or turned in an assignment.

Students who are withdrawn may petition the department chair for reinstatement into their classes.

Incompletes: A student will be given the grade I only if nonacademic circumstances beyond the student’s control prevent the student from completing a small segment of the course—e.g., the final examination. For a student to receive the grade of I, he/she must be doing satisfactory work (an average grade of C or better) up to the point that he/she could not continue. Arrangements must be made with Instructor to remove the incomplete grade within one quarter.

  1. Attendance and Class Participation Policy

This course assumes substantial and informed student participation. General discussion of theory and practice is encouraged and expected of all students. At a minimum, being informed requires class attendance, completion of assigned readings and homework, and attention to health care news and world events. Class attendance and thoughtful participation are important and will be reflected in part in the final grade. Please notify the instructor of an absence before the class commences.

  1. Late Assignments and Make-up Examination Policy

Make-up exams are not provided, except in hardship cases that should be discussed in advance with the Instructor. Any assignment turned in late may have points deducted up to one letter grade for each day the assignment is late or fraction thereof. There is no scheduled make-up time for exams or paper presentations. If a student cannot take an exam or present at the scheduled time, they must consult with the Instructor on scheduling the make-up.

  1. Syllabus Deviation Policy

The course syllabus and schedule of topics provide a general plan for the course; deviations may be necessary. Additional or substitute reading materials may be required and made available to students via handout or other means.

  1. Student Code of Conduct and Policy on Academic Honesty

All students at this University are expected to engage in academic pursuits on their won with complete honesty and integrity. Any student found guilty of dishonesty in any phase of academic work will be subject to disciplinary action. The complete Academic Honesty policy is located in the GSU Graduate Catalog, Section 1350: Students and faculty are expected to review and conform to the university’s policy on academic honesty. Information on the Student Code of Conduct and related policies and procedures are available at:

Special attention should be paid to the sections on plagiarism and multiple submissions:

Plagiarism. Plagiarism is defined as, “appropriating and putting forth as one’s own the ideas, language, or designs of another” (The Living Webster, 1975) – and it is strictly forbidden. Written and oral presentations must be a student’s own work. Students plagiarizing or cheating in any form will face disciplinary action which could result in an “F” in this course and suspension or expulsion from the University. Copying from written materials, presentations, websites, etc. without source acknowledgement and referencing is plagiarism. Read it, appreciate it, learn from it, and make sure you source it – and then reflect it with your own thoughts and words! If you are uncertain about what constitutes plagiarism, please contact the instructor.

Multiple Submissions.It is a violation of academic honesty to submit substantial portions of the same work for credit more than once without the explicit consent of the faculty member(s) to whom the material is submitted for additional credit. In cases in which there is a natural development of research or knowledge in a sequence of courses, use of prior work may be desirable, even required; however, the student is responsible for indicating in writing, as a part of such use, that the current work submitted for credit is cumulative in nature.

  1. Disability Accommodations Policy

Students who wish to request accommodation for a disability may do so by registering with the GSU Office of Disability Services. Students may only be accommodated upon issuance by the Office of Disability Services of a signed Accommodation Plan and are responsible for providing a copy of that plan to instructors of all classes in which an accommodation is sought. The Office of Disability Services is located in the GSU Student Center, Suite 230 and online here:

  1. Course Evaluations Statement

Your constructive assessment of this course plays an indispensable role in shaping education at Georgia State. Upon completing this course, please take time to fill out the online course evaluation.

  1. Career Services

The School of Public Health provides career services & student leadership opportunities (student clubs & organizations) to all current SPH students and alumni. SPH Career Services can help students with resume writing, interviewing, job searching, internship development, and professional networking. Students are invited to attend our career events and workshops, and individualized career counseling appointments can be arranged. To see what career panels, career fairs, and events are available this semester, please visit: The SPH Career Services office is co-located with the Office of Academic Assistance in room 640 at One Park Place.

  1. Communication

Students should check Desire2Learn at least every other day especially before driving or riding to GSU for this class. The syllabus, any changes to the syllabus, lecture slides and homework will be posted to Desire2Learn. Should you have any questions about the course or its requirements, please ask your question during class or contact the Instructor via Desire2Learn. Students also may make an appointment to meet with the Instructor on class concerns. Should you wish to contact the Instructor about your grades, please address them in writing or in person to the Instructor. Please do not use e-mail to communicate about grade concerns.

PH 7160 is a graduate level course, and student behavior is to be in keeping with that expected of graduate students and professionals. Students are expected to show courtesy and respect for classmates and faculty. Cell phones are to be silenced prior to the beginning of class.

  1. Copyright Policy

“For the purpose of copyright, students must adhere to the following rules:

1) Materials in the course reserves may only be accessed by a passcode or password by students enrolled in that course, and only for the semester of course enrollment

2) Students may not distribute copies of course reserves materials to other students

  1. Grade Point Average Requirements

An overall grade point average (GPA) of 3.0 or better must be earned to receive the MPH degree. All core courses must be completed with a grade of B or better, and no more than six semester hours of grades less than B will be accepted for the degree. No grade below a C will be accepted toward the degree. Please refer to the Institute’s academic standing policy on Academic Warning and Suspension described in the Institute of Public Health section of the Graduate Catalog:

Important Websites

This includes the following websites:

Influential organizations and sources of topic reviews and references but not peer reviewed:

The Commonwealth Fund

The Kaiser Family Foundation

The Robert Wood Johnson Fund

Peer Reviewed Journals:

Health Affairs

New England Journal of Medicine

Milbank Quarterly

Peer Reviewed Governmental sources of Evidenced Based Medicine and Public Health:

US Preventive Service Task Force

Community Guide

  1. Tentative course schedule, topics, and readings

Date / Topic / Readings & Assignments
1. August 27 / Topic(s): Overview of course/Syllabus/Assignments /Communication/Desire2 Learn
Introductions
History of US health care
Components of a health care system / Readings: Shi & Singh pp. 5-7, Ch. 3
2. September 3 / Topic(s): Review of library services
Library Classroom 2, 2nd floor, Library North, Sharon Leslie, Instructor / Readings: None
3. September 10 / Topic(s): The finances of US healthcare Part I / Readings: Shi & Singh Ch. 6
4. September 17 / Topic(s): The finances of US healthcare Part II / Readings: Shi & Singh Ch. 6
Paper # 1 Review of Literature due at noon.
5. September 24 / Topic(s): Healthcare workforce / Readings: Shi & Singh Ch. 4 & Ch. 7
Professions Mini-presentation will be given
6. October 1 / Topic(s): Hospitals/Acute care
Readings: Shi & Singh Ch. 8 / Topic for paper #2 is due at noon.
7. October 8 / Topic(s): Integrated delivery systems/Managed care / Readings: Shi & Singh Ch. 9
Issue paper #1 is due at noon.
8. October 15 / Topic(s): Healthcare costs, Technology, and Quality / Readings: Shi & Singh Ch. 5 & 12
9. October 22 / Topic(s): Long term care/Issues of aging / Readings: Shi & Singh Ch. 10
10. October 29 / Topic(s): Vulnerable populations / Readings: Shi & Singh Ch. 11
Vulnerable population mini-presentation will be given
11. November 5 / Topic(s): Health Policy and Healthcare reform / Readings: Shi & Singh, Ch. 13
Outline of Issue Paper #2 is due at noon.
12. November 12 / Topic(s): Healthcare in other countries
The future of health care / Readings: Shi & Singh pp. 20-28
13. November 19 / Topic(s): Public Health Part I / Reading: Shi & Singh Ch. 2
Issue paper #2 is due at noon.
Thanksgiving Break November 24 -29
14. December 3 / Topic(s): Public Health Part II / Final is due at noon.

Appendix A: Paper #1

An Analysis of an Important Health Service Topic

The student should choose one of the following topics:

Topic 1: High deductible health plans and consumer directed health plans: In order to reduce costs insurers and employers have adopted high deductible health plans. What is the evidence that these plans have had a positive or negative effect on cost or health outcomes? What are the best aspects of high deductible plans that should be included in health reform and what are the aspects to be avoided?

Topic 2: The State of Massachusetts passed legislation to reform health care in 2006. Much has been written about the positive and negative affects of the reform; unfortunately, much of the literature has been based on opinion or limited analysis. What is the evidence that the Massachusetts healthcare reform has had positive or negative effects or both? Please review the peer-reviewed literature to answer the question of the positive and negative effects of this initiative. What are the policy implications for the national healthcare reform laws that were passed in 2010? State your conclusions.

Step 1: Obtain the Necessary Understanding to Write an Evidenced Based Paper

  1. Read the syllabus and Appendix A carefully.
  2. Read the following URLs:
  3. Attend and absorb as much as you can from the Library Presentation in class 1.
  4. Within 24-72 hours of the Library Presentation do first PubMed search.

Information about the literature in health policy and health services research.

  • Examples of peer-reviewed journals:

Health Affairs

New England Journal of Medicine

Milbank Quarterly

  • Please note that student should be able to identify if an article is an original research paper or a review paper and whether source is peer reviewed. Please review:
  • Original research articles describe a study performed by the authors. Original research articles usually have sections such as Introduction, Methods, Results and Discussion (IMRAD). Their study designs may be observational, longitudinal, cross-sectional, retrospective and experimental. Please review:

Examples:

Half Of Older Americans Seen In Emergency Department In Last Month Of Life; Most Admitted To Hospital, And Many Die There

A Randomized Trial of Nighttime Physician Staffing in an Intensive Care Unit

  • Other cited articles may be primary research or review articles. Review articles may be called Review, Commentary, Perspectives, Editorial or similar terms. In review articles the authors comment on already published work thus called secondary analysis.

Examples:

Hospital-Acquired Infections Due to Gram-Negative Bacteria

Emergency care for children in the United States

  • If the student does not know if source is peer-reviewed, go to the Library home page in the databases section, select U then Ulrichsweb. Enter the source name and look for the referee’s shirt that signifies the source is peer reviewed.

A Review of the Quality of Health Care for American Indians and Alaska Natives

  • There is a hierarchy of importance of evidence and articles in the scientific literature including Public Health. In the considering the strength of the literature to cite, please use the following hierarchy; see:
  • Strongest: Original research studies published in peer reviewed literature are strongest (MMWR, Community Guide, US Preventative Services Taskforce Report are important and peer-reviewed). Primary research articles describe a study performed by the authors. Primary research articles usually have sections such as Introduction, Methods, Results and Discussion.
  • Strong: Review articles may be strong if well done. Review articles may be called Review, Commentary, Perspectives, Editorial or similar terms. In review articles the authors comment on already published work. The list of references usually contain primary research articles
  • Good sources of general information and references but not peer reviewed: Respected Foundation websites, CDC.gov, government reports and white papers.
  • Centers for Disease Control
  • The Commonwealth Fund
  • The Kaiser Family Foundation
  • The Robert Wood Johnson Fund
  • Weak, not peer reviewed: “Piece of my mind editorials”, Newspaper articles and editorials, Blogs, Wikipedia

Step 2: Research the Topic and Find Literature