Introduction to Health Policy and Management
HPAM-GP 1830.003Fall 2014 Victory Syllabus
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NEW YORK UNIVERSITY
ROBERT F. WAGNER GRADUATE SCHOOL OF PUBLIC SERVICE
INTRODUCTION TO HEALTH POLICY AND MANAGEMENT
HPAM-GP.1830.003
Fall 2014
Days:Mondays 6:45 p.m. – 8:25 p.m. (Dates: 9/08/14 – 12/08/14)
Professor:Jacob Victory, Assistant Professor ()
Location: 194 Mercer Street, Room 306
Office: N/A
Office hours: By appointment and immediately after each class.
COURSE SYLLABUS
This core specialization course in the NYU Wagner MPA: Health Policy and Management program explores major topics in the study of health and health care delivery. We will discuss determinants of health, the social distribution of health and disease, and health disparities; the organization and financing of the U.S. health care system, its historical context, the roles and behaviors of its key actors, and its comparison to health systems of other nations; the quality, cost and accessibility of health care services; and health care delivery system improvement and reform. We will examine these themes using a multidisciplinary approach that employs sociological, political, economic and ethical perspectives on health and disease, the health care system, and the challenges of meeting the varied (and often conflicting) needs and motivations of health care system stakeholders. The objective of this course is to build understanding of fundamental ideas, issues and problems in health policy and management and thereby to provide a strong foundation for future studies and careers in the health care field.
COURSE COMPETENCIES
Course focus:
The ability to assess population and community health needs from a public service perspective
The ability to examine social and behavioral determinants of health and understand how health systems can address the needs of vulnerable populations
The ability to understand how policy and delivery processes work, and to consider the demographic, cultural, political and regulatory factors involved in and influencing health policy and management decision-making
Relevant content for the following competencies is also included:
The ability to understand and apply legal and ethical principles to managerial and leadership decisions affecting health care organizations
The ability to measure, monitor and improve safety, quality, access and system/care delivery processes in health care organizations
The ability to draw implications and conclusions to develop an evolving vision that results in long-term organizational viability
The ability to communicate and interact productively (via listening, speaking and writing) on matters of healthcare with a diverse and changing industry, work force and citizenry
The ability to present convincingly to individuals and groups the evidence to support a point of view, position or recommendation
LEARNING OBJECTIVES
At the conclusion of this course, students will be prepared to:
Describe the organization, financing and performance of the U.S. health care delivery system
Identify determinants of health and explain their impact on the distribution of health and disease
Define the roles of key stakeholders – providers, government and private payers, employers, regulators, patients – and describe their incentives and behavior
Compare the U.S. health care system to models of health care organization and financing abroad
Explain fundamental concepts of health care payment and performance measurement
Define major health policy developments over the past 50 years and explain their significance
Analyze strengths, weaknesses and feasibility of policy and management approaches that aim to promote health, prevent disease and improve health services delivery and assess the impact of these approaches on quality, access, cost and equity goals
BOOKS AND READINGS
Students should arrive to class prepared to participate in the discussion of these themes based on their critical analysis of assigned readings.
Required textbook:
Health Care Delivery in the United States (10th edition). A. Kovner & J. Knickman, eds. New York, NY: Springer Press, 2011.
Other required readings:
Assigned weekly readings that are not included in the required textbook will be postedon Sakai.
WRITTEN REQUIREMENTS
In addition to attending and participating in classes, students are required to complete two papers, one, a memo written by each student, due October 20, 2014, and another, a group research paper, due December 8, 2014. Instructions for written assignments are included at the end of this syllabus and also will be distributed and described in class. Grading information is provided at the end of this syllabus.
COURSE SESSIONS
A. POPULATION HEALTH
September 8, 2014: Week 1. Introduction: Health, Disease and Community
Overview of course
Definitions of health and disease
Relationship between health and medical care
Health Care Delivery in the United States
Knickman, J. and Kovner, T. Chapter 1: The Current U.S. Health Care System, pp. 3-8.
Posted on Sakai:
Schroeder, S. 2007. We Can Do Better: Improving the Health of the American People. New England Journal of Medicine 357: 1221-1228.
Colgrove, J. 2002. The McKeown Thesis: A Historical Controversy and Its Enduring Influence. American Journal of Public Health 92(5): 725-729.
Gawande, A. 2011. Cowboys and Pit Crews: 2011 Commencement Address at Harvard Medical School. The New Yorker, posted May 26.
September 15, 2014: Week 2. Epidemiologic Measures and Determinants of Health
Relationships between socioeconomic status, race/ethnicity, gender and health
Population health inequalities and social justice implications
Health Care Delivery in the United States
Russo, P. Chapter 5: Population Health, pp. 85-102.
Posted on Sakai:
Adler, N. and Rehkopf, D. 2008. U.S. Disparities in Health: Descriptions, Causes and Mechanisms. Annual Review of Public Health 29: 235-252.
Marmot, M. 2005. Social Determinants of Health Inequalities. The Lancet 365: 1099-1104.
Williams, D. and Jackson, P. 2005. Social Sources of Racial Disparities in Health. Health Affairs 24(2): 325-334.
September 22, 2014: Week 3. Public Health Policy and Management
Public health infrastructure
Prevention and health promotion frameworks
Health behavior
Policy approaches to improving public health
Health Care Delivery in the United States
Leviton, L., Rhodes, S. and Chang, C. Chapter 6: Public Health: Policy, Practice, and Perceptions, pp. 103-123.
Orleans, C. and Cassidy, E. Chapter 7: Health and Behavior, pp. 125-149.
Sakai
Roberts, M. and Reich, M. 2002. Ethical Analysis in Public Health. The Lancet 359(9311): 1055-1059.
Robert Wood Johnson Foundation Commission to Build a Healthier America 2009. Beyond Health Care: New Directions to a Healthier America. Executive Summary and Introduction, pp. 9-25.
B. ORGANIZATION OF THE U.S. HEALTH CARE SYSTEM
September 29, 2014: Week 4. U.S. Health Policy and Reform: 1900 to Present
Historical development of health care delivery system
Government role in health care system
Comparative health systems
Models of delivery and payment in other developed nations
Health Care Delivery in the United States
Sparer, M. Chapter 2: Health Policy and Health Reform, pp. 25-45.
Frogner, B., Waters, H. and Anderson, G. Chapter 4: Comparative Health Systems, pp. 67-82.
Posted on Sakai
Blendon, R. and Benson, J. 2001. Americans’ Views on Health Policy: A Fifty-Year Historical Perspective. Health Affairs 20(2): 33-46.
Starr, P. 2011. Remedy and Reaction: The Peculiar American Struggle Over Health Care Reform. New Haven, CT: Yale University Press. Introduction.
Rothman, David, J. 1993. A Century of Failure: Health Care Reform in America. Duke University. Journal of Health Politics & Law 18(2): 271-286.
October 6, 2014: Week 5. Health Care Financing
Fundamental characteristics of health care markets
Medicare, Medicaid/CHIP and private insurance
Spending growth in the U.S.
Managed care and cost containment
Implications of 2010 Patient Protection and Affordable Care Act (PPACA)
Health Care Delivery in the United States
Knickman, J. Chapter 3: Health Care Financing, pp. 47-66.
White, H. Chapter 12: Health Care Costs and Value, pp. 257-276.
Appendix: Major Provisions of the Patient Protection and Affordable Care Act of 2010, pp. 365-376.
Posted on Sakai
Bodenheimer, T. 2005. High and Rising Health Care Costs, Part 1: Seeking an Explanation. Annals of Internal Medicine 142(10): 847-854.
Cutler, D. 2010. Analysis and Commentary: How Health Care Reform Must Bend the Cost Curve. Health Affairs 29(6): 1131-1135.
NO CLASS MONDAY, OCTOBER 13, 2014.
October 20, 2014: Week 6. U.S. Health Care System in International Perspective
Memo due today.
- Comparative health systems
- Models of delivery and payment in other developed nations
Health Care Delivery in the United States
- Frogner, B., Waters, H. and Anderson, G. Chapter 4: Comparative Health System, pp. 67-82.
Posted on Sakai
- Murray, C. and Frenk, J. 2000. A Framework for Assessing the Performance of Health Systems. Bulletin of the World Health Organizations 78(6): 717-731.
- Davis, K., Schoen, C. and Stremekis, K. 2010. Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally. 2010 Update. Commonwealth Fund, Pub. No. 1400.
- Weisz, D., Gusmano, M., Rodwin, V., and Neuberg, L. 2008. Population Health and the Health System: A Comparative Analysis of Avoidable Mortality in Three Nations and Their World Cities. European Journal of Public Health 18(2): 16-172.
October 27, 2014:Week 7. Providers and Organization of Care
Acute and ambulatory care delivery
Evolving organizational forms
Health Care Delivery in the United States
Caronna, C. and Ong, M. Chapter 9: Organization of Medical Care, pp. 181-204.
McCarthy, D. Chapter 10: Integrative Models and Performance, pp. 205-231.
Posted on Sakai
Bodenheimer, T. 2007. Coordinating Care—A Perilous Journey through the Health Care System. The New England Journal of Medicine 358(10): 1064-1071.
Rittenhouse, D. 2009. Primary Care and Accountable Care: Two Essential Elements of Delivery System Reform. New England Journal of Medicine 361(24): 2301-2303.
November 3, 2014: Week 8. Medical Professionals and the Health Care Workforce
Historical and emerging roles for physicians and health professionals
Health care labor markets
Professionalization and power in organized medicine
Health Care Delivery in the United States
Scheffler, R. and Spetz, J. Chapter 12: Health Workforce, pp. 315-329.
Posted on Sakai
Goodman, C. and Fisher, E. 2008. Physician Workforce Crisis? Wrong Diagnosis, Wrong Prescription. New England Journal of Medicine 358(16): 1658-1661.
Peterson, M. 2001. From Trust to Political Power: Interest Groups, Public Choice, and Health Care. Journal of Health Politics, Policy and Law 26(5): 1145-1163.
Weisz, G. et al. 2007. The Emergence of Clinical Guidelines. The Milbank Quarterly 85(4): 691-727.
November 10, 2014:Week 9. Patient Decision-Making and the Provider‒Patient Relationship
Role of the patient in the health care system
Patient preferences and informed patient decision-making
Provider‒patient relationship
Consumer-directed care and patient demand for and use of information
Posted on Sakai
Hibbard, J. and Cunningham, P. 2008. How Engaged Are Consumers in Their Health and Health Care, and Why Does It Matter? Center for Studying Health System Change, Research Brief No. 8 (October).
Mechanic, D. 1998. The Functions and Limitations of Trust in the Provision of Medical Care. Journal of Health Politics, Policy and Law 23(4): 661-686.
Sepucha, K. and Mulley, A. 2009. A Perspective on the Patient’s Role in Treatment Decisions. Medical Care Research and Review 66(1 suppl): 53S-74S.
Arnold, S. and Scanlon, D. 2009. Realizing True Consumer-Directed Health Care: What the Policy Community Needs. Medicare Care Research and Review 66 (1 suppl): 3S-8S.
C. HEALTH CARE SYSTEM PERFORMANCE, CHALLENGES AND DEBATES
November 17, 2014: Week 10. Meeting Changing Population Needs
Chronic disease management
Long-term care
End-of-life issues
Posted on Sakai
Bodenheimer, T., Wagner, E., Grumbach, K. 2002. Improving Primary Care for Patients with Chronic Illness: The Chronic Care Model, Part 2. Journal of the American Medical Association 288: 1909-1914.
Gawande, A. 2010. Letting Go: What Should Medicine Do When It Can’t Save Your Life? The New Yorker August 2 issue.
Kane, R. and Kane, R. 2001. What Older People Want from Long-Term Care, and How They Can Get It. Health Affairs 20(6): 114-127.
Kaye, H., Harrington, C. and LaPlante, M. Long-Term Care: Who Gets It, Who Provides It, Who Pays, and How Much? Health Affairs 29(1): 11-21.
November 24, 2014. Week 11. Improving Quality of Care
Safety and quality of U.S. health care delivery
Measuring, regulating and improving quality and patient safety
Challenges of quality improvement and adverse event reduction in health care
Quality improvement frameworks and interventions
Health Care Delivery in the United States
Clancy, C. and Lloyd, R. Chapter 11: High Quality Health Care, pp. 233-255.
Kropf, R. Chapter 16: Health Information Technology, pp. 331-349.
Posted on Sakai
Landrigan, C. et al. 2010. Temporal Trends in Rates of Patient Harm Resulting from Medical Care. New England Journal of Medicine 363: 2124-2134.
December 1, 2014: Week 12. Managing New Medical Technology
Expanding use of pharmaceutical and medical devices in health care
Treatment benefits versus monetary costs associated with medical innovation
Role of pharmaceutical/biotech industry in health care system
Health Care Delivery in the United States
Satvat, A. and Leight, J. Chapter 13: Comparative Effectiveness, pp. 277-295.
Posted on Sakai
Cutler, D. and McClellan, M. 2001. Is Technological Change in Medicine Worth It? Health Affairs 20(5): 11-29.
Gilsdorf, J. 2004. As Drug Marketing Pays Off, My Mother Pays Up. Health Affairs 23(1): 208-212.
Steinman, M., Landefeld, S. and Baron, R. 2012. Industry Support of CME – Are We At a Tipping Point? New England Journal of Medicine 366(12): 1069-1071.
December 8, 2014: Week 13. Expanding Access and Reducing Disparities in Access and Treatment
Group research papers due today.
Barriers to care for vulnerable patient populations
The uninsured and underinsured in the U.S.
Implications of 2010 Patient Protection and Affordable Care Act
Health Care Delivery in the United States
Billings, J., Cantor, J. and Clinton, C. Chapter 8: Access to Care, pp. 151-178.
Posted on Sakai
Ayanian, J. et al. 2000. Unmet Health Needs of Uninsured Adults in the United States. Journal of the American Medical Association 284(16): 2061-2069.
Hurley, R. et al. 2007. Community Health Centers Tackle Rising Demands and Expectations. Center for Studying Health System Change, Issue Brief No. 116 (December).
Fuchs, V. 2009. Health Reform: Getting the Essentials Right. Health Affairs 28(2): w180-w183.
WRITTEN REQUIREMENTS AND GRADING
In addition to attending and participating in class meetings, all students are required to submit the following written assignments by the following deadlines. Final grades will be calculated accordingly:
Grades:This class will not be graded on a curve. The grading rubric will be shared prior to each assignment. This course follows the NYU Wagner School’s general policy guidelines on incomplete grades, academic honesty and plagiarism. It is the student’s responsibility to become familiar with these policies. All students of this class are expected to pursue and meet the highest standards of academic excellence and integrity.
- Incomplete grades:
- Academic honesty:
Individual or Team Assignment% of Final GradeDue Date
Memo: Individual30% 10/20/14
Research Paper: Teams of Four 45% 12/8/14
Class Participation 25% Throughout class
Class Participation: (25% of class grade). This course depends on active and ongoing participation by all class participants. Participation starts with reading all course materials and listening. Class participants are expected to read and discuss the weekly readings on a weekly basis. You will not earn the 25% of your grade for class participation simply by attending classes. While attendance is a large component, to fully earn the 25% for class participation, students must come prepared to engage the class. To “engage,” each student must listen to all points of view, share his/her thoughts on at least one subject or discussion raised within each class, critique thoughts (in a respectful, reflective and thoughtful manner), ask questions, and/or promote thoughtful dialogue with class participants. My lectures are frequently very interactive with students in the class and I have the right to call on any member of the class at any time during class. (If, for some reason, you have not read the class readings and feel unprepared to respond to being called on in a class, please let me know. It is understandable that this may be the case on rare occasion. If this, however, becomes a regular or frequent happening, your participation grade/percentage will be severely affected.)As other instructors have noted, please note that the quality and quantity of participation can be, but are not necessarily, correlated.
Lateness Policy – Please submit assignments on time. Assignments must be emailed to me () by 11:59 pm on the date due.Extensions will be granted only in case of emergency. This is to respect those who abide by class deadlines. Points will be taken off if the papers are not submitted on the date due. Papers submitted late and without extensions will be penalized by one-half letter grade for each day late.
WRITTEN ASSIGNMENTS
General Guidelines for Memos:
Please see the New York University Writing Center Guide to Writing Memos, posted on the course Sakai site, for memo composition guidelines. Citations are required and a separate references page is not necessary. If relevant, appropriate exhibits (not included in page length) are acceptable but not required. All written work should be double-spaced in 12-point Times New Roman font with 1” margins. Please print the papers on one side of the paper, and not on both sides.
Memo
(Individual)
Due October 20, 2014 (Week 6)
You are the Chief Operating Officer of a large healthcare system, composed of acute, long term care, and community based organizations in addition to long term care managed care plans. Given your current studies in health policy and management, the Chief Executive Officer ofthis large healthcare system has requested that you prepare a high-level briefing for the system’s Board of Directors in which you describe: (a) factors that have contributed to dramatic growth in health care spending over the past 50 years; and (b) how health care payment and delivery models are transforming to promote greater accountability for cost and quality in the health care system. Please conclude your memo with your analysis of the most promising approaches for constraining cost growth while maintaining or improving quality, as well as the limitations or open questions that accompany new reimbursement and delivery models that are intended to promote “accountable care.”
The memo must be four pages in length. Please include references to course readings as well as any relevant outside sources that support your analysis. Citations and a references page (not included in page length) are required.
Research Paper (With at least four student partners)
Due December 8, 2014
12-page research paper
Instructions: In at least a four-student team (some team may vary in the number of student partners due to class size), please prepare a 12-page research paper on the topics that follow:
Please prepare a 12-page research paper in which you focus on one dimension of performance of the U.S. health care delivery system. Please examine how performance on this dimension is influenced by the organization and financing of health care in the U.S. and behavior of key health system stakeholders, what must be improved or reformed to achieve performance gains in your selected area, and the implications of your analysis for health policy and management. You may focus on performance in a broadly-defined area (such as quality of care, cost or access to care) or you may define your focus more narrowly within one of these categories (e.g., quality of care for chronically-ill elderly patients, cost-effectiveness of new medical technologies, access to specialized care for low-income populations). In your analysis, please consider all stakeholders relevant to your specified focus—providers, payers and purchasers, patients, communities, policy-makers, and other groups that play a role in performance in your focal area—and be sure to examine performance and implications for reform at both the policy and delivery system levels.