P11.2836 Current Issues in Health Policy
DRAFT
New York University
Robert F. Wagner Graduate School of Public Service
P11. 2836 – Current Issues in Health Policy
Spring, 2010- Version 4.0
Professor: Gerry E. Goodrich
Mondays – Mondays 6:45 – 8:25 pm
Room: Meyer Hall, Room 157
Course Description
As this course begins in early 2010 the most current issue in health policy is the health reform legislation before Congress. This legislation will be reviewed in the course and will constitute an ongoing thread throughout the course.
Overall, the course is an introduction to major health policy issues and examines the role of government in the health care system. The course materials are built around the reading of several recent works describing the functioning of major health care institutions and/or the roles of physicians in these institutions. The role of government in health care – what makes for health policy – is examined from several perspectives. Because much of government health policy relates to or is implemented through payment systems, several sessions involve some discussion of the policy implications of how government pays for care. Sessions, mostly, altenate between the reading of serveral current books on hospitals, physicians and health care and a selection of journal articles on various topics. Class discussion will build on the readings.
The reading of the course materials is essentail to obtaining value from the course and is expected
.
Course Objectives
Develop an understanding of the major health policy issues addressed in the 2010 health reform legislation consideredy by congress and acquire a basic understanding of the objectives of the drafters of the legislation.
Demonstarte an ability to articulate the future trends these issues will likely follow over the next several years.
Provide an introduction to selected readings and journals in the health policy arena.
Course Requirements/Grading
Two papers are required for the course (both ≤ 6 pages, doubled spaced, 14 pt font), each accounting for 40% of the final grade. Class discussion and debate are integral to the course and will account for 20% of the final grade. Papers can be submitted in class or via email. There is no midterm and no final exam.
Students are expected to have studied the assigned readings. The readings for the course will be several specified books or collections of articles. See Book List, below. Articles will be posted in the Assigned Readings section of Blackboard®. There is no text book for the course, and the required books are readily available at area bookstores or on the web (e.g., amazon.com, barnesandnoble.com, etc.). Copies of PowerPoint materials used in class will be posted in the Session Notes section on the Blackboard®.site.
Required Papers
1. Personal Resume (Pass/Fail) – Provide a brief resume or CV that describes who you are, employment experience (if any) and your career aspirations.
Due Date: Session 2 – 2/01/10, in class or prior by electronic submission.
2. Paper 1 – Site Visit Memo or Interview with Grandparent/Elderly Person
A. Site Visit Memo
Visit one of the following healthcare “landmarks” in New York City and prepare a short memorandum to the landmark “owner” suggesting changes that should be made to improve the operations of the site. The paper should be no longer than six pages.
- Bellevue Hospital – Emergency Department
- New York Presbyterian/Weill Cornell Campus
The Ronald O. Perelman Heart Institute
- New York Presbyterian Hospital/Columbia Campus
Vanderbilt Clinic
- NYC Department of Health Clinic, 27th Street and 9th Avenue
- Memorial Sloan Kettering, Pediatric Oncology Outpatient Department
- St. Vincent’s Hospital and Medical Center, Outpatient Building
- Harlem Hospital, HIV clinic
- Weill Cornell Eye Associates, 11th Floor, 1305 York Avenue
- Agreed upon “landmark” of choice
B. Interview
Interview a relative or close friend who is over 65 and is a Medicare benficiary. Write a short memorandum regarding your conclusions as to the person’s understanding of his/her health coverage and describe, based on the interview, the strengths and weaknesses of the Medicare benefits the person receives. The paper should be no longer than six pages.
Due Date: 03/08/10 – Submit electronically or bring to class
3. Paper 2 – “The Dartmouth Atlas of Health Care” memo (40% of final grade) - Six or fewer pages – Review the Dartmouth Atlas of Helth Care of 2008 (http://www.dartmouthatlas.org/data/download.shtm) or go online to the Dartmouth Atlas Benchmarking site where you can look at specific hospitals or communities across the country (http://cecsweb.dartmouth.edu/atlas08/datatools/bench_s1.php).
Pick an example of variation in utilization that you believe is unwarranted and describe the factors that are likely to contribute to the differences among areas (or hospitals). Then pick one contributing factor and make some suggestions about what might be done to reduce variation. Be specific and detailed in your suggestions, including who ought to do what to whom. Be realistic, don’t make suggestions that are cannot be implemented because of technical, financial, or political considerations. This is not a research paper, but footnote sources of ideas you use for the causes of variation (or the suggested solutions if the ideas come from a specific source).
Due Date: 04/12/10 – Submit electronically or bring to class
Office Hours
If you have questions about the reading materials or you need other help, please contact me at
or call me at my Weill Cornell Medical College office, 646-962-6006.
Office hours can be arranged by appointment.
Session 1 – 01/25/10: Course Introduction
Introduction to HR 3950, The Senat Refrom Bill, the “Patient Protection and Affordable Care Act”
§ Introductions
§ Description of course content, goals, and requirements
§ Overview and discussion of recent health reform act
§ Scale and Excellence
Required Reading:
Health Affairs: http://healthaffairs.org/blog/2009/11/19/the-senate-health-reform-bill-a- first-look/
Senator Max Baucus, Chairman’s Mark, America’s Health Futures Act – 2009
John Iglehart, ‘Settleing in for a Long Debate,” New England Journal of Medicine, December 17, 2009, p e56
The New York Times, news and columns by David Leonhart
Session 2 – 02/01/10: How Good is America’s Health System?
Required Reading:
T.R. Reid, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, 2009
§ Comparative analysis of other nation’s health systems to that of the United States
§ One person’s search for the best treatment
Optional Reading:
S. Schoenbaum S, A. Audet, and K. Davis, “Obtaining Greater Value from Health Care: The Roles of the U.S. Government,” Health Affairs (November/December 2003): 183-190.
G. Anderson, P Hussey, B Frogner, et al., “Health Spending in the United States and the Rest of the World,” Health Affairs (July/August, 2005): 903-914.
National Health Expenditure Accounts, Handouts
Session 3 – 02/08/10: The Stimulus Bill – HITECH
§ The Health Information Technology for Economic and Clinical Health Act (HITECH)
§ HIT – Health Information Technology: Incentives for adoption
§ Meaningful Use, P4P (Paying for Performance), Value Purchasing
Required Reading:
Materials to be distributed
Session 4 – 02/15//10: No Class – President’s Holiday
Session 5 – 02/22/10: Medicare Basics – Paying for Care for those over 65
Medicare: The basics and Issues for reform
§ Description of who and what is covered by Medicare
§ Review of how Medicare pays for health care
§ Introduction to MedPac
Required reading:
“Medicare, A Primer, 2009,” Kaiser Family Foundation, http://www.kff.org/medicare/upload/7615-02.pdf
M. Moon, “Medicare,” New England Journal of Medicine 344, No. 12 (March 22, 2001): 928-931.
K. Davis, K. Schoen, M. Doty et al., “Medicare Versus Private Insurance: Rhetoric and Reality,” Health Affairs - Web Exclusive (9 October 2002): W311-324
M. Pauly, “Means Testing in Medicare,” Health Affairs - Web Exclusive (8 December 2004): W4-546-557
MedPac, Payment Basics and Payment Basics Physician services payment System. www.MedPac.gov
Optional reading:
To be determined
Paper 1, see assignment above
Health Care “landmark” choice due; submit choice by email.
Session 6 – 3/01/10: How Good Are America’s Physicians?
Required Reading:
Charles R. Morris, The surgeons: Life and Death in a Top Heart Centre, 2008
§ An inside look at the work of cardiac surgeons
§ Case study of cardiac surgery at New York Presbyterian Hospital/Columbia University
Session 7 – 03/08/10: How Consistent is America’s Health Care?
§ Review of the variation in medical practice
§ Discussion of causes of variation
§ Discussion of the implications for policy
Required reading:
A. Gawande, “The Cost Conundrum,” New Yorker, June 1, 2009
MedPac, Report to the Congress: Measuring regional variation in service use (December 2009)
MedPac, Fact sheet: Measuring regional variation in service use (December 2009)
Optional Reading:
E. Fisher, D. Wennberg, T. Stukel, et al., “The Implications of Regional Variation in Medicare Spending - Part 2: Health Outcomes and Satisfaction with Care,” Annals of Internal Medicine 138, No. 4 (2003): 288-299
J. Wennberg, E. Fisher, T. Stukel, et al., “Use of Hospitals, Physician Visits, and Hospice During the Last Six Months of Life among Cohorts Loyal to Highly Respected Hospitals in the United States,” British Medical Journal 328, No. 7440 (March 13, 2004): 607-610.
K. Baiker, A. Chandra, J. Skinner, et al., “Who You Are and Where You Live: How Race and Geography Affect the Treatment of Medicare Beneficiaries,” Health Affairs - Web Exclusive (7 October 2004): VAR33-44.
D. Eddy, “Evidence-Based Medicine: A Unified Approach,” Health Affairs (January/February, 2005): 9-17.
Session 8 – 3/15/10 – No Class - Spring Recess
Sessions 9 – 3/22/10: How Good is America’s Health Service? The Mayo Clinic
Required Reading:
Leonard Berry and Kent Seltman, Management Lessons from Mayo Clinic: Inside One of the Worlds Most Admired Service Organizations, 2008
§ Service Excellence at the Mayo Clinic
Session 10 – 3/29/10: Medicaid: The basics and issues for reform
§ History and financing of Medicaid
§ Description of who and what is covered by Medicaid
§ Discussion of recent reforms/Issues for reform/Role of managed care
Required reading:
Rosenbaum, Sarah, Medicaid and National Health Reform, NEJM,Vol. 361, # 21, Nov. 19, 2009, p 2009.
“Medicaid, A Primer, 2009,” Kaiser Family Foundation, http://www.kff.org/medicaid/upload/7334-03.pdf
D. Boyd, “The Bursting State Fiscal Bubble and State Medicaid Budgets,” Health Affairs (January/February 2003): 44-61.
B. Vladeck, “Where the Action Really Is: Medicaid and the Disabled,” Health Affairs (January/February 2003): 90-100.
J. Hoadley, P. Cunningham, and M. McHugh, “Popular Medicaid Programs Do Battle with State Budget Pressures: The Perspective from Twelve States,” Health Affairs (March/April 2004): 143-154.
D. Draper, R. Hurley, and A. Short, “Medicaid Managed Care: The Last Bastion of the HMO?” Health Affairs (March/April 2004): 155-167.
Session 11 – 4/05/10: The American Hospital – What next?
Required Reading:
Thomas H. Lee and James J. Mongan, Chaos and Organization in Health Care, 2009
§ From the leadership of Partners, Massachusetts General Hospital and The Brigham and Women’s Hospital
Session 12 – 4/12/10: Government, Epidemics, Influenza and the CDC
§ H1N1
§ Vaccines
§ CDC
Required Reading:
John M. Barry, The Great Influenza: The story of the deadliest pandemic in history (Paperback - Oct 4, 2005)
Session 13 – 4/19/10: Medical errors – Medical malpractice
§ Brief overview of current malpractice law
§ Description of what is known about medical errors
§ Analysis of the effectiveness of the legal system and malpractice law in assuring quality and compensating victims of harm
§ Discussion of current “crisis” and proposals for reform
Required reading:
Institute of Medicine, “Report Brief - To Err is Human: Building a Safer Health System” - http://www.nap.edu/catalog/9728.html
M. Mello, D. Studdert, and T. Brennan, “The New Medical Malpractice Crisis,” New England Journal of Medicine 343 No. 23 (2003): 2281-4.
W. Sage, “Medical Liability and Patient Safety,” Health Affairs (July/August 2003): 26-36.
M. Hatlie and S. Sheridan, “The Medical Liability Crisis of 2003: Must We Squander the Chance to Put Patients First?” Health Affairs (July/August 2003): 37-40.
A. Chandra, S. Nundy, S. Seabury, “The Growth of Physician Medical Malpractice Payments: Evidence from the National Practitioner Data Bank,” Health Affairs - Web Exclusive (31 May 2005): W5-240-249.
Session 14 – 4/26/10: Low Income-ness, Un-insurance, and Costs
§ Description of the size and characteristics of the uninsured population
§ Review of the causes of un-insurance
§ Description of the dynamics of current cost increases
§ Review of the causes and implications of cost increase
Required Reading:
J. Billings, L. Zeitel, J. Lukomnik, et al., “Impact of Socioeconomic Status on Hospital Use in New York City” Health Affairs (Spring 1993): 162-173.
J. Billings, J. Anderson, L. Newman, “Recent Findings on Preventable Hospitalizations” Health Affairs (Fall 1996): 239-249.
Kaiser Family Foundation, The Uninsured: A Primer, October, 2008.
D. Altman and L. Levitt, “The Sad History of Health Care Cost Containment as Told in One Chart,” Health Affairs – Web Exclusive (23 January 2002): W83-4.
H. Aaron, “Should Public Policy Seek to Control the Growth of Health Care Spending?” Health Affairs – Web Exclusive (8 January 2003): W3 28-36.
M. Pauly, “Should We Be Worried about High Real Medical Spending Growth in the United States?” Health Affairs – Web Exclusive (8 January 2003): W3 15-27.
Session 15 – 5/03/10: Re-writing the health reform act
§ So what happens now?
Required Readings:
Gawnde, Atul,“Department of Medicine – Testing, Testing,” The New Yorker, December 14, 2009, p 34-41.
Michael Porter, “A Strategy for Health Care Reform – Toward a Value-Based Sytem ValueSystem,” Volume New England Jounal of Medicine, 361:109-112, July 9, 2009.
Book List
Required:
T.R. Reid, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, 2009
Leonard Berry and Kent Seltman, Management Lessons from Mayo Clinic: Inside One of the Worlds Most Admired Service Organizations, 2008
Charles R. Morris, The surgeons: Life and Death in a Top Heart Centre, 2008
John M. Barry, The Great Influenza: The Story of the Deadliest Pandemic in History, 2005)
Optional:
Julie Salamon, Hospital: Man, Woman, Birth, Death, Infinity, Plus Red Tape, Bad Behaviour, Money, God, and Diversity on Steroids, 2009
Michael Porter and Elizabeth Teisberg, Redefining Health Care: Creating Value-Based Competition on Results, Harvard Business School Press, 2006
Tracy Kidder, Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World, 2009
- 10 -