NEW YORK UNIVERSITY ROBERT F. WAGNER GRADUATE SCHOOL OF PUBLIC SERVICE. HEALTH AND MEDICAL CARE P Section 2. Fall 2010 COURSE SYLLABUS

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1 1 NEW YORK UNIVERSITY ROBERT F. WAGNER GRADUATE SCHOOL OF PUBLIC SERVICE HEALTH AND MEDICAL CARE P Section 2 Fall 2010 Mondays 4:55-6:35pm Silver 706 Professor Lucy MacPhail Office: Puck Building, 295 Lafayette Street, Office 3062 Office hours: Mondays 3-4:30 pm or by appointment lucy.macphail@nyu.edu COURSE SYLLABUS This introductory course in the Health Policy and Management program explores core topics in the study of health and health care delivery in the United States. We will discuss the distribution of health and disease in society, the organization of the U.S. health care system and roles and behaviors of its key actors, the historical context for developments in public health and medicine, the quality and accessibility of health care services, and current events in health care reform. We will examine major themes in health care policy and practice using an interdisciplinary approach that employs sociological, political, economic and ethical perspectives on health and disease, characteristics of health care in the U.S., and the complexity of achieving high quality and affordability given the varied (and sometimes conflicting) motivations of policy-makers, payers, providers and patients. Students will also consider the U.S. health care system in an international context to provide a comparative lens on its nature and performance versus those of other industrialized nations. The objective of this course is to build understanding of fundamental ideas and problems in the areas of health and medical care and thereby to provide a strong foundation for future studies and careers in the health care field. 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. Three books are required. The primary textbook, Health Care Delivery in the United States (Kovner and Knickman, eds.), describes the organization and performance of the U.S. health care delivery system. The collection of readings in (Lee and Estes, eds.) complements the textbook with focused insight into specific issues confronting the public health and medical care systems. The Sociology of Health and Illness (Conrad, ed.) provides a sociological perspective on health and health care delivery. Additional required readings on the syllabus are designed to supplement these materials and may be downloaded from.

2 2 REQUIRED BOOKS (9 th Edition). A. Kovner and J. Knickman, eds. New York, NY: Springer Press (2008). (7 th Edition). P. Lee and C. Estes, eds. Boston, MA: Jones and Bartlett (2003). The Sociology of Health and Illness: Critical Perspectives (8 th Edition). P. Conrad, ed. New York, NY: Worth Publishers (2008). ADDITIONAL REQUIRED READINGS Assigned readings not included in the required books will be posted on. RECOMMENDED READINGS In addition to assigned readings, I encourage students to browse recent issues of well-respected journals such as Journal of the American Medical Association, New England Journal of Medicine, American Journal of Public Health and Health Affairs. The list of relevant web sites at the end of Kovner and Knickman s book (Appendix C) may also be helpful. COURSE SESSIONS A. PUBLIC HEALTH AND THE DISTRIBUTION OF HEALTH AND DISEASE IN SOCIETY Week 1. September 13: Introduction Health, Illness and Community Introduction to the course Overview of the state of public health and medical care in the U.S. Definitions of health and illness Relationship between health status and health care Knickman, J. and Kovner, A. Introduction: The State of Health Care Delivery in the United States. Ch. 1, pp Link, B. and Phelan, J. McKeown and the Idea that Social Conditions Are Fundamental Causes of Disease. pp

3 3 The Sociology of Health and Illness: Critical Perspectives McKinlay, J. and McKinlay, S. Medical Measures and the Decline of Mortality, Ch. 1, pp Colgrove, J. (2002). The McKeown Thesis: A Historical Controversy and Its Enduring Influence. American Journal of Public Health 92(5): Week 2. September 20: Epidemiologic Measures and the Distribution of Disease Descriptive versus analytic methods Measurement and assessment of health status Relationship between socioeconomic status (SES) and health Predictors of morbidity and mortality Chiasson, M. and Jonas, S. Measuring Health Status. Ch. 2, pp Orleans, C. and Cassidy, E. Health-Related Behavior. Ch. 10, pp (Focus on pp ). Marmot, M. The Influence of Income on Health: Views of an Epidemiologist. pp Adler, N. and Newman, K. (2002). Socioeconomic Disparities in Health: Pathways and Policies. Health Affairs 21(2): Fuchs, V. A Tale of Two States and Rodwin, V. & Croce-Galis, M. Population Health in Utah and Nevada: An Update on Victor Fuchs Tale of Two States. In The Sociology of Health and Illness: Critical Perspectives (7 th edition). P. Conrad, ed. New York, NY: Macmillan, Optional Reading: For an exploration of social factors as predictors of morbidity and mortality, see The Sociology of Health and Illness: Critical Perspectives, Chapters 2, 3, 4 and 7. Week 3. September 27: Public Health and Medicine Public health infrastructure Achievements in public health Public health versus medicine Ethics of resource allocation REMINDER: FIRST BLACKBOARD ASSIGNMENT DUE TODAY Leviton, L., Rhodes, S. and Chang, C. Public Health: Policy, Practice, and Perceptions. Ch. 4,

4 4 pp The Centers for Disease Control and Prevention. Achievements in Public Health, : Control of Infectious Diseases. pp The Centers for Disease Control and Prevention. Achievements in Public Health, : Decline in Deaths from Heart Disease and Stroke. pp Office of Public Health and Science, Department of Health and Human Services. Healthy People 2010 Objectives. pp The Centers for Disease Control and Prevention. Achievements in Public Health, : Changes in the Public Health System. pp (Optional) Lasker, R. and Weiss, E. Broadening Participation in Community Problem Solving: A Multidisciplinary Model to Support Collaborative Practice and Research. pp B. ORGANIZATION OF HEALTH CARE DELIVERY IN THE UNITED STATES Week 4. October 4: Overview of the U.S. Health Care Delivery System Characteristics and historical origins of the U.S. health care system International comparison of U.S. health care system versus other developed nations Brief modern history of health reform efforts Sparer, M. The Role of Government In U.S Health Care. Ch. 5, pp Rodwin, V. Comparative Analysis of Health Systems Among Wealthy Nations. Ch. 6, pp Davis, K. et al. (2007). Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care. Commonwealth Fund, Pub. No Blendon, R. and Benson, J. (2001). Americans Views on Health Policy: A Fifty-Year Historical Perspective. Health Affairs 20(2): Rothman, D. (1993). A Century of Failure: Health Care Reform in America. Journal of Health Politics, Policy and Law 18(2): Monday October 11 Columbus Day (No Class) Week 5. October 18: Financing of Health Care in the U.S. Flow of funds in the U.S. health care system Payers Medicare, Medicaid, SCHIP and private insurance

5 5 Rise of managed care organizations (MCOs) and managed care backlash Spending growth and cost containment efforts Practical and ethical complexity of rationing as a cost control strategy REMINDER: PAPER 1 DUE TODAY Hunt, K. and Knickman, J. Financing Health Care. Ch. 3, pp Finkler, S. and Getzen, T. Costs and Value. Ch. 17, pp Dudley, R. and Luft, H. Managed Care in Transition. pp The Sociology of Health and Illness: Critical Perspectives Bodenheimer, T. and Grumbach, K. Paying for Health Care. Ch. 25, pp Introduction to Rationing Medical Care. pp Bodenheimer, T. and Fernandez, A. (2005). High and Rising Health Care Costs, Part 4: Can Costs Be Controlled While Preserving Quality? Annals of Internal Medicine 243(1): (Optional) Bodenheimer, T. (1997). The Oregon Health Plan: Lesson for the Nation, Part 1. New England Journal of Medicine 337(9): (Optional) State of Oregon Health Services Commission. A Brief History of Health Services Prioritization in Oregon. Published March 2007, accessible at URL: Week 6. October 25: Provider Organizations and the Provision of Health Care Services Acute and ambulatory care delivery Organization of health care services Accountable health care systems REMINDER: SECOND BLACKBOARD ASSIGNMENT DUE TODAY Gourevitch, M. et al. Acute Care. Ch. 7, pp Cuellar, A. & Gertler, P. (2005). How The Expansion of Hospital Systems Has Affected Consumers. Health Affairs 24(1): Burns, L. and Pauly, M. (2002). Integrated Delivery Networks: A Detour on the Road to Integrated Health Care? Health Affairs 21(4): Shortell, S. and Casalino, L. (2008). Health Care Reform Requires Accountable Health Care Systems. Journal of the American Medical Association 300(1):

6 6 Week 7. November 1: Dynamics of the Health Care Workforce Historical and emerging roles for physicians and health professionals Health care labor markets Professionalization and power in organized medicine Brewer, C. and Rosenthal, T. The Health Care Workforce. Ch. 12, pp Peterson, M. From Trust to Political Power: Interest Groups, Public Choice and Health Care. pp The Sociology of Health and Illness: Critical Perspectives Conrad, P. and Schneider, J. Professionalization, Monopoly, and the Structure of Medical Practice. Ch. 16, pp Light, D. Countervailing Power: The Changing Character of the Medical Profession in the United States. Ch. 19, pp Week 8. November 8: Patient Behavior and Decision-Making Patient as consumer and co-producer of care outcomes The provider patient relationship Consumer-directed care and patient demand for and use of information Orleans, C. and Cassidy, E. Health-Related Behavior. pp (Focus on pp ). Mechanic, D. (1998). The Functions and Limitations of Trust in the Provision of Medical Care. Journal of Health Politics, Policy and Law 23(4): 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. 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. C. HEALTH CARE SYSTEM PERFORMANCE, CHALLENGES AND DEBATES Week 9. November 15: Adapting to a Changing Burden of Disease Care delivery for chronic disease Long-term care

7 7 REMINDER: THIRD BLACKBOARD ASSIGNMENT DUE TODAY Anderson, G. and Knickman, J. Chronic Care. Ch. 8, pp Feldman, P. et al. Long-Term Care. Ch. 9, pp Estes, C. et al. The Politics of Long-Term Care Reform Under the Clinton Health Plan: Lessons for the Future. pp Wallace, S. et al. Long-Term Care and the Elderly Population. pp 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: Week 10. November 22: Managing Technological Innovation Growth in use of high-cost drugs and medical technologies in health care Treatment benefits versus monetary costs associated with medical innovation Commercialization of medical treatment and implications for providers and patients Strongin, R. et al. Pharmaceuticals. Ch. 11, pp Bodenheimer, T. (2005). High and Rising Health Care Costs, Part 2: Technological Innovation. Annals of Internal Medicine 142(11): Cutler, D. and McClellan, M. (2001). Is Technological Change in Medicine Worth It? Health Affairs 20(5): Gilsdorf, J. (2004). As Drug Marketing Pays Off, My Mother Pays Up. Health Affairs 23(1): Brennan, T. et al. (2006). Health Industry Practices that Create Conflicts of Interest: A Policy Proposal for Academic Medical Centers. Journal of the American Medical Association 295(4): Week 11. November 29: Quality of Care The state of quality and safety in U.S. care delivery Quality measurement, monitoring and enforcement Complexity of quality improvement and error reduction in health care Quality improvement frameworks and interventions Wakefield, D. and Wakefield, B. The Complexity of Health Care Quality. Ch. 15, pp

8 8 Kropf, R. Information Management. Ch. 13, pp Bodenheimer, T. The American Health Care System: The Movement for Improved Quality in Health Care. pp McGlynn, E. and Brook, R. Keeping Quality on the Policy Agenda. pp Institute of Medicine (1999). To Err is Human: Building a Safer Health System. Washington, D.C.: National Academy of Sciences. Executive Summary. Institute of Medicine (2001). Crossing the Quality Chasm: A New Health System for the 21 st Century. Washington, D.C.: National Academy of Sciences. Executive Summary. (Optional) Leape, L. and Berwick, D. (2005). Five Years After To Err is Human : What Have We Learned? Journal of the American Medical Association 293(19): Week 12. December 6: Access to Care and the Uninsured Barriers to care for vulnerable patient populations The uninsured and underinsured in the U.S. The Patient Protection and Affordability Act of 2010 and implications of health reform REMINDER: FOURTH BLACKBOARD ASSIGNMENT DUE TODAY Billings, J. and Cantor, J. Access to Care. Ch. 16, pp Ayanian, J. (2000). Unmet Health Needs of Uninsured Adults in the United States. Journal of the American Medical Association 284(16): Phillips, K., Mayer, M. and Aday, L. (2000). Barriers to Care Among Racial/Ethnic Groups under Managed Care. Health Affairs 19(4): Gusmano, M., Fairbrother, G. and Park, H. (2002). Exploring the Limits of the Safety Net: Community Health Centers and Care for the Uninsured. Health Affairs 21(6): Kaiser Family Foundation (2010). Summary of New Health Reform Law, available at Week 13. December 13: Health Care Reform in the U.S. Current developments and debates in health reform Future of the U.S. health care delivery system Competing philosophies on and agendas for health care system change Course wrap-up Oberlander, J. (2010). Long Time Coming: Why Health Reform Finally Passed. Health

9 9 Affairs 29(6): Jennings, C. and Hayes, K. (2010). Walking the Tightrope of Health Insurance Reform between 2010 and New England Journal of Medicine 362(24): Rittenhouse, D. (2009). Primary Care and Accountable Care: Two Essential Elements of Delivery System Reform. New England Journal of Medicine 361(24): Porter, M. (2009). A Strategy for Health Care Reform Toward a Value-Based System. New England Journal of Medicine 361(2): REMINDER: PAPER 2 DUE WEDNESDAY, DECEMBER 15

10 10 COURSE REQUIREMENTS In addition to attending and participating in classes, students are required to submit two papers and three short written exercises. These requirements are described briefly below and details of each assignment will be posted on. Course grades will be calculated as follows: % Final Grade Date(s) Due Paper 1 20% October 18 Paper 2 40% December 15 Assignments 30% Complete 3 of 4: 9/27, 10/25, 11/15, 12/6 Class Participation 10% Paper 1 Students will prepare a policy memo on trends in diabetes based on data from the National Center for Health Statistics. This assignment will allow students to demonstrate their ability to understand, interpret and discuss quantitative data. Class readings will also be useful in preparing this memo. (No more than 3 double-spaced pages in 12-point font). Paper 2 Students will develop a thoughtful and well-organized discussion of a provocative concept in Health and Medical Care using course materials. This paper will allow students to engage in critical reflection on course readings and discussion and should result in a carefully-structured essay with wellsupported opinions and ideas. Footnoted references to course materials are required to demonstrate synthesis of course content. (5-7 double-spaced pages in 12-point font). Assignments Each student must answer three of the four questions (posted under assignments on ). The response should be in the form of a concise one-page essay. These essays should be based on course materials, relevant data and ideas from peer-reviewed journals, media or websites, and/or your own experiences. Students are also asked to respond to at least one classmate s essay on three of the four questions. Class Participation - Classroom discussion and debate are essential to this course. Student performance will be evaluated on engagement in the classroom and constructive contribution to class discussions.