NUR 841: Health Care Policy in Perspective: Principles of Economics, Politics and Ethics. Spring 2003 COURSE SYLLABUS

Transcription

1 College of Nursing Michigan State University NUR 841: Health Care Policy in Perspective: Principles of Economics, Politics and Ethics Spring 2003 COURSE SYLLABUS Sections: 001 (East Lansing) 701 (Gaylord) Faculty: Manfred Stommel

2 Katherine Dontje Instructors Manfred Stommel, Ph.D., Associate Professor Office: B-222 West Fee Hall Phone: (517) Fax: , Office Hours: Thursdays by appointment Dontje, Katherine, M.S.N., APRN, BC, FNP, Assistant Professor, College of Nursing Office: A-114 Life Sciences Phone: (517) Fax: , Office Hours: Thursdays by appointment Class Meetings Thursdays, 1:15-3:05 Course Description This two-credit course is designed to provide an understanding of the economic, organizational and political environment in which advanced practice nurses spend a major part of their professional life. The course juxtaposes a macro- or system-perspective to a micro- or businessperspective. Basic principles of economic and organizational theory will be employed to describe the structure of the U.S. health care market, the financing of the service delivery system, and the organizational context of service delivery. A few comparisons with the health care systems of other advanced industrial countries will serve to address issues of equity, access, and quality of care. The insights gained from an understanding of the basic economic and organizational principles underpinning the U.S. health care system will be applied to a discussion of the role of the advanced practice nurse in the provision of primary care. This includes an examination of the patterns of cooperation and competition among various primary care providers. It also includes an emphasis on reimbursement procedures for APN services, as well as the ethics of clinical decisionmaking under a system of economic incentives and disincentives inherent in re-imbursement rules. Prerequisites NUR801 or permission from instructor.

3 Instructional Methods Class time will be spent in the form of lectures, interspersed with ample discussions. In addition, students will participate in a limited number of group projects that require independent research. The instructors will select a few of the projects for presentation in class. For the discussion sections in this course to be successful, it is required that students complete all assigned readings in time. Course Objectives Upon completion of NUR 841, the student should be able to: 1. Contrast and compare major features of the U.S. health care system to those of other advanced industrial countries. 2. Analyze the variety of public and private mechanisms for financing health care services. 3. Analyze how market forces and government regulations shape the labor markets in health care. 4. Analyze how ethical principles, social policies and economic interests influence access, delivery and organization of primary care. 5. Discuss principles of effectiveness, efficiency and cost to evaluate health care services. 6. Discuss principles of evaluation of health care policies based on population outcomes.

4 METHOD OF EVALUATION 1. IN-CLASS MID-TERM (40%) The mid-term exam is an individual exam that requires the student to answer questions in the format of SHORT essays (approximately one page of response per question). 2. GROUP PRESENTATIONS IN CLASS (30%) Students will be asked to form groups (with a maximum of 5 members), which will work together on the current policy debate concerning prescriptive authority for APNs in the State of Michigan. The assignment involves a short, historic outline of past legislative conflict over this issue, an identification of the major lobbying groups that have weighed in on this debate (both pro and con), and a concise statement of the current policy positions of these lobbying groups. This discussion is to be followed by a description and evaluation of the legislative dynamic of coalition building on either side of the issue. More details follow in class. 3. SHORT INIDIVIDUAL COURSE PAPER (30%) Each student will prepare a short paper that contains a realistic budget plan for a particular clinical setting of your choice. After a brief description of the clinical practice to which the budget plan is to apply, including a profile of the typical clientele, the financial plan should outline costs of operating the clinic/practice (including details on fixed and variable costs, supplies, personnel, etc.) and all sources of revenues, including reimbursements for services (insurance-based, out-ofpocket), public and private grants, etc. The emphasis in constructing the budget plan is on a realistic budget plan that can serve as the basis for an ongoing practice. Details about this assignment will be announced in class. Required Books Bodenheimer, Thomas S. & Grumbach Kevin Understanding Health Policy: A Clinical Approach. (2nd edition) Stamford, CN: Appleton & Lange.

5 Buppert, C Nurse Practitioner's Business Practice and Legal Guide. Gaithersburg, MD: Aspen Publishers, Inc. + weekly articles available through Blackboard. Web-Based Activities We are utilizing Blackboard (BB) as a supplement to this course. BB is a webbased classroom experience that allows material to be up to date with easy access. It is the individual students responsibility to learn how to work through the system. Weekly readings, course information and forms, course documents, activities, grades and discussion board are all located in BB. It is strongly suggested that you check into BB on a frequent basis at it is the students responsibility to be present and active in the course. Access to BB is through the College of Nursing web page and then accessing NUR 841 course syllabus. Another route is < Access requires use of your MSU pilot account.

6 Course Calendar Week 1 (January 9): General perspectives on the role of markets in the provision of healthcare: The workings of the price system in unregulated markets. (Weekly Assigned Readings) Week 2 (January 16): The injection of third-party insurance in the market system and its consequences: adverse selection and moral hazard (Weekly Assigned Readings + B&G: chapter 1) Week 3 (January 23): The financing of U.S. Health Care: Who pays for what and how? Out-of-pocket Expenditures, Individual private insurance, employer-based insurance, government-based Insurance (Medicare, Medicaid, Champus/VA, HIS) Access to Care: Lack of Insurance, Income and Other Barriers (Weekly Assigned Readings + B&G: chapters 2-3) Week 4 (January30): The U.S. Health Care Delivery System I: Reimbursement of providers, capitation payments versus fee-for-service payments; Managing Reimbursement for Services (Weekly Assigned Readings + B&G: chapters 4-5; Buppert: chapter 9) Week 5 (February 6): The U.S. Health Care Delivery System II: Hospitals, Nursing homes, and Community-Based Care; Nurse-Managed Clinics; (Weekly Assigned Readings + B&G: chapters 6, 7, 16)

7 Week 6 (February 13): The U.S. Health Care Delivery System III: Nurses, physicians, Allied Health Professionals: Their training and Labor Markets. (Weekly Assigned Readings + B&G: chapter 17; Buppert: chapter 2) Week 7 (February 20): Work arrangements for nurse practitioners: Employment versus Self-employment Preparing for Practice: Contracting; Employer Expectations (Weekly Assigned Readings + Buppert: Chapters1 and 10, 11; MNA: NP Resource Document) Week 8 (February 27): Midterm Spring Break Week 9 (March 13): Political Dimensions of The U.S. Health Care System I: Regulatory Politics and Lobbying: Professional Organizations, Professional Licensing and Professional Politics. (Weekly Assigned Readings) Week 10 (March 20): Policy Issues related to the role of the APN: How policy and laws affect the APN role; Influencing/lobbying for policy changes (Weekly Assigned Readings + Buppert: Chapters 3) DUE DATE FOR COST OF PRACTICE PROJECT Week 11 (March 27): Relevant regulations of NP Practice

8 (Weekly Assigned Readings + Buppert: Chapters 4-6) Week 12 (April 3): Cost control and quality of care: conflicting or compatible goals? Discussion of quality indicators such as HEDIS Cost control and rationing of health care services; (Weekly Assigned Readings + B&G: chapters 8-9) Week 13 (April 10): Professional and Ethical Issues: Panel Discussion Responsibilities of NP; Future Challenges for NP; Practice Questions (Weekly Assigned Readings + Buppert: Chapters 8, 14 and 16) Due Date for Group Paper Week 14 (April 17): International comparisons: Canada, Germany, Great Britain, and Japan The uniqueness of the United States among advanced industrial nations: Government programs and regulations without national health insurance; (Weekly Assigned Readings + B&G: chapter 14) Week 15 (April 24): Class Presentation