New York University Robert F. Wagner Graduate School of Public Service Health Economics and Payment Systems: Top Domestic Policies (HPAM-GP 4831.001) Spring 2012 Tuesday, 6:45-8:25pm Silver Center 2011 Instructor Information: Leonardo Trasande, MD, MPP Email: leonardo.trasande@nyu.edu; leonardo.trasande@nyumc.org; Phone: 646.501.2520 Medical School Office: 227 East 30th Street, Room 711 Wagner School Office: 295 Lafayette Street, Room 3049 Office Hours: by appointment Tuesday afternoons at Puck, or Medical School For Administrative Matters: Wagner: Rafael Hernandez, 212.998.7477, rafael.hernandez@nyu.edu COURSE OBJECTIVES Building on 11.4830, this course examines US domestic health policy issues from an economics perspective. Topics covered will be influenced by the current policy topics under discussion in the US. We will focus on the tradeoffs and contrasts between a market-based versus a governmentbased system. There will be a strong focus on applying theoretical insights from 11.4830 and interpreting the relevant empirical literature. The focus of this course is on achieving the following competencies: The ability to synthesize evidence, and apply statistical, financial, economic and costeffectiveness tools/techniques in organizational analysis 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 The ability to present convincingly to individuals and groups the evidence to support a point of view, position or recommendation Relevant content for the following competencies is also included: 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 LEARNING OBJECTIVES At the end of this course, students will be able to: 1. Understand key statistical methods commonly used in the health economic literature in order to evaluate the strengths and weaknesses of policy options to improve health and health care delivery,
2. Define health and describe the methods commonly used to measure it in order to understand the way in which public policies are effective at improving health outcomes, 3. Identify common forms and root causes of market failure in health care markets and discuss the role of government intervention to address these failures, 4. Describe the factors that affect the demand for health and health services in order to predict responses price, quality, and other factors commonly influenced by health policies, 5. Describe the factors that affect the supply for health and health services in order to develop policies that ensure adequate quantity and quality of health services are delivered, 6. Understand key concepts in health insurance including moral hazard and adverse selection in order to understand the dynamics of health insurance markets. PREREQUISITES P11.1018 Microeconomics for Public Management, Planning and Policy Analysis P11.1011 Statistical Methods for Public, Nonprofit and Health Management P11.4830 Health Economics: Principles Students must have a working knowledge of basic economic and statistical concepts such as supplydemand analysis, elasticity, economic surplus analysis, decision-making by firms under perfect and imperfect competition, hypothesis testing and multivariable regression. Students are also expected to have a basic understanding of the U.S. health care delivery system. BLACKBOARD AND EMAIL All course materials will be posted on the Blackboard site for this class. Students can login to Blackboard at http://classes.nyu.edu/ using your NYU net ID and password. Some class announcements will be distributed via e-mail (as well as posted on Blackboard), thus, it is important to actively use your NYU e-mail account, or have appropriate forwarding set up on NYUHome (https://home.nyu.edu/). READINGS Required Textbook: Sherman Folland, Allen C. Goodman and Miron Stano, The Economics of Health and Health Care, 6th edition, Prentice Hall, 2009 (I own a 5th edition.) Recommended Textbooks: James W. Henderson, Health Economics and Policy, 5th edition, Thomson South-Western, 2010; Thomas Rice. The Economics of Health Reconsidered, 3rd edition, Health Administration Press, 2009. Health Care Economics References Donald A. Barr, Introduction to U.S. Health Policy, Johns Hopkins University Press, 2007. Frank W. Musgrave, The Economics of U.S. Health Care Policy: The Role of Market Forces, M.E. Sharpe, Inc., 2006. Other Required Readings All other readings are posted on Blackboard. COURSE REQUIREMENTS
Readings Before each class, students should complete the readings for that week and be prepared to summarize and discuss them in class. Assignments/Exams Two take home assignments and a final exam will focus on problem solving with questions that involve quantitative and graphical analysis, interpretation, and writing (essay questions). Exam questions could anything from multiple choice responses to open-ended, essay questions. Both exams will be closed note and closed book. Both topics in lectures covered in lecture and/or readings are fair game for the tests. Class Participation Participation and discussion are expected. Throughout the semester, discussion questions and newspaper articles may be distributed in class or posted on Blackboard, and students will be encouraged to comment on them in class or in discussion forums on Blackboard. Grading Overall course grades will be based on the following weights: 20% take-home assignment 1 20% take-home assignment 2 50% final exam 10% class participation ACADEMIC INTEGRITY As members of the NYU Wagner community, we are all expected to adhere to the highest standards of intellectual and academic integrity. Wagner, as a community, has adopted a disciplinary process, which is available at http://www.nyu.edu/wagner/current/policies/. It is important that all Wagner students are aware of both the type of activities that qualify as infractions and the consequences of academic dishonesty. You are encouraged to review the academic code as soon as possible and to use it as a resource to guide you academically and professionally. COURSE SCHEDULE Date Topic Readings (Assignments) March 20 Health care reform and cost control. Orszag PR, Emanuel EJ. Health Care Reform and Cost Control. NEJM 363;7 601-3. Newhouse JP. Assessing Health Reform's Impact On Four Key Groups Of Americans. Health Affairs 29, no:8, 2010. David R. Williams, Mark B. McClellan and Alice M. Rivlin, Beyond The Affordable Care Act: Achieving Real Improvements In Americans' Health. Health Affairs, 29, no.8 (2010):1481-1488. Assignment 1 posted.
March 27 April 3 April 10 Childhood Obesity: Economic Origins, Consequences, and Opportunities. Protecting Children from Environmental Exposures: An Economic Priority. Innovation in Health Care -- from Pharma to IT and Elsewhere. (Guest Lecturer: Dan Makarov) Cawley J. The Economics Of Childhood Obesity. Health Aff March 2010 29:3364-371 Personal Responsibility And Obesity: A Constructive Approach To A Controversial Issue. Kelly D. Brownell, Rogan Kersh, David S. Ludwig, Robert C. Post, Rebecca M. Puhl, Marlene B. Schwartz, and Walter C. Willett. Health Aff March 2010 29:3379-387; Wallinga D. Agricultural policy and childhood obesity: a food systems and public health commentary. Health Aff (Millwood). 2010 Mar-Apr;29(3):405-10. Trasande L, Chatterjee S. The Impact of Obesity on Health Service Utilization and Costs in Childhood. Obesity (Silver Spring). 2009 Sep;17(9):1749-54. Epub 2009 Mar 19. Erratum in: Obesity (Silver Spring). 2009 Jul;17(7):1473. Trasande L. How much should the US invest in childhood obesity prevention? Health Affairs, 2010 Mar-Apr;29(3):372-8 Trasande L, Liu Y, Fryer GE, Weitzman M. Trends in U.S. Hospitalizations, Charges and Costs Associated with Childhood Obesity, 1999-2005. Health Affairs 2009 Jul-Aug;28(4):w751-60. Trasande L, Schechter C, Landrigan PJ. Public Health and Economic Consequences of Environmental Methylmercury Toxicity to the Developing Brain. Environ Health Perspect. 2005 May;113(5):590-6. Griffiths C, McGartland A, Miller M.A comparison of the monetized impact of IQ decrements from mercury emissions. Environ Health Perspect. 2007 Jun;115(6):841-7. Trasande L, Liu Y. Reducing The Staggering Costs Of Environmental Disease In Children, Estimated At $76.6 Billion In 2008 Health Affairs, 2011 May;30(5):863-70. Assignment 1 due at start of Class ELECTRONICALLY to leonardo.trasande@nyu.edu. Folland, Chapter 17. Berndt, Ernst, Pharmaceuticals in U.S. Health Care: Determinants of Quantity and Price J Economic Perspectives, 2002 Danzon PM and Pauly MV, Insurance and New Technology: From Hospital to Drugstore Health Affairs, 2001
April 17 April 24 Behavioral economics. (Guest Lecturer: Brian Elbel) Return on investment of smoking cessation interventions in patients with cardiovascular disease (Guest Lecturer: Joseph Ladapo) Assignment 2 posted. Schlesinger and Elbel. Bounded Rationality and the Conceptual Underpinnings of Health Policy: A rationale and Roadmap for Addressing the Challenges of Choice in Medical Settings. Working Paper., 2007. Richard Frank, Behavioral Economics and Health Economics NBER Working paper 10881. Jessica Greene Paper on Consumer Behavior. Assignment 2 due at start of class ELECTRONICALLY to leonardo.trasande@nyu.edu. Sheila Leatherman, Donald M. Berwick, Debra Iles, et al., Making the Business Case for Quality, Health Affairs, 22(2), March/April, 2003, pp. 17-30. Koh HK, Sebelius KG. Promoting prevention through the Affordable Care Act. N Engl J Med 2010 Manning et al, The Taxes of Sin: Do Smokers and Drinkers Pay Their Way? JAMA 261:1604-9 May 1 Quality improvement Claasen et al, 'Global Trigger Tool' Shows That Adverse Events In Hospitals May Be Ten Times Greater than Previously Estimated. Health Affairs, 30, no.4 (2011):581-589. Pauly MV, The Trade-Off Among Quality, Quantity, And Cost: How To Make It If We Must. Health Affairs 30, NO. 4 (2011): 574 580 Goodman et al, The Social Cost Of Adverse Medical Events, And What We Can Do About It. Health Affairs, 30, no.4 (2011):590-595. Provonost PJ, Lilliford R. A Road Map For Improving The Performance Of Performance Measures NO. 4 (2011): 569 573 How A Regional Collaborative Of Hospitals And Physicians In Michigan Cut Costs And Improved The Quality Of Care. Share et al. Health Affairs, 30, no.4 (2011):636-645 Van Den Bos et al. The $17.1 Billion Problem: The Annual Cost Of Measurable Medical Errors Health Affairs, 30, no.4 (2011):596-603 Final Exam distributed. Final Exam Due May 15, 5pm