Graduate School of Business Professor Enthoven Stanford University Winter Quarter 1986 B.431 -Health Care Finance and Organization I. Introduction and Overview* (a) Victor Fuchs, Who Shall Live? Chapters 1,2,3 (Required text, 80 (b) Robert M. Gibson, Katherine Levit, Helen Lazenby, and Daniel R. Waldo, "National Health Expenditures, 1983, Health Care Financing Review, Winter 1984 (Syllabus, 30 II. Review of the Economics of Health and Health Care* (a) Victor Fuchs, Who Shall Live? Chapters 4,5,6 (Required text, 70 (b) Alain Enthoven, Health Plan, Chapter 1 (Syllabus, 12 III. Why Costs are Increasing* (a) Alain Enthoven, Health Plan, Chapter 2 (Syllabus, 24 (b) Charles Weller, "Free Choice as a Restraint of Trade in American Health Care Delivery and Insurance,@ Iowa Law Review, July 1984 (Syllabus, 42 IV. Cutting Cost Without Cutting the Quality of Care* (a) Health Plan, Chapter 3 (Syllabus, 18 (b) Joseph P. Newhouse, et al., ASome Interim Results from a Controlled Trial of Cost Sharing in Health Insurance," NEJM 305:25, December 17, 1981 (Syllabus, 7 (c) Robert H. Brook, M. D., et al., ADoes Free Care Improve Adults' Health," NEJM 309: 1426-34, December 8, 1983
(Syllabus, 9 Also Arnold Relman editorial. V. Private Health Insurance Industry Required Readings: (a) Ross H. Arnett, III, and Gordon R. Trapnell, "Private Health Insurance, New Measures of a Complex and Changing Industry," Health Care Financing Review, Winter 1984, pp. 31-42 (Syllabus, 12 (b) Enthoven and Wilson, Teaching Note on the Private Health Insurance Industry, June, 1985 (Syllabus, 40 VI. Medicare I: Overview* (a) Kathleen Lohr and M. Susan Marquis, "Medicare and Medicaid: Past, Present and Future," RAND note prepared for U.S. Dept. of Health and Human Services, May 1984 (Syllabus, 45 pages plus references). (b) Paul Ginsburg and Marilyn Moon, "An Introduction to the Medicare Financing Problem,@ Proceedings of the Conference on the Future of Medicare, Subcommittee on Health of the Ways and Means, U.S. House of Representatives, February 1, 1984 (Syllabus, 11 VII. Medicare II: Prospective Payment* (a) Alain Enthoven and Roger Noll, "Will the Prospective Payment System Solve Medicare' s Financial Problem?" GSB Research Paper 751, July 10,1984 (Syllabus, 27 (b) Donald Simborg, "DRG Creep, A New Hospital-Acquired Disease," NEJM, June 25, 1981 (Syllabus, 3 VIII. Medicaid and the Failure of the Safety Net* (a) Stevens and Stevens, Welfare Medicine in America, Chapter 4 (Syllabus, 7 (b) Karen Davis and Diane Rowland, AUninsured and Underserved: Inequities in Health Care in the United States," Milbank Memorial Fund Quarterly, Vol. 61, No.2, 1983 (Syllabus,
28 (c) Myers and Leighton, "Medicaid and the Mainstream," Western Journal of Medicine, 1984 (Syllabus, 11 IX. Tax Reform and Health Insurance (a) Alain Enthoven, AA New Proposal to Reform the Tax Treatment of Health Insurance,@ Health Affairs, Spring, 1984 (Syllabus, 39 (b) Proposed Specifications for the Health Equity and Incentives Reform Act of 1985 (Revised January 11, 1985) (Syllabus, 5 (c) Alain Enthoven and Philip Briggs, ABenefit Tax Debate," Business Insurance, March 18, 1985 (Syllabus, 2 X. Prepaid Group Practice* (a) Health Plan, Chapter 4 (Syllabus, 15 (b) Manning, W.G., et al., AA Controlled Trial of the Effect of a Prepaid Group Practice on Use of Services,@ NEJM, June 7, 1984 (Syllabus, 6 (c) Alain Enthoven, '@The RAND Experiment and Economical Health Care," NEJM, June 7, 1984 (Syllabus, 3 (d) Harold Luft, "How Do HMOs Achieve Their Savings,@ NEJM, June 15, 1978 (Syllabus, 8 (e) Scott Fleming, "Major Characteristics, Principles and Policies of the Kaiser Permanente Medical Care Program (Syllabus, 4 XI. Fee-for-Service Alternative Delivery Systems: PPOs and IPAs (a) Alain Enthoven, AAn Economic Analysis of the Preferred Provider Organization Concept,@ March 5, 1984 (Syllabus, 23 (b) Jon Gabel and Dean Ermann, APreferred Provider Organizations: Performance, Problems, and Promise,@ Health
Affairs, Spring, 1985 (Syllabus, 17 XII. Economic Regulation of Health Services* (a) Health Plan, Chapter 6 (Syllabus, 17 (b) Roger Noll, AConsequences of Public Utility Regulation of Hospitals,@ IOM Controls on Health Care, 1975 (Syllabus, 23 pages.) (c) Brian Biles, et al., AHospital Cost Inflation Under State Rate Setting Programs,@ NEJM September 18, 1980 (Syllabus, 23 (d) Charles A. Saunders, ARate Setting in the Hospital -The Beginning or the End?@ NEJM, September 18, 1980 (Syllabus, 3 XIII. Competition of Alternative Delivery Systems (a) Enthoven, Health Plan, Chapter 5 (Syllabus, 23 (b) Enthoven and Wilson, Teaching Note on the Competition of Alternative Delivery Systems, July, 1985 (Syllabus, 19 (c) Marilyn Jackson-Beeck, John H. Kleinmen, AEvidence for Self-Selection Among Health Maintenance Organization Enrollees,@ Journal of the American Medical Association, November 25, 1983. Vol. 250, No. 20 (Syllabus, 4 XIV. Consumer Choice Health Plan (a) Alain Enthoven, Health Plan, Chapter 7 (Syllabus, 30 XV. Employer Perspective on Health Insurance and Cost Control* (a) Harvey Sapolsky, et al., ACorporate Attitudes Toward Health Care Costs,@ Milbank Memorial Fund Quarterly, Health and Society, Vol. 59, No.4, 1981 (Syllabus, 25 (b) Richard O'Brien, AGeneral Motors Corporation - Health Care Cost Containment Efforts,@ January 18, 1985 (Syllabus, 20
XVI. The Hospital and Hospital Management Industries* (a) Kidder, Peabody and Company, Hospital Management Industry, Part I, November 1984 (Syllabus, 28 (b) Lawrence Lewin, et.al, "Investor-Owneds and Nonprofits Differ in Economic Performance,@ Hospitals, Vol. 55, July 1, 1981 (Syllabus, 7 (c) A.S. Relman, AThe New Medical-Industrial Complex,@ NEJM,October 23, 1980 (Syllabus, 7 (d) R.V. Pattison and H.M. Katz, A'Investor-Owned and Not-for-Profit Hospitals," and A.S. Relman editorial, NEJM, August 11, 1983 (Syllabus, 9 XVII. Nursing Homes and Lonq-Term Care* (a) Health Care Financing Administration, Long Term Care: Background and Future Directions, January 1981 (Syllabus, 64 (b) Anne R. Somers, "Long Term Care for the Elderly and Disabled: A New Health Priority,@ NEJM, (307:4) pp. 222-225, July 22, 1982 (Syllabus, 3 (c) Nicholas Rango, "Nursing Home Care in the United States," NEJM, Sept. 30, 1982, pp. 883-89 (Syllabus, 9 XVIII. Ethics and Limited Resources* (a) Ernle Young has written a brief case study that will be discussed in class. It is included in the class notes for this class. (b) Alan Garber, Victor Fuchs, and James Silverman, "Case Mix, Costs and Outcomes: Differences Between Faculty and Community Services in a University Hospital,@ NBER Working Paper No. 1159 (Syllabus, 24 (c) B. Lo and A.R. Jonson, "Clinical Decisions to Limit Treatment," Annals of Internal Medicine 93(5) 764-68, November 1980 (Syllabus, 4
(d) President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-Sustaining Treatment, March 1983: "Conclusions on Elements of Good Decision-making," pp. 89-90; "Constraints on a Patient's Decision Imposed to Achieve Equitable Allocation of Resources," pp. 95-100; "Catholic Church on Due Proportion in the Use of Remedies," pp. 305-307 (Syllabus, 7 XIX. Summary and Conclusions *Class notes are included for this class. (a) Paul Ellwood, M. D. and Barbara Paul, "Here Come the Supermeds," Interstudy, January, 1985 (Syllabus, 21 (b) Henry J. Aaron and William B. Schwartz, "Hospital Cost Control: A Bitter Pill to Swallow," Harvard Business Review, March-April 1985 (Syllabus, 7 (c) Jeff Goldsmith, ADeath of a Paradigm," Health Affairs, Fall, 1984 (Syllabus, 14