University of Michigan
School of Public Health
Department of Health Management and Policy
HMP 600: The Health Services System
Fall, 2012
Richard Lichtenstein, PhD, MPH
Course Syllabus and Outline
Course Information
Course Number:
Course Title:
Term:
HMP 600 Section: 001
The Health Services System
Fall, 2012
Professor:
Richard Lichtenstein, PhD, MPH
E-mail: [email protected]
Phone: (734) 936-1316
Office Hours: Tuesdays, 2:30-4:00 PM, M3124 SPH II.
Graduate Student
Instructors:
Ruth Brown ([email protected]), Michelle Osterman ([email protected])
Other contact information and office addresses TBD
Course Materials:
Required: Readings and PowerPoint Slides
Available on the C-Tools website: https://ctools.umich.edu/portal (log in, then go
to HMP 600 tab. The readings and PowerPoint slides will be in the “Resources”
section of CTools, and will be organized according to the Topic)
There will also be a series of Weekly “To Do” lists presented along the left
side of the CTools site that will enable you to access all of the recorded
lectures, readings, PowerPoint slides, and other required assignments with a
single click. Dates for each week are presented at the top of the To Do list.
For those who would like hard copy versions of the required readings, they will
also be available for purchase at:
Dollar Bill’s Copying
611 Church St., Ann Arbor, MI; phone: (734) 665-9200
The price is: $129.13. Please call in advance if you would like
to purchase a course pack
Course Description:
This course focuses on major issues in the organization and financing of the health services system
in the US. The following topics are covered: the role of values in the development of health care
policy; methods for assessing the health status of populations; techniques for analyzing the need
for, access to, and use of health services; racial and ethnic disparities in health and health care; the
current supply and distribution of, and policy issues related to, the professions comprising the
health workforce; the current supply and distribution of, and policy issues related to, hospitals,
ambulatory care facilities, nursing homes, home health care, and other long-term care programs;
health care costs and expenditures; and public and private health care financing programs including
private health insurance, managed care, Medicare, Medicaid and the Affordable Care Act of 2010
(Health Reform).
Course Format
This semester (Fall, 2012), the course will be offered in a new format for the first time. After the
first three classes, all of the lecture material in this course will be provided in recorded form online.
Students will be responsible for watching all of the lectures and doing all the readings on their own,
and at their own pace. After Tuesday, September 11, the class will be divided into two randomly
assigned groups, and each group will be assigned to attend a one-hour discussion section on either
Tuesdays or Thursdays at 1PM in the same room in which we will begin the course (The SPH II
Auditorium). The list of students in each section is included in CTools under
Resources/Syllabus/HMP 600 Discussion Session Assignments. The hope is that once the
students have watched the lectures and done the readings, they will be able to bring questions to
these discussion sessions and will be able to talk about the topic areas in greater depth. This format
places more responsibility for learning on the students, but it will also enable us to discuss the
material much more comprehensively and will allow students to bring their experience into the
classroom.
There is also a schedule for weekly discussion topics in CTools under:
Resources/Syllabus/”Schedule of HMP 600 Discussion Topics”. NOTE: there are a few weeks
during the semester when the entire class will meet in one session. This will happen when we have
quizzes on Tuesdays and during the week of Fall Break. There will be no discussion sessions
during the week of Quiz #2 and Thanksgiving.
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Course Objectives and Competencies
Objectives
The objective of the course is to provide the student with a systematic approach for examining and
evaluating a health care system, with special emphasis on selected components and features. The health
care system in the United States is used to illustrate this descriptive, analytic, and evaluative approach.
(The general approach, however, is designed to apply to other health care systems as well.) The student
will thus learn both the conceptual approaches and techniques needed to analyze the performance of a
health services system and, at the same time, the student will obtain a thorough understanding of the US
health services system.
Put another way, the course is intended to provide the future health services administrator, planner, policy
analyst, or researcher with the fundamentals that are necessary for being able to anticipate -- within the
limits of what is possible with the available tools -- how changes in one part of the health services system
are likely to affect its other parts. The hope is that approaches learned in the class will be of future value
regardless of the changes that may occur in the US system or the systems of other countries.
Overall Competencies
As a result of taking this class, the student will be able to:
1) Demonstrate a deep and broad knowledge and understanding of the history and development
of the US health services system.
2) Understand and apply basic epidemiologic principles, measures, and methods to assess the
health status of a population; identify risk factors in individuals and communities; evaluate the
impact of population-based interventions and initiatives.
3) Assess the extent to which different racial and ethnic sub-populations confront disparities in
health status and health care.
4) Demonstrate broad understanding of the various patient-related, provider-related, and systemrelated factors that are related to the volume and type of health care used by a population.
5) Recognize the interdependence of the different professions within the health workforce, and
assess the degree to which each profession is meeting the health needs of the population and
the goals of an effective, efficient health services system.
6) Identify the various facilities and programs that exist in a health services system, and assess
the degree to which each form of organization, individually and in combination with other
types of organizations, is meeting the health needs of the population and the goals of an
effective, efficient health services system.
7) Evaluate the degree to which the various types of health care expenditures made by a nation
are efficient, effective and sustainable over time.
8) Identify the major characteristics of various health financing programs in the US, including:
private insurance and managed care, Medicare, Medicaid and Health Reform
9) Evaluate the likely effect that different models of health insurance and different levels of
coverage are likely to have on patients, providers, and the overall health system.
10) Work collaboratively with others as part of a team or group, demonstrating commitment to the
team’s goal and encouraging individuals to put forth their best effort.
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Course Requirements and grading:
Your course grade will be based on your performance on 4 short papers, three short-answer
exams, and your participation in class. The following table indicates how these activities relate to
your course grade:
Papers:
Short Quizzes:
Class Participation
4 @10 percent of total each
3 @15 percent each
15 percent
40%
45%
15%
------100%
Assignments:
Paper Deadlines, Dates of Examinations, and Other Activities
The first exercise (Values), and all of the team papers should be submitted via the CTools
Drop Box. All students must submit the Values Exercise (which will not be graded). For
the team papers, only one member of the team should submit the paper (with all team
members’ ID numbers at the top of the first page). If you have any questions about
submitting papers, please contact my assistant, Barbara Klumpp, at [email protected]
(Ms. Klumpp's office is M 3148 SPH II)
Activity
Date
Watch Video: My Right Knee (Don Berwick)
Access the video at:
Thursday, Sept. 6 (watch before class)
http://www.sph.umich.edu/richmedia/HMP602-881/Disc_1_web/IntroVid/MyRightKnee.html
Paper on Values (not graded) Submit via Drop Box
Paper on Health Status (One copy per team should
Submitted via Drop Box by one team member)
First Quiz*
Paper on the Health Workforce
Paper on Hospitals
Second Quiz*
Paper on Health Financing/Health Reform
Third Quiz (During Final Exam Time)*
Friday, Sept. 7 (Due at 11:00 a.m.)
Tues. September 18 (at 1:00 p.m.)
Tues. October 2 (1:00-2:30)
Friday, October 12 (at 1:00 p.m.)
Thurs. November 8 (at 1:00 p.m.)
Tues. November 20 (1:00-2:30)
Tues. December 11 (at 1:00 p.m.)
Wed. December 19: 4:00-5:30 P.M.
* All Quizzes will be held in the SPH II Auditorium. All students in the class will take the
quiz at the stated date and time.
NOTE: THERE WILL BE NO CLASS ON TUESDAY, OCT. 16 (FALL BREAK)
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Format for (Two-Page) Papers:
You will be asked to write four two-page papers for this course. In order to promote your
skills at working in teams, and to enhance learning and discussion of the issues presented
in these papers, these exercises will be done as team projects. Students should form
teams of 3-4 people and work collectively in completing the assignment. The same team
should remain together for all papers in the course (except the first - which is an
individual assignment). The student ID numbers (not names) of all people on the team
should be listed on the front of the paper and all students on the team will receive the
same grade on the paper. The grading scheme and other guidelines for these papers are
provided on a separate sheet (“Writing Guidelines” under Resources/Syllabus in
CTools). The first exercise and all team papers are to be submitted via CTools Drop Box
The assignment for the first (individual) paper (Values) should be submitted by everyone
via the CTools Drop Box. For the team papers, each team should designate one member
who will submit the paper via CTools Drop Box.
It is expected that all members of the team will participate actively in developing and/or
writing each paper. If there is someone in your group who, in the opinion of other
members of the group, is not pulling his/her weight (i.e. is a “free rider”), please contact
Dr. Lichtenstein.
If you need help in finding a team, please see Dr. Lichtenstein at the beginning of class
during the first three sessions of the semester.
Format for Quizzes:
The two mid-term quizzes and the final will be in-class, closed book examinations. They
will each consist of approximately 25 short answer questions, worth 4 points each, that
require you to either agree or disagree with a statement (2 points) and then to provide an
explanation for your answer (2 points). You are not to write your name on quizzes either.
Instead, you should write your student ID # on every page of the exam. Be sure to bring
your student ID # with you to the exam!
Academic Conduct
The conduct of all students taking this course should be consistent with that expected of a
public health professional. Courtesy, honesty, and respect should be shown by students
toward fellow students, faculty, visitors to the course, and administrative support staff.
Similarly, students should expect me, as the instructor, to treat them fairly; to exhibit
respect for their ideas and opinions; and to strive to assist them in maximizing the value of
their experience in this course and, more generally, in their SPH education.
“Student academic misconduct” refers to behavior that includes plagiarism, cheating on
exams or assignments, fabrication of data, falsification of records or official documents,
intentional misuse of equipment or materials (including library materials), or aiding and
abetting the perpetration of such acts. All members of student teams established for the
purpose of writing papers in this course must contribute to every paper. If a given student
does not pull his or her own weight in the writing of a paper, it is the responsibility of other
team members to report that fact to the instructor. Papers turned in by a student team must
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reflect that team’s own work. Any sources used to obtain information for the paper must be
cited on the paper. It is not permissible to use student papers written in previous years in
the preparation of a paper for this class.
The three examinations are to be written “in class” and no notes, electronic devices or
other aids may be ever used during an exam.
Academic misconduct of any kind is unacceptable. Detected violations of proper
academic conduct will be dealt with firmly. For example, any form of cheating on an
assignment or exam will result in the student's failing that assignment or exam, with
no opportunity to make up the work. If a student is determined to have violated proper
academic conduct twice during the course, he or she will fail the course and his or her
behavior will be reported to the student's department chair and to the Associate Dean for
Academic Affairs. I expect other students to notify me if they observe, or otherwise
detect, academic misconduct on the part of another student or students. Such
disclosures will be held in strict confidence.
Academic Well-being
Physical, psychological, and emotional well-being is vital for effective learning. Students
are encouraged to contact the University's office for Services for Students with Disabilities
(SSWD; http://www.umich.edu/~sswd) or the office for Counseling and Psychological
Services (CAPS; http://www.umich.edu/~caps). Any student who feels that he/she may
need special accommodation for any sort of disability or wishes to discuss any relevant
and/or confidential information is encouraged to make an appointment with the Instructor.
Classroom Expectations/Etiquette:
Class Participation
Although even when we divide the class into two discussion groups, the groups will still be
large, I want to encourage everyone to participate in the discussion sessions by asking or
answering questions, and by contributing your knowledge and experience to the class.
Some students have had very rich experiences in the health care system and their
contributions in class are often a key aspect of other students’ learning. Similarly, students
who have done the readings or class exercises carefully can often make significant
contributions to the class. Class participation will account for 15% of your grade. The
quality of your participation counts more than quantity! As described in a previous
section, “Courtesy, honesty, and respect should be shown by students toward fellow
students, faculty, visitors to the course, and administrative support staff.” NOTE: The way
this portion of the grade is calculated, positive class participation generally will help
increase your overall grade, but it will not, in most cases, reduce it.
Use of Laptop Computers
Students are welcome to bring their laptops to lectures and the discussion sessions so that
they can follow along with the PowerPoint presentations, or can look up articles or
concepts mentioned in class. Students are not to use their laptops during the class to check
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e-mail, to read the newspaper, to play games, to do their internet shopping, or anything else
unrelated to class! Such practices not only reflect bad manners, but also are very
distracting to other students in the class! I reserve the right to outlaw computers in the
classroom if I find that students are abusing this privilege.
Additional Information:
Obtaining the Readings and PowerPoint Slides
Readings and Course packs
Readings for HMP 600 are divided into seven parts, which are organized according to the
major topics in the Course Outline. The readings are available on the Internet (in CTools);
and for purchase as a printed and bound course pack at Dollar Bill Copying (see below).
Readings via CTools
All of the HMP 600 readings are available electronically (as pdfs) via CTools. Once you
are on the HMP 600 site, go to the TO DO links (arranged by week number) (on the left
side of the site) and then look for the appropriate week of the course. Once you click on
the To Do link, you will see everything you need to get done during the identified week.
You can download and print the readings for the course using a fast internet connection
and a good printer for just the monetary cost of paper and ink. This will save you the cost
of the printed course pack (explained below), but will require a larger input of your time.
Readings at Dollar Bill Copying
Dollar Bill’s Copying at 611 Church St. in Ann Arbor, phone: (734) 665-9200, has all of
the readings available as a course pack (divided into three bound parts). The cost of the
entire course pack is: $129.13 (I suggest you call Dollar Bill’s and order the bound course
pack in advance to ensure that they will have a copy available.) Note, there are a few
articles on the reading list that are not contained in the course pack because their
publishers charged ridiculously high royalty fees for the article. You will have to download
those articles and print them yourself even if you buy the course pack.
Required and Not Required Readings on the Reading Lists
I have listed two groups of readings for each topic on the reading list of each section of the
course: “Required” and “Not Required” readings. The reading lists are included in each
topic section of the course and also in a separate section (“Reading Lists”) under Resources
in CTools. The “Required” Readings are the articles I consider to be the most important
and these are the only readings contained in this syllabus (see below), included in the
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course packs, and provided as pdfs in on the To Do lists in CTools. I will feel free to ask
questions about the Required Readings on exams. To get the most out of the readings, I
strongly suggest that students not only read the articles individually, but also form study
groups for the purpose of discussing readings, outlining the articles and sharing notes on
the articles.
Since health care in the US is changing so rapidly these days and so much is being written
about various aspects of the system, I have also included the additional “Not Required”
readings on each reading list. These readings are provided purely as a service to students
who might want to read more about a particular topic.
PowerPoint Presentations
The PowerPoint presentations that I use in class will be available on the HMP 600 site in
CTools, under Resources (and in the TO DO lists). The PowerPoint slides for each topic
(section) of the course are clearly indicated by a PowerPoint icon inside the topic folders.
You can download the PowerPoint presentations to your laptop computer and bring that to
classes/discussion sessions, and/or print out the slides on paper. Note: If you are going to
print out the slides, I would suggest you go to the CTools Resources section called
Printable Slides and print those out. (I recommend using the "handout" print function,
and printing 3 slides to a page in grayscale or black and white.)
You should always bring the appropriate slide presentation to class with you.
Please note: Use of the HMP 600 PowerPoint slides for any purpose other than activities
connected to this class, by any student or other person, without proper academic citation to
Dr. Lichtenstein, or his written permission, will be considered a copyright violation and a
breach of the University’s Code of Academic Conduct.
Course Outline, Readings, and Competencies
The next two pages contain the Course Outline, which includes the topics covered and the general
dates on which you should be watching the lectures and doing the readings on a given topic. This
should help you prepare for the discussion sessions in advance.
Following the outline is the entire course reading list, provided on a topic-by-topic basis.
All of the required readings are included on these lists. You will also see that I have provided
URLs to access the actual articles in most cases. These readings and links to the articles are also
provided in the To Do lists for each week of the course.
I have also included specific competencies students should acquire in each section of the course.
The University of Michigan
School of Public Health
Department of Health Management and Policy
HMP 600: The Health Services System
Fall, 2012
Richard Lichtenstein, Ph.D., MPH
8
COURSE OUTLINE
______________________________________________________________________________
______________________________________________________________________________
TOPIC
DATES
SESSIONS
Reading List #
______________________________________________________________________________
I. Introduction and Overview
September. 4-6
1-2
1
IA. Social Values in Medical Care Sept. 11
3
1
II. The Medical Care Process
4-8
2
(September 13 – 27)
A. Overview
Sept. 13
B. Health Status and Need
Sept. 18-20
C. Utilization of Services
Sept. 20-27
______________________________________________________________________________
Quiz #1 Tuesday, Oct.2 (1.5 hour, in class, closed book)
Covers Sessions 1-8
______________________________________________________________________________
III. Workforce Issues
(October. 4-30)
9-15
3
A.
B.
C.
D.
Introduction
Physicians
Nursing
Non-physician
clinicians
Oct. 4
Oct. 9-11
Oct. 18-23
Oct. 25-Oct. 30
9
9-12
12-13
14-15
NOTE: There will be no class on October 16 due to the Fall Study Break.
COURSEPACK
TOPIC
DATES
SESSIONS
SECTION
______________________________________________________________________________
IV. Facilities and Programs
A. Intro; Regional Systems
B. Hospitals/Health Systems
C. Int. Org of Hosp./Hosp.-
Nov. 1- Nov. 13
16-19
Nov. 1
Nov. 1-Nov. 6
Nov. 8
16
16-18
17
9
4
Physician Integration
D. Long Term Care
V. Health Expenditures and Costs
Nov 13
18-19
4
Readings Only
Not covered in class 5
VI. The Drug Industry
Nov. 15
20
6
______________________________________________________________________________
Quiz #2
Tuesday, Nov. 20 (1.5 hour, in class, closed book)
Covers Sessions 9-19
______________________________________________________________________________
______________________________________________________________________________
THANKSGIVING BREAK
Nov. 22
____________________________________________________________________
VII. Health Care Financing
A. Private Health Insurance
B. Government Involvement in
Medical Care
C. Medicare
D. Medicaid
E. Health Reform
Quiz #3
Nov. 27-Dec.11
21-25
Nov. 27-29
21-22
NOV. 29
NOV. 29-Dec 4
Dec. 4-6
Dec. 11
22
23
24
25
7
Wednesday, Dec. 19, 4:00-5:30 P.M., SPH II Aud. (During Final Exam Time)
______________________________________________________________________________
______________________________________________________________________________
10
Readings, and Specific Competencies
Section 1:
Introduction and Overview (Sessions 1 and 2), and Social Values (Session 3)
Required Readings
Introduction
Davis, K., Schoen, C., Schoenbaum, SC. & Stremikis, K. (2010). “Mirror, mirror on the wall: how the
performance of the U.S. health care system compares internationally, 2010 update.” Commonwealth
Report.
http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jun/Mirror-MirrorUpdate.aspx
Fuchs, VR (2010). Health care is different—that’s why expenditures matter. JAMA, 202(18): 1859-1860.
http://jama.ama-assn.org.proxy.lib.umich.edu/cgi/reprint/303/18/1859
Berwick, DM, Nolan, TW, and Whittington, J. (2008) “The Triple Aim: Care, Health, and Cost.” Health
Affairs 27(3):759–769.
http://content.healthaffairs.org.proxy.lib.umich.edu/cgi/content/full/27/3/759?maxtoshow=&hits=
10&RESULTFORMAT=&fulltext=the+triple+aim&searchid=1&FIRSTINDEX=0&resourcetype
=HWCIT
Editorial “A Formula for Cutting Health Costs” New York Times (2012)
http://www.nytimes.com/2012/07/22/opinion/sunday/a-formula-for-cutting-healthcosts.html?pagewanted=all
Health Reform
Kaiser Family Foundation. (2011). Summary of new health reform law.
http://www.kff.org/healthreform/upload/8061.pdf
Connors, E E, Gostin, LO. “Health Care Reform—A Historic Moment in US Social Policy.” JAMA.
2010;303(24):2521-2522.
http://jama.ama-assn.org/content/303/24/2521.full.pdf+html
Editorial. Treating you better for less. (2012) The New York Times. June 2, 2012
http://www.nytimes.com/2012/06/03/opinion/sunday/treating-you-better-for-less.html
11
Iglehart, J. “Implementing Health Care Reform — An Interview with HHS Secretary Kathleen Sebelius.”
N Engl J Med. 2011; 364:297-299
http://www.nejm.org/doi/pdf/10.1056/NEJMp1014722
Values
Donabedian, A. (1973). "Chapter 1: Social Values." Aspects of Medical Care Administration.
Cambridge: Harvard University Press. pp.1-27.
Sullum, J. “The Tyranny of Public Health.” Medical Sentinel. Volume 4, May/June 1999, pp. 100-102.
http://www.jpands.org/hacienda/article20.html
Hall MA. (2012). Supreme Court arguments on the ACA – a clash of two world views. NEJM, 366(16):
1462-3.
http://www.nejm.org.proxy.lib.umich.edu/doi/full/10.1056/NEJMp1201848
Required Video to Watch
• Watch the video: My Right Knee, which features a wonderful presentation made by Don Berwick,
the Director of the Centers for Medicare and Medicaid Services, and former President of The
Institute for HealthCare Improvement (IHI). Berwick raises a series of important issues about
how healthcare is provided in the US today. We will refer to many of these issues throughout the
course. The video is available at:
•
http://www.sph.umich.edu/richmedia/HMP602-881/Disc_1_web/IntroVid/MyRightKnee.html
Required Exercise:
•
Read the Exercise on Values (in CTools/Resources/Introduction and Orientation) or in the To Do
List for Week 1, which deals with the horrible case of baby Jubilee Holloway. Assign a number to
the case on the scale that is provided in the exercise and bring that number to class. (Additional
instructions will be provided on campus)
Competencies for Introduction and Overview and Values:
1. Understand the scope of this course—what is and is not included in the course content
2. Examine the major issues that are currently facing the US Health Care System
3. Review the major trends and terminology in the current US Health Care System
4. Appreciate the role of costs, quality and access in the US Health Care System
5. Recognize the central role of social values in health policy
6. Examine how societal values are related to the provision of care on an individual and societal level
7. Distinguish between Libertarian and Egalitarian value positions
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___________________________________________________________
Section 2A: The Medical Care Process: Health Status (Sessions 4 - 6)
Required Readings:
Health Status
Koh, HK. (2010). “A 2020 vision for healthy people.” NEJM.
http://content.nejm.org/cgi/reprint/362/18/1653.pdf?ssource=hcrc
Koh HK, Graham G, Gled SA. (2011). Reducing racial and ethnic disparities: the action plan from the
Department of Health and Human Services. Health Affairs, 30(10): 1822-9.
http://content.healthaffairs.org.proxy.lib.umich.edu/content/30/10/1822.full
Woolf SH, Braveman P. (2011). Where health disparities begin: the role of social and economic
determinants—and why current policies may make matters worse. Health Affairs, 30(10): 1852-9.
http://content.healthaffairs.org.proxy.lib.umich.edu/content/30/10/1852.full
Measuring Health Status
Ware, J.E., Jr. and Sherbourne, C.D. (1992). "The MOS 36-item short-form health survey (SF-36)." 1.
Conceptual Framework and Item Selection. Medical Care 30(6): 473-483.
http://www.jstor.org.proxy.lib.umich.edu/stable/pdfplus/3765916.pdf
Competencies for Health Status:
1.
Define health status and need for health care
2.
Examine different approaches to measuring health status
3.
Discuss the determinants of health status
4.
Examine how the health status of individuals relates to their social environments
5.
Define health disparities and identify the primary determinants of these disparities
6.
Examine several ways of measuring health status, including measures of mortality, morbidity,
dysfunction, and self-rated health
Section 2B: The Medical Care Process: Use of Services (Sessions 7-8)
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Required Readings
Utilization of Services
Edwards, R. “Access: Reform will boost health care coverage, but the consequences won’t be nearly as
cut and dried as you might expect.” Hospitals and Health Networks. August 2010: 16.
http://digital.hhnmag.com/RIDE/%28S%28zr30k445gn0ijaj2h5znch45%29%29/viewer.aspx?id=1
5&pageId=1&lang=&lid=0
Eisenberg, JM. (2002). "Physician Utilization. The State of Research About Physicians’ Practice
Patterns." Medical Care. 40(11): 1016-1035.
*(READ 1016-1024; SKIM 1024-1035).
http://www.jstor.org.proxy.lib.umich.edu/stable/pdfplus/3767817.pdf
Selvaraj, S, Yeshwant K, Elakiya, PS, Balaji, N, Mohan, SK. “Evidence-based medicine - a new
approach to teach medicine: a basic review for beginners.” Biology and Medicine, Vol 2 (1): 1-5, 2010.
Review Article.
http://biolmedonline.com/Articles/vol2_1_1-5.pdf
Bodenheimer, T, and West, D. “Low-Cost Lessons from Grand Junction, Colorado.” N Engl J Med
2010; 363:1391-1393.
http://www.nejm.org/doi/pdf/10.1056/NEJMp1008450
Institute of Medicine. (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in
Healthcare. Washington, D.C.: National Academy of Sciences. "Summary." pp.1-27.
http://www.nap.edu/openbook.php?record_id=12875&page=1
Wennberg, JE., Fisher, ES., and Skinner, JS. (2002). "Geography and the Debate Over Medicare Reform."
Health Affairs. 21(2):W96-W114. (Only pages W96-W104 are required).
http://content.healthaffairs.org/cgi/reprint/hlthaff.w2.96v1?maxtoshow=&hits=10&RESULTFORMAT=
&fulltext=geography+and+the+debate+over+medicare+reform&searchid=1&FIRSTINDEX=0&resourcet
ype=HWCIT
Gawande, A. (2009). “The Cost Conundrum: What a Texas Town Can Teach us About Health Care.” The
New Yorker. June 1, 2009.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all
________________________________________________________________
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Competencies for Use of Services:
1.
Understand the correlates of health care utilization
2.
Determine reasons why utilization might differ in geographic regions
3.
Examine why utilization differs among different populations
4.
Understand the role that provider and system factors play in the use of services
5.
Understand the existence of, and reasons for, “unequal treatment” in the US health care system
15
First Quiz
Covers Sessions 1-8
October 2, 2012 @ 1:00
16
Section 3A:
The Health Care Workforce: Physicians (Sessions 9-10)
Required Readings:
General
Kocher R, Sahni NR. (2011). Rethinking health care labor. NEJM, 365(15): 1370-2.
http://www.nejm.org.proxy.lib.umich.edu/doi/full/10.1056/NEJMp1109649
Iglehart, JK. “Despite Tight Budgets, Boosting US Health Workforce May Be Policy That Is 'Just Right'.
“ Health Affairs, 30, no.2 (2011):191-192
http://content.healthaffairs.org/content/30/2/191.full.pdf+html
Physicians
Kocher, R, Emanuel, EJ and. DeParle, NM. “The Affordable Care Act and the Future of Clinical
Medicine: The Opportunities and Challenges.” Ann Intern Med October 19, 2010 153:536-539; published
ahead of print August 23, 2010.
http://www.annals.org/content/153/8/536.full.pdf+html
Carrier ER, Yee T, Stark LB. (2011). Matching supply to demand: addressing the U.S. primary care
workforce shortage (Policy brief no. 7). National Institute for Health Care Reform.
http://www.nihcr.org/PCP_Workforce.html
Bodenheimer, T. and Hoangmai, HP. (2010). “Primary care: current problems and proposed solutions.”
Health Affairs, 29(5): 799-805.
http://content.healthaffairs.org.proxy.lib.umich.edu/cgi/reprint/29/5/799
Mullan, F. (2002). "Some thoughts on the white-follows-green law." Health Affairs. 21(1):158-159.
http://content.healthaffairs.org.proxy.lib.umich.edu/cgi/content/full/21/1/158
McAllester M. (2012) America is stealing the world’s doctors. The New York Times. March 7, 2012
http://www.nytimes.com/2012/03/11/magazine/america-is-stealing-foreign-doctors.html?pagewanted=all
________________________________________________________________
Competencies for Workforce, General, and Physicians:
17
1.
Understand the overall composition of the health care workforce.
2.
Identify various methods for determining the adequacy of supply of various health professionals.
3.
Understand the role and function of physicians within the larger health care system
4.
Understand the impact of various laws and reports on the supply of physicians in the US
5.
Examine factors influencing a perceived shortage or surplus of physicians
6.
Determine the socio-demographic composition of physicians and how that influences the practice of
medicine
7.
Assess the extent of the mal-distribution of physicians by specialty and geographic area in the US
18
Section 3B: The Health Care Workforce: Nursing (Session 11-12)
Required Readings
Nursing
Aiken, LH. (2011) “Nurses for the Future. N Engl J Med 2011; 364:196-198
http://www.nejm.org/doi/pdf/10.1056/NEJMp1011639
Auerbach DI, Bauerhaus PI, Staiger DO. (2011). Registered nurse supply grows faster than projected
amid surge in new entrants ages 23-26. Health Affairs, 30(12): 2286-92.
http://content.healthaffairs.org.proxy.lib.umich.edu/content/30/12/2286.full
Rosenberg K. (2011). Nursing staffing matters—again. American Journal of Nursing, 111(7): 15.
http://journals.lww.com/ajnonline/Fulltext/2011/07000/Nurse_Staffing_Matters_Again.8.aspx
McHugh, MD, Kutney-Lee, A, Cimiotti, JP, Sloane, DM and Aiken, LH. (2011) “Nurses' Widespread
Job Dissatisfaction, Burnout, And Frustration With Health Benefits Signal Problems For Patient Care.”
Health Affairs, 30, no.2 (2011):202-210.
http://content.healthaffairs.org/content/30/2/202.full.pdf+html
Frellick, M. (2011) “A Path to Nursing Excellence: Quality and staff recruitment gains offset Magnet’s
pricey application process.” Hospitals and Health Networks. April 2011: 41.
http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/04A
PR2011/0411HHN_FEA_workforce&domain=HHNMAG
________________________________________________________________
Competencies for Nursing:
1.
Understand the nature of the nursing profession and the role of nurses in the US Health Care System
2.
Recognize the different educational pathways that lead to the RN designation and how these have
changed over time.
3.
Identify the factors that are leading to the shortage of nurses in the US.
4.
Discuss the impact of the nursing shortage on the quality of care provided by nurses
19
Section 3C: The Health Care Workforce: NPs, PAs, and Non-Physician Clinicians (Session 13-14)
Required Readings:
Naylor, MD. & Kurtzman, ET. (2010). “The role of nurse practitioners in reinventing primary care.”
Health Affairs, 29(5): 893-899.
http://content.healthaffairs.org.proxy.lib.umich.edu/cgi/reprint/29/5/893
Edlin, M. (2010). “NPs and PAs extend the reach of PCPs.” Managed Healthcare Executive, 18-20.
http://managedhealthcareexecutive.modernmedicine.com/mhe/article/articleDetail.jsp?id=663845
Clark, C. (2011) “APRNs Provide Care Equal to Doctors, Review Concludes.” Health Leaders Media
(Online). August, 10, 2011.
http://www.healthleadersmedia.com/print/PHY-269597/APRNs-Provide-Care-Equal-to-DoctorsReview-Concludes
Harris G. (2011) “Calling the nurse ‘doctor,’ a title physicians oppose.” The New York Times. October
11, 2011.
http://www.nytimes.com/2011/10/02/health/policy/02docs.html?pagewanted=all
Coplan B, Mayer JE. (2011). Physician assistants—one less doctor(ate) in the house. JAMA, 305(24):
2571-2.
http://jama.jamanetwork.com.proxy.lib.umich.edu/article.aspx?articleid=646693
________________________________________________________________
Competencies for Non-Physician Clinicians:
1.
Identify the health professions that fall under the term “Non-Physician Clinicians” and the scope of
practice of these providers
2.
Differentiate between the training and practice requirements of nurse practitioners (NPs) and
physician assistants (PAs)
3.
Define the demographic and practice characteristics of NPs and PAs
4.
Examine these health professions as complements to, and substitutes for, physicians
20
Section 4A:
Health Facilities and Programs: Hospitals (Sessions 15 and 16)
Required Readings:
Hospitals and Integrated Delivery Systems
Gourevitch, MN., Caronna, CA., and Kalkut, G. (2005). "Acute Care." In Jonas and Kovner's
Health Care Delivery in the United States. Eighth Edition. Edited by Kovner, A.R., and
Knickman, J.R. New York: Springer Publishing Company. pp. 191-218.
https://ctools.umich.edu/access/content/group/e82f085c-bd6e-4099-a8a6f77318cbd290/E%20Hospitals%20and%20Long%20Term%20Care/Gourevitch__Acute_Care1.pdf
McCarthy, D.(2011) “Integrative Models and Performance.” In Jonas and Kovner's Health Care Delivery
in the United States. Tenth Edition. Edited by Kovner, A.R., and Knickman, J.R. New York: Springer
Publishing Company. Pp. 205-231.
Carrier ER, Dowling M, Berenson RA. (2012). Hospitals’ geographic expansion in quest of well-insured
patients: will the outcome be better care, more cost, or both? Health Affairs, 31(4): 827-35.
http://content.healthaffairs.org.proxy.lib.umich.edu/content/31/4/827.full
Sataline, S. (2010) “Cash-Poor Governments Ditching Public Hospitals.” Wall Street Journal. August 29,
2010.
http://online.wsj.com/article/SB10001424052748703618504575459823259071294.html
Kaiser Family Foundation. (2012, March). Community health centers: the challenge of growing to meet
the need for primary care in medically underserved communities [Policy brief].
http://www.kff.org/uninsured/upload/8098-02.pdf
Hospital-Physician Relationships
Kocher R, Sahni NR. (2011). Hospitals’ race to employ physicians – the logic behind a money-losing
proposition. NEJM, 364(19): 1790-3.
http://www.nejm.org.proxy.lib.umich.edu/doi/full/10.1056/NEJMp1101959
Gold J. (2011). FAQ on ACOs: accountable care organizations, explained. Kaiser Health News. October
21, 2011.
http://www.kaiserhealthnews.org/stories/2011/january/13/aco-accountable-care-organizationfaq.aspx
21
Matthews AW. (2012, January 23). Can accountable-care organizations improve health care while
reducing costs? The Wall Street Journal.
http://online.wsj.com/article/SB10001424052970204720204577128901714576054.html
________________________________________________________________
Competencies for Hospitals:
1.
Understand the hierarchy of health services facilities, i.e. primary, secondary, and tertiary levels of
care
2.
Recognize the extent to which regionalization has occurred in the US
3.
Identify the classifications that are used to describe hospitals in the US (e.g. ownership, function,
teaching status, size, location, etc.)
4.
Understand how the role of the community hospital has evolved in the US health care system
5.
Examine the internal organization of community hospitals and relationships between the hospital
Board, the Medical Staff and the Executive Office
6.
Understand how hospital-physician alignment in community hospitals has changed over the years
7.
Examine the role of Accountable Care Organizations (ACOs) in integrating hospitals and physicians.
8.
Assess the role of Community Health Centers (CHCs) in treating low-income populations.
22
Section 4B:
Long-Term Care (Sessions 17 and 18)
Required Readings:
Long-Term Care
Kaye, HS, Harrington, C & LaPlante, MP (2010). “Long-term care: who gets it, who provides it, who
pays, and how much?” Health Affairs, 29(1): 11-21.
http://content.healthaffairs.org.proxy.lib.umich.edu/cgi/reprint/29/1/11
Vladeck BC. (2011). The continuing paradoxes of nursing home policy. JAMA, 306(16): 1802-3.
http://jama.jamanetwork.com.proxy.lib.umich.edu/article.aspx?articleid=1104540
Tarkan L. (2011,). A nursing home shrinks until it feels like a home. The New York Times. October 31,
2011.
http://www.nytimes.com/2011/11/01/health/shrinking-the-nursing-home-until-it-feels-like-ahome.html?pagewanted=all
Berger J. (2012,). A shift from nursing homes to managed care at home. The New York Times. February
23, 2012.
http://www.nytimes.com/2012/02/24/nyregion/managed-care-keeps-the-frail-out-of-nursinghomes.html?pagewanted=all
Gazelle, G. (2007) "Understanding Hospice --- An Underutilized Option for Life's Final Chapter." N Engl
J Med 357:321-324.
http://content.nejm.org/cgi/content/full/357/4/321
________________________________________________________________
Competencies for Long-Term Care:
1.
Define long-term care and contrast it with acute care
2.
Identify the array of programs that comprise the long-term care continuum
3.
Understand societal changes in the needs for long-term care
4.
Identify differences between institutions that provide long-term care such as nursing homes and
home health agencies
5.
Assess efforts to expand the long-term care continuum beyond the nursing home
6.
Examine the role of Hospices in the US Health System
23
Section 5: The Drug Industry (Session 19)
Required Readings:
Avorn J. (2011). Learning about the safety of drugs – a half-century of evolution. NEJM, 365(23): 21513.
http://www.nejm.org.proxy.lib.umich.edu/doi/full/10.1056/NEJMp1110327
Spatz, ID. (2010). “Health Reform Accelerates Changes In The Pharmaceutical Industry.” Health
Affairs, 29, no.7 (2010):1331-1336
http://content.healthaffairs.org/content/29/7/1331.full.pdf+html
Wazana, A. (2000). “Physicians and the Pharmaceutical Industry: Is a Gift Ever Just a Gift?” JAMA,
Vol 283, No. 3. January 19, 2000.
http://jama.ama-assn.org/content/283/3/373.full.pdf+html
24
________________________________________
Competencies for the Drug Industry:
1. Identify different institutional entities in the pharmaceutical industry
2. Assess the role that regulation plays in protecting the public’s health
3. Understand the phases of drug development and the role that the FDA plays
4. Understand direct-to-consumer (DTC) and other types of pharmaceutical marketing
5. Identify the factors that have led to rising drug costs in the US
25
Second Quiz
Covers Sessions 9-20
November 20, 2012 @ 1:00
26
Section 6: Health Care Costs and Expenditures (May not be covered by a lecture)
Required Readings:
Expenditures
Chernew, ME., Baicker, K. & Hsu, J. (2010). “The spector of financial Armageddon—health care and
federal debt in the United States.” NEJM, 362(13):1166-1168.
http://content.nejm.org/cgi/reprint/362/13/1166.pdf
Kaiser Family Foundation. (2012). Health care costs: a primer. May, 2012.
http://www.kff.org/insurance/upload/7670-03.pdf
Redberg, RF (2011) “Squandering Medicare’s Money.” New York Times. May 25, 2011.
http://www.nytimes.com/2011/05/26/opinion/26redberg.html
Abelson, R. (2010) “Employers Push Costs for Health on Workers.” New York Times. September 2,
2010.
http://www.nytimes.com/2010/09/03/business/03insure.html
________________________________________________________________
Competencies for Costs and Expenditures:
1.
Understand how health care costs are measured
2.
Examine the effects of rapidly rising costs on various stakeholders
3.
Examine trends in, and reasons for, the explosion of health care costs
4.
Compare costs of care between the US and other countries
5.
Define different approaches to cost containment in the US
Section 7A:
Health Care Financing: Private Health Insurance (Sessions 21-22)
27
Overview
Knickman, J.R. (2011). "Health Care Financing." In Jonas and Kovner's Health Care Delivery in the
United States. Tenth Edition. Edited by Kovner, A.R., and Knickman, J.R. New York: Springer
Publishing Company. pp. 47-66.
Center for Healthcare Research & Transformation.(2010). The Patient Protection and Affordable Care
Act at the State and Local Level. Policy Brief. June, 2010. Web. 19 May 2011.
http://www.chrt.org/assets/policy-briefs/CHRT-Policy-Brief-June-2010.pdf
Required Readings:
Private Health Insurance
Morrisey, M.A. (2008) “History of Health Insurance in the United States” in Health Insurance. Chicago:
Health Administration Press, 2008, pp. 3-20.
Kaiser Family Foundation. (2008). How private health insurance works: A primer. 2008 Update The
Foundation.
http://www.kff.org/insurance/upload/7766.pdf.
Abelson R, Bernstein N. (2011). Health insurers push premiums sharply higher. The New York Times.
September 27, 2011.
http://www.nytimes.com/2011/09/28/business/28insure.html?pagewanted=all
________________________________________________________________
Competencies for Private Health Insurance and Managed Care:
1.
Understand historical factors determining how private health insurance was shaped in the United
States
2.
Examine the effects that insurance has on patient/consumer behavior
3.
Examine populations with—and without—access to health insurance in the United States
4.
Define managed care and assess different models of managed care
28
Section 7B: Health Care Financing: Public Programs (Sessions 23-25)
Medicare
Required Readings:
Kaiser Family Foundation. (2010). Medicare, a primer (2010). The Foundation.
http://www.kff.org/medicare/upload/7615-03.pdf.
Kaiser Family Foundation . (2010). Medicare at a glance: A fact sheet. The Foundation. September, 2010.
http://www.kff.org/medicare/upload/1066-13.pdf
Baicker K, Chernew ME. (2011). The economics of financing Medicare. NEJM, 365(4): e7.
http://www.nejm.org.proxy.lib.umich.edu/doi/full/10.1056/NEJMp1107671
Medicaid
Required Readings
Kaiser Family Foundation. (2010) Medicaid, a Primer. The Foundation. June, 2010.
http://www.kff.org/medicaid/upload/7334-04.pdf
Iglehart JK. (2012). Expanding eligibility, cutting costs – a Medicaid update. NEJM, 366(2): 105-7.
http://www.nejm.org.proxy.lib.umich.edu/doi/full/10.1056/NEJMp1113561
Rosenbaum S. (2011). Medicaid and access to health care – a proposal for continued inaction? NEJM,
365(2): 102-4.
http://www.nejm.org.proxy.lib.umich.edu/doi/full/10.1056/NEJMp1106046
Baicker K. and Finkelstein A, (2011). The Effects of Medicaid Coverage – Learning from the Oregon
Experiment NEJM, 365: 683-685
http://www.nejm.org/doi/full/10.1056/NEJMp1108222
29
Health Reform
Required Readings
Oberlander, J. (2010). “Long time coming: why health reform finally passed.” Health Affairs, 29(6):
1112-1116.
http://content.healthaffairs.org.proxy.lib.umich.edu/cgi/reprint/29/6/1112
Berenson, RA. “Implementing Health Care Reform — Why Medicare Matters.” N Engl J Med 2010;
363:101-103
http://www.nejm.org/doi/pdf/10.1056/NEJMp1005588
The Kaiser Family Foundation. (2010) “Health Reform and Communities of Color: Implications for
racial and ethnic health disparities.” Facts on Health Reform. The Foundation. September, 2010.
http://www.kff.org/healthreform/upload/8016-02.pdf
More to come!
________________________________________________________
Competencies for Medicare, Medicaid and Health Reform:
1.
Understand the historical development of Medicare, Medicaid, and SCHIP
2.
Understand the differences between Medicare and Medicaid in terms of social values, populations
covered, benefits covered, and the administration of the programs
3.
Identify historical attempts to achieve universal coverage in the United States, as well as the
stakeholders proposing—and opposing—such coverage
4.
Become familiar with the major sections of the “Affordable Care Act” (Health Reform) and discuss
its potential impact on the US Health Care System
30
Final Examination
Will cover sessions 21-25
December 19 @ 4PM
31