Health Economics: - NYU Wagner Graduate School of Public ...



Health Economics: Topics in Domestic Health PolicyHPAM-GP 4831.001Spring 2019Instructor InformationSherry GliedEmail: sherry.glied@nyu.edu (sg162@nyu.edu)Office Address: Puck, Room 2100Office Hours: posted on Wagner websiteCourse InformationClass Meeting Times: Mondays, 4:55 pm – 6:35 pmClass Location: Waverly Building, 24 Waverly Place, Room 661Course Prerequisites MicroeconomicsStatistics IHealth Econ IProficiency in Excel expected.Course DescriptionThe purpose of this course is to further extend students’ understanding of health economics and its application to US health policy and management petenciesThis course will address the following CAHME competencies: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. [This competency will be assessed through Assignment 3, which focuses on changing technological costs.]The ability to synthesize evidence, and apply statistical financial, economic and cost effectiveness tools/techniques in organizational analysis.[This competency will be assessed through Assignments 1, 2, and 3, which require students to apply statistical and economic techniques.]The ability to present convincingly to individuals and groups the evidence to support a point of view, position or recommendation.[This competency will be assessed through Assignments 1, 2, and 3, in which students will be required to support a policy or management position.] 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.[This competency will be assessed through Assignments 1, 2, and 3, in which students will be required to write policy and management memos.] Assignments, exams, and class participation in the course will assess progress against these competencies, and no student will receive a B or higher without demonstration of satisfactory progress towards mastery of each competency.Course and Learning ObjectivesLearning Assessment TableProgram Competency Corresponding Course Learning ObjectiveCorresponding Assignment Title (Memo, Team Paper, Exam, etc.)Denote Level of Competency Expected to Achieve via the Assignment (basic = 1, intermediate = 2, advanced = 3) 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.Be able to apply economic theories to understanding the organization of the health care system, health behaviors, and the impact of policy.Assignment #1, #2, #3 3, 2, 2The ability to synthesize evidence, and apply statistical financial, economic and cost-effectiveness tools/techniques in organizational analysisBecome familiar with the techniques health economists use to assess policy effects.Assignment #32The ability to present convincingly to individuals and groups the evidence to support a point of view, position or recommendation.Be able to use evidence to make policy recommendations.Assignment #1,2,3 2, 2, 3 Late Assignment PolicyExtensions will be granted only in case of emergency, out of respect to those who abide by deadlines despite equally hectic schedules. Late submissions without extensions will be penalized 10% per 24-hour period. RequirementsPlease do all required readings before class and be prepared to discuss the policy reading assigned each week.Three 2-3 page papers (23% of grade each) Final exam – (25% of grade) – online – week of May 13Weekly preparatory problems – 6% of grade (graded as complete/incomplete)Required TextTitle: Health EconomicsAuthors: Jay Bhattacharya, Peter Tu, Timothy HydePublisher: Palgrave Macmillan, 2013ISBN: 113702996X, 9781137029966AssignmentsAll papers are to be submitted via the NYU Classes course site as WORD documents at least 1 hour before the start of class on their due date (3:55 pm). Be sure your name is part of the document file name.GradingAssignments 1, 2, and 3 will ask you to examine a policy/management issue and to use data to support your answer. Each paper will be graded out of 50. In your response, you should:Compose a clear, coherent, concise argument [20 points]Apply theories learned in class [10 points]Relate your analysis to at least one idea mentioned in the readings [5 points]Analyze evidence accurately [5 points]Use evidence to support your argument [10 points]Detailed Course OverviewTopicsVertical integration/boundaries of the firm/ACOsCompetition/Consolidation/Prices/TechnologySupply/human capital Rx –add shortages/genericsCoverage and expansion – including Medicare – block grantsQualitySession 1: April 1, 2019Physicians Deliverables:Reading and Prep questions Objectives:Be able to use the theory of human capital investment to understand workforce policy choices.Become familiar with econometric analysis of professional earnings.Readings:Text Chapter 5Kleiner, Morris M. "Battling over jobs: occupational licensing in health care." American Economic Review 106.5 (2016): 165-70.Glied, Sherry, Ashwin Prabhu, and Norman Edelman. “The Cost of Primary Care Doctors.” Frontiers in Health Policy Research.Ketel, Nadine, Edwin Leuven, Hessel Oosterbeek, and Bas van der Klaauwa. "The Returns to Medical School: Evidence from Admission Lotteries."American Economic Journal: Applied Economics?8, no. 2 (2016): 225-254.Clemens, Jeffrey, and Joshua D. Gottlieb. 2014. "Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?"?American Economic Review, 104(4): 1320-49 – ignore all the math. Session 2: April 8, 2019Hospitals and Vertical IntegrationDeliverables:Readings and prep questionsObjectives:Understand the economics of the boundaries of the firm and vertical integration.Understand how non-profit and for-profit hospitals differ from both a financial and economic perspective.Readings: Text Chapter 6Stiglitz, Economics. Norton, 1993; Managing the Firmpages 576-584Burns, Lawton R., and Mark V. Pauly. "Accountable care organizations may have difficulty avoiding the failures of integrated delivery networks of the 1990s." Health Affairs 31.11 (2012): 2407-2416.Roberts ET, McWilliams JM, Hatfield LA, et al. Changes in Health Care Use Associated With the Introduction of Hospital Global Budgets in Maryland.?JAMA Intern Med.?2018; 178(2):260–268. doi:10.1001/jamainternmed.2017.7455. McWilliams, J. Michael, Laura A. Hatfield, Bruce E. Landon, Pasha Hamed, and Michael E. Chernew. "Medicare spending after 3 years of the Medicare Shared Savings Program."?New England Journal of Medicine?379, no. 12 (2018): 1139-1149.Baker, George P., and Thomas N. Hubbard. "Contractibility and asset ownership: On-board computers and governance in US trucking."?The Quarterly Journal of Economics?119, no. 4 (2004): 1443-1452 (only). Assignment 1: Electronic Health Records – due Session 3Write a 2-3 page memorandum analysing how electronic health records will affect the industrial organization of the health care system. Are electronic health records the GPS of medicine? Do patterns of participation in EHRs support your hypothesis? See NCHS Data Brief No. 129, September 2013 (on course site) and related briefs for data. Session 3: April 15, 2019Smoking/addictionDeliverables: Assignment 1 dueReadings and prep questionsObjectives:Be able to apply behavioral economics concepts to the study of health issues.Know how to use a social welfare framework to assess health behaviors.Readings:Text Chapter 4, 24Manning, W. & Keeler, E. (1989). The Taxes of Sin: Do Smokers and Drinkers Pay their Way. Journal of the American Medical Association, 261(11), 1604-1609. Kenkel, D. & Sindelar, J. (2011). Economics of Health Behaviors and Addictions: Contemporary Issues and Policy Implications in S. Glied & P.C. Smith, Oxford Handbook of Health Economics (206-231). USA: Oxford University Press.Cutler, David M., Amber I. Jessup, Donald S. Kenkel, and Martha A. Starr. "Economic approaches to estimating benefits of regulations affecting addictive goods."?American journal of preventive medicine?50, no. 5 (2016): S20-S26.Saffer, Henry, D. Dench, D Dave, &M. Grossman. E-cigarettes and Adult Smoking. NBER Working Paper No. 24212. January 2018.Session 4: April 22, 2019Rx Deliverables: Readings and prep questionsObjectives:Understand the economics of innovation.Be familiar with the pros and cons of alternative policy strategies for addressing pharmaceutical prices.Readings:Text Chapter 12Lakdawalla, DN, DP Goldman, PC Michaud, N Sood, R Lempert, Z Cong, H de Vries, I Guttierez. (2009) US Pharmaceutical Policy in a Global Marketplace. Health Affairs 28: 1, w138-w150. Sertkaya et al. (2014) executive summaryGrabowski, Henry G., Joseph A. DiMasi, and Genia Long. "The roles of patents and research and development incentives in biopharmaceutical innovation."?Health Affairs?34, no. 2 (2015): 302-310.Dubois, Pierre, Olivier De Mouzon, Fiona Scott‐Morton, and Paul Seabright. "Market size and pharmaceutical innovation."?The RAND Journal of Economics?46, no. 4 (2015): 844-848. Policy issue: SovaldiRead: Pricey Sovaldi Ends Up Being Cost-Effective Hep C Treatment For Prisoners: A Bitter Pill To Swallow?Assignment 2 – due April 29: Joseph Stiglitz recommends that, at least in some cases, we should move from patents to prizes. Using the theories and evidence from class, and the information in the Bain and Co. study to identify a situation where you might (or might not) want to use a prize instead of a patent. On course site: FDA – Joseph E. Stiglitz, “Prizes, Not Patents”, PAECON. net, issue no. 42, 18 May 2007, pp. 48-49. Bain and Co.- A new pharma launch paradigm: From one size fits all to a tailored product approach.Session 5: April 29, 2019Quality Deliverables: Readings and prep questionsAssignment 2 due before classObjectives:Understand the variations in quality in the US health care systemUnderstand the pros and cons of alternative strategies for improving quality, including competitive and regulatory strategies.Readings:Fisher, Elliott S., et al. "Variations In The Longitudinal Efficiency Of Academic Medical Centers: Increased intensity of care does not appear to be associated with higher quality or to result in better survival at AMCs." Health Affairs 23.Suppl2 (2004)Kessler, DP. Evaluating the Medical Malpractice System and Options for Reform. The Journal of Economic Perspectives, Vol. 25, No. 2 (Spring 2011), pp. 93-110Pashigian, Bedros Peter. Price theory and applications. McGraw-Hill College, 1995. Christianson, Jon B., and Douglas Conrad. "Provider payment and incentives." The Oxford handbook of health economics. Oxford University Press, 2012. Mukamel, Dana B., Simon F. Haeder, and David L. Weimer. "Top-down and bottom-up approaches to health care quality: the impacts of regulation and report cards." Annual review of public health 35 (2014): 477-497.Session 6 – May 6, 2019Costs – Technology Deliverables: Readings and prep questionsObjectives:Be able to evaluate and apply theories of why health care costs are high and rising.Be able to assess alternative policy instruments for reducing costs.Readings:White, C. (2013) Contrary to Cost-Shift Theory, Lower Medicare Hospital Payment Rates for Inpatient Care Lead to Lower Private Payment Rates. Health Affairs May, 5935-943. Scheffler, Richard M., Daniel R. Arnold, Brent D. Fulton, and Sherry A. Glied. "Differing Impacts Of Market Concentration On Affordable Care Act Marketplace Premiums."?Health Affairs?35, no. 5 (2016): 880-888.Propper, C.& Leckie, G. (2011). Increasing Competition between Providers in Health Care Markets: The Economic Evidence. in S.Glied & P.C. Smith, Oxford Handbook of Health Economics (671-687). USA: Oxford University Press.Chandra, A. & Skinner, J. (2012). Technology Growth and Expenditure Growth in Health Care, Journal of Economic Literature, 50(3), 645–680.Chernew, M. & Dustin, M. (2011). Health Care Cost Growth. in S.Glied & P.C. Smith, Oxford Handbook of Health Economics (308-328). USA: Oxford University Press. Geruso, Michael, and Timothy Layton. Upcoding: Evidence from Medicare on squishy risk adjustment. No. w21222. National Bureau of Economic Research, 2015. Sections 1 and 8 onlyBarbash, G.I. , Friedman, B., Glied, S.A., & Steiner C.A. (2014) Factors Associated With Adoption of Robotic Surgical Technology in US Hospitals and Relationship to Radical Prostatectomy Procedure Volume. Annals of Surgery, 259(1). 1–6.Assignment 3: Due May 13Using the data and app at HCUP-net, choose an ICD-9 code diagnosis with at least 150,000 discharges in 2006 (on course site). Examine the trend in spending per discharge. Can it be explained by changes in the characteristics of those diagnosed? Can it be explained by economy-wide inflation? Technological change? Hospital per diems? Write a 2-3 page memo explaining what’s going on and why, including at least one graphic.Session 7 – May 13, 2019Equity/taxes/MedicareDeliverables:Readings and prep questionsAssignment 3 due before classObjectives:Understand the relationships between efficiency and equity in health care.Be able to assess alternative policy strategies for balancing efficiency and equity.Readings:Cutler, D., Lleras-Muney A. & Vogl, T (2011). Socioeconomic Status and Health: Dimensions and Mechanisms in S.Glied & P.C. Smith, Oxford Handbook of Health Economics (124-163). USA: Oxford University Press.Sheiner, L., (2011) Intergenerational Aspects of Health Care Spending in S.Glied & P.C. Smith, Oxford Handbook of Health Economics (870-889). USA: Oxford University Press.Glied, Sherry A. "Financing Medicare Into The Future: Premium Support Fails The Risk-Bearing Test." Health Affairs 37.7 (2018): 1073-1078.Deaton, Angus. "Policy implications of the gradient of health and wealth." Health affairs 21.2 (2002): 13-30.Finkelstein, A. et al. (2012). The Oregon Health Insurance Experiment: Evidence from the First Year. The Quarterly Journal of Economics, 127(3), 1057-1106.Baicker, K., Taubman, S. L., Allen, H. L., Bernstein, M., Gruber, J. H., Newhouse, J. P., et al. (2013). The Oregon Experiment — Effects Of Medicaid On Clinical Outcomes. New England Journal of Medicine, 368(18), 1713-1722. FINAL EXAM posted online by 12:00pm *******FINAL EXAM to be completed by 11:00pm *******Academic IntegrityAcademic integrity is a vital component of Wagner and NYU. All students enrolled in this class are required to read and abide by Wagner’s Academic Code. All Wagner students have already read and signed the?Wagner Academic Oath. Plagiarism of any form will not be tolerated and students in this class are expected to?report violations to me.?If any student in this class is unsure about what is expected of you and how to abide by the academic code, you should consult with me.Henry and Lucy Moses Center for Students with Disabilities at NYUAcademic accommodations are available for students with disabilities. Please visit the Moses Center for Students with Disabilities (CSD) website and click on the Reasonable Accommodations and How to Register tab or call or email CSD at (212-998-4980 or mosescsd@nyu.edu) for information. Students who are requesting academic accommodations are strongly advised to reach out to the Moses Center as early as possible in the semester for assistance.NYU’s Calendar Policy on Religious HolidaysNYU’s Calendar Policy on Religious Holidays states that members of any religious group may, without penalty, absent themselves from classes when required in compliance with their religious obligations. Please notify me in advance of religious holidays that might coincide with exams to schedule mutually acceptable alternatives. ................
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