Issues in Health Care Policy and Health Care Reform



P8516: Issues in Health Care Policy and Health Care Reform

Instructor: Sherry Glied, Ph.D.

Office: Room 610, 600 West 168th St., 6th floor

e-mail: sag1@columbia.edu

Phone: 305-3924

2 points.

This course introduces students to the analysis of issues in health policy through an in-depth examination of several of the major issues related to health care reform and the functioning of the health care system. The first part of the course examines competing views of how a health care system should work. The second part of the course traces issues in the reform of the US health care system. While the principle focus is on the U.S. health system, we also study the relevance of these ideas to other types of health care systems.

At the end of the course, the students should be able to analyze a major health policy reform issue from several perspectives.

Requirements:

3 short assignments: 15%

October 1

October 29

November 26

Class participation: 10%

Policy analysis paper (20 –25 pages): 45%

Topic selected and described: October 8

First draft: November 12

Final paper: December 17

Final test: 30%

Required course materials:

Readings package. Available at Copyquick.

Glied, Sherry. Chronic Condition. on reserve in library.

I. What are the Problems of the Health Care System?

September 13

a. Introduction to the US Health Care System

1. Tuohy, Caroline. 1999. “Dynamics of a Changing Health Sphere: The United States, Britain, and Canada.” Health Affairs 18(3): 114-131.

2. White, Joseph. 1995. Competing Solutions. Washington, D.C.: Brookings Institution Press. Chapters 3, 4.

3. Blendon, Robert J. and John M. Benson. “Americans’ Views on Health Policy: A Fifty-Year Perspective.” Health Affairs 20(2): 33-46.

September 17

b. Access

1. Weissman and Epstein, Falling through the Safety Net. Johns Hopkins Press, 1994. 55-112.

2. McGinnis. JM and WH Foege. 1993. “Actual Causes of Death in the United States.” JAMA 270(18): 2207-12.

3. Carroll, Douglas, George Davey Smith, and Paul Bennett. “Some Observations on Health and Socioeconomic Status.” Journal of Health Psychology 1(1): 23-39.

4. Epstein, Richard. 1997. Mortal Peril. Addison-Wesley: 1-19, 111-116.

September 24

c. Costs of Health Care

1. Anderson, G. and Sotir Hussey, P. “Comparing Health System Performance in OECD Countries.” Health Affairs 20(3): 219-232.

2. Kronick R., and Gilmer T., " Explaining the Decline in Health Insurance Coverage 1979-1995" Health Affairs 18(2): 30-47, 1999.

3. Glied, Chronic Condition, Chapters 3, 4

4. Morris, Charles R. 1999. “The Health-Care Economy is Nothing to Fear.” Atlantic Monthly December. 86-95.

October 1

d. Quality

1. Kohn, Linda T. , Janet M. Corrigan, and Molla S. Donaldson, Editors; Committee on Quality of Health Care in America, Institute of Medicine. To Err Is Human: Building a Safer Health System. IOM, 2000. Executive Summary.

2. Gawande, Atul. New Yorker. 1999. 40-55.

3. Kaplan, HS, et al. “Identification and Classification of the Causes of Events in Transfusion Medicine.” Transfusion 1998; 38: 1071-1081, and accompanying editorial 999-1003.

4. Chassin, Mark. “Is Health Care Ready for Six Sigma Quality?”Milbank Quarterly, 76(4), 565-591.

Guest speaker: Dr. Harold Kaplan

October 8

Who Should Run the Health Care System?

a. Physicians

1. Glied, Chronic Condition, Chapter 2.

2. Roos N.P. and L.L. Roos. 1994. “Small Area Variations, Practice Style, and Quality of Care.” in Why are Some People Healthy and Others Not? ed. Evans, Barer, and Marmor. New York, De Gruyter: 231-246.

3. The Reinhardt –Relman letters 1986. “Letter to Arnold Relman” Health Affairs Summer: 6-16.

4. Rosenbaum, S. et al.. 1999. “Who Should Determine when Health Care is Medically Necessary?” New England Journal of Medicine 340(3): 229-232; comments New England Journal of Medicine 341(1); 58-60.

October 15

Who Should Run the Health Care System?

b. Markets

1. Council of Economic Advisers, 1993. Economic Report of the President. United States GPO: 141-144.

2. Glied, Sherry. Chronic Condition. Cambridge, MA: Harvard University Press: 38-48, 74—85.

3. Pauly, Mark V. 1978. “Is medical care different?” in Competition in the Health Care Sector (Greenberg, ed.), Germantown, MD, Aspen Systems: 23-38.

4. Herzlinger, Regina. 1997. Market-Driven Health Care. Reading, MA: Perseus Press: 245-282.

APHA week

October 22

Health System Models

a. Single Payer & Conservative Alternatives

1. Glied, Chronic Condition, Chapter 6.

2. Naylor, C. David. 1999. “Health Care in Canada: Incrementalism Under Fiscal Duress.” Health Affairs 18(3): 9-24. (19-33)

3. Himmelstein, D. et al. “A National Health Program for the United States.” New England Journal of Medicine Jan. 12, 1989: 102-108

4. Goodman, John C. “Medical Savings Accounts: An Idea Whose Time has Come.” in Empowering Health Care Consumers through Tax Reform ed. Arnett, 145-172.

5. Pauly, Mark. “An Efficient and Equitable Approach to Health Reform.” in Empowering Health Care Consumers through Tax Reform ed. Arnett, 55-70.

Who Should Run the Health Care System?

October 29

c. Experts

1. Leichter, Howard M. 1999. “Oregon’s Bold Experiment: Whatever Happened to Rationing?” Journal of Health Politics, Policy, and Law 24(1): 147-160.

2. Meltzer, David. 2001 “Theoretical Foundations of Medical Cost-Effectiveness” in Medical Care Output and Productivity 97-113.

3. McDonough, John E. 1997. “Tracking the Demise of Hospital Rate Setting.” Health Affairs 16(1): 142-149.

4. Morone, James. “The Bureaucracy Empowered.” in The Politics of Health Care Reform, 148-164.

Nov. 5

Who Should Run the Health Care System?

Community Partnerships

1. Berry, Jeffrey M, Kent E. Portney, and Ken Thomson. 1993. The Rebirth of Urban Democracy, Brookings, 195-213, 283-300.

2. Lasker, Roz, Elisa S. Weiss, and Rebecca Miller. 2001. “Partnership Synergy: A Practical Framework for Studying and Strengthening the Collaborative Advantage.” Milbank Quarterly 79(2), 179-205.

3. Denhardt, Robert B. and JV Denhardt. “The New Public Service: Serving Rather than Steering.” Public Administration Review. November 2000, 60(6): 549-559.

Guest speaker: Dr. Roz Lasker

November 12

b. Managed Competition & The Clinton Plan

1. Enthoven, A. “The History and Principles of Managed Competition.” Health Affairs Supplement 1993, 24-48.

2. Zelman and Brown. “Looking Back on Health Reform: No Easy Choices” Health Affairs 17(6): 61-68, 1998.

3. Glied, Chronic Condition Chapter 7

4. Skocpol, Theda. Boomerang. 1996. Norton. 1-19.

IV. Getting There

November 26

a. Politics and Public Opinion

1. Blendon, Kim, and Benson. “The Public Versus the WHO on Health System Performance.” Health Affairs 20(3) 2001: 10-21.

2. Brown, L. “Dogmatic Slumbers: American Business and Health Policy.” in The Politics of Health Care Reform, 205-223.

3. Ball PM. “What Medicare’s Architects Had in Mind.” Health Affairs 14(4) 1995: 62-72.

4. Rothman, David. “A Century of Failure: Class Barriers to Reform.” in The Politics of Health Care Reform, 11-25

5. Weissert, Carol S. and William G. Weissert. Governing Health. Johns Hopkins, 13-62.

Guest speaker: Ms. Rima Cohen

December 3

b. Incrementalism

1. Glied, Sherry. “Challenges and Options for Increasing the Number of Americans with Health Insurance.” Commonwealth Fund Report #415. December 2000. Inquiry, forthcoming.

2. Brown, Larry and Michael Sparer. “Window Shopping: State Health Reform Politics in the 1990s.” Health Affairs, Vol. 20, number 1 (Jan/Feb 2001)

3. Sparer, Michael. “Devolution of Power: An Interim Report Card,” Health Affairs, Vol. 17, Number 3 (May/June 1998).

4. Kronick, R. “Where Should the Buck Stop: Federal and State Responsiblities in Health Care Financing Reform.” Health Affairs Supplement 1993: 87-98.

December 10

c. Financing and Equity

1. Summers, L. “Some Simple Economics of Mandated Benefits.” American Economic Review May 1989: 177-183.

2. Rosen, H. Public Finance . Chapter 13, 274-293. 1993

3. Auerbach, A., J Gokhale, and L. Kotlikoff. “Generational Accounts and Lifetime Tax Rates.” Economic Review, First Quarter 1993, 2-13.

4. Titmuss, R. “The Right to Give.” in The Gift Relationship. 305-315.

5. Levy, Frank. The New Dollars and Dreams. 187-197.

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