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The University of Texas at Tyler
Executive Health Care Administration MPA Program
FALL 2014
COURSE NUMBEREHCA 5360.030
COURSE TITLEIntroduction to the American Healthcare System
INSTRUCTORE. Gordon Whyte, MSHCA, PhD
INSTRUCTOR
INFORMATION (c) 985-686-3263(o) 903-566-7493
Preferred contact: email or cell. Rarely call office.
REQUIREDTEXTHealth Policy Issues: An Economic Perspective, 5th edition, Feldstein, 2011, Health Administration Press: ISBN: 13-978-1-56793-418-2
RECOMMENDED READING
The origins of the medical, hospital, and insurance industries are very well described in Paul Starr’s The Social Transformation of American Medicine (NY: Basic Books, 1982). An update of Starr’s book is found in Journal of Health Politics, Policy and Law, 2004, Vol. 29, Nos. 4 & 5.
ADDITIONAL READINGS
The Patient Protection and Affordable Care Act is the law of the land but will for a while remain controversial. With the ruling of the Supreme Court confirming the constitutionality of the law, and theresults of the November 2012 election, as a class, we must continue our professional assessments and developing “reasoned opinions” about the Act itself and the future of health care reform in the country. Therefore, other readings will be posted on Blackboard for your reading, consideration and discussions.
COURSE
DESCRIPTION
An introduction to the American healthcare delivery system, its components,organizations, and management. Subjects will include thehistorical development, structure, operation, and current and future directions of the American healthcare delivery system, and healthcare ethics.Additionally, students will examine and analyze the health care systems of other countries.
Course Overview
The course examines the ways in which health care services are organized and delivered, the influences that impact health care public policy decisions, factors that determine the allocation of health care resources and the establishment of priorities, and the relationship of health care costs to measurable benefits. The course enables students to assess the role of organized efforts to influence health policy formulation, and the contributions of medical technology, research findings, and societal values on our evolving health care delivery system.
Since almost every medical or technological advance or change in the way health care is delivered is accompanied by new and vexing policy, ethical and legal dilemmas, class time is devoted to open discussion of these complex and value-laden issues.
Course materials are drawn largely from the required text, supplemented by articles from the current literature. As appropriate, information is presented in its social, political and economic contexts to enhance understanding of the forces that shape the system and the evolving mandates for change.
Course Objectives
1. Discuss the basic fundamental concepts and components of the health care delivery system.
2. Identify publics in both the private and public health care sectors of the industry.
5. Propose a conceptual model for explaining the delivery of health care services.
6. Explain the role of the health services administrator in today’s health care delivery system.
7. Identify trends in the health industry which indicate a need for a restructuring of the
health care delivery system.
8. Examine and analyze the health care systems of other countries.
EHCA Health Services Administration Competencies
Upon Completion of Introduction to Health Systems course, the student should be able to:
1.Identify the main components and issues of the organization, financing and delivery of health services and public health systems in the US.
2.Analyze the relationship between a health care delivery organization and its external environment.
3.Describe the difference between the production of health and the production of health care services.
4.Articulate the major issues confronting the delivery of health care services.
Class Procedures and Requirements
Written Essays – The first of two written essays is designed to provide the student with the opportunity to articulate, question and explain the major issues facing the American health care delivery system with the implementation of PPACA. The first essay is 6000 words in length approximately 20 typed pages and written by the individual student. Assistance from classmates and other professionals is encouraged but the final written product must be the individual’s alone. Papers are not to reflect a student’s political views and news organizations are not satisfactory reference sources.
The second essay is also 6000 words in length (approximately 20 pages) and is composed and written by a pre-selected group of students. This paper will be accompanied by aPowerPoint presentation of the essay. Approximately 25-30 PPT slides are expected in the presentation. These slides represent the content of a 30 minute oral presentation by the group though such a presentation is not possible due to format and time constraints.
Course Discussion Boards – Two selected topics will be posted on Blackboard at assigned times during the semester. Each student will compose and post a thoughtful response to each topic. Student responses must be at least 300 words in length and contain one outside (non-textbook) references that supports your opinion. In addition to the posting of your own response, each student must write and submit a thoughtful reaction to at least three (3) of your classmates’ postings.
Assignments - Students are accountable for reading assignments, and for informed participation in class discussions and posted discussion boards. All formal papers must be submitted in APA Format using 12pt. font and 1” margins, double-spaced.All assignments must be submitted through Blackboard. Please be aware of the due dates and closing dates of each assignment.
Assignments will be graded on knowledge, reflected synthesis of relevant information, organization, and logic. However, papers are not to reflect a student’s political views and news organizations are not satisfactory reference sources.
Course Participation – the on-campus portion of the course provides the students with their greatest opportunity to discuss and exchange ideas and concepts, with the other health care professionals in the class. Student preparation and information exchange is essential for a complete learning experience in this course and therefore can be reflectedin their grade. Absences even excused absences will have a negative effect on your grade.
Late Assignments or Projects:Late student assignments may be accepted. However, the student will be penalized one grade level for each late day. To clarify, the assignment may be accepted and graded except as noted in this syllabus schedule. Then that grade will be reduced one grade level based on the grading scale (listed below) for each day that the assignment is late, e.g., if you score a B on a paper or discussion board that was due on Friday but submitted on Saturday, your grade will be a reduced to C. Some assignments are not accepted late. See syllabus schedule (P.5) for details
Grading policy
Individual Essay / 35%Two discussion boards (15 points each) / 30%
Group Essay (25%-written paper; 10% PPT presentation) / 35%
Total Points / 100%
Grading Scale
For graduate courses, UTTyler does not endorse the option of plus/minus grades. Therefore grades in EHCA 5360 will be as follows:
A / 90-100 / C / 70-79B / 80-89 / F / Below 70
STUDENTS RIGHTS AND RESPONSIBILITIES
To know and understand the policies that affect your rights and responsibilities as a student at UT Tyler, please follow this link: http://www.uttyler.edu/wellness/StudentRightsandResponsibilities.html
DISABILITY SERVICES
In accordance with federal law, a student requesting accommodation must provide documentation of his/her disability to the Disability Support Services counselor. If you have a disability, including a learning disability, for which you request an accommodation, please contact Ida MacDonald in the Disability Support Services office in UC 282, or call (903) 566-7079.
STUDENT ABSENCE DUE TO RELIGIOUS OBSERVANCE
Students who anticipate being absent from class due to a religious observance are requested to inform the instructor of such absences by the second class meeting of the semester.
SOCIAL SECURITY AND FERPA STATEMENT
It is the policy of The University of Texas at Tyler to protect the confidential nature of social security numbers. The University has changed its computer programming so that all students have an identification number. The electronic transmission of grades (e.g., via e-mail) risks violation of the Family Educational Rights and Privacy Act; grades will not be transmitted electronically.
Academic Honesty
The faculty expects from its students a high level of responsibility and academic honesty. Because the value of an academic degree depends upon the absolute integrity of the work done by the student for that degree, it is imperative that a student demonstrates a high standard of individual honor in his or her scholastic work.
Scholastic dishonesty includes, but is not limited to, statements, acts or omissions related to applications for enrollment of the award of a degree, and/or the submission, as one's own work of material that is not one's own. As a general rule, scholastic dishonesty involves one of the following acts: cheating, plagiarism, collusion and/or falsifying academic records. Students suspected of academic dishonesty are subject to disciplinary proceedings.
Professor’s note: All of your work is submitted through Blackboard. The university provides a software package to its professors called SafeAssign. This software is able to read your electronic submissions and point out to the professor any plagiarized passages in your work. Please, Please learn to properly cite other people’s work. Never in my career have I ever known a professor to penalize a student for having “too many references”.
Class Schedule*
EHCA 5360Fall 2014
Due Date / Topic / Readings / Assignments1 / In-class Session # 1
Monday
September 15th
6:00-10:00 / Review of the Syllabus And
Introduction to the American Health Care System / Feldstein Chapters:
1, 2, 3, 5, 7 / 1)Hupfeld Video (below)
2) Kaiser Foundation video (below)
2 / In-class Session # 2
Tuesday
September 16th
1:00-5:00 PM / Public Health
Physicians:
Their Roles and Responsibilities in the American Healthcare System / Feldstein Chapters:
4, 10, 11, 12, 13 / 1:00 - George Roberts, Jr. FACHE, CEO
Northeast Texas Public Health District
3 / In-class Session # 3 Tuesday
September 16th
6:00- 10:00 / Medicare
Medicaid / Feldstein Chapters:
8, 9, 25, 27
4 / In-class Session # 4
Wednesday
September 17th
8:00-12:00 / Hospitals
Their current and Future Roles in the American Healthcare System / Feldstein Chapters:
14, 15, 16, 17, 18, 19
5 / In-class Session # 5
Wednesday September 17th
1:00-5:00 / Patient Protection and affordable care act
AND
The future of American health care delivery / Feldstein Chapters:
36,Appendix
6 / Discussion Board # 1 / Ethics / . / Topic will be posted on Blackboard on September 26th and is due 11:00 PM October 5th
7 / Individual Essay / Submitted through Blackboard no later than: 11:00p.m. October 26th
8 / Group Essay / Group Essays & PPT Presentations / Submitted through Blackboard / Due before 11:00 p.m. Sunday November 23rd Late assignments are not accepted for this assignment
9 / Discussion Board # 2 / Topic: TBD / Topic will be posted on Blackboard on November 29th and is due 11:00 PM December 7th
Late postings are notaccepted for this assignment.
*Schedule may be revised if necessary. Students will be notified if this is the case
.** All formal papers must be submitted through Blackboard and must be written in APA format 12 pt. font, 1” margins, double-spaced.
- Overview of the Patient Protection and Affordable Care Act (ACA)
- Health Care reform: Stan Hupfeld:
- Commonwealth Fund Health care Reform Implementation Timeline
THE
COMMONWELTH
FUND
Mirror,Mirroron theWall, 2014Update:
How theU.S. HealthCareSystemComparesInternationally
ExecutiveSummary
The United Stateshealth care systemisthe most expensiveinthe world, butthis reportandprior editionsconsistentlyshow the U.S.underperformsrelativeto othercountriesonmost dimensionsofperformance.Amongthe 11nationsstudied
inthisreport- Australia,Canada,France,Germany,the Netherlands, NewZealand,Norway,Sweden,Switzerland,the United Kingdom, andthe UnitedStates-theU.S.rankslast, asitdidinthe 2010, 2007, 2006, and 2004 editionsof Mirror, Mirror. Most troubling,the U.S.failstoachievebetterhealthoutcomesthanthe othercountries,andasshown inthe earliereditions,the U.S.islast ornear lastondimensionsofaccess,efficiency,and equity.Inthis edition ofMirror,Mirror,the United Kingdom ranksfirst, followedcloselybySwitzerland(Exhibit ES-1).
Expandingfrom thesevencountriesincludedin2010, the 2014 edition includes datafrom 11countries.Itincorporatespatients'and physicians'surveyresultson careexperiencesand ratingsonvariousdimensionsofcare.Itincludesinformation from the most recent threeCommonwealthFund internationalsurveysofpatients and primarycare physiciansabout medical practicesand views oftheir countries' healthsystems(2011-2013).Italso includesinformationonhealthcare outcomes featuredinThe CommonwealthFund'smost recent(2011) nationalhealthsystem scorecard,andfrom theWorldHealth Organization(WHO)andthe Organizationfor EconomicCooperationandDevelopment (OECD).
Click to download Powerpoint chart (//media/files/publications/fund
report/2014/jun/exhibitesl.pptx?la=en).
The most notablewaythe U.S.differsfrom otherindustrializedcountriesisthe absenceofuniversalhealthinsurancecoverage.5Other nationsensurethe accessibilityofcarethroughuniversalhealth systemsand throughbetterties betweenpatientsandthe physicianpracticesthat serveas their medical homes. The AffordableCare Actisincreasingthe numberofAmericanswithcoverageand improvingaccesstocare,though the data inthisreportare from yearsprior tothe fullimplementationofthe law.Thus,itisnotsurprisingthat the U.S. underperformsonmeasuresofaccessandequity betweenpopulationswithabove averageand below-averageincomes.
The U.S.also ranksbehind most countriesonmany measuresofhealthoutcomes, quality,andefficiency.U.S.physiciansface particulardifficultiesreceivingtimely information,coordinatingcare,anddealing withadministrativehassles.Other countrieshave ledinthe adoptionofmodernhealthinformationsystems, butU.S. physiciansand hospitalsare catchingupasthey respondtosignificantfinancial incentivestoadopt and make meaningfuluse ofhealthinformationtechnology systems.Additional provisionsinthe AffordableCare Actwillfurtherencourage the efficientorganizationanddeliveryofhealthcare,as wellasinvestment in importantpreventiveandpopulationhealthmeasures.
For allcountries,responsesindicateroom forimprovement.Yet,the other10 countriesspendconsiderablyless onhealthcareper personand asapercentof grossdomesticproductthan does the United States.Thesefindings indicatethat, from the perspectivesofboth physiciansand patients,the U.S.healthcaresystem could domuch betterinachievingvalue forthe nation'ssubstantialinvestmentin health.
MajorFindings
•Quality:The indicatorsofquality weregroupedintofour categories:effective care,safe care,coordinatedcare,and patient-centeredcare.Comparedwith the other10countries,the U.S.faresbest onprovisionand receiptof preventiveand patient-centeredcare.Whiletherehas been some improvementinrecentyears,lower scoresonsafe andcoordinatedcarepull the overallU.S.quality scoredown. Continuedadoptionofhealthinformation technologyshould enhancethe ability ofU.S.physicianstoidentify,monitor,andcoordinatecare for their patients,particularlythosewithchronic conditions.
•Access:Notsurprisingly- given the absenceofuniversalcoverage-peopleinthe U.S.gowithout neededhealthcarebecauseofcost more often than
people dointhe othercountries.Americanswere the most likely tosay they hadaccessproblemsrelatedtocost.PatientsintheU.S.have rapid accessto specializedhealthcareservices;however,they are less likely toreportrapid accesstoprimarycarethan peopleinleadingcountriesinthe study.Inother countries,likeCanada,patientshave little tonofinancialburden,but experiencewaittimes forsuch specializedservices.Thereisafrequent misperceptionthat trade-offsbetweenuniversalcoverageand timely access tospecializedservicesare inevitable;however,the Netherlands,U.K.,and Germanyprovideuniversalcoveragewithlowout-of-pocketcostswhile maintainingquick accesstospecialtyservices.
•Efficiency:Onindicatorsofefficiency,the U.S.rankslast among the11 countries,withthe U.K.andSwedenrankingfirst andsecond,respectively. The U.S.has poor performanceonmeasuresofnationalhealthexpenditures andadministrativecostsas wellasonmeasuresofadministrativehassles, avoidable emergencyroom use, andduplicativemedical testing.Sicker survey respondentsinthe U.K.andFranceare less likely tovisit the emergency
room for aconditionthat could have been treatedbyaregulardoctor,hadone
been available.
•Equity:The U.S.ranksaclear last onmeasuresofequity.Americanswith below-averageincomeswere much more likely than their counterparts in othercountriestoreportnotvisiting aphysicianwhen sick; notgettinga recommendedtest,treatment,orfollow-upcare;ornotfillingaprescription orskippingdoseswhen neededbecauseofcosts.Oneachoftheseindicators, one-thirdormore lower income
neededcarebecauseofcostsinthe past year.
•Healthylives:The U.S.rankslast overallwith poor scoresonallthree indicatorsofhealthylives- mortalityamenabletomedical care,infant mortality,and healthylifeexpectancyatage 60.The U.S.andU.K.had much higherdeathratesin2007 from conditionsamenabletomedicalcarethan
some ofthe othercountries,e.g., rates25percentto50percenthigherthan AustraliaandSweden.Overall, France,Sweden,andSwitzerlandrank highest onhealthylives.
SummaryandImplications
The U.S.rankslast of11nationsoverall.Findingsinthis reportconfirm many of thoseintheearlierfour editionsofMirror, Mirror, withthe U.S.still rankinglast on indicatorsofefficiency,equity,andoutcomes.The U.K.continuestodemonstrate strongperformanceandrankedfirst overall,though lagging notablyonhealth outcomes.Switzerland,which wasincludedforthe first time inthis edition,ranked secondoverall.Inthe subcategories,the U.S.rankshigheronpreventivecare,and isstrongonwaiting times forspecialistcare,butweak onaccesstoneeded servicesandability toobtain prompt attentionfrom primarycarephysicians.Any attempttoassessthe relativeperformanceofcountrieshas inherentlimitations. Theserankings summarizeevidenceonmeasuresofhighperformancebasedon nationalmortalitydata andthe perceptionsandexperiencesofpatientsand physicians.Theydonotcaptureimportantdimensionsofeffectivenessor
efficiencythat might beobtainedfrom medical recordsoradministrativedata. Patients'andphysicians'assessmentsmight beaffectedbytheir experiencesand expectations,which could differ bycountryandculture.
Disparitiesinaccesstoservicessignal the need toexpandinsurancetocoverthe uninsuredandtoensurethat allAmericanshave anaccessiblemedical home.
Under the AffordableCare Act, low-tomoderate-incomefamiliesare noweligible forfinancial assistanceinobtainingcoverage.Meanwhile,the U.S.hassignificantly acceleratedthe adoptionofhealthinformationtechnologyfollowing the enactment oftheAmericanRecoveryandReinvestmentAct, andisbeginningtoclosethe gap withothercountriesthat have ledonadoptionofhealthinformationtechnology. SignificantincentivesnowencourageU.S. providerstoutilize integratedmedical recordsandinformationsystemsthat are accessibletoprovidersandpatients. Thoseeffortswilllikely help cliniciansdelivermore effectiveandefficientcare.
ManyU.S.hospitalsand health systemsare dedicatedtoimprovingthe processof care toachievebettersafetyandquality, butthe U.S.can also learn from innovationsinothercountries- including public reportingofquality data, paymentsystemsthat rewardhigh-qualitycare,andateam approachtomanagementofchronicconditions.Basedonthesepatientand physicianreports,and withthe enactmentofhealthreform,the United Statesshould beable tomake significant stridesinimprovingthe delivery,coordination,andequity ofthe healthcare systemincoming years.
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