HPAM-GP 1830.001 Spring 2017 Victory Syllabus
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NEW YORK UNIVERSITY
ROBERT F. WAGNER GRADUATE SCHOOL OF PUBLIC SERVICE
INTRODUCTION TO HEALTH POLICY AND MANAGEMENT
HPAM-GP.1830.001 (6233)
Spring 2018
Days:Mondays 6:45 p.m. – 8:25 p.m.
Location:GCASL Room 383; Washington Square
Professor: Jacob Victory, Assistant Professor of Health Policy and Management, Adjunct Faculty ()
Office: N/A
Office hours: By appointment and immediately after each class.
COURSE SYLLABUS
This core specialization course in the NYU Wagner MPA: Health Policy and Management program explores major topics in the study of health and health care delivery. We will discuss determinants of health, the social distribution of health and disease, and health disparities; the organization and financing of the U.S. health care system, its historical context, the roles and behaviors of its key actors, and its comparison to health systems of other nations; the quality, cost and accessibility of health care services; and health care delivery system improvement and reform. We will examine these themes using a multidisciplinary approach that employs sociological, political, economic and ethical perspectives on health and disease, the health care system, and the challenges of meeting the varied (and often conflicting) needs and motivations of health care system stakeholders. The objective of this course is to build understanding of fundamental ideas, issues and problems in health policy and management and thereby to provide a strong foundation for future studies and careers in the health care field.
COURSE COMPETENCIES
Assignments and participation in class and case study discussion in this course will be used to assess progress against the competencies listed below. No student will receive a B or higher without demonstrating satisfactory progress toward mastery of each competency. The level of competency expected to be achieved is denoted in brackets according to the following key and the following mechanism of how the competency will be assessed[1]:
[1] = Basic: Foundational understanding of knowledge/skill/competency.
[2] = Intermediate: Student demonstrates greater depth of understanding of this knowledge/skill/competency and can use this ability to analyze a problem.
[3] = Advanced: Student demonstrates expertise in this knowledge/skill/competency and can use this ability to evaluate, judge, and synthesize information.
Course focus:
The ability to assess population and community health needs from a public service perspective (CSD/CP) [2]
The ability to examine social and behavioral determinants of health and understand how health systems can address the needs of vulnerable populations (CSD/CP) [2]
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 (IP/TP/CP) [2]
Relevant content for the following competencies is also included:
The ability to understand and apply legal and ethical principles to managerial and leadership decisions affecting health care organizations (CP/CSD) [2]
The ability to measure, monitor and improve safety, quality, access and system/care delivery processes in health care organizations (CP/CSD/TP)[1]
The ability to draw implications and conclusions to develop an evolving vision that results in long-term organizational viability (IP/TP/CSD) [3]
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 (CP/CSD)[3]
The ability to present convincingly to individuals and groups the evidence to support a point of view, position or recommendation (CP/CSD) [3]
LEARNING OBJECTIVES
At the conclusion of this course, students will be prepared to:
Describe the organization, financing and performance of the U.S. health care delivery system (CP/CSD/TP)[2]
Identify determinants of health and explain the impact on the distribution of health and disease (CP/CSD)[2]
Define the roles of key stakeholders – providers, government and private payers, employers, regulators, patients – and describe their incentives and behavior (CP/TP) [3]
Compare the U.S. health care system to the organization and financing models abroad (CP) [1]
Explain fundamental concepts of health care payment and performance measurement (CP/CSD/TP) [2]
Define key health policy developments over the past 50 years and explain their significance (CP/IP) [1]
Analyze strengths, weaknesses and feasibility of policy and management approaches that aim to promote health, prevent disease and improve health services delivery and assess the impact of these approaches on quality, access, cost and equity goals (CP/CSD) [1]
BOOKS AND READINGS
Students should arrive to class prepared to participate in the discussion of these themes based on their critical analysis of assigned readings.
Required textbook:
Health Care Delivery in the United States (11th edition). A. Kovner & J. Knickman, eds. New York, NY: Springer Press, 2015.
Other required readings:
Assigned weekly readings that are not included in the required textbook will be postedon Sakai.
WRITTEN REQUIREMENTS
In addition to attending and participating in classes, students are required to complete one memo (due March 27, 2017, and written by the individual student)and a final research memo and presentation (dueon May 8, 2017, and written and presented by student groups of at least four in each group). Instructions for written assignments are included at the end of this syllabus and also be discussed in class. Grading information is provided at the end of this syllabus.
COURSE SESSIONS
A. POPULATION HEALTH
January 22, 2018: Week 1. Introduction: Health, Disease and Community
Overview of course
Definitions of health and disease
Relationship between health and medical care
Health Care Delivery in the United States
Knickman, J. and Kovner, T. Chapter 1: The Challenge of Health Care Delivery and Health Policy pp. 3-12.
Dangremond, C. Chapter 2: A Visual Overview of Health Care Delivery in the United States pp. 13-27.
Posted on Sakai:
Schroeder, S. 2007. We Can Do Better: Improving the Health of the American People. New England Journal of Medicine 357: 1221-1228.
Colgrove, J. 2002. The McKeown Thesis: A Historical Controversy and Its Enduring Influence. American Journal of Public Health 92(5): 725-729.
Gawande, A. 2011. Cowboys and Pit Crews: 2011 Commencement Address at Harvard Medical School. The New Yorker, posted May 26.
January 29, 2018: Week 2. Epidemiologic Measures and Determinants of Health
Relationships between socioeconomic status, race/ethnicity, gender and health
Population health inequalities and social justice implications
Health Care Delivery in the United States
Russo, P. Chapter 5: Population Health, pp. 79-94.
Posted on Sakai:
Adler, N. and Rehkopf, D. 2008. U.S. Disparities in Health: Descriptions, Causes and Mechanisms. Annual Review of Public Health 29: 235-252.
Marmot, M. 2005. Social Determinants of Health Inequalities. The Lancet 365: 1099-1104.
Williams, D. and Jackson, P. 2005. Social Sources of Racial Disparities in Health. Health Affairs 24(2): 325-334.
February 5, 2018: Week 3. Public Health Policy and Management
Public health infrastructure
Prevention and health promotion frameworks
Health behavior
Policy approaches to improving public health
Health Care Delivery in the United States
Leviton, L., Kuehnert, P.L., and Wehr, K., C. Chapter 6: Public Health: A Transformation for the 21st Century, pp. 99-112.
Cassidy, E., Trujillo, M., and Orleans, C. T., Chapter 7: Health and Behavior, pp, 119-142.
Sakai
Roberts, M. and Reich, M. 2002. Ethical Analysis in Public Health. The Lancet 359(9311): 1055-1059.
Robert Wood Johnson Foundation Commission to Build a Healthier America 2009. Beyond Health Care: New Directions to a Healthier America. Executive Summary and Introduction, pp. 9-25.
B. ORGANIZATION OF THE U.S. HEALTH CARE SYSTEM
February 12, 2018: Week 4. U.S. Health Policy and Reform
Historical development of health care delivery system
Government role in health care system
Comparative health systems
Models of delivery and payment in other developed nations
Health Care Delivery in the United States
Sparer, M., and Thompson, F.J., Chapter 3: Government and Health Insurance: The Policy Process pp. 29-49
Posted on Sakai
Blendon, R. and Benson, J. 2001. Americans’ Views on Health Policy: A Fifty-Year Historical Perspective. Health Affairs 20(2): 33-46.
Starr, P. 2011. Remedy and Reaction: The Peculiar American Struggle Over Health Care Reform. New Haven, CT: Yale University Press. Introduction.
Rothman, David, J. 1993. A Century of Failure: Health Care Reform in America. Duke University. Journal of Health Politics & Law 18(2): 271-286.
NO CLASS ON FEBRUARY 19, 2018
February 26, 2018:Week 5. Health Care Financing
Fundamental characteristics of health care markets
Medicare, Medicaid/CHIP and private insurance
Spending growth in the U.S.
Managed care and cost containment
Implications of 2010 Patient Protection and Affordable Care Act (PPACA)
Health Care Delivery in the United States
Knickman, J. Chapter 11: Health Care Financing, pp. 231-249.
Calabrese, T., and Safian K., Chapter 12: Health Care Costs and Value, pp. 253-269.
Appendix: Major Provisions of the Patient Protection and Affordable Care Act of 2010, pp. 343-361
Knickman, J.R., and Kovner, A. R., Chapter 16: The Future of Health Care Delivery and Health Policy, pp. 334-341.
Posted on Sakai
Bodenheimer, T. 2005. High and Rising Health Care Costs, Part 1: Seeking an Explanation. Annals of Internal Medicine 142(10): 847-854.
Cutler, D. 2010. Analysis and Commentary: How Health Care Reform Must Bend the Cost Curve. Health Affairs 29(6): 1131-1135.
March 5, 2018:Week 6. Comparative Health Systems
Comparative health systems
Models of delivery and payment in other developed nations
Health Care Delivery in the United States
Gusmano, M., and Rodwin, V., Chapter 4: Comparative Health Systems, pp. 53-71.
Posted on Sakai
Murray, C. and Frenk, J. 2000. A Framework for Assessing the Performance of Health Systems. Bulletin of the World Health Organizations 78(6): 717-731.
Davis, K., Schoen, C. and Stremekis, K. 2010. Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally. 2010 Update. Commonwealth Fund, Pub. No. 1400.
Weisz, D., Gusmano, M., Rodwin, V., and Neuberg, L. 2008. Population Health and the Health System: A Comparative Analysis of Avoidable Mortality in Three Nations and Their World Cities. European Journal of Public Health 18(2): 16-172.
NO CLASS ON MARCH 12, 2018
March 19, 2018:Week 7. Providers and Organization of Care
Acute and ambulatory care delivery
Evolving organizational forms
Health Care Delivery in the United States
Landry, A. Y., Cathleen O.E., Chapter 9: Organization of Medical Care, pp. 183-209
Posted on Sakai
Bodenheimer, T. 2007. Coordinating Care—A Perilous Journey through the Health Care System. The New England Journal of Medicine 358(10): 1064-1071.
Rittenhouse, D. 2009. Primary Care and Accountable Care: Two Essential Elements of Delivery System Reform. New England Journal of Medicine 361(24): 2301-2303.
March 26, 2018: Week 8. Medical Professionals and the Health Care Workforce
MEMO #1 DUE TODAY
A paper copy of the completed Memo #1 is due before the start of Week 8’s class session. This memo must also be emailed to the instructor before the start of the last class session.
Historical and emerging roles for physicians and health professionals
Health care labor markets
Professionalization and power in organized medicine
Health Care Delivery in the United States
Spetz, J., and Chapman S. A., Chapter 10: Health Workforce, pp. 213-224
Posted on Sakai
Goodman, C. and Fisher, E. 2008. Physician Workforce Crisis? Wrong Diagnosis, Wrong Prescription. New England Journal of Medicine 358(16): 1658-1661.
Peterson, M. 2001. From Trust to Political Power: Interest Groups, Public Choice, and Health Care. Journal of Health Politics, Policy and Law 26(5): 1145-1163.
Weisz, G. et al. 2007. The Emergence of Clinical Guidelines. The Milbank Quarterly 85(4): 691-727.
April 2, 2018:Week 9. Patient Decision-Making and the Provider‒Patient Relationship
Role of the patient in the health care system
Patient preferences and informed patient decision-making
Provider‒patient relationship
Consumer-directed care and patient demand for and use of information
Posted on Sakai
Hibbard, J. and Cunningham, P. 2008. How Engaged Are Consumers in Their Health and Health Care, and Why Does It Matter? Center for Studying Health System Change, Research Brief No. 8 (October).
Mechanic, D. 1998. The Functions and Limitations of Trust in the Provision of Medical Care. Journal of Health Politics, Policy and Law 23(4): 661-686.
Sepucha, K. and Mulley, A. 2009. A Perspective on the Patient’s Role in Treatment Decisions. Medical Care Research and Review 66(1 suppl): 53S-74S.
Arnold, S. and Scanlon, D. 2009. Realizing True Consumer-Directed Health Care: What the Policy Community Needs. Medicare Care Research and Review 66 (1 suppl): 3S-8S.
C. HEALTH CARE SYSTEM PERFORMANCE, CHALLENGES AND DEBATES
April 9, 2018: Week 10. Meeting Changing Population Needs
Chronic disease management
Long-term care
End-of-life issues
Posted on Sakai
Bodenheimer, T., Wagner, E., Grumbach, K. 2002.Improving Primary Care for Patients with Chronic Illness: The Chronic Care Model, Part 2. Journal of the American Medical Association 288: 1909-1914.
Gawande, A. 2010. Letting Go: What Should Medicine Do When It Can’t Save Your Life? The New Yorker August 2 issue.
Kane, R. and Kane, R. 2001. What Older People Want from Long-Term Care, and How They Can Get It. Health Affairs 20(6): 114-127.
Kaye, H., Harrington, C. and LaPlante, M. Long-Term Care: Who Gets It, Who Provides It, Who Pays, and How Much? Health Affairs 29(1): 11-21.
April 16, 2018: Week 11. Improving Quality of Care
Safety and quality of U.S. health care delivery
Measuring, regulating and improving quality and patient safety
Challenges of quality improvement and adverse event reduction in health care
Quality improvement frameworks and interventions
Health Care Delivery in the United States
Clancy, C. and Fraser I., Chapter 13: High Quality Health Care, pp. 273-293
Posted on Sakai
Landrigan, C. et al. 2010.Temporal Trends in Rates of Patient Harm Resulting from Medical Care. New England Journal of Medicine 363: 2124-2134.
April 23, 2018: Week 12. Managing New Medical Technology
Expanding use of pharmaceutical and medical devices in health care
Treatment benefits versus monetary costs associated with medical innovation
Role of pharmaceutical/biotech industry in health care system
Health Care Delivery in the United States
Kropf, R. Chapter 15: Health Information Technology, pp. 311-326
Posted on Sakai
Cutler, D. and McClellan, M. 2001. Is Technological Change in Medicine Worth It? Health Affairs 20(5): 11-29.
Gilsdorf, J. 2004. As Drug Marketing Pays Off, My Mother Pays Up. Health Affairs 23(1): 208-212.
Steinman, M., Landefeld, S. and Baron, R. 2012. Industry Support of CME – Are We At a Tipping Point? New England Journal of Medicine 366(12): 1069-1071.
April 30, 2018: Week 13. Expanding Access and Reducing Disparities in Access and Treatment
Barriers to care for vulnerable patient populations
The uninsured and underinsured in the U.S.
Implications of 2010 Patient Protection and Affordable Care Act
Health Care Delivery in the United States
Garcel, J.M., Ward, E.A., and Rodriguez L.J., Chapter 8: Vulnerable Populations: A Tale of Two Nations, pp. 149-175.
Posted on Sakai
Ayanian, J. et al. 2000.Unmet Health Needs of Uninsured Adults in the United States. Journal of the American Medical Association 284(16): 2061-2069.
Hurley, R. et al. 2007. Community Health Centers Tackle Rising Demands and Expectations. Center for Studying Health System Change, Issue Brief No. 116 (December).
Fuchs, V. 2009. Health Reform: Getting the Essentials Right. Health Affairs 28(2): w180-w183.
May 7, 2018: Week 14. Team Final Paper & Presentation Due Today
Team final project and presentations
A paper copy, and an electronic version emailed to the instructor, of the completed Memo #2 and presentations are due before the start of Week 14’s class session. Teams will be presenting their paper and topic to the entire class. Each team will have five minutes to present this presentation.
WRITTEN REQUIREMENTS AND GRADING
In addition to attending and participating in class meetings, all students are required to submit the following written assignments by the following deadlines. Final grades will be calculated accordingly:
Grades: This class will not be graded on a curve. The grading rubric will be shared prior to each assignment. This course follows the NYU Wagner School’s general policy guidelines on incomplete grades, academic honesty and plagiarism. It is the student’s responsibility to become familiar with these policies. All students of this class are expected to pursue and meet the highest standards of academic excellence and integrity.
- Incomplete grades:
- Academic honesty:
Individual or Team Assignment% of Final GradeDue Date
Memo 1: Individual 30% March 26,2018
Final Paper (Memo 2): Teams of Four 40% May 7, 2018
Presentation of Memo 2: Team 5% May 7, 2018
Class Participation 25% Throughouteach class
Class Participation: (25% of class grade). This course depends on active and ongoing participation by all class participants. Participation starts with reading all course materials and listening to each other and the instructor during class sessions. Class participants are expected to read and discuss the weekly readings on a weekly basis.
You will not earn the 25% of your grade for class participation simply by attending classes.
While attendance is a large component, to fully earn the 25% for class participation, students must come prepared to engage and speak in the class each week that the class meets as a group. To “engage,” each student must listen to all points of view, share his/her thoughts on at least one subject or discussion raised within each class, critique thoughts (in a respectful, reflective and thoughtful manner), ask questions, and/or promote thoughtful dialogue with class participants. My lectures are frequently very interactive with students in the class and I have the right to call on any member of the class at any time. It is always my goal to know every student’s name.
I encourage you to take the class participation requirement very seriously, as I certainly do and want to see that you are fully engaged in the course subject during each class each week. (If, for some reason, you have not read the class readings and feel unprepared to respond to being called on in a class, please let me know. It is understandable that this may be the case on rare occasion. If this, however, becomes a regular or frequent happening, your participation grade/percentage will be severely affected.)As other instructors have noted, please note that the quality and quantity of participation can be, but are not necessarily, correlated.
Lateness Policy – Please submit assignments on time. Both assignments must be emailed to me () immediately before the class session on the day they are due. A paper copy must also be presented to the instructor at the start of each class that each assignment is due. Extensions will be granted only in case of emergency. This is to respect those who abide by class deadlines. Papers and presentations submitted late and without extensions will be penalized, as will papers that do not follow explicit directions relayed in class and/or via this syllabus. The instructor will subtract five points for each day the assignment is late. Please note that if a paper copy is not submitted to me at the beginning of the class in which it is due, it is considered a late submission.