HPAM-GP 2836 Current Issues in Health Policy
New York University
Robert F. Wagner Graduate School of Public Service
HPAM-GP 2836 – Current Issues in Health Policy
Spring, 2016 - Version 1.0
Professor John Billings
Room: Global Center for Academic and Spiritual Life (GCASL) 383
Course Description
This course is an introduction to major health policy issues and examines the role of government in the health care system. An important focus of the course is an assessment of the role of policy analysis in the formation and implementation of national and local health policy. Because much of government health policy relates to or is implemented through payment systems, several sessions involve some discussion of the policy implications of how government pays for care, with a more detailed review of the economics of payment systems available in Health Economics: Principles (HPAM-GP4830). The role of the legal system with respect to adverse medical outcomes, economic rights, and individual rights is also discussed. Proposals for health policy reform at the national and local level are examined throughout the course, as well as Medicare and Medicaid reforms currently being implemented or considered.
In an effort to accommodate a subset of students with scheduling challenges, this class will be held in four all-day Friday marathons on September 4th, September 18th, October 2th, and October 16th. There will be a morning and afternoon session on each of these days, with a lunch break between sessions and a brief break during the morning and afternoon sessions. This is a continuing experiment, and I have attempted to adapt the content of course to make these sessions less gruelling, but expect we may make some changes along the way.
Course Requirements/Grading
There are three assignments are required for the course: two papers (one ≤ 8 pages and one ≤ 6 pages) and a PowerPoint slide assignment based on the first paper. These assignments account for 85% of the final grade (35% paper 1, 25% PowerPoint assignment, and 25% paper 2). Class discussion/debate and discussion group participation are integral to the course and will account for 15% of the final grade. Papers can be submitted in class or NYU Classes File Exchange. There is no midterm or final exam.
Students are expected to have studied the assigned readings. The readings for the course are primarily journal articles that will be posted in the Assigned Readings section of NYU Classes. There is no text book for the course (although some alternative texts are suggested in the readings for the AM Session of Day 1 for students with no prior health experience). The books required for the second paper are readily available at area bookstores or on the web (e.g., amazon.com, barnesandnoble.com, etc.). Copies of PowerPoint materials used in class will be posted in the Session Notes section on the NYU Classes site at least 24 hours in advance of the class.
Assignments and participation in class discussions in this course will be used to assess progress against the competencies listed below that the Wagner Health Policy and Management Program has created pursuant to its accreditation with the Commission on Accreditation for Health Management Education (CAHME). 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:
[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
· The ability to assess population and community health needs from a public service perspective (Dartmouth Atlas Memo) [3]
· The ability to examine social and behavioral determinants of health and understand how health systems can address the needs of vulnerable populations (Class Discussion – Session 7) [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 (Dartmouth Atlas Memo, Book Memo, Class Discussion) [3]
· The ability to present convincingly to individuals and groups the evidence to support a point of view, position or recommendation (Assignment 2 - PowerPoint Presentation) [2]
Office Hours
By appointment (212-998-7455) - - 295 Lafayette Street – 2nd Floor
If you have questions about the reading materials or you need other help, please contact my administrative assistant, Christopher Harris [295 Lafayette Street - 3rd Floor - 212-998-7416 –.
Session 1 – 1/26/16: Square One: The role of government in health/health care
§ Description of course content, goals, and requirements
§ A discussion of the role of policy analysis in public policy formation and the impact of public policy on the health system
§ Objectives of government in health and health care, discussion of limitations of government, and some examples
§ Discussion of implications for policy
Required reading:
S. Schoenbaum S, A. Audet, and K. Davis, “Obtaining Greater Value from Health Care: The Roles of the U.S. Government,” Health Affairs (November/December 2003): 183-190.
N. Tang, J. Eisenberg, G Meyer, “The Roles of Government in Improving Health Care Quality and Safety,” Joint Commission Journal on Quality and Safety (January, 2004): 47-54.
Session 2 – 2/02/16: Square 2: How health care is organized/financed/paid for
§ Brief overview of how health care is organized, financed, and paid for
§ A little bit about insurance and “managed” care
§ Discussion of the implications for policy
Required reading:
Kaiser Family Foundation: How Private Health Coverage Works: A Primer – 2008 Update. http://www.kff.org/insurance/7766.cfm
Get a little health economics by reviewing this:
S. Glied, “Health Insurance and Market Failure since Arrow”, Columbia University, Project Muse.
Suggested reading on how the health care delivery system is organized:
T. Bodenheimer and K. Grumbach, Understanding Health Policy – Fifth Edition (New York: McGraw Hill, 2008) – Chapters 4-7.
- or -
L.Shi, D. Singh, Delivering Health Care in America (Jones & Bartlett Publishers, 2003) – Chapters 1, 7, 8, and 9 – Preview available at http://books.google.com
- or -
A Kovner, J Knickman, Health Care Delivery in the United States – 10th Edition (New York: Springer Publishing Company, 2011) – Chapters 4-5.
Session 3 – 2/09/16: Square 3: Medical practice and health policy
§ Review of the enormous variation in medical practice
§ Discussion of causes of variation
§ Discussion of the implications for policy
Required reading:
E. Fisher, D. Wennberg, T. Stukel, et al., “The Implications of Regional Variation in Medicare Spending - Part 2: Health Outcomes and Satisfaction with Care,” Annals of Internal Medicine 138, No. 4 (2003): 288-299
J. Wennberg, E. Fisher, T. Stukel, et al., “Use of Hospitals, Physician Visits, and Hospice During the Last Six Months of Life among Cohorts Loyal to Highly Respected Hospitals in the United States,” British Medical Journal 328, No. 7440 (March 13, 2004): 607-610.
K. Kozhimannil, M. Law, and B. Virnig, “Cesarean Delivery Rates Vary Tenfold Among US Hospitals; Reducing Variation May Address Quality and Cost Issues,” Health Affairs (March, 2013): 527-535
D. Eddy, “Evidence-Based Medicine: A Unified Approach,” Health Affairs (January/February, 2005): 9-17.
D. Jones, “Visions of a Cure,” Isis (September 2000):91:504-541 – [http://www.jstor.org/browse/00211753/ap010310?frame=noframe&userID=/01cc99333c3c2f10d557f64a8&dpi=3&config=jstor]
A. Gawande, “The Cost Conundrum,” New Yorker, June 1, 2009
Sessions 4-5 – 2/16/16 and 2/23/16: Medicare: The basics and Issues for reform
§ A discussion of the role and objectives of government in health
§ Description of who and what is covered by Medicare
§ Review of how Medicare pays for health care
§ Description of the recent expansion Medicare to provide coverage for prescription drugs
Required reading:
C. Eibner, D. Goldman, J. Sullivan et al., “Three Large-Scale Changes to the Medicare Program Could Curb Its Costs but Also Reduce Enrollment,” Health Affairs (May, 2013): 891-899.
K. Davis, C. Shoen, S. Guterman, “Medicare Essential: An Option to Promote Better Care and Curb Spending Growth,” Health Affairs (May, 2013)” 900-909.
Henry J. Kaiser Family Foundation, Prescription Drug Coverage for Medicare Beneficiaries: A Summary of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (December 10, 2003), http://www.kff.org/medicare/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=28710
Also take a look at:
Henry J. Kaiser Family Foundation, Policy Options to Sustain Medicare for the Future, http://kaiserfamilyfoundation.files.wordpress.com/2013/02/8402.pdf
Medicare and You: 2016 - http://www.medicare.gov/Pubs/pdf/10050.pdf
Sessions 5-6 – 2/23/16 and 3/01/16: Medicaid: The basics and issues for reform
§ History and financing of Medicaid
§ Description of who and what is covered by Medicaid
§ Discussion of recent reforms/Issues for reform/Role of managed care
Required reading:
S. Decker, “In 2011 Nearly One-Third of Physicians Said They Would Not Accept New Medicaid Patients but Rising Fees May Help,” Health Affairs (August, 2012) 1673-1679.
B. Sommers, K. Baicker, and A. Epstein, Mortality and Access to Care among Adults after State Medicaid Expansions,” NEJM 2012;367:1025-34.
D. Draper, R. Hurley, and A. Short, “Medicaid Managed Care: The Last Bastion of the HMO?” Health Affairs (March/April 2004): 155-167.
J. Billings, T. Mijanovich, “Improving the Management of Care for High-Cost Medicaid Patients” Health Affairs no 6 (2007) 1643-1655.
See also: Medicaid: A Primer 2013 - http://kff.org/medicaid/issue-brief/medicaid-a-primer/
Session 7 – 3/08/16: The major challenges confronting the health “system”:
Part 1 - Disparities and Part 2 - Uninsurance
§ Overview of disparities in health services, utilization, and outcomes
§ Discussion of the factors that are contributing to these disparities
§ Description of the size and characteristics of the uninsured population
§ Review of the causes of uninsurance
Required Reading:
J. Billings, L. Zeitel, J. Lukomnik, et al., “Impact of Socioeconomic Status on Hospital Use in New York City” Health Affairs (Spring 1993): 162-173.
J. Billings, “Management Matters: Strengthening the Research Base to Help Improve Performance of Safety Net Providers,” Health Care Management Review 28, No 4 2003): 323-334.
Jha AK, Orav EJ. Low-Quality, High-Cost Hospitals, Mainly in the South, Care for Sharply Higher Shares of Elderly Black, Hispanic, and Medicaid Patients, Health Affairs (October 2011): 1904-1911.
Kaiser Family Foundation, Primer-The Uninsured and Key Facts about Health Insurance and the Uninsured in the Era of Health Reform – November, 2015
Session 8 – 3/22/16: The major challenges confronting the health “system”:
Part 3 - Costs
§ Description of the dynamics of current cost increases
§ Review of the causes and implications of cost increase
§ Discussion of the implications of these challenges for policy makers and providers and for the current health reform initiative
Required Reading:
D. Altman and L. Levitt, “The Sad History of Health Care Cost Containment as Told in One Chart,” Health Affairs – Web Exclusive (23 January 2002): W83-4.
Phillipson T, Eber M, Lakdawalla DN, “An Analysis of Whether Higher Health Care Spending in the United States Versus Europe is “Worth It” in the Case of Cancer,” Health Affairs (April, 2012): 667-675.
P. Cunningham, “The Growing Financial Burden of Health Care,” Health Affairs (May 2010): 1037-1044.
W Hsiao, A Knight, S Kappel, et al., “What Other States Can Learn from Vermont’s Bold Experiment: Embracing A Single-Payer Health Care Financing System,” Health Affairs (July 2011): 1232-1241.
U. E. Reinhardt, Is it Time for a More Rational All-Payer System? Health Affairs (November, 2011): 2125-2133.
D. Cutler and N. Sahni, “If Slow Rate of Health Care Spending Growth Persists, Projections May Be Off by $700 Billion,” Health Affairs (May, 2013): 841-850.
Song Z, Safran DG, Landon BD et al., “The ‘Alternative Quality Contract,’ Based on a Global Budget, Lowered Medical Spending and Improved Quality” Health Affairs (August, 2012): 1885-1894.
Session 9 – 3/29/16: Prior efforts to respond to these challenges: The role
of the states, the Clinton Health Plan, and other federal
initiatives
§ Overview of policies/programs at the federal, state, and local level to reduce disparities, expand coverage, and control costs
§ Discussion of the strengths and limits of state/local initiatives
§ Discussion of the Clinton health plan, what problems it might have solved or created, and why it failed
§ Implications for current reform initiatives
Required Reading:
J. Holahan, L. Blumberg, A. Weil, et al, “Roadmap to Coverage – Report for the Blue Cross Blue Shield of Massachusetts Foundation,” October, 2005
S. Long and K Stockey, “Sustaining Health Reform in a Recession: An Update on Massachusetts,” Health Affairs (June 2010): 1234-1241.
W. Zelman, “The Rationale behind the Clinton Health Care Reform Plan,” Health Affairs (Spring 1994): 9-29.
D. Yankelovich, “The Debate That Wasn’t: The Public and the Clinton Health Plan,” Health Affairs (Spring 1995): 7-23.
R. Blendon, M. Brodie, and J. Benson, “What Happened to America’s Support for the Clinton Health Plan,” Health Affairs (Summer 1995): 7-23.
Session 10 – 4/05/16: Health Reform 2010
§ Overview of Patient Protection and Affordable Care Act (PPACA)
§ Discussion policy, politics, and power
Required Reading:
Kaiser Family Foundation: “Summary of New Health Reform Law” – http://kaiserfamilyfoundation.files.wordpress.com/2011/04/8061-021.pdf
Kaiser Family Foundation: “Health Reform Implementation Timeline” – http://kff.org/interactive/implementation-timeline/
J Morone, “Presidents and Health Reform: From Franklin D. Roosevelt to Barack Obama,” Health Affairs (June 2010): 1096-1100.
J Oberlander, “Long Time Coming: Why Health Reform Finally Passed,” Health Affairs (June 2010): 1112-1116.
S. Shortell, L Casalino, and E. Fisher, “How CMS Innovation Should Test Accountable Care Organizations,” Health Affairs (July 2010): 1293-1298.
C. Price and C. Eibner, “For States That Opt Out of Medicaid Expansion: 3.6 Million Fewer Insured and $8.4 Billion Less in Federal Payments,” Health Affairs (June, 2013): 1030-1036.
Session 11 – 4/12/16: Responding to the ACA and Market Changes: Academic
Medical Centers 2016
Guest Lecturer: Gerry Goodrich – Director, Weill Cornell Physician
Network
§ A unique American institution: the Academic Medical Center
§ Special circumstances of the New York City market
§ Responding to market changes, the ACA, and other trends on how money changes hands