PH3812:ComparativeHealthcareSystems:

PolicyChallengesandEconomicPerspectives

Seminar/discussionformat

SpringSemester,2012

Fridays, 1:00- 3:50PM E 705 SPH

ProfessorRosenau

Contact:

This is a Pass/Fail course

CourseObjectives:Students will be able to:

  • Critically evaluate the overall effectiveness of the respective healthcare systems for 14 industrialized countries
  • Assess each healthcare system’s strengths and weaknesses
  • Compare the market orientation implicit in each country’s health system and assess how this influences payment for value
  • Explain the recent healthcare reform efforts in each country and estimate possible lessons for the US
  • Justify the policy choices of various stakeholders in the various countries
  • Appraise and criticize policymakers’ actions in each of the countries

Propose the best policy practices, given the culture and the context of each country

Students will study and analyze in detail the health systems of the United States, United Kingdom, Australia, Germany, Canada, France, Thailand, Italy,Norway, Japan, Switzerland, Netherlands, Spain, France, and China.

CourseRequirements and Evaluation

30%: Seminar Preparation and Presentation

Ateachclassmeetingat least onestudent(possibly more depending on enrollment) willpresentandplay a leadership role inthediscussionof a specific country.That student will organize the seminar for that week, select the readings from the bibliographies in the course syllabus (in consultation with the professor), consider the subtopics for discussion, etc. The student, working with the professor and any guest lecturer for that week’s seminar, will assign articles for the other students to read and/or present on the country being studied that week. They will prepare questions for class discussion. The rubric for grading the student’s performance on seminar organization will be distributed at the first class meeting. Please note that the articles eligible for inclusion have already been collected for each country – see the remainder of the syllabus. Links are provided where at all possible. Additions, if timely, can be made to these preliminary bibliographies – see below.

Theuse of overheads and/or handouts isrecommended.

30% Class participation - Attendance is required. Allstudentsareexpectedtoreadeachassigned articleandparticipateinthediscussion. The may receive additional task, assigned by the student leading that week’s seminar. Please prepare discussion questions as you will be called upon for questions as time permits each week.

40%: TermPaper–Content:

Severalapproachesareavailable: see the Rubric

A. Anindepth, criticalstudyofonecountry’healthcaresystem;or,

B. Acomparisonofthehealthcaresystemofseveralcountrieswithrespecttoaonetopic(e.g., managing pharmaceuticals,orlong-termcare, health system reform,etc.)

Please do not use papers or sections of papers submitted in other classes concurrently or in the past.

Deadlines:relatedtothetermpaper

January 20th –turninatitleandabriefdescriptionofyourtopic

February 3rd –turninaninitialbibliography

February 24th -turninanoutlineofyourpaper

April 20th-turninyourpaper

Websites: informationabouthealthpolicyintheindustrializedcountries

Commonwealth:

Kaiser Family Foundation:

Kaiser Family Foundation:

European Observatory on Health Systems and Policies:

January 13th2012:INTRODUCTIONandCourseOrganization

  • courseformat,syllabus,bibliography,readingsets;
  • courserequirements--termpaper,discussionleaderresponsibilities,seminarparticipationresponsibility
  • discussionleaderassignments
  • Slide show :

Review introductory material before the first class at:

Health Care Spending in U.S. Growing More Rapidly Than in Most Other Developed Countries, Analysis Shows

The United States not only spends significantly more per capita on health care than other industrial nations, but also since 1980 has experienced one of the highest annual growth rates, a new Kaiser Family Foundation analysis shows.

Fox. “U.S. scores dead last again in healthcare study” Reuters. June 23, 2010:

Fairfield. “Health Spending vs. Results” New York Times, June 6, 2010:

“Tax : Average tax burden on workers’ earnings starts to rise again, putting pressure on real after-tax pay” OECD. May 11, 2011:

COUNTRYSTUDIES

January 20th:UnitedStates(January 16th is a holiday)

[Suggested themes: ACA reform law, costs, insurance, quality of care, medical errors, after-hours]

The Commonwealth Fund.“The U.S. Health Care System, 2011.” 115-120. International Profiles of Health Care, 2011, edited by Thomson, Osborn, Squires, and Read, published by the Commonwealth Fund, 2011.

READINGS:

Comparing the US and others industrialized countries on several indicators:

15. OECD Report Finds U.S. Pays More By Far For Health Care – read one of the following:

In most cases, those higher costs don't translate into better outcomes, says report comparing 34 nations.

--Reuters: Costly U.S. Health System Delivers Uneven Care: OECD
The U.S. healthcare system is more effective at delivering high costs than quality care, according to a new study that found first-rate treatment for cancer but insufficient primary care for other ailments. The study, released on Wednesday by the 34-nation Organization for Economic Cooperation and Development, or OECD, said Americans pay more than $7,900 per person for healthcare each year -- far more than any other OECD country -- but still die earlier than their peers in the industrialized world (Morgan, 11/23).

--National Journal: For Health Care, Americans Pay More And Get Less
By every measure, the U.S. pays more for its medical system—more dollars per person, a greater percentage of GDP, and higher prices for doctors, hospitals, administrative costs, and drugs. Total health care spending costs about $8,000 per person here, compared with the second-biggest spender, Norway, which spends less than $5,500 per person. “The U.S. is just this astonishing outlier compared to everyone else,” said Mark Pearson, the head of the social policy division of the Organization for Economic Cooperation and Development, which produced the study of 34 countries (Sanger-Katz, 11/23).

--Kaiser Health News: Report: U.S. Outspends Other Countries On Health Care
The U.S. has the best five-year survival rate for breast cancer and comes in second, behind Japan, in terms of colorectal cancer survival. But the U.S. ranks 27th in life expectancy at birth, 31st in premature mortality, and 25th in the rate of cardiovascular mortality. The U.S. has the second worst rate of adult diabetes, behind Mexico, and has the highest rate of adult obesity, at 34 percent (Appleby, 11/23).

Krueger, P.M., Bhaloo, T., Vaillancourt Rosenau, P. Health Lifestyles in the United States and Canada: Are We Really So Different? 2009. Social Science Quarterly, Vol 90, No 5

Nunez Daw, C., Truong, D., Vaillancourt Rosenau, P. “Health Policy in the United States: Consumers and Citizens in a Market Polity” in Democratizing Health. Lofgren, H., de Leewu, E., Leahy, M. 2011. Edward Elgar Publishing Limited. pg 222-238

Krug, E.G., Powell, K.E., Dahlberg, L.L. Firearm-Related Deaths in the United States and 35 Other High- and Upper-Middle-Income Countries. 1998. International Epidemiological Association. 27:214-221

Murray, C., Kulkarni, S., Michaud, C., Tomijima, N., Bulzacchelli, M., Iandiorio, T., Ezzati, M. Eitgh Americas: Investigating Mortality Disparities across Races, Counties and Race-Counties in the United States. 2006. PLoS Med. 3(9): e260. DOI: 10.1371/journal.pmed.0030260

Pozen, A., Cutler, D. Medical Spending Differences in the United States and Canada: The Role of Prices, Procedures and Administrative Expenses. 2010. Inquiry 47:124-134.

Morra, D., Nicholson, S., Levinson, W., Gans, D., Hammons, T., Casalino, L. US Physician Practices versus Canadians: Spending Nearly Four Times as much Money Interacting with Payers. 2011. 30:8, pg 1-8. DOI:10.1377/hlthaff.2010.0893

“Land of the Free, Home of the Poor” PBS Newshour Aug. 16, 2011

Review introductory material on the US health system if this is new to you:

[review material for those unfamiliar with the US health sytem]

Schoen C, Osborn R, Doty MM, Bishop M, Peugh J, Murukutla N. “Toward Higher-Performance Health Systems: Adults' Health Care Experiences in Seven Countries, “2007. Health Affairs, 2007;26(6):w717-w734.

Nolte and McKee, “Variations in Amenable Mortality- tends in 16 high-income nations” Health Policy 2011 (online first) LINK??

Sanmartin, et al “Comparing Health and Health Care Use in Canada and the United States” Health Affairs, vol 25, no. 4 pp0 1133+

Wennberg et al, “Executive Summary” Tracking the Care of Patients with Severe Chronic Illness; The Dartmouth Atlas of Health Care 2008

Floyd J. Fowler Jr, PhD; Patricia M. Gallagher, PhD; Denise L. Anthony, PhD; Kirk Larsen, MA; Jonathan S. Skinner, PhD “Relationship Between Regional Per Capita Medicare Expenditures and Patient Perceptions of Quality of Care”JAMA.2008;299(20):2406-2412.

Health System Reform:

Shi, Singh & Tsai. Chapter 21: The Changing U.S. Health System in Comparative Health Systems: Global Perspectives edited by Johnson & Stoskopf, Jones and Bartlett Publishers, 2010.

Muennig & Glied. “What Changes In Survival Rates Tell US About US Health Care” Health Affairs. November 2010 29:11:

Rand Health. “How Will Health Care Reform Affect Costs and Coverage?” Research Highlights. 2011:

Fiscella. “Health Care Reform and Equity: Promise, Pitfalls, and Prescription” Annals of Family Medicine.2011. vol 9: p. 78-84:

Congressional Budget Office: “Key Issues in Analyzing Major Health Insurance Proposals” December 2008;

Cassidy, “Economics: “Which Way for Obama?” New York Review of Books, June 12th, 2008, vol 55, no. 10

Leonhardt, “Obamanomics,” New York TimesAugust 24, 2008,

Causes for health care costs and spending growth:

Keehan et all, “National Health Spending Projections through 2020” Health Affairs August 2011.

Squires ( July 2011) “The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations,” The Commonwealth Fund This analysis concentrated on 2010 OECD health data for Australia, Canada, Denmark, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

“Quality, not quantity” The Economist (print edition). June 16, 2011:

Reinhardt “Does the Aging of the Population Really Drive the Demand for Health Care” Health Affairs, November December 2003 [ not the aging population]

Anderson et al “Health Spending in the United States and the Rest of the Industrialized World” Health Affairs, vol 24, no. 4, July/ August 2005 ( it’s not waiting lists or litigation]

Reinhardt “Why Does U.S. Health Care Cost So Much? (Part 1)”, “Why Does U.S. Health Care Cost So Much? (Part 2: Indefensible Administrative Costs)”, “Why Does U.S. Health Care Cost So Much? (Part 3: An Aging Population Isn’t the Reason)”, AND “Why Does U.S. Health Care Cost So Much (Part 4: A Primer on Medicare)” NYT Economix; explaining the science of everyday life” November 14, November 21st, December 5th and December 12th, 2008 – NYT Blog postings.[Its lots of things but mostly administrative costs].

January 27rd: France

Durand-Zaleski, I., Chevreul, K. “The French Health Care System, 2011.” 47-58. International Profiles of Health Care, 2011, edited by Thomson, Osborn, Squires, and Read, published by the Commonwealth Fund, 2011.

Bergeron, H., Nathanson, C.A. Construction of a Policy Arena: The Case of Public Health in France, Journal of Health Politics, Policy and Law. 2012;37.

Presentation of Research term paper research, SafeAssign and general library skills.

AUDIO:

all 2008

Health Care Lessons from France

France at Forefront of Free, Innovative Cancer Care

Frances Model Health Care for New Mothers

READINGS:

[Suggested themes: universal care, international comparison, system pros/cons, insurance]

Overview:

Steffen. “The French Health Care System: Liberal Universalism” Journal of Health Politics, Policy, and Law. Vol. 35. No. 3. June 2010

Kobouloff-Dacremont & Baiyasi. Chapter A: France in Comparative Health Systems Update: France, China, and Peru edited by Johnson & Stoskopf, Jones and Bartlett Publishers, 2012.

Chevreul, et al. “France: Health System Review” Health Systems in Transition. Vol. 6. No. 12. 2010:

Welch. “Why I Prefer French Health Care” Reason Magazine. January 2010:

[please all read this introduction] Durand-Zaleski, “The Health System in France” Eurohealth 2008 vol 14,

A “Summary and review” of this book, available at Book Reviews, JHPPL, pp 841-4 August 2008, ]

Insurance:

Rodwin, Victor, Universal Health Insurance in France; How Sustainable? Washington DC, Health Office; Embassy of France, 2006 available free, online at:

Buchmueller TC, OECD Health Working Papers No. 12, Private Health Insurance in France, Mar 2004 (ejournal)

Rodwin V.G., "The Health Care System Under French National Health Insurance: Lessons for Health Reform in the United States"AJPH, Vol 93 No 1, pp 31-37, Jan 2003.

Gauthier-Villars. “France Fights Universal Care’s High Cost” The Wall Street Journal. August 7, 2009:

Bellanger et al, “The ‘Health Benefit Basket’ in France,” European Journal of Health Economics 2005, supplement # 1, volume 6, pp 24-29

Comparison:

Cody. “For French, U.S. Health Debate Hard To Imagine” The Washington Post. September 23, 2009:

Dutton, Paul Differential Diagnoses: A Comparative History of Health Care Problems and solutions in the United States and France, Cornell University Press 2007.

Polton, “France’s public-private health care system differs from ours” Canadian Centre for Policy Alternatives Monitor, May 2006 , page 22 only

Quality and Cost:

Giraud-Roufast and Chabot, “Medical Acceptance of Quality Assurance in HealthCare: The French Experience” JAMA Dec 10, 2008, vol 300, no. 22.pp 2663+

Kaiser Family Foundation, “Cost Sharing for Health Care” France, Germany, and Switzerland” January 2009 pp 1-11

Gusmano, Rodwin and Weisz “A New Way to Compare Health Systems: Avoidable Hospital Conditions in Manhattan and Paris” Health Affairs March/April 2006

February 3rd:Australia

Guest expert: Shelton Brown (UTSPH Austin campus)

Healy, J., The Commonwealth Fund.“The Australian Health Care System, 2011.” 13-22. International Profiles of Health Care, 2011, edited by Thomson, Osborn, Squires, and Read, published by the Commonwealth Fund, 2011.

READINGS:

[Suggested themes: private insurance, Aussie medicare, marketing]

Overview:

[all to read executive summary and conclusion as background] Health Systems in Transition: vol 8, no. 5, 2006, “Australia Health System: Review”

[ all to browse] Australian Government: Dept. Of Health and Aging Home Page:

Taylor. “Australian PM wins health deal aimed at re-election” Reuters, April 20, 2010:

Lofgren, H., Leahy, M.,de Leewu, E. “From Activism to State Inclusion: Health Consumer Groups in Australia” in Democratizing Health. Lofgren, H., de Leewu, E., Leahy, M. 2011. Edward Elgar Publishing Limited.

Tatchell M., Tatchell R. & Tatchell T.. Chapter 10: Australia in Comparative Health Systems: Global Perspectives edited by Johnson & Stoskopf, Jones and Bartlett Publishers, 2010.

Private Insurance:

Collins. “A Historical Perspective on Risk Equalisation for Private Health Insurance in Australia” ACERH Research Forum. June 10, 2008:

Connelly and Brown, “Lifetime Subsidies in Australian Private Health Insurance Markets with Community Rating’ paper. August 7, 2006.Available for Purchase

Brown and Connelly, “Lifetime Cover in Private Insurance Markets” International Journal of Health Care Finance and Economics 5, 75-88, 2005

Australian Medicare System:

Nichol, Bill “Hospitals then and now: changes since the start of Medicare, Australian Health Review, April 2007, vol 31

Gray, Gwen The Politics of Medicare, UNSW Press (January 31, 2005) & Australia Policy Online (

Other:

Mooney. “Closing the 17 year gap means opening not just the Treasury coffers but our hearts” Australian and New Zealand Journal of Public Health. 2008. vol. 32. no. 3:

Mackenzie et al “Direct-to-consumers advertising under the radar: the need for realistic drugs policy in Australia” Internal Medicine Journal, 2007, vol 37, pp 224-8

Vitry et al, “General Correspondence “Letters to the Editor: Direct-to-consumer Adverstising Policy in Australia: realism in whose interests?” Internal Medicine Journal, 2007.

Morgan, et al , Centralized drug Review Processes in Australia, Canada, New Zealnd, and the United Kingdom, Health Affairs, vol 25, No. 2 2006

Scott, “Pay for Performance in health care: strategic issues for Australian experiments” MJA 187: No. 1, 2 july 2007.

Armstrong., et al “Federal Election 2007; Challenges in Health and Health Care for Australia” The Medical Journal of Australia vol 187, # 9, 5- November 2007, pp 485-489

February 10th: United Kingdom/Britain

Harrison, A., Gregory, S., Mundle, C., Boyle, S. “The English Health Care System, 2011.” 40-46. International Profiles of Health Care, 2011, edited by Thomson, Osborn, Squires, and Read, published by the Commonwealth Fund, 2011.

VIDEO:

“United Kingdom” Sick around the World – 10 minutes

AUDIO:

all 2008

Denied Treatment; U.K. Vet Stands Up for Liberty

MS Patient Falls into American Insurance Gap

Britain Weighs the Social Cost of “Wonder Drugs”

READINGS:

[Suggested themes: primary care, health reform, technology, quality and-performance]

General Introduction:

Jones, K., Baggott, R. “Health consumer groups in the United Kingdom: progress or stagnation?” in Democratizing Health. Lofgren, H., de Leewu, E., Leahy, M. 2011. Edward Elgar Publishing Limited. pg 30-46

Ramesh, R. NHS Among developed World’s Most Efficient Health Systems, says study. Guardian UK. August 7, 2011.

Oliver, A., Brown, L. Incentivizing Professionals and Patients: A Consideration in the Context of the United Kingdom and the United States. 2011. Journal of Health Politics, Policy and Law. Vol. 36, No. 1, Pg 59-87. DOI: 10.1215/03616878-1191108

Lopes, Jr., Coppola & Riste. Chapter 5: United Kingdom in Comparative Health Systems: Global Perspectives edited by Johnson & Stoskopf, Jones and Bartlett Publishers, 2010.

Boyle. “United Kingdom (England): Health System Review” Health Systems in Transition. vol. 13. no. 1. 2011:

Smith, P. & Goddard M. (2009). The English National Health Service: An Economic Health Check. Retrieved from

Whalen, “UK. Panel Balks at Drug Payments; Agency says government shouldn't pay for higher-priced Novartis, Bristol-Myers medications” May 5 ,2011 WSJ

Reform:

Ham, C. Competition in the NHS in England: Debate About Commissioning Detracts from the Radical Extension of Market Principles in the Health and Social Care Bill. British Medical Journal. 2011. Vol 342. Pg 395-396. doi:10.1136/bmj.d1035

Light & Connor. “Reflecting on commissioning and the English coalition government NHS reforms” Social Science and Medicine 72 (2011) 821-822.:

Gray, “England’s Approach to Improving End-of-Life Care: A strategy for Honoring Patients’ Choices July 2011, Commonwealth Fund’s Issue in International health Policy

Mountford and Davie. “Toward an Outcomes-Based Health Care System: A View From the United Kingdom” JAMA. December 1, 2010 – vol. 304, no. 21:

Campbell. “Doctors warned to expect unrest over NHS reforms” guardian.co.uk. November 19, 2010:

Is Choice Working for Patients in the English NHS; BMJ, 16- August – 2008, vol. 337; pp365-366

Ham, What to Do with Insolvent Hospitals: Will Politicians Allow Providers to Fail? BMJ, 2007, 335: 170

Propper et al 2007 “Did ‘Targets and Terror’ Reduce Waiting Times in England for Hospital Care?” The B.E. Journal of Economic Analysis & Policy, vol 8, issue 2, 25pp.

Bevan and Robinson, “The Interplay between Economic and Political Logics: Path Dependency in Health Care in England” JHPPL, vol 30, nos.1-2, 2005.

Light, Donald, “Will the NHS Strategic Plan Benefit Patients?”BMJ 26 July 2008, vol 337 pp 210 –+