GIHM 5306: Introduction to Health Care Organization
(same as Medical Aspects of Health Organization Management)
DRAFT SYLLABUS
Class time:
Location:
3:00 to 4:30, Tuesdays and Thursdays, Fall Semester
Room 5BC200 – Texas Tech Health Sciences Center
Instructor:
Ty Borders, Ph.D.
Assistant Professor
Department of Health Services Research and Management
School of Medicine, Texas Tech University Health Sciences Center
Office hours: 2:00 to 4:00 Mondays, Room 1C165, TTUHSC or after class.
Phone:
743-6984 (work)
E-mail:
somtfb@ttuhsc.edu
I. Course Objectives
The class will familiarize students with the organization of the U.S. health care system
and epidemiological methods used to assess and evaluate health care needs. Part I will
cover the determinants of health and health services use. Part II will cover the
organization of health services. Part III will cover managerial epidemiology.
Students will be able to do the following at the conclusion of the course:
1. Describe the physiological, social, and economic determinants of health.
2. Define health, illness, and disease.
3. Discuss the limited contribution of medical care to population health.
4. Describe the determinants of health services use.
5. Describe the major health care systems in the U.S.
6. Describe the evolution of the major health care professions.
7. Describe U.S. health care financing.
8. Describe epidemiological methods for assessing population health care needs.
9. Discuss the role of epidemiology in designing health programs.
10. Use epidemiological indicators as part of the strategic marketing process.
11. Identify epidemiological indicators for assessing health care quality.
II. Prerequisites
Graduate student standing or consent of the instructor.
III. Intended Audience
Health services research, health organization management, public administration,
medical, allied health, and other graduate students interested in U.S. health care
organization and population health.
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IV. Reading Materials
Required Texts:
Williams, S.J. and Torrens, S.J. (Eds.) 1999. Introduction to Health Services. (5th
edition). Albany, NY: Delmar.
Kindig, David A. 1997. Purchasing Population Health. Ann Arbor: University of
Michigan Press.
Fos, P.J. and Fine D.J. 2000. Designing Health Care for Populations: Applied
Epidemiology for Health Care Administrators. San Francisco: Jossey-Bass.
Assigned Articles:
Additional articles may be assigned.
Becker, M.H. and Maiman, L.A. (1983). Models of health-related behavior. In
Mechanic, David (Ed.) Handbook of Health, Health Care and the Health Professions.
The Free Press, pp. 539-568.
Blanchfield, B.B., Franco, S.J., and Mohr, P.E. (2000). Critical access hospitals: How
many rural hospitals meet the requirements. Journal of Rural Health 16(2): 119-128.
Borders, T.F., Rohrer, J.E., and Vaughn, T.E. (2000). Limitations of secondary data for
strategic marketing in rural areas. Health Services Management Research, forthcoming.
Evans, R.B. and Stoddart, G.L. (1990). Producing health, consuming health care. Social
Science and Medicine 31(12): 1347-1363.
Geyman J.P, et al. Educating generalist physicians for rural practice: How are we doing?
(2000) Journal of Rural Health. 16(1):56-80.
Hays, R.D., Shaul, J.A., Williams, V.S., Lubalin, J.S., Harris-Kojetin, L.D., Sweeney,
S.F., and Cleary, P.D. (1999). Psychometric properties of the CAHPS 1.0 Survey
measures. Medical Care 37(3): MS22-MS31.
Hendryx, M., Urdaneta, M., and Borders. T.F. (1995). The relationship between supply
and hospitalization rates for mental illness and substance use disorders. Journal of
Mental Health Administration 22 (2): 167-176.
Hillman, A.L., Pauly, M.V., and Kerstein, J.J. (1989). How do financial incentives
affect physicians’ clinical decisions and the financial performance of health maintenance
organiations?” New England Journal of Medicine 321(2): 86-92.
Ikegami, N. and Campbell, J.C. (1999). Health care reform in Japan: The virtues of
muddling through. Health Affairs 18(3): 56-73.
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Manning, W.G., Newhouse, J.P., Duan, N., Keeler, E.B., Leibowitz, A., and Marquis,
M.S. (1987). Health insurance and the demand for medical care: Evidence from a
randomized experiment. The American Economic Review, June, 251-277.
McHorney, C.A., Ware, J.E., Lu, J.F.R., and Sherbourne, C.D. (1994). The MOS 36item Short-Form Survey (SF-36): III. Test of data quality, scaling assumptions, and
reliability across diverse patient groups. Medical Care 32(1): 30-66.
Miller R.H. and Luft, H.S. (1994). Managed care plan performance since 1980: A
literature analysis. JAMA 271(19): 1512-1519.
Naylor C.D. (1999). Health care in Canada: Incrementalism under fiscal duress. Health
Affairs 18(3): 9-26.
Phillips, K.A., Morrison, K.R., Andersen, R., and Aday, L.A. 1998. "Understanding the
Context of Healthcare Utilization: Assessing Environmental and Provider-Related
Variables in the Behavioral Model of Utilization." Health Services Research 33(3): 571596.
Wells, K.B., Sherbournce, C., Schoenbaum, M., Duan, N., Meredith, L, Unutzer, J.,
Miranda, J., Carney, M.F., and Rubenstein, L.V. (2000). Impact of disseminating quality
improvement programs for depression in managed care. JAMA 283(2): 212-220.
Wright, J.G., Hawker, G.A., Bombardier, C., Croxford, R., Dittus, R.S., Freund, D.A.,
and Coyte, P.C. (1999). Physician enthusiasm as an explanation for variation in the
utilization of knee replacement surgery. Medical Care 37(9): 946-999.
V. Student Evaluation
Mid-term exam
Final exam
Paper
Class participation
30%
30%
30%
10%
Grading: At the minimum, 90 % = A, 80 % = B, and 70 % = C.
V. A. Exams
The midterm exam will cover weeks 1-7 of the course. The final exam will be similar to
the midterm exam but will cover only the second half of the course. Both tests will be
multiple choice in format.
V. B. Student Paper
Students will be required to write a literature review a current health services research,
health care management, or health policy topic. The written report must be 15 to 20
pages excluding title page, abstract/executive summary, tables, graphs, references, and
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appendices; 12 font; double spaced; 1 inch margins. The paper will be due at least one
week before the end of the semester.
The paper should be divided into the following sections:
1.
2.
3.
4.
5.
6.
7.
Title
Abstract (a half to one page summary of the paper)
Introduction
Review of current health services research, policy, and management literature
Summary / discussion
References
Appendix (charts, graphs, etc., if necessary)
The paper will be graded according to the following criteria:
Abstract (5 pts.)
(inclusion of a succinct half to one page summary of the purpose of the paper, major
findings from the literature review, and major implications for health management
and/or policy)
Thoroughness and Precision in Developing the Subject (30 pts.)
(appropriateness of material discussed; the degree to which relevant literature has
been appropriately discussed and summarized; few gaps in the development of the
topic)
Organization and clarity of expression (30 pts.)
(the degree to which the author breaks the paper into appropriate sections and
subsections; the degree to which thoughts are stated clearly and concisely)
Discussion of implications for health management and/or policy (30 pts.)
(the degree to which the author discusses the importance of the topic to health
management and/or policy)
Quality of references cited (5 pts)
(the number and quality of references; whether references have been appropriately
cited within the paper)
V. B. C. Homework
There will be two brief homework exercises related to the calculation and interpretation
of descriptive epidemiological indicators. These will not be graded, but it is
recommended that students complete the exercises to be prepared for the final exam.
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1. Course Outline
Part I. Determinants of Health and Health Services Use
Week 1 (Aug. 29): Course introduction
Week 2 (Sept. 5): U.S. Health Care System and population health
Overview of U.S. health care system
W&T Ch. 1
Trends in health and health services use
Kindig Ch. 1
What is health?
Kindig Ch. 2, 4
Measures of population health
Week 3 (Sept. 12): Determinants of population health
Social, psychological, and economic
determinants of health
Limited contribution of medical care to health
W&T Ch. 2, 3
Kindig Ch. 5
Evans & Stoddart art.
Week 4 (Sept. 19): Access
Definitions of access
Models of access
Social and psychological determinants of access
Inequities in access
W&T Ch. 4
Phillips et al. article
Becker & Maiman ch.
Aday article.
Week 5 (Sept. 26): Quality
Overview of quality
Structure, process, and outcome
Small area variation
W&T Ch. 16
Donabedian article
Wright et al. article
Wennberg article
Part II. Organization of the U.S. Health Care System
Week 6 (Oct. 3): Medical care markets - market failure and FFS insurance
Costs of health services, financial access
Kindig Ch. 3
Supply-induced demand
Hendryx et al. article
Employer and government sponsored insurance
W&T Ch. 5,7
Week 7 (Oct. 10): Mid-term examination
Week 8 (Oct. 17): Medical care markets - controlling expenditures
Organization of managed care
W&T Ch. 6
Managed care performance
Miller & Luft art.
Rationing health services
Kindig Ch. 6
RAND Health insurance experiment
Manning et al. article
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Week 9 (Oct. 24): Health care professionals
Impact of economic factors on phys. behavior
Rise of the medical profession
M.D. education and supply
Geographic maldistribution of doctors
Nurse education and supply
Week 10 (Oct. 31): Health care provider organizations
Ambulatory care
Hospital care
Reorganization of provider groups
Critical access hospitals
Hillman et al. article
W&T Ch. 14
Wells et al. article
Geyman article
W&T Ch. 9
W&T Ch. 10
Kindig Ch. 7
Blanchfield article
Week 11 (Nov. 7): Public health system and health care reform
Role of public health
W&T Ch. 8
Politics of health policy
Kindig Ch. 7-9
Comparative health systems: Japan and Canada
Ikegami article
Nauyler article
Part III. Epidemiological Methods for Health Services Managers
Week 12 (Nov. 14): Descriptive and analytical epidemiology
Role of epidemiology in management
Fos Ch. 1-3, Ch. 8
Descriptive epidemiological indicators
Borders et al. article
Homework to be discussed November 21
Week 13 (Nov. 21) Analytical epidemiology
Case control studies
Observational studies
Clinical trials
Homework to be discussed November 28
Week 14 (Nov. 28): Assessing health outcomes
Validity, reliability
Disease management
Health status
Consumer satisfaction
Ch. 10, p. 202, #1-18
Ch. 10, p. 203, #1-5
Fos Ch. 4 -5
ARTICLE
ARTICLE
Ch. 12, p. 230, #1-10
Ch. 12, p. 233-234, #1-7
Ch. 12, p. 235, #1-5
Fos. Ch. 6-7
McHorney et al. art.
Hays et al. article
Week 15 (Dec. 12): Final exam
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