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Robert F. Wagner Graduate School of Public Service
New York University
INTRODUCTION TO HEALTH POLICY AND MANAGEMENT
HPAM-GP.1830.001
Spring 2014
Four Friday sessions: February 7*, 14, 28 and March 14
9:00 am to 3:30 pm
7 East 12th Street, LL23
Professor Victor Rodwin (victor.rodwin@nyu.edu)
Office Hours: Thursdays 4:00-5:30 PM, and by appointment
*This first session only will meet in Washington Place room 101
COURSE SYLLABUS
This introductory course is designed to build an understanding of fundamental issues in
the field of HPAM and to familiarize students with basic concepts and ideas about distribution
of health and illness in society, the organization of health care systems; and the relationship
between the two. Class readings cover major topics in the study of health and health care
delivery. They review the determinants of health; the nature of health disparities; historical
developments in public health; the financing of health care systems; the quality, cost and
accessibility of health care services; and the prospects for health care delivery system
improvement and reform. We will examine these topics and concepts from a range of diverse
perspectives including economics, sociology, anthropology, politics and ethics. In addition, we will
emphasize the challenges of meeting the varied (and often conflicting) needs and motivations of
health care system stakeholders; and the ways in which the United States health care system differs
from those of other wealthy nations.
For each of our four intensive sessions, I will ask students to comment on the assigned
readings and beginning on the second session, to comment on the issues we are discussing in the
context of a health care system in a country of their choice other than U.S., so that you develop a
comparative perspective on the health care system in the U.S.
COURSE COMPETENCIES
Course focus:
 The ability to assess population and community health needs from a public service
perspective
 The ability to examine social and behavioral determinants of health and understand how
health systems can address the needs of vulnerable populations
 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
HPAM-GP 1830.001 Rodwin Spring 2014 Syllabus
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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
 The ability to measure, monitor and improve safety, quality, access and system/care delivery
processes in health care organizations
 The ability to draw implications and conclusions to develop an evolving vision that results
in long- term organizational viability
 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
 The ability to present convincingly to individuals and groups the evidence to support a point
of view, position or recommendation
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
 Identify determinants of health and explain their impact on the distribution of health and
disease
 Define the roles of key stakeholders – providers, government and private payers, employers,
regulators, patients – and describe their incentives and behavior
 Compare the U.S. health care system to models of health care organization and financing
abroad
 Explain fundamental concepts of health care payment and performance measurement
 Define major health policy developments over the past 50 years and explain their
significance
 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
REQUIRED READINGS
Students should arrive to class prepared to participate in the discussion of class themes
based on their analysis of assigned readings.
Required textbook:
Health Care Delivery in the United States (10th edition). A. Kovner & J. Knickman, eds.
New York, NY: Springer Press, 2011.
Other books:
Groopman, J. How Doctors Think. New York: Houghton Mifflin (2007).
Choice of Nestle, M. Food Politics. Berkeley: UC Press (2013); or Shilts, R. And the Band
Played On. New York: St Martin’s Press (1988).
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Other required readings:
Assigned articles that are not included in the required textbook will be posted on NYU Classes.
WRITTEN REQUIREMENTS
In addition to attending and participating in all 4 intensive classes, students are required to
complete a short exercise (Feb. 14) a memo and a final research paper. Please note: To provide
sufficient time for absorbing class material and preparing the written work, the final research
paper is due shortly after the four intensive class sessions conclude on March 14. Written
assignment instructions and grading criteria are included at the end of this syllabus.
COURSE SESSIONS
2/7/14: SESSION 1. INTRODUCTION TO CLASS AND ISSUES IN POPULATION
HEALTH
REQUIRED READING:
Textbook
 Chapter 5: Russo, P. Population Health, pp. 85-102
Books
 Groopman, J. How Doctors Think. New York: Houghton Mifflin (2007). Introduction and
Ch. 1
Articles
 Banks, J. Marmot, M. Oldfield, Z. and Smith, J. Disease and Disadvantage in the United
States and England. JAMA. 295 (17) 2006:2037-2045.
 Rodwin, V. Croce-Galis, M. Population Health in Utah and Nevada: An Update on Victor
Fuchs’
Tale of Two States. In Conrad, P. ed. Sociology of Health and Illness. NY
Worth, 2000.
 Mokdad, A. et. al. Actual Causes of Death in the U.S. 2000. JAMA, March 10, 2004. 291:10.
 Marmot, M. Status Syndrome: A Challenge to Medicine. JAMA, March 15, 2006. 295:11.
 Schroeder, S. 2007. We Can Do Better: Improving the Health of the American People.
New England Journal of Medicine 357: 1221-1228.
 McKinlay, J. and McKinlay, S. The Questionable Contribution of Medical Measures to the
Decline of Mortality in the United States in the Twentieth Century. MMFQ, 1977, Summer.
 Frumkin, H. Urban sprawl and Public Health. Public Health Reports. 2002. 117, May-June:
201-217.
 Colgrove, J. The McKeown Thesis: A Historical Controversy and Its Enduring Influence.
AJPH.2002 92(5): 725-729.
 Williams, D. and Jackson, P. 2005. Social Sources of Racial Disparities in Health.
Health Affairs 24(2): 325-334.
 Robert Wood Johnson Foundation Commission to Build a Healthier America 2009.
Beyond Health Care: New Directions to a Healthier America. Executive Summary, pp. 925.
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SESSION SCHEDULE:
9:00 - 10:40 am: Introduction: Health, Disease and Community



Overview of the course
Definitions of health and disease
Relationship between health and medical care
[15-minute break]
10:55 am – 12:35 pm: Clinical versus Epidemiological Perspectives


Relationships between socioeconomic status, race/ethnicity, gender and health
Population health inequalities and social justice implications
[Lunch break: 12:35 – 1:20 pm]
1:20 - 3:00 pm: Public Health Policy and Management


Public health infrastructure
Prevention and health promotion
3:00 - 3:30 pm: Flex time (wrap-up, questions, etc.)
2/14/14: SESSION 2. CASE STUDIES IN PUBLIC HEALTH
REQUIRED READING:
Textbook
 Chapter 6: Leviton, L., Rhodes, S. and Chang, C. Public Health: Policy, Practice, and
Perceptions, pp. 103-123.
Articles
 Roberts, M. and Reich, M. 2002. Ethical Analysis in Public Health. The Lancet
359(9311): 1055-1059.
Books
 Choice of Nestle, M. Food Politics. Berkeley: UC Press (2002); or Shilts, R. And the
Band Played On. New York: St Martin’s Press (1988).
SESSION SCHEDULE:
9:00 – 10:40 am: Key themes in public health


Ethics: Utilitarianism, and other approaches
The role government, civil society and interest groups
[15-minute break]
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10:55 am - 12:35 pm: AIDS and Public Health

Presentation of Shilts Book and how it reflects public health themes
[Lunch break: 12:35 – 1:20 pm]
1:20 – 3:00 pm: Nutrition and Public Health

Presentation of Nestle Book and how it reflects public health themes
3:00 – 3:30 pm: Flex time (wrap-up, questions, etc.)
2/28/14: SESSION 3. THE U.S. HEALTH CARE SYSTEM: AN INTERNATIONAL
PERSPECTIVE
REQUIRED READING:
Textbook
 Chapter 2: Sparer, M. Health Policy and Health Reform, pp. 25-45.
 Chapter 3: Knickman, J. Health Care Financing, pp. 47-66.
 Chapter 9: Caronna, C. and Ong, M. Organization of Medical Care, pp. 181-204.
 Chapter 10: Integrative Models and Performance, pp. 205-231.
 Chapter 12: White, H. Health Care Costs and Value, pp. 257-276.
 Appendix: Major Provisions of the Patient Protection and Affordable Care Act of 2010,
pp. 365-376.
Articles
 Krugman and Wells. The health care crisis and what to do about it? New York Review of
Books. Grassley, C. Health Care Reform – A Republican View. NEJM (361) 25, 2009.
 Brown, L. The Amazing Noncollapsing U.S. Health Care System—Is Reform Finally at
Hand? NEJM, January 24, 2008; 358:4.
 Brown, Lawrence D. 2011. “The Elements of Surprise: How Health Reform Happened”
Journal of Health Politics, Policy and Law 36(3): 419-427.
 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.
 Bodenheimer, T. 2007. Coordinating Care—A Perilous Journey through the Health
Care System. The New England Journal of Medicine 358(10): 1064-1071.
SESSION SCHEDULE:
9:00 – 10:40 am: U.S. Health Policy and Reform: Historical Overview 1900-Present


Historical development of health care delivery system
Government role in health care system
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[15-minute break]
10:55 am - 12:35 pm: 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 (ACA)
[Lunch break: 12:35 – 1:20 pm]
1:20 – 3:00 pm: Providers and Organization of Care


Acute and ambulatory care delivery
Evolving organizational forms: ACOs and medical homes
3:00 – 3:30 pm: Flex time (wrap-up, questions, etc.)
3/14/14: SESSION 4. HEALTH SYSTEM PERFORMANCE, CHALLENGES AND
DEBATES
REQUIRED READING:
Textbook
 Chapter 8: Billings, J., Cantor, J. and Clinton, C. Access to Care, pp. 151-178.
 Chapter 11: Clancy, C. and Lloyd, R. High Quality Health Care, pp. 233-255.
 Chapter 16: Kropf, R. Health Information Technology, pp. 331-349.
Articles
 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.
 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.
 Landrigan, C. et al. 2010. Temporal Trends in Rates of Patient Harm Resulting from
Medical Care. New England Journal of Medicine 363: 2124-2134.
 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.
 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.
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SESSION SCHEDULE:
9:00 am – 10:40 am: The Role of Patients



Expanding use of drugs and medical devices in health care
Comparative effectiveness
Relationship between providers and medical technology manufacturers
[15-minute break]
10:55 – 12:35 pm: 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
[Lunch break 12:35 – 1:20 pm]
1:20 – 3:00 pm: Week 13. Expanding Access and Reducing Disparities in Care
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
Barriers to care for vulnerable patient populations
The uninsured and underinsured in the U.S.
Implications of the ACA
Guest speaker: Errol Pierre on state health insurance exchanges
3:00 – 3:30 pm: Conclusion
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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:
1. Written Exercise
2. Memo
3. Research Paper
4. Presentation and Participation
Clasand
Class Participation
% of Final Grade
15%
20%
45%
20% and can determine
borderline grades
up or down
Due Date
2/13
3/13
4/4
2/7, 2/14, 2/28, 3/14
Lateness Policy – Please submit written assignments on time. Late assignments will be penalized
by one-half letter grade for each day late.
Class Participation – Attendance at all four intensive class sessions is mandatory. Participation
performance is assessed based on preparation, engagement and quality of contributions to in-class
discussion and group work.
WRITTEN ASSIGNMENT GUIDELINES
General Instructions for Written Assignments – All written assignments should be submitted in
Times New Roman 12-point font, double-spaced, with one-inch page margins.
Format Instructions for Memo – The memo should be a maximum of 4 pages. Complete
citations in the form of footnotes or end notes are required. A separate references page (in
addition to footnotes or endnotes) is not required. Exhibits may be used if appropriate but are
optional and do not count toward the page length. Please see the NYU Writing Tutors guide to
memo-writing posted on NYU Classes for memo formatting guidelines and observe these
guidelines for memos submitted in this course.
Format Instructions for Final Research Paper – The final research paper should be a maximum
of 10 pages. Complete citations in the form of parenthetical citations, footnotes or end notes are
required, and a separate references page is also required. Exhibits may be used if appropriate but
are optional and do not count toward the page length.
Plagiarism Policy – Academic integrity is crucial to the mission of NYU Wagner. Plagiarism of
any form will not be tolerated. Please review the NYU policy on plagiarism (posted on NYU
Classes) prior to submitting written work in this course.
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WRITTEN ASSIGNMENT DESCRIPTIONS
Written Exercise
Due Thursday, February 13
Assignment: Based on a quick perusal of the textbook, please write a two page essay in which
you highlight the most important themes in the field of health policy and management and
explain why you want to study in this area.
Memo: Select either Topic
Due Thursday, March 13 by 11:59 pm
Topic 1: Please write a concise, well-structured memo to the attention of the mayor,
governor or other government official of a town/city or state you have inhabited (or of
interest to you) in which you provide analysis on how to improve the health of the local
population. Please discuss:
a. Background on health and disease in your focal population using available
information/data;
b. Determinants of health as they pertain to your focal population;
c. 2-3 top-priority objectives that the municipal or state government should pursue to achieve
meaningful improvements in population health over the next 10 years;
d. Promising strategies to achieve these objectives, with consideration of feasibility and
potential barriers to implementation
Topic 2: Please write an editorial essay to your newspaper of choice in which you argue
for national attention to health care disparities in the U.S. health care system. Please
include:
a. Evidence on the current state of racial/ethnic, socioeconomic and/or geographic
health care delivery inequities and disparities in the U.S. health system;
b. In-depth analysis of one area of health care disparities;
c. The most promising opportunities for reducing disparities in availability of care
and treatment in the health care system.
Final Research Paper
Due Friday, April 4 by 11:59 pm
Topic: Please prepare a 10-page research paper in which you examine one dimension of
performance of the U.S. or another health care delivery system. You may focus on
performance in a broadly-defined area (such as quality of care, cost or access to care) or you
may define your focus more narrowly (e.g., coordination of care for chronically-ill elderly
patients, cost-effectiveness of new medical technologies, access to specialty care for lowincome populations, etc.). In your research paper, please discuss:
HPAM-GP 1830.001 Rodwin Spring 2014 Syllabus
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a. Background on this dimension of health system performance;
b. How performance on this dimension is influenced by the organization and financing of
health care in the U.S. and the incentives/needs/constraints of key health system
stakeholders;
c. What must be improved or reformed to achieve performance gains in your selected area;
d. Implications of your analysis for health policy and management.
In your analysis, please consider all stakeholders relevant to your specified focus—such as
providers, payers and purchasers, patients/consumers, communities, policy-makers, other groups
that play a role in performance in your focal area—and be sure to examine performance and
implications for reform at both the policy and delivery system levels.
Please include references to course readings as well as relevant outside sources that
support your analysis. Citations and a references page (not included in page length) are
required.
HPAM-GP 1830.001 Rodwin Spring 2014 Syllabus