NEW YORK UNIVERSITY
ROBERT F. WAGNER GRADUATE SCHOOL OF PUBLIC SERVICE
INTRODUCTION TO HEALTH POLICY AND MANAGEMENT – HPAM-GP 1830.002
Fall, 2013
Prof. Victor Rodwin
Tuesdays 11:00-12:40 pm
Room 194 Mercer St.
Office hours: Tuesdays 1:30pm-3:30pm
Email: victor.rodwin@nyu.edu
Administrative Aide : jessica.holmes@nyu.edu
COURSE SYLLABUS
This introductory course is designed to build an understanding of fundamental issues in the field of
health policy and management and to familiarize students with basic concepts and ideas concerning the
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.
In the course of the semester, I will ask students to learn about a health care system in one other
country of their choice so that they may develop a comparative perspective on the health care system in the
United States. Students should come to class prepared to comment on the required readings and participate in
the discussion of major class themes.
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
Relevant content for the following competencies is also included:
 The ability to understand and apply ethical principles to managerial and leadership decisions
affecting health care organizations
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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 longterm organizational viability
The ability to communicate and interact productively (by listening, speaking and writing) on matters
of health care with a diverse and changing industry, work force and citizenry
The ability to present convincingly (to individuals and groups) evidence to support a point of view,
position or recommendation
Learning Objectives
 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
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CLASS READINGS
Every week, I expect students to complete the readings noted on this syllabus. The textbook, edited
by Kovner and Knickman, focuses on the organization and financing of health care delivery in the United
States. In addition, there are two required books to read (one by Groopman; the second, a choice of the book
by Nestle or Shilts) and articles designed to extend the materials in the textbook and expose students to other
views. Groopman’s book provides a clinical perspective on health care, often not appreciated by managers
and policy wonks. Nestle highlights the political nature of a major public health issue, obesity and nutrition
policy. Shilts provides historical case study material on the evolution of the AIDS epidemic and the
importance of public health infrastructure. These books should be available at Bobst Library, most medical
libraries, and the NYU Professional Bookstore.
Most articles listed on this syllabus can be download from the NYU Classes site for this course.
Students must also be prepared to find additional background materials, on their own, about the country they
choose as a standard of comparison to the US.
REQUIRED TEXTBOOK
Kovner, A. and Knickman, J., ed. Health Care Delivery in the United States (10th Edition). New York:
Springer Press (2011).
ADDITIONAL BOOKS AND JOURNALS
I encourage students to browse recent issues of well-respected journals, e.g., American Journal of Public
Health; Journal of the American Medical Association; New England Journal of Medicine; The Journal of
Health Politics, Policy and Law, and Health Affairs. Kovner and Knickman’s book also contains be helpful
websites and references.
Groopman, J. How Doctors Think. New York: Houghton Mifflin (2007).
Nestle, M.
Food Politics. Berkeley: UC Press (2013).
Shilts, R.
And the Band Played On. New York: St Martin’s Press (1988).
CLASS TOPICS AND READINGS
PART A: INTRODUCTION
Class I. September 3: Health, Disease and Community
• Discussion of course readings and class requirements.
• Clinical and other perspectives
• Definitions of health and illness. What does it mean to speak of the “social production of disease?”
• How are health status and health care related?
Required reading
Textbook:
Chapter 5: Russo, P. Population Health
Book:
Groopman, J. How Doctors Think, Introduction and Ch. 1.
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Articles:
1. Schroeder, S. We Can Do Better—Improving the Health of the American People. New England
Journal of Medicine. September 20, 2007. 357:1221-8.
2. Robert Wood Johnson Foundation Commission to Build a Healthier America 2009. Beyond
Health Care: New Directions to a Healthier America. Executive Summary, pp. 9-25
PART B: DISTRIBUTION OF HEALTH, DISEASE AND PUBLIC HEALTH PROBLEMS
Class II. September 10th: Introduction to Epidemiological Perspectives
• Descriptive vs. analytic methods
• Social factors and disease
• How do we assess and measure health status?
Required reading
Textbook:
Chapter 6: Levitan, L. Rhodes, S. and Chang C. Public Health: Policy, Practice and Perceptions
Chapter 7: Orleans, C. and Cassidy, E. Health and Behavior, pp. 125-149.
Articles:
1. Banks, J. Marmot, M. Oldfield, Z. and Smith, J. Disease and Disadvantage in the United States
and England. JAMA. 295 (17) 2006:2037-2045.
2. Fuchs, V. A Tale of Two States. In Who Shall Live: Health Economics and Social Change. NY:
Basic Books, 1974.
3. 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(?).
4. Mokdad, A. et. al. Actual Causes of Death in the U.S. 2000. JAMA, March 10, 2004. 291:10.
5. Marmot, M. Status Syndrome: A Challenge to Medicine. JAMA, March 15, 2006. 295:11.
6. Social Determinants of Health: The Solid Facts.The World Health Organization, optional
Class III. September 17: Health Disparities and Urban Health
• How do such factors as age, gender, race, poverty, occupation and lifestyle affect mortality risk?
• Are these relationships consistent across nations and cities?
• Is there an urban health penalty?
Required reading
1. Adler, N. and Rehkopf, D. U.S. Disparities in Health: Descriptions, Causes and Mechanisms.
Annual Review of Public Health. 2008.29:235-252.
2. Williams, D. and Jackson P. Social Sources of Racial Disparities in Health. Health Affairs .2005.
24(2):325-334.
3. Horton, R., The Infected Metropolis. Lancet.
4. Vlahov, G. & Galea, S. Urbanization, Urbanicity, and Health. Journal of Urban Health. 2002.
79(4): S1-S12.
5. House, J. Understanding Social Factors and Inequalities in the Health. J. of Health and Social
Behavior. 2002. 43(2) 125-142.
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Class IV. September 24: Public Health and Policy
• Public health infrastructure
• Ethical and historical perspectives
• Public health and the built environment
Required reading
1. 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.
2. Frumkin, H. Urban sprawl and Public Health. Public Health Reports. 2002. 117, May-June: 201217.
3. Colgrove, J. The McKeown Thesis: A Historical Controversy and Its Enduring Influence.
AJPH.2002 92(5): 725-729.
4. Roberts, M. and Reich, M. Ethical analysis in public health. The Lancet .2002 (359), March 23.
Class V. October 1: Public Health Case Studies: Oral Presentations by Groups: AIDS
 Public health and social justice
 Public health and politics
 Public health and civil liberties
 Other themes
Shilts, R. And the Band Played on….
Class VI. October 8: Public Health Case Studies: Oral Presentations by Groups: Food Politics
 Public health and social justice
 Public health and politics
 Public health and civil liberties
 Other themes
Nestle, M. Food Politics
October 15th – No class – Fall Recess
PART C: HEALTH CARE ORGANIZATION, FINANCING
Class VII. October 22: The U.S. Health System and Role of Government in International Perspective
• History, trends, and characteristics
• What social, medical, and technological factors have shaped the current health care arrangements?
• What is the role of government in U.S. health care?
• How does the US health care system compare to that of other wealthy nations?
**First Paper due. Submit for all to read on NYU Classes by midnight the night before this class**Late
papers will be penalized by one-half letter grade for each day late.
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Required reading
Textbook:
1. Ch. 1: The Current U.S. Health Care System.
2. Ch. 2: Sparer, M. Health Policy and Health Reform.
3. Ch. 4: Frogner, Waters, Anderson. Comparative Health Systems
Class VIII. October 29: Cost Containment and Managed Care
• Cost containment vs. efficiency
• Strengths and weaknesses of managed care
• Alternative mechanisms for financing health care
Required reading:
Textbook:
1. Ch. 3: Knickman, J. Health Care Financing.
2. Ch. 12: White, H. Health Care Costs and Value.
Articles:
1. Cutler, D. Analysis and Commentary: How Health Care Reform Must Bend
the Cost Curve. Health Affairs 2010. 29(6):1131-1135.
2. Bodenheimer, T. Coordinating Care – A Perilous Journey through the Health Care
System. NEJM 2007.358 (10): 1064-1071.
Paper I Due
Class IX. November 5: The Performance of Health Care Systems
• Dimensions of health care system performance
• On the basis of what criteria should health care systems be assessed?
• Equity criteria and social justice
Required reading:
Textbook:
1. Ch. 8: Billings, J. and Cantor, J. and Clinton, C. Access to Care.
2. Ch. 11: Clancy, C. and Lloyd, R. High Quality Health Care.
Articles:
1. Schoen, C. Davis, K. How, S. and Schoenbaum, S. U.S. Health System Performance: A National
Scorecard. 2006. Health Affairs (DO1 10.1377/hlthaff.25.w457).
2. Goodman, Musgrave and Herrick. Lives at Risk: Single Payer National Health Insurance Around
the World. New York: Rowman and Littlefield, 2004. Ch. 2 and 4.
3. Schoen, C., R. Osborn, D. Squires, MM. Doty, R. Pierson, and S. Applebaum. 2010. How
Health Insurance Design Affects Access To Care And Costs, By Income, In Eleven Countries.
Health Affairs 29(12): 2323–2334.
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PART D. HEALTH CARE DEMANDS, NEEDS AND CHALLENGES
Class X. November 12: Quality Assessment and Quality Assurance
• How do we measure and monitor the quality of health care services?
• How do we assess the effectiveness and appropriateness of care?
• What is the role of trust in assuring quality of medical care and how has quality evolved over time?
Required reading:
Textbook:
1. Ch. 16: Kropf, R. Health Information Technology.
2. Ch. 11: Clancy, C. and Lloyd, R. High Quality Health Care.
Articles:
1. Mechanic, D. The Functions and Limitations of Trust in the Provision of Medical Care. Journal of
Health Politics, Policy and Law. 1998.23 (4): 661-686.
2. Bodenheimer, T., Wagner, E., Grumbach, K. Improving Primary Care for Patients with Chronic
Illness: The Chronic Care Model, Part 2. J. of the American Medical Association. 2002. 288:
1909-1914.
3. Landrigan, D. et. al. Temporal Trends in Rates of Patient Harm Resulting from Medical Care.
NEJM. 2010.362:2124-2134.
Class XI. November 19: How Could the Health Care System Respond to Changing Health Care Needs?
• The need for long-term care and alternative modes of delivery
• Chronic illness and aging
• Perspectives on the future of medical care organization
Required reading:
Textbook:
1. Ch. 9: Caronna, C. and Ong, M. Organization of Medical Care.
2. Ch. 10: McCarthy, D. Integrative Models and Performance.
3. Ch. 8: Anderson, G. and. Knickman, J. Chronic Care.
Articles:
1. Shoven, J. New Age Thinking: The aging of the world’s population won’t be the crisis we fear.
Foreign Policy, Jan/Feb 2008.
2. Gawande, A. Letting Go: What Should Medicine Do When It Can’t Save Your Life? The New
Yorker, Aug. 2, 2010.
3. Gilsdorf, K. As Drug Marketing Pays Off, My Mother Pays Up. Health Affairs.2004. 23(1):2082012.
4. Steinman, M. Landenfeld, S. and Baron, R. Industry Support of CME –Are We At a Tipping
Point? NEJM. 2012. 366(12):10-69-1069-1071.
Class XII. November 26: The Role of Patients in Health Care: Trends and Issues
**Second Paper** Submit for all to read on NYU Classes by midnight the night before this class.
Papers will be penalized by one-half letter grade for each day late.
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• Issues of patient compliance
• The relationship of patients, physicians, and the health care system
• Information and consumer issues
Required reading
Book:
Groopman, J. How Doctors Think, Chapter of your choice and Epilogue and Afterword (pp. 260-279).
Articles:
1. Zola, I. Medicine as an Institution of Social Control. The Sociology Review. 1972. 20(4):487504.
2. Sepulcha, K and Mulley, A. A Perspective on the Patient’s Role in Treatment Decisions. Medical
Care Research and Review 2009. 66 (1 suppl):3S-8S.
XIII. December 3 (last class): Health Care Reform
Articles: (Read #1-4+ your choice of #5-10)
1. Side-by-Side Comparison of Major Health Care Reform Proposals, Kaiser Family Foundation.
http://www.kff.org/healthreform/sidebyside.cfm
2. Krugman and Wells. The health care crisis and what to do about it? New York Review of Books.
3. Grassley, C. Health Care Reform – A Republican View. NEJM (361) 25, 2009.
4. Brown, L. The Amazing Noncollapsing U.S. Health Care System—Is Reform Finally at Hand?
NEJM, January 24, 2008; 358:4.
5. Brown, Lawrence D. 2011. “The Elements of Surprise: How Health Reform Happened”
Journal of Health Politics, Policy and Law 36(3): 419-427.
6. Peterson, Mark A. 2011. “It Was a Different Time: Obama and the Unique Opportunity for
Health Care Reform” Journal of Health Politics, Policy and Law 36(3): 429-436.
7. White, Joseph. 2011. “Muddling Through the Muddled Middle” Journal of Health Politics,
Policy and Law 36(3): 443-448.
8. Jonathan Oberlander “Throwing Darts: Americans' Elusive Search for Health Care Cost
Control” Journal of Health Politics, Policy and Law 36(3): 477-484 (2011).
9. Thompson, Frank J. 2011. “The Medicaid Platform: Can the Termites Be Kept at Bay?”
Journal of Health Politics, Policy and Law 36(3): 549-554.
10. Marmor, Theodore R. 2011. “Health Reform 2010: The Missing Philosophical Premises in
the Long-Running Health Care Debate” Journal of Health Politics, Policy and Law 36(3): 567570.
FINAL EXAM: Dec. 10th
COURSE REQUIREMENTS
In addition to attending and participating in classes, you must submit two short papers and take a final
examination based on the class readings. These requirements are described below. The papers should be
based on class readings and whatever additional reading you have done on a health care system in the country
you have chosen to compare with the United States.
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Course grades will be calculated as follows.
% Final Grade
Date Due
Oral Presentations
10% Oct. 8th
Paper I
25%
Oct. 21st
Paper II
25%
November 25th
Final Exam
35%
December 10th
Class Participation
5%
Paper I (Book Review) – Please write an 5 page concise essay in which you review the book you have read
for class V. Show how your understanding of required class articles supports the statements you make in
reviewing this book. More details will be posted on NYU Classes before the end of September.
Paper II – This concise paper will require a thoughtful, and well-organized discussion of questions posed. It
should not be based on new research. Rather, it will provide you with an opportunity to reflect upon the
required readings. The paper should be 6 pages in length. You should present a carefully organized essay
with arguments supported with footnotes that refer to required readings for this class. If you need more space,
you may include appendices. Once again, I shall provide more details on this assignment before the end of
October. Once again, these papers should be posted on NYU Classes so that all can read and discuss.
Final Exam – This will consist of some multiple choice questions, as well as some essay questions based on
the required readings. What is important in this exercise is to demonstrate understanding of the key
arguments made by authors of the readings we have discussed in the course of the semester.
Class Participation
Classroom discussion and debate are essential to this class. I expect that you come to class ready to discuss
the assigned readings.
Administrative Procedure
If you have trouble posting the required essays and responses on NYU Classes, please contact the NYU
Classes Helpline. If you would like to schedule office visits with the instructor, please drop by on Tuesdays
during office hours, or better yet schedule time with me in advance.