NEW YORK UNIVERSITY
Robert F. Wagner School of Public Service
P11.2867 -- HEALTH SYSTEMS AND REFORM:
COMPARATIVE INTERNATIONAL PERSPECTIVES
Spring, 2009
Prof. Victor Rodwin
Phone: 212-998-7459
Office Assistant: Fedor Kabalin: 212-998-7460
Tuesday 4:55 - 6:35 pm - 194 Mercer: Rm. 306
Office: Puck Bldg., 295 Lafayette St., #3006
E-mail: victor.rodwin@nyu.edu
fedor.kabalin@nyu.edu
COURSE DESCRIPTION
Health systems around the world are grappling with problems of cost, access, equity and
quality of health care, and the tradeoffs among these objectives. Economic and political reforms
designed to promote markets, manage competition, organize systems for public contracting,
improve management, and change financial incentives in the health sector have been debated in
most countries, and in many cases, implemented. While health system reform has received more
attention than public health, there has also been increasing attention to what is often termed the
“new public health.” As reforms to improve population health have been added to the political
agenda, there have been new efforts to rekindle health reform.
In this seminar, we will apply some perspectives and tools of public policy analysis, and
draw on international comparisons of health systems to analyze efforts at health system and
public health reform. The readings, lectures and class discussions should make students more
knowledgeable about policy options and policy changes in different countries. The seminar
opens with an overview of how forces of “globalization” may affect health system reform. Next,
we focus on ideas, concepts and theories of health care reform. We then attempt to go beyond the
OECD and controversial WHO approach to health system performance and examine what may
be learned in the United States from health systems and reform efforts in wealthy industrialized
nations. The course provides a special focus on the experience of Britain, Germany and France.
Each case will apply a common, general framework for analyzing health systems and reform
while emphasizing different perspectives for approaching these topics. Students are required to
select a wealthy OECD nation and become “experts” about the health system and efforts to
reform it.
Prerequisites
The seminar assumes that students will be familiar with policy analysis and with our
current system of health care organization and financing in the United States. Courses such as
P11.1022, P11.1830, P11.1834 or their equivalents are required.
Course requirements
Students must do all of the required reading before each class. I will also ask you to write
several short briefs (2-page position papers) that apply the concepts covered in the readings to
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the country of your choice). Finally, I will ask you to make a presentation in the course of the
semester and to complete a final paper (10-15 pages, double spaced) on what Tom Daschle
should know about the experience of one or several wealthy OECD nations that would inform
feasible health care reform in the United States. Alternatively, students may choose to compare a
health system and efforts to reform it in the U.S. and another wealthy OECD nation. A two-page
proposal for the final paper will be due before February 17th.
Teaching Method and Grading
Classes will consist of short lectures and questions aimed to provoke discussion about the
readings and the issues they raise. There will also be many short student presentations and
debates.
The position papers and two-page proposal will count for 40 percent of the grade. The
final paper will count for 60 percent of the grade. The grade may be raised or lowered by up to
one half a letter based on class contributions.
Required Books
1. Tom Daschle, Critical: What We Can Do About the Health-Care Crisis. New York: St.
Martin’s Press, 2008.
2. Oliver, Mossialos, Maynard, eds. Analysing the Impact of Health System Changes in EU
Member States. Special Issue of Health Economics (14)51, 2005. I will distribute this journal
in class and ask you to share copies.
3. Aaron, H. and Schwartz, W. (with Cox, M.) Can We Say No? The Challenge of Rationing
Health Care. Washington D.C.: Brookings, 2005. Ch.1-3.
Required Articles
I will post these articles on blackboard. They are noted in the course outline below.
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OUTLINE OF COURSE TOPICS AND READINGS
INTRODUCTION
1.
Course Themes: Globalization and Health System Reform
January 20
Tom Daschle, Critical: What We Can Do About the Health-Care Crisis. New York: St.
Martin’s Press, 2008. Read Part I: “The Crisis,” Pp. 1-42.
Davis, K. “International Health Policy: Common Problems, Alternative Strategies,”
Health Affairs (18)3, May/June, 1999: 135-143.
Krugman, P. and Wells, R. “The Health Care Crisis and What to Do About It.” New York
Review of Books (53)5, March 23, 2006.
Oliver, A., Mossialos, E. and Maynard, A. “The Contestable Nature of Health Policy
Analysis.” Health Economics, 14:S3-6 2005.
IDEAS, CONCEPTS AND THEORIES OF HEALTH CARE REFORM
2.
Health Reform for the U.S.: The Views and Analysis of Tom Daschle January 27
Tom Daschle, Critical: What We Can Do About the Health-Care Crisis. New York: St.
Martin’s Press, 2008. Read Part II-V: pp. 43-206
3.
Managed Competition, Public Competition and Managed Care
February 3
Enthoven, A. “The History and Principles of Managed Competition,” Health Affairs
(12), Supplement, 1993.
Saltman, R. and von Otter, C. “Public Competition versus Mixed Markets: An Analytic
Comparison,” Health Policy, (11) 1989, pp. 43-55.
Chernichovsky, D. 1995. “Health System Reforms in Industrialized Economies: An
Emerging Paradigm. The Milbank Quarterly. 73 (3), pp. 339-72.
Chernichovsky, D. 2002. “Pluralism, Choice, and the State in the Emerging Paradigm in
Health Systems.” The Milbank Quarterly. 80 (1), pp. 5-40.
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4.
Health System Performance and Reform
February 10
Coyne, J. and Hilsenrath, P, “The World Health Report 2000: Can Health Care Systems
Be Compared Using a Single Measure of Performance?” American Journal of Public
Health (92)1, 2002.
Navarro, Vicente, “The World Health Report 2000: Can Health Care Systems Be
Compared Using a Single Measure of Performance?” American Journal of
Public Health (92)1, 2002.
The World Health Organization, The World Health Report 2000.
http://www.who.int/whr/2000/en/report.htm
Schoen C. Davis, K. How, S.and Schoenbaum S. U.S. Health System Performance: A
National Scorecard. Health Affairs Web Exclusive. Sept. 20, 2006: W457-475.
McGlynn, E. There is no perfect health system Health Affairs (23)3 May/June.
Hussey, P. Anderson, G. et. al. “How Does the Quality of Care Compare in Five
Countries?” Health Affairs (23)3, 2004.
5. Public Health and Health System Reform
February 17
Baker, E. et. al. “Health Reform and the Health of the Public.” JAMA (272)16, 1994.
Fielding, J. and Halton, N. “Where is the Health in Health System Reform?” JAMA
(272)16,1994.
Alderslade, R. “The New Public Health,” unpublished paper (See Blackboard).
Frieden, T. and Mostashari, F. “Health Care as if Health Mattered.” JAMA (299)8, 2008.
Reinhardt, U. “Reorganizing the Financial Flows in American Health Care.” Health
Affairs (12), Supplement, 1993. (This article illustrates what the first two are criticizing.
It also adds needed piece on financing that is de-emphasized by Daschle and advocates of
managed competition).
6. Obstacles to Reform
February 24
Brown, L. “The Amazing Noncollapsing U.S. Health Care System – Is Reform Finally at
Hand? New Eng.J. of Med. (358) 4, 2008.
Oberlander, J. “Learning from Failure in Health Care Reform.” New Eng.J. of Med
New Eng.J. of Med (357) 17, 2007
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Blumenthal, D. and Morone, J. “The Lessons of Success – Revisiting the Medicare
Story.” New Eng.J. of Med (357) 17, 2007
Vladeck, B. “Universal Health Insurance in the United States: Reflections on the Past, the
Present, and the Future.” American Journal Public Health (93) 1, 2003, pp. 25-30.
COMPARATIVE ANALYSIS, CASE STUDIES AND POLICY LEARNING
7. Learning from Abroad: Issues of Method
March 3
Marmor, T. Freeman, R. and Okma, K. “Comparative Perspectives and Policy Learning
in the World of Health Care.” J. of Comparative Policy Analysis (7)4. 2005: 331-348.
Klein, R. “Risks and Benefits of Comparative Studies: Notes from Another Shore.”
Milbank Q. (69)2, 1991.
Maynard, A. “European Health Policy Challenges.” In Special Issue of Health
Economics.
8. Lessons from Abroad: A PBS Documentary
March 10
Aaron, H. and Schwartz, W. (with Cox, M.) Can We Say No? The Challenge of Rationing
Health Care. Washington D.C.: Brookings, 2005. Ch.1-3.
Light, D.W. “Universal Health Care: Lessons From the British Experience,” American
Journal Public Health (93) 1, 2003, pp. 25-30.
Enthoven, A. “In Pursuit of an Improving National Health Service,” Health Affairs
(19)3, 2000.
Oliver, A. “The British National Health Service: 1979-2005.” In Health Economics.
Spring Break
March 17
9. Britain’s NICE: Lessons for a Federal Health Board in the U.S.?
March 24
Klein, R. “Big Bang Health Reform: Does It Work? The Case of Britain’s 1991 NHS
Reforms,” Milbank Quarterly (73)3, 1995.
Klein, R. “What’s Happening to Britain’s National Health Service?” New Eng. J. of
Medicine(345)4, 2001.
Pearson, S. and Rawlins, M. “Quality, Innovation and Value for Money.” JAMA (294)20,
2005.
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Steinbrook, R. “Saying No Isn’t NICE – The Travails of Britain’s National
Institute for Clinical Excellence.” New England J. of Medicine (359)19, 2008.
10. Health Care Rationing in Britain
March 31
Aaron, H. and Schwartz, W. (with Cox, M.) Can We Say No? The Challenge of Rationing
Health Care. Washington D.C.: Brookings, 2005. Chapters 4-8.
Optional Readings:
Marmot, M. “Acting on the Evidence to Reduce Inequalities in Health,” Health Affairs
(18) 3, May/June 1999, pp. 42-44.
Illsley, R. “ Reducing Health Inequalities: Britain’s Latest Attempt,” Health Affairs (18)
3, May/June 1999, pp. 45-46.
11. Reform in Germany: “Manacled Competition?”
April 7
Brown, L and Amelung, V. “Manacled Competition’: Market Reforms in German Health
Care,” Health Affairs (18) 3, May/June 1999, pp.76-94.
Altenstetter, C. “Insights From Health Care in Germany.”American Journal Public
Health (93) 1, 2003, pp. 25-30.
Worz M. and Busse, R.. “Analysing the Impact of Health Care System Change in the EU
Member States: Germany.” Health Economics.
12. French Exceptionalism in Health Care Reform: Is the Status Quo Sustainable?
April 14
Belanger, M. and Mosse, P. “The Search for the Holy Grail: Combining Decentralized
Planning and Contracting Mechanisms in the French Health Care System.” In Health
Economics.
Rodwin and Contributors, Universal Health Insurance in France: How Sustainable?
Washington D.C: Embassy of France, 2006. (Available on line:
http://www.nyu.edu/wagner/health/universal.pdf).
Lancry, P.J and Sandier S. "Rationing health care in France." Health Policy 50, (1999):
23-38.
Sorum, Paul C. “Striking Against Managed Care: The Last Gasp of La Medicine
Liberale?” JAMA 280 (7), (1998): 659-664.
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13.
France: Contemporary Debates
April 21
Rodwin V., “The Rise of Managed Care in the United States: Lessons for French Health
Policy.” In C. Altenstetter and J. Bjorkman, eds., Health Policy Reform, National
Variations and Globalization. New York: St. Martin’s Press, 1997.
Durand-Zaleski, I., Colin, C. and Blum-Boisgard, C. “Preliminary Evaluation of an
Attempt to Merge Mandatory Practice Guidelines and Cost Containment in France,”
British Medical J. (315) 1997, pp. 9-20.
Sorum, P. C. "Striking Against Managed Care: The Last Gasp of la Medicine
Liberale?" JAMA 280, no. 7 (1998): 659-64.
Sorum, P. C. "Two Tiers Of Physicians in France: General Pediatrics Declines,
General Practice Rises." JAMA 280, no. 12 (1998): 1099-101.
14.
Final Presentations
April 28
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Short Bibliography on Health Systems and Reform Efforts Abroad
1. C. Altenstetter and J. Bjorkman, eds., Health Policy Reform, National Variations and
Globalization. New York: St. Martin’s Press, 1997.
2. O. Anderson, The Health Services Continuum in Democratic States. Ann Arbor, MI:
Health Administration Press, 1989.
3. P. Basch, Textbook of International Health. Oxford: Oxford University Press, 1999.
4. A. Bennett, and O. Adams, Looking North: What Can We Learn from Canada’s Health Care
System? San Francisco: Jossey-Bass, 1993.
5. J. Campbell and N. Ikegami, The Art of Balance in Health Policy: Maintaining Japan’s LowCost Egalitarian System. New York: Cambridge University Press, 1998.
6. J. De Kervasdoue, J. Kimberly, and V. Rodwin, eds., The End of an Illusion: The Future of
Health Policy in Western Industrialized Nations. Berkeley: University of California Press,
1984.
7. A. Ellenweig, Analyzing Health Systems: A Modular Approach. New York: Oxford
University Press, 1992.
8. M. Field, ed., Success and Crisis in National Health Systems. New York: Routledge, 1989.
9. D. Fox, Health Policies, Health Politics. Princeton, NJ: Princeton University Press, 1986.
10. R. Freeman, The Politics of Health in Europe. Manchester and New York: Manchester
University Press, 2000.
11. W. Glaser, Health Insurance in Practice: International Variations in Financing, Benefits,
and Problems. San Francisco: Jossey-Bass, 1991.
12. L. Graig, Health of Nations: An International Perspective on U.S. Health Care Reform.
Washington, DC: CQ Press, 1999.
13. Health Affairs, Pursuit of Health Systems Reform (Special Issue,10, Fall 1991.
14. Health Affairs International Health Reform. (Special Issue 18;3, May/June 1999.
15. J. Hurst, The Reform of Health Care: A Comparative Analysis of Seven OECD Countries.
Paris: OECD, 1992.
16. E. Immergut, Health Politics: Interests and Institutions in Western Europe. New York:
Cambridge University Press, 1992.
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17. Investing in Health: World Bank Development Report. Washington, DC: World Bank, 1993.
18. M. Jerome-Forget, J. White, and J. Weiner, eds., Health Care Reform through Internal
Markets: Experience and Proposals. Washington, DC: Brookings Institute for Research on
Public Policy, 1995.
19. Journal of Health Policy, Politics and Law, “Comparative Health Policy” Special Issue, 17,
Winter, 1992.
20. R. Klein, The New Politics of NHS, third edition. London: Longman, 1995.
21. M. Lassey, W. Lassey, and M. Jinks, Health Care Systems Around the World. Upper Saddle
River, NJ: Prentice Hall, 1997.
22. H.M. Leichter, A Comparative Approach to Policy Analysis: Health Care Policy in Four
Nations. Cambridge: Cambridge University Press, 1979.
23. J. Lemco, ed. National Health Care: Lessons for the United States and Canada. Ann Arbor:
University of Michigan Press, 1994.
24. T. Marmor, Understanding Health Care Reform. New Haven: Yale University Press, 1994.
25. J. Merrill, The Road to Health Care Reform. New York: Plenum, 1994.
26. OECD, The Reform of Health Care: A Comparative Analysis of Seven OECD Countries
(Paris: OECD, 1992).
27. OECD, Health: Quality and Choice. Paris, 1994.
28. OECD, New Directions in Health Policy. Paris, 1995.
29. OECD, Health Care Reform: The Will to Change. Paris, 1996.
30. OECD, Internal Markets in the Making: Health Systems in Canada, Iceland and the United
Kingdom. Paris, 1995.
31. L. Payer, Medicine and Culture: Varieties of Treatment in the United States, England, West
Germany and France. New York: Henry Holt, Owl Book Edition, 1996.
32. M. Raffel, ed., Health Care Reform in Industrial Countries. University Park, PA:
Pennsylvania State University Press, 1997.
33. V. Rodwin, The Health Planning Predicament: France, Quebec, England and the United
States. Berkeley: University of California Press, 1984.
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34. M. Roemer, National Health Systems of the World (Vols. 1 and 2). New York: Oxford, 1991.
35. R. Saltman, and C. Van Otter, Planned Markets and Public Competition: Strategic Reform in
Northern Europe Health Systems. Philadelphia: Open University Press, 1992.
36. R. Saltman, and C. Van Otter, Implementing Health Care Reform. Bristol. PA: Open
University Press, 1995.
37. R. Saltman and J. Figueras, European Health Care Reform. Cophenhagen: World Health
Organization, 1997.
37. C. Tuohy, Accidental Logics: The Dynamics of Change in the Health Care Arena in the
United States, Britain, and Canada. New York: Oxford, 1999.
38.A. Wall,ed., Health Care Systems in Liberal Democracies. London. Routledge, 1996.
Websites
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OECD/Education, Employment, Labour and Social Policy Directorate: http://www.oecd.org;
OECD in Figures http://www.ocde.org/publications/figures/Index.htm; OECD Free On-Line
Documents http://www.ocde.org/els/papers/papers.htm
International Clearinghouse of Health System Reform Initiatives (ICHSRI)
http://www.insp.mx/ichsri/
European Clearing House on Health Systems Reform
http://www.leeds.ac.uk/nuffield/infoservices/ECHHSR/home.html
Clearinghouse on Health Sector Reform in Latin America and the Caribbean
http://www.americas.health-sector-reform.org
Publications of the International Health Systems Group (IHSG)
http://www.hsph.harvard.edu/ihsg/publications.html
Centers for Disease Control and Prevention: http://www.cdc.gov
UNAIDS The Joint UN Programme on HIV/AIDS:
United Nations Children's Fund (UNICEF) works for children worldwide:
http://www.unicef.org
United Nations Development Programme: http://www.undp.org
United Nations Population Fund – UNFPA: http://www.unfpa.org
UN International Drug Control Programme: http://www.undcp.org
UNESCO home page - United Nations Educational, Scientific and Cultural Organization:
http://www.unesco.org
United Nations’ InfoNation
http://www.un.org/Pubs/CyberSchoolBus/infonation/e_infonation.htm
WHO/OMS: World Health Organization: http://www.who.int; WHO Statistical Information
System (WHOSIS) http://www.who.int/whosis/; WHO Europe http://www.who.dk/
The World Bank Group: http://www.worldbank.org; Development data
http://www.worldbank.org/data/; Health Reform Online
http://www.worldbank.org/healthreform/
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International Longevity Center - USA, Ltd.: http://www.ilcusa.org