DRAFT: 9/2/2014
SUP-500: Introduction to U.S. Health Care Policy
Fall 2014 Syllabus
Day: Tuesdays 4:10-6pm
Room: L230
Instructors
Sheila Burke
Kennedy School of Government
79 JFK Street, Mailbox 103
Phone : 617-495-7741
Email: Sheila_Burke@harvard.edu
Benjamin Cook
Cambridge Health Alliance
120 Beacon Street
Phone: (617) 503-8449
Email: bcook@charesearch.org
Course Assistant- Jessica Altman
Email – Jessica_altman@hks15.harvard.edu
Phone - (650) 465 - 0994
Office Hours - TBD
Sheila Burke and Benjamin Cook
Office Hours: TBD - Tuesdays - T410
Assistant: Elizabeth Steffen – Elizabeth_Steffen@harvard.edu
Course Overview
The aim of this course is to provide students with an overview of the U.S. health care system, its
components, and the policy challenges created by its organization. During the fall 2014 we will
give special attention to the status and implementation of the new reform legislation at the state
and federal levels and to the budgetary implications of health care spending more broadly. We
will focus on the major health policy institutions and important issues that cut across institutions,
including private insurers and the federal/state financing programs (Medicare and
Medicaid/SCHIP). Attention also will be given to mental health issues, disparities in access to
care, the quality of care, structure of the delivery system, the challenges of long-term care and
the aging of the population, and the drivers of cost growth. The course will draw on lectures by
the faculty and national expert “guests”, on assigned readings, and on in-class discussions.
Students are expected to actively participate in the discussion. Literature from economics,
political science, medical sociology, and ethics will be referenced throughout the course;
however, no disciplinary background is assumed, nor is any special familiarity with the field of
health care required.
Course Learning Objectives: At the conclusion of this course, students will be able to:
1. Describe basic concepts related to health insurance coverage
2. Explain how both private health insurance and public health insurance are financed and
work
3. Compare and contrast private and public financing and delivery models of healthcare
services
4. Identify the various determinants of access to care for low-income and vulnerable
populations
5. Evaluate how specific policy proposals will likely affect access to care and healthcare
spending
6. Analyze how the political process affects the financing and delivery of healthcare the
U.S.
Course Webpage: When possible, the PowerPoint files for each lecture will be posted to the
course page in advance of the class.
9/9 - Intro - Overview of Course: US Health Care System
9/16 - Topic – Private Insurance
9/23 - Topic – Disparities
9/30 - Topic - Medicaid / Memo #1 Assigned
10/7 - Topic – Medicare / Memo #1 Due
10/14 – Topic -Health Care Costs: Mike Chernew
10/21 – Topic -Affordable Care Act / Memo #1 Returned
10/28 – Topic – Politics and Public Opinion: Bob Blendon / Memo #2 Assigned
11/4 - Topic – Aging and Long Term Care: David Grabowski
11/11 –
VETERANS DAY (no class)
11/18 - Topic – Mental Health: Thomas McGuire / Memo #2 Due
11/25 - Topic - Quality of Care: Ashish Jha / Memo #2 Returned
12/2 Final Presentations
Course Requirements
Students will be expected to complete the assigned readings, attend and participate in class
discussions, write 2 policy memos, and participate in a group exercise.
Electronic Materials
This class uses the available websites to post lecture slides, supplementary materials, and some
announcements.
Course Grading
Final grades for the course will be determined as follows:
Memo 1 (due 10/14):
Memo 2 (due TBD):
Group Exercise:
30%
30%
40% [20% memo/20% in class presentation]
*Final course grade also will consider attendance and class participation
Class Protocol
Students are expected to attend all classes. During class, cell phones must be turned off or on
vibrate mode. Laptops are permitted for note taking purposes.
Course Materials
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There are no required textbooks for this course.
Links to required readings available online are listed within syllabus.
Readings not available online will be given out at the beginning of the course. Additional
materials may be distributed during the course of the semester.
9/9/14 INTRO to COURSE and OVERVIEW of US HEALTH CARE SYSTEM
In addition to describing the basic approach and structure of the course, the goal of the first
lecture is to detail the general goals, structure, and performance of the U.S. health system.
Attention will be paid both to the substantial progress made over the past century in advancing
our nation’s health and health care as well as to the challenges that remain. Dimensions of the
recent health reform bill will be introduced in this context, providing a framework for discussion
throughout the semester.
Learning Objectives:
 Describe course objectives, format and administration
 Discuss impetus for recent health care reform legislation and an overview of challenges
facing the US health care system
1.
2.
Stephen J. Williams, Paul R. Torrens. Introduction to Health Services Fifth Edition.
Chapter 1, “Historical Evolution and Overview of Health Services in the United
States,” 3-35. Albany, New York: Delmar Publishing. (PDF available on Course
Page)
Cutler DM, Rosen AB, Vijan S. The value of medical spending in the United States,
1960-2000. N Engl J Med. 2006 Aug 31;355(9):920-7.
http://www.nejm.org/doi/pdf/10.1056/NEJMsa054744
3.
SKIM: Centers for Medicare and Medicaid Services, Office of the Actuary, “National
Health Expenditures Projections 2010-2020” [Available at:
http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trendsand-Reports/NationalHealthExpendData/downloads/proj2010.pdf
4.
Atul Gawande, “The Cost Conundrum – What a Texas town can teach us about
health care.” The New Yorker: June 1, 2009
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?cur
rentPage=all
5.
6.
7.
8.
9.
9/16/14
Nolte, E, and C. Martin McKee. “Avoidable Through Health Care – Progress in the
US Lags that of Three European Countries,” Health Affairs August 2012.
http://content.healthaffairs.org/content/early/2012/08/20/hlthaff.2011.0851.full
The Editorial Board, “The Shame of American Health Care,” The New York Times,
November 17, 2013. http://www.nytimes.com/2013/11/18/opinion/the-shame-ofamerican-health-care.html?_r=0
Squires, D. “The Global Slowdown in Health Care Spending Growth,” JAMA,
Published online June 26, 2014.
http://jama.jamanetwork.com/article.aspx?articleID=1885447&utm_source=Silverchai
r%20Information%20Systems&utm_medium=email&utm_campaign=JAMA:OnlineFir
st06/26/2014
Davis, K, et al. “Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care
System Compares Internationally.” The Commonwealth Fund Executive Summary,
June 2014. http://www.commonwealthfund.org/~/media/files/publications/fundreport/2014/jun/1755_davis_mirror_mirror_2014.pdf
B. Meier, et al., “Hospital Billing Varies Wildly, U.S. Data Shows,” New York
Times, May 8, 2013. http://www.nytimes.com/2013/05/08/business/hospitalbilling-varies-wildly-us-data-shows.html?pagewanted=all
PRIVATE INSURANCE
This lecture provides a discussion of various concepts related to insurance: uncertainty, risk,
adverse selection, and moral hazard. It applies these concepts to a few health insurance reform
issues, namely community rating, guaranteed issue, and benefit mandates. It evaluates several
advantages and disadvantages to group insurance in the employment-based setting –
particularly those related to the so-called “tax subsidy” for employment-based insurance.
Learning Objectives:
 Discuss a brief history of US employment–based insurance system
 Describe how moral hazard and adverse selection affect insurance markets and efforts
to reform the health insurance system
1.
Blumenthal D. “Employer-Sponsored Health Insurance in the United States – Origins
and Implications,” New England Medical Journal 355(1), 2006: 82-88.
http://www.nejm.org/doi/pdf/10.1056/NEJMhpr060703
2.
Kaiser Family Foundation. “How Private Health Coverage Works: A Primer, 2008
Update.” April 2008.
http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7766.pdf
3.
4.
5.
6.
Income, Poverty, Health Insurance Coverage in the U.S. 2011. Current Population
Reports P60-243; September 2012. Pp 21-27.
http://www.census.gov/prod/2012pubs/p60-243.pdf
Baicker K, Chandra A. “Myths and misconceptions about U.S. health insurance.”
Health Aff (Millwood). 2008 Nov-Dec;27(6):w533-43.
http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/cgi/reprint/27/6/w533
Schoen, C, et al. “Access, Affordability, and Insurance Complexity Are Often Worse
in the United States Compared to Ten Other Countries,” Health Affairs 32(12), 2013:
2205-2215. http://content.healthaffairs.org/content/32/12/2205.full.pdf
L. Clemans-Cope, et al., “Limiting the Tax Exclusion of Employer-Sponsored Health
Insurance Premiums: Revenue Potential and Distributional Consequences,” Robert
Wood Johnson Foundation: Urban Institute, May 2013. (6 pages + appendix).
Skim. http://www.urban.org/UploadedPDF/412816-Limiting-the-Tax-Exclusion-ofEmployer-Sponsored-Health-Insurance-Premiums.pdf
9/23/14
DISPARITIES
This lecture provides an overview of racial/ethnic and socioeconomic status disparities in health
and health care outcomes in the U.S, This class will explore explanations for the relationships
between these factors and various health outcomes, using examples from mental health and
mental health care to highlight concepts. We will discuss how disparities might arise from
multiple levels, including the physician-patient interactions and the health care system.
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Learning Objectives:
Describe evidence on racial/ethnic disparities in health outcomes and health care use in
the United States
Describe the mechanisms by which disparities arise, and the ramifications that this has
on measurement and tracking of disparities and policies aimed at reducing these
disparities.
1.
2.
3.
4.
5.
6.
9/30/14
Centers for Disease Control and Prevention. CDC Health Disparities and Inequalities
Report — United States, 2013. MMWR 2013;62(Suppl 3).
http://www.cdc.gov/mmwr/pdf/other/su6203.pdf
Williams, David R., and Chiquita Collins. "Racial residential segregation: a
fundamental cause of racial disparities in health." Public health reports 116.5 (2001):
404. http://www.publichealthreports.org/issueopen.cfm?articleID=1121
IOM, What healthcare system administrators need to know about racial and ethnic
disparities in healthcare.
http://www.iom.edu/~/media/Files/Report%20Files/2003/Unequal-TreatmentConfronting-Racial-and-Ethnic-Disparities-in-Health-Care/DisparitiesAdmin8pg.pdf
IOM, What healthcare providers need to know about racial and ethnic disparities in
healthcare. http://www.iom.edu/~/media/Files/Report%20Files/2003/UnequalTreatment-Confronting-Racial-and-Ethnic-Disparities-in-HealthCare/Disparitieshcproviders8pgFINAL.pdf
AHRQ, National Healthcare Disparities Report, 2013,
http://www.ahrq.gov/research/findings/nhqrdr/nhdr13/2013nhdr.pdf
Cook, Benjamin L., Thomas G. McGuire, and Alan M. Zaslavsky. "Measuring
racial/ethnic disparities in health care: methods and practical issues." Health services
research 47.3pt2 (2012): 1232-1254.
http://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2012.01387.x/pdf
MEDICAID
This lecture provides an overview of the Medicaid program. It begins by discussing eligibility,
financing, and administration of the Medicaid program by federal and state governments. It then
discusses issues related to Medicaid spending – focusing on both long-term care and Medicaid
managed care – and expansions to Medicaid through the state Children’s Health Insurance
Program (CHIP). The lecture concludes by discussing several long-term challenges facing the
Medicaid program.
Learning Objectives:
 Define key features of :
- Medicaid history
- Covered services
- Population
- Provider payments
- Federal/state role
 Describe key elements of health reform
- Take up by states
- Continuing political discussion
1. Kaiser Commission on Medicaid and the Uninsured, Medicaid: A Primer, March 2013.
http://kaiserfamilyfoundation.files.wordpress.com/2010/06/7334-05.pdf
2. Sommers, B. Baicker, K. Epstein, A. Mortality and Access to Care among Adults after
State Medicaid Expansions. New England Journal of Medicine, 2012.
http://www.nejm.org/doi/pdf/10.1056/NEJMsa1202099
3. Kaiser Commission on Medicaid and the Uninsured, Medicaid's Role for Dual Eligible
Beneficiaries, April 2012. http://www.kff.org/medicaid/upload/4091-08.pdf.
4. Kaiser Commission on Medicaid and the Uninsured, Where are States Today? Medicaid
and CHIP Eligibility Levels for Children and Non-Disabled Adults, July 2012.
http://www.kff.org/medicaid/7993.cfm
5. Kaiser Commission on Medicaid and the Uninsured, How will the Medicaid Expansion
for Adults Impact Eligibility and Coverage?, July 2012.
http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8338.pdf
6. Rosenbaum, Sara and Timothy Westmoreland, “The Supreme Court’s Surprising
Decision on the Medicaid Expansion: How Will the Federal Government and States
Proceed?” Health Affairs, 31(8): 2012 pp 1663-1572.
http://content.healthaffairs.org/content/31/8/1663.full.pdf
7. Kaiser Commission on Medicaid and the Uninsured, Medicaid Financing: An Overview of
the Federal Medicaid Matching Rate (FMAP), September 2012.
http://www.kff.org/medicaid/8352.cfm
8. Baicker et al. “The Oregon Experiment Effects of Medicaid on Clinical Outcomes” NEJM
368(18), 2013:1713-1722. http://www.statecoverage.org/files/NEJM_OR_Experiment.pdf
9. H. A. Pollack, “State Medicaid Policy and Health Reform,” Journal of Health Politics,
Policy and Law 38(1), 2013: 161-163.
http://jhppl.dukejournals.org/content/38/1/161.full.pdf
10. A. B. Frakt, A. E. Carroll, “Sound Policy Trumps Politics: States Should Expand
Medicaid,” Journal of Health Politics, Policy and Law 38(1), 2013: 165-178.
http://jhppl.dukejournals.org/content/38/1/165.full.pdf
11. Kaiser Family Foundation, What Difference Does Medicaid Make?” May 2013. (10 pages
+ appendices) http://kaiserfamilyfoundation.files.wordpress.com/2013/05/8440-whatdifference-does-medicaid-make2.pdf
12. S. Dorn, M. McGrath, and J. Holohan. “What is the Result of States Not Expanding
Medicaid?” Urban Institute, August 2014. http://www.rwjf.org/en/researchpublications/find-rwjf-research/2014/08/what-is-the-result-of-states-not-expandingmedicaid-.html
10/7/14
MEDICARE
Medicare was signed into law on July 30, 1965, 48 years ago and is considered by many to
have been a tremendous success. It withstood tremendous opposition from physician groups
and many hospitals, particularly those in the South who were being forced to desegregate
because of the law. But questions have arisen about its design and sustainability. Fears about
insolvency have plagued the program for years. Medicare was central to the new reform
legislation as more than half of the $938B price tag will be paid from Medicare savings, which
will also extend the solvency of the program. Medicare has also been the subject of much
discussion in the recent efforts to address the long-term Federal budget deficit and calls for
reform constant. This session will provide an overview of the history of the program, its design
and the challenges it faces going forward.
Learning Objectives:
 Define key features of Medicare
- History
- Covered services
- Payment structures
- Beneficiaries
 Describe current debate over future structure and design
1.
2.
3.
4.
5.
6.
7.
8.
9.
Kaiser Family Foundation. Medicare At A Glance. November 2012.
http://kff.org/medicare/fact-sheet/medicare-at-a-glance-fact-sheet/
Kaiser Family Foundation. The Facts on Medicare Spending and Financing. July 28,
2014. http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/
Ball R.M. “What Medicare’s Architects Had in Mind.” Health Affairs 14(4), 1995: 6272. http://content.healthaffairs.org/content/14/4/62.full.pdf
Kaiser Family Foundation: The Nuts and Bolts of Medicare Premium Support
Proposals, June 2011 http://www.kff.org/medicare/upload/8191.pdf
Alain Enthoven and Alan Glaseroff. August 16, 2012. “Bring Medicare into the 21st
Century,” Health Affairs (blog). http://healthaffairs.org/blog/2012/08/16/bringmedicare-into-the-twenty-first-century/
Chernew ME, Frank RG and Parente ST. “Slowing Medicare Spending Growth:
Reaching for Common Ground. Am J Manag Care. 2012;18(8):465-8. http://ezpprod1.hul.harvard.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true
&db=aph&AN=79720856&site=ehost-live&scope=site
Health Affairs Health Policy Briefing. “Reconstructing Medicare.” June 20, 2013.
http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_95.pdf
Baicker, K. et al. ”Public Financing of the Medicare Program Will Make It’s Uniform
Structure Increasingly Costly to Sustain,” Health Affairs 32(5), 2013: 882-890.
http://content.healthaffairs.org/content/32/5/882.full.pdf
Chandra, A., Dalton, MA, and Holmes, J. “Large Increases In Spending on Postacute
Care in Medicare Point to the Potential for Cost Savings in These Settings,” Health
Affairs 32(5), 2013: 864-872. http://content.healthaffairs.org/content/32/5/864.full.pdf
10.
11.
E. Porter, “Medicare Needs Fixing, but Not Right Now,” The New York Times,
February 27, 2013. http://www.nytimes.com/2013/02/27/business/medicare-needsfixing-but-not-right-now.html?pagewanted=all
J. P. Newhouse, A. M. Garber, “Geographic Variation in Medicare Services,” NEJM
368(16), 2013: 1465-1468. http://www.nejm.org/doi/pdf/10.1056/NEJMp1302981
Optional Readings:
12.
13.
The Kaiser Family Foundation. Comparison of Medicare Support Proposals, July 26,
2012 http://www.kff.org/medicare/upload/8284.pdf
The Kaiser Family Foundation. Policy Options to Sustain Medicare for the Future.
January, 2013. http://kff.org/medicare/report/policy-options-to-sustain-medicare-forthe-future/
10/14/14 HEALTH CARE COSTS: Mike Chernew, Professor of Health Care Policy in the
Department of Health Care Policy at Harvard Medical School
This session will provide an overview of the factors that drive increases in health care spending
and the consequences of continued spending growth. The lecture also will explore potential
approaches to slow spending growth and strengths and limitations of these approaches.
Learning Objectives:
 To understand the distinction between the level of spending and rate of spending
growth.
 To identify drivers of spending growth
 To examine ways to slow growth
1.
2.
3.
4.
5.
6.
Chernew ME, Hirth RA, Sonnad S, Ermann R, Fendrick AM. “Managed Care,
Medical Technology, and Health Care Cost Growth: A Review of the Evidence.”
Medical Care Research and Review 1998; 55(3): 259-288.
http://deepblue.lib.umich.edu/bitstream/handle/2027.42/68674/10.1177_1077558798
05500301.pdf?sequence=2
Feldstein, Paul J. “The Rise of Medical Expenditures,” Health Policy Issues: An
Economic Perspective, 5th Edition. Health Administration Press, Chpt 1. (PDF
available on Course Page)
Hartman, M. et al. 2010, “Health Spending Growth at Historic Low in 2008,” Health
Affairs 29(1): 147-155. http://content.healthaffairs.org/content/29/1/147.full.pdf
Sisko, A., et al. 2010. “National Health Spending Projections: The Estimated Impact
of Reform Through 2019,” Health Affairs 29(10): 1933-1941.
http://content.healthaffairs.org/content/29/10/1933.full.pdf
“Bending the Cost Curve through Market-Based Incentives” NEJM 376(10), 2012.
http://www.nejm.org/doi/pdf/10.1056/NEJMsb1207996
Fuchs, V. R. “The Gross Domestic Product and Health Care Spending,” New
England Journal of Medicine 369(2), 2013:107-109.
http://www.nejm.org/doi/pdf/10.1056/NEJMp1305298
7.
8.
Chernew, M.E. et al. “The Specter of Financial Armageddon – Health Care and
Federal Debt in the United States,” NEJM 362(13), 2010: 1166-1168.
http://comedsoc.org/images/HCR%20Financial%20Armegeddon%20Chernew%20N
EJM%204-1-10.pdf
Chandra, A, Holmes, J, and Skinner, J. “Is This Time Different? The Slowdown in
Health Care Spending.” Brookings Papers on Economic Activity, Fall 2013, pp.261323.
http://www.brookings.edu/~/media/Projects/BPEA/Fall%202013/2013b_chandra_hea
lthcare_spending.pdf
Optional Readings:
9.
10/21/14
“A Systematic Approach to Containing Health Care Spending” The New England
Journal of Medicine Sounding Board. http://www.nejm.org.ezpprod1.hul.harvard.edu/doi/pdf/10.1056/NEJMsb1205901
AFFORDABLE CARE ACT
The failure to reshape the nation’s health care system in 1993 was not the first time an
administration tried to tackle this issue; but after years of efforts, the passage of the Patient
Protection and Accountability Act was realized in March of 2010. The main objective of this
session is to examine why the effort was successful, the key elements and goals of the
legislation, implementation challenges that lie ahead, and remaining issues to be resolved in the
reform of our health care system. Among those issues discussed: insurance reform, exchanges,
essential health benefits.
Learning Objectives:
 Describe key elements of legislation
 Discuss progress in implementation and potential road blocks
 Describe differing roles state and federal government
1.
2.
3.
4.
5.
Hinda Chaikind, Curtis W. Copeland, C. Stephen Redhead, Jennifer Staman.
PPACA: A Brief Overview of the Law, Implementation and Legal Challenges.
Congressional Research Service, March 2, 2011.
http://www.nationalaglawcenter.org/assets/crs/R41664.pdf.
Oberlander J. Long time coming: why health reform finally passed. Health Aff
(Millwood). 2010 Jun;29(6):1112-6. http://content.healthaffairs.org.ezpprod1.hul.harvard.edu/content/29/6/1112.full.pdf
A Guide to the Supreme Court’s Affordable Care Act Decision
http://www.kff.org/healthreform/8332.cfm
Feldstein, Paul J. “The Politics of Health Care Reform” Health Policy Issues: An
Economic Perspective, 5th Edition. Health Administration Press. Chapter 36. (PDF
available on Course Page)
Jon Kingsdale and John Bertko: “Insurance Exchanges Under Health Reform: Six
Design Issues For The States” in Health Affairs 29, No. 6 (2010): 1158–1163.
http://content.healthaffairs.org/content/29/6/1158.full.pdf
6.
7.
8.
9.
10.
11.
10/28/14
Antos, JR. “Health Care Reform After the ACA,” The New England Journal of
Medicine 370(24), 2014: 2259-2261.
http://www.nejm.org/doi/pdf/10.1056/NEJMp1404298
Blumenthal, D, and Collins, SR. “Health Care Coverage Under the Affordable Care
Act – A Progress Report,” New England Journal of Medicine, Published online, July
2, 2014. http://www.nejm.org/doi/pdf/10.1056/NEJMhpr1405667
K. Keith, et al., “Implementing the Affordable Care Act: State Action on the 2014
Market Reforms,” The Commonwealth Fund, February 2013. (12 pages)
http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2013/1
662_Keith_implementing_ACA_state_action_2014_reform_brief_v2.pdf
Kaiser Family Foundation, Summary of Affordable Care Act, April 2013.
http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/
Ezekiel Emanuel, “Inside the Making of Obamacare,” Wall Street Journal, March 7,
2014.
http://online.wsj.com/news/articles/SB1000142405270230382420457942155391438
2752
Ezra Klein, “11 Facts about the Affordable Care Act,” Washington Post, June 24,
2012. http://www.washingtonpost.com/blogs/wonkblog/wp/2012/06/24/11-factsabout-the-affordable-care-act/
POLITICS and PUBLIC OPINION: Bob Blendon, Senior Associate Dean for
Policy Translation and Leadership Development and Professor of Health
Policy and Political Analysis, Harvard School of Public Health
For more than a century Americans have debated some form of health reform. The most recent
debate raged for a year and the public’s views weighed heavily on the administration and the
congress as the discussions went on. The current debate over the budget also has raised
questions about the status of the major entitlement programs, Medicare and Medicaid, their
solvency, and their contribution to long-term budget concerns. This session will help us
understand how Americans view these issues, how those views have changed and how they
influence the process of public policy formation.
1.
2.
3.
4.
5.
Litman, Theodor J. 1997. “The Relationship of Government and Politics to Health
and Health Care – A Sociopolitical Overview.” In Theodor Litman and Leonard
Robins, eds., Health Politics and Policy, 3 ed., Albany, NY: Delmar, pp. 3-45. (PDF
available on Course Page)
Blendon, Robert, and John M. Benson. "Elections, partisan views, and health policy”
in American Public Opinion and Health Care, Washington, D.C., CQ Press; 2011.
(PDF available on Course Page)
Blendon, Robert J., and John M. Benson. “Health Care in the 2010 Congressional
Election,” New England Journal of Medicine e30, 2011; 1-5.
http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/pdf/10.1056/NEJMp1011714
Blendon, Robert J., and John M. Benson. “The Public’s View about Medicare and the
Budget Deficit,” New England Journal of Medicine e8, 2011; 1-4.
http://www.nejm.org/doi/pdf/10.1056/NEJMp1107184
Kaiser Family Foundation. Health Tracking Poll 2013. http://kff.org/healthreform/poll-finding/kaiser-health-tracking-poll-june-2013/
6.
7.
8.
11/4/14
Blendon, RJ, and Benson, JM. “The Public and the Conflict over Future Medicare
Spending,” New England Journal of Medicine 369(11), 2013: 1066-1073.
http://www.nejm.org/doi/pdf/10.1056/NEJMsr1307622
Evans, CL. 1995. Chapter 2 – “Committees and Health Jurisdictions in Congress” in
Thomas E. Mann and Norman J. Ornstein, eds., Intensive Care: How Congress
Shapes Health Policy, Washington, DC: American Enterprise Institute and The
Brookings Institution, pp.25-51. (PDF available on Course Page)
Oleszek, W.J. 2010. “Congress and Lawmaking.” Congressional Procedures and the
Policy Process, 8th Edition. Washington, D.C.: CQ Press, Chapter 1, pp. 1-45. (PDF
available on Course Page)
AGING and LONG TERM CARE: David Grabowski, professor of health care
policy in the Department of Health Care Policy at Harvard Medical School.
The main objective of this session is to give an overview of the provision of long-term care in the
United States and the vital importance of Medicare and especially Medicaid in the financing of
care. Attention will also be given to discussing the important ways that long-term care is distinct
from acute care. Finally, we will discuss implications of the Patient Protection and Affordable
Care Act for long-term care.
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1.
2.
3.
4.
Learning Objectives:
Describe LTC and why it is important
Discuss key policy challenges
Discuss LTC and health reform
Kaye HS, Harrington C, LaPlante MP. Long-term care: who gets it, who provides it,
who pays, and how much? Health Aff (Millwood). 2010 Jan-Feb;29(1):11-21.
http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/content/29/1/11.full.pdf
Grabowski DC. Medicare and Medicaid: Conflicting Incentives for Long-Term Care.
The Milbank Quarterly 2007;85(4): 579-610.
http://www.milbank.org/quarterly/8504feat.html
Miller EA. The affordable care act and long-term care: comprehensive reform or just
tinkering around the edges? J Aging Soc Policy. 2012;24(2):101-17.
http://www.tandfonline.com/doi/pdf/10.1080/08959420.2012.659912
Health Affairs-Robert Wood Johnson Foundation Policy Brief. Care for Dual Eligibles.
June 2012. Available at:
http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_70.pdf
11/11/14
VETERAN’S DAY: No Class
11/18/14
MENTAL HEALTH: Thomas McGuire, Department of Health Care Policy,
Harvard Medical School.
About one in four adults in the U.S. suffer from a diagnosable mental disorder in a given year.
This high level of morbidity has economic and social consequences including for the
organization of financing of mental health care. In this class, we will examine policies and
services that influence access to mental health care and treatment of persons with mental
illness. We will provide a historical overview of mental health care policy in the United States,
the basics of mental health care economics, and discuss how historical changes contribute to
the current state of mental health care policy and efforts at mental health care reform.
Learning Objectives
 Provide a historical overview of mental health care policy in the United States
 Examine core economic concepts important to understanding development of mental
health care policy
 Discuss the ramifications of the Parity Act and Affordable Care Act on mental health
care policy in the U.S.
1.
2.
3.
4.
11/25/14
Kessler, Ronald C., et al. 2005. "Prevalence, severity, and comorbidity of 12-month
DSM-IV disorders in the National Comorbidity Survey Replication." Archives of
general psychiatry 62(6): 617-627.
http://archpsyc.jamanetwork.com/article.aspx?articleid=208671&gt
Frank, Richard G., and Sherry Glied. "Changes in mental health financing since
1971: implications for policymakers and patients." Health Affairs 25.3 (2006): 601613. http://content.healthaffairs.org/content/25/3/601.full.pdf
Barry, Colleen L., and Haiden A. Huskamp. "Moving beyond parity—mental health
and addiction care under the ACA." New England Journal of Medicine 365.11 (2011):
973-975. http://www.nejm.org/doi/pdf/10.1056/NEJMp1108649
McGuire, Thomas G., et al. (2014) “Assessing Incentives for Service-Level Selection
in Private Health Insurance Exchanges,” Journal of Health Economics, (35): 47-63.
http://www.sciencedirect.com/science/article/pii/S0167629614000101
QUALITY of CARE: Ashish Jha, Professor of Health Policy at Harvard
School of Public Health
This lecture will give an introduction to the current state of quality of care in the U.S., focusing
on two prominent approaches recently used to spur improvement – public reporting and pay for
performance. The lecture will detail the conceptual underpinnings of these approaches as well
as their strengths and limitations and attention will be given to quality-oriented provisions
included in the recent health reform bill.
Learning Objectives:
1.
2.
Epstein AM. Will Pay for Performance Improve Quality of Care? The Answer Is in the
Details. N Engl J Med 2012; 367:1852-1853.
http://www.nejm.org/doi/pdf/10.1056/NEJMe1212133
Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG. Systematic review: the
evidence that publishing patient care data improves quality of care. Ann Intern Med.
2008; 148(2): 111-23. http://ezpprod1.hul.harvard.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true
&db=aph&AN=28399253&site=ehost-live&scope=site
3.
4.
5.
Epstein AM, Lee TH, Hamel MB. Paying Physicians for High-Quality Care. New
Engl J Med. 2004; 350(4): 406-410. http://www.nejm.org.ezpprod1.hul.harvard.edu/doi/pdf/10.1056/NEJMsb035374
Epstein, AM. Public release of public performance data: A progress report from the
front. JAMA 2000; 283(14):1884-1886. http://jama.ama-assn.org.ezpprod1.hul.harvard.edu/cgi/content/full/283/14/1884
Berenson, RA, and Kaye, DR. “Grading a Physician’s Value – The Misapplication of
Performance Measurement,” The New England Journal of Medicine 369(11), 2013:
2079-2081. http://www.nejm.org/doi/pdf/10.1056/NEJMp1312287
Optional Readings:
6.
7.
8.
Jha AK. “Time to Get Serious About Pay for Performance.” JAMA. 2013;309(4):347348. http://jama.jamanetwork.com.ezpprod1.hul.harvard.edu/article.aspx?articleid=1558286
Sutton M, Nikolova S, Boaden R, Lester H, McDonald R, Roland M. “Reduced
Mortality with Hospital Pay for Performance in England.” N Engl J Med 2012;
367:1821-1828. http://www.nejm.org/doi/pdf/10.1056/NEJMsa1114951
Werner RM, Dudley RA. “Medicare’s New Hospital Value-Based Purchasing
Program Is Likely To Have Only A Small Impact On Hospital Payments.” Health
Affairs September 2012 31:1932-1940.
http://content.healthaffairs.org/content/31/9/1932.full.pdf
9.
Jha AK, Joynt KE, Orav JE, Epstein AM. “The Long-Term Effect of Premier Pay for
Performance on Patient Outcomes.” N Engl J Med 2012; 366:1606-1615.
http://www.nejm.org/doi/pdf/10.1056/NEJMsa1112351
10.
11.
Jha AK, Orav EJ, Epstein AM. “The Effect of Financial Incentives on Hospitals That
Serve Poor Patients.” Ann Intern Med. 2010 Sep 7; 153(5):299-306. http://ezpprod1.hul.harvard.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true
&db=aph&AN=53485560&site=ehost-live&scope=site
Damberg CL, Raube K, Teleki, Dela Cruz E. “Taking Stock of Pay for Performance:
A Candid Assessment from the Front Lines.” Health Affairs. 2009; 28(2); 517-525.
http://content.healthaffairs.org/content/28/2/517.full.pdf
12.
Epstein AM. “Pay for Performance at the Tipping Point.” N Engl J. Med. 2007;
356(5): 515-517. http://www.nejm.org.ezp-
prod1.hul.harvard.edu/doi/pdf/10.1056/NEJMe078002
13.
Epstein AM. “Paying for Performance in the United States and Abroad.” N Engl J
Med. 2006; 355(4): 406-408. http://www.nejm.org.ezp-
prod1.hul.harvard.edu/doi/pdf/10.1056/NEJMe068131
14.
Epstein AM. “Rolling down the runway: the challenges ahead for quality report
cards.” JAMA 1998; 279(21):1691-1696. http://jama.jamanetwork.com.ezp-
prod1.hul.harvard.edu/article.aspx?articleid=187602
12/2/13
GROUP PRESENTATIONS AND HAND IN FINAL MEMO