CALIFORNIA STATE UNIVERSITY, LONG BEACH
COLLEGE OF HEALTH AND HUMAN SERVICES
Department of Health Care Administration
HCA 503 Healthcare Economics
Spring 2012
Instructor: Richard L. Tradewell, MBA, Ph.D.
E-Mail: rtradewe@csulb.edu
HCA Dept. Administrative Coordinator:
Deby McGill, dmcgill@csulb.edu
Office Location: E Tec 101
Call Number: 9327
Class Location: ET-105
Tel: 562/985-5694
Catalog Description
Pre-requisites: ECON 101 or 300
Application of microeconomics principles to the health care, the flow of funds through
the health care system including physicians, hospitals, managed care, nursing homes and
pharmaceutical firms. The third party payment, asymmetric information and health care
systems.
Course Description
This course studies basic health economic concepts such as opportunity cost, production
of good health, the demand for medical care, production and cost theory, cost-benefit
analysis, and health care systems and institutions. Other topics of interest include analysis
of the behavior of health care providers, profit maximization, perfect and imperfect
competition, and nonprofit firms’ objectives. The role of government in health matters
and medical care markets as well as a review of limited health care policies are studied
and discussed along with basic and applied research.
Learning Objectives, Domain and Competency Table
The Health Care Administration Department has adopted a competency-based
curriculum, based on the American College of Health Care Executives (ACHE)
Competency Assessment Tool and Healthcare Leadership Alliance (HLA) Competency
Directory. This course is designed to develop competencies in the Knowledge of
Healthcare Environment (KHE) and Business Skills and Knowledge (BSK). This course
also enhances students’ writing and presentation skills that address the domain,
Communication and Relationship Management (CRM).
Learning Objective
Domain
demonstrate an understanding of the KHE
laws and principles of economics,
and the impact of these laws and
principles on healthcare
organizations
Competency
A. Healthcare systems
and organizations
D. The community and
the environment
Activity (A1),
Assignment (A2) or
Assessment (A3)
A1-Lecture/Class
participation; A2Discussion and
article review; A3Quiz and final exam
2
Learning Objective
Domain
describe the various kinds of health
care markets
KHE
BSK
Activity (A1),
Assignment (A2) or
Assessment (A3)
A. Healthcare systems
A1-Lecture/Class
and organizations
participation; A2D. The community and
Discussion and
the environment
article review; A3Quiz and final exam
KHE-A. Healthcare
A1-Lecture/Class
systems and
participation; A2organizations
Discussion and
BSK-A. General
article review; A3management
Quiz and final exam
KHE- D. The community A1-Lecture/Class
and the environment
participation; A2BSK- G. Risk
Discussion and
management
article review; A3Quiz and final exam
A.General management
A3. Term paper
CRM
B. Communication skills
demonstrate an understanding of the KHE cost-benefit concept and its
BSK
application in health services
delivery,
demonstrate an understanding of
governmental regulations and
analyze the economic impact of
various healthcare policies on the
health care
analyze the health care system from
economics point of view
Demonstrate writing and oral
communication skills
KHEBSK
Competency
A2-Article review
and discussion
questions; A3
Article review
Required Text
Getzen, Thomas, 2010. Health Economics and Financing: Wiley Publishing, 4th Ed.
Recommended Text
Feldstein, Paul J. , 2011. Health Policy Issues: An Economic Perspective. Fifth Edition.
Health Administration Press, AUPHA.
(Dr. Feldstein, our dear friend at UCI, provides an invaluable source for essays and
critical thinking).
Other Course Materials
Please note there are additional reading assignments that can be found online at:
http://ereserves.library.csulb.edu or http://coast.library.csulb.edu and click the link (EReserves). You will be asked to select a department (Health Care Administration) or to
select an instructor (Richard Tradewell). After making the selection click the "Go"
button and look for your course. Next you will see a page listing the course - please select
it and you will be prompted for a password (hca503rt). Enter the password and accept the
usage policy. You will then see the list of additional readings. If you have any problems
accessing this information, please visit the eReserves Problem Report or let Tech Support
know and they will help you.
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Course Format
Quizzes/Examination
Each quiz will include about 10 multiple choice questions. You will have one hour to
answer 10 questions. You may take the quiz at any time during the week. You may use
your notes, textbook and any other material available to you to answer quiz questions.
The final exam is a take home which will be provided at the conclusion of the course. It
is a comprehensive exam with integrative components which requires thorough analysis
of economic principles and health care policies. Under no circumstances, make up
quizzes/exams will be given unless the student has proven medical and other problems.
Assignment/Online Discussions
Each week starting on Tuesday and ending on Monday there will be class discussion (s)
of assigned readings and related questions. There will be five or ten questions in each
week to discuss (depending on the schedule). Each student is required to post a response
(or two responses) to the assigned question before the class discussion begins online. We
will use Beachboard, Discussions tool for this purpose. Keep your responses brief –
usually a paragraph or two. My feedback to students will be provided on a timely basis.
Also, students are expected to comment on the other students’ responses. The discussion
questions will deal with the specific assignment, and it will be important that the student
carefully review the readings before responding.
Critical Essay
This paper should be high-quality, appropriate for graduate study, and must be APA style,
10-12 inch font, and double spaced. The paper topic must be chosen from recent news
reports published in newspapers, journals, magazines or Internet. The key to success in this
paper is to explain the economics foundations of the underlying issue or problem appeared
in the news. The chosen topic should be currently important and must be cleared with the
instructor before proceeding. Work-in-progress may reviewed with the instructor for
preliminary feedback. The paper should educate the reader and at least:
a. clearly state and explain the underlying health care and economic issue(s) and
problem(s)
b. describe and explain relevant health, economic, political, and historical background of
the issue
c. explain how economics is related to the chose topic and what economics laws and
principles are applicable
d. describe potential solutions for the issue and policy
e. explain how this issue, problem or policy is viewed by relevant interest groups and how
it affects (or is likely to affect) various health care organizations
f. suggest what you think will be done nor or in the future
g. suggest how health care administrators and their organizations could influence the
outcome
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Course Evaluation and Grading
Final Exam
Quizzes
Class Discussions
Critical Essay
Term Paper Presentation
TOTAL
100 points
100 points (5 quizzes x 20 points)
80 points (8 x 10 points)
100 points
20 points
400 points
Cutoff Points
In this course, students can accumulate up to 320 points from all course requirements.
Course grades will be determined based on the following schedule:
360 points or greater
Less than 360 and greater than 320 points
Less than 320 and greater than 280 points
Less than 280 and greater than 240 points
Less than 240 points
A
B
C
D
F
Summary of Key Online Quiz Deadlines
Quiz I Available Feb 8, 2012 12:00 AM - Feb 13, 2012 11:59 PM
Quiz II Available Mar 7, 2012 12:00 AM - Mar 12, 2012 11:59 PM
Quiz III Available Mar 21, 2012 12:00 AM - Mar 26, 2012 11:59 PM
Quiz IV Available Apr 4, 2012 12:AM – Apr 9, 2012 11:50 PM
Quiz V Available Apr 18, 2012 12:00 AM - Apr 23, 2012 11:59 PM
Final Exam will be posted and discussed in class May 8, 2012 and due May 15.
Summary of Essay Deadlines
Essay topic and sources: March 6, 2012 (To be shared with classmates)
Optional Draft due: March 27, 2012
Final essay due: April 17, 2012
Cheating and Plagiarism
Please ensure that your behavior conforms to University Policy. See:
http://www.csulb.edu/divisions/aa/undergrad/senate/documents/policy/2008/02/
Plagiarism
Plagiarism is the dishonest act of presenting the words or thoughts of another writer as if
they were your own. You commit plagiarism whenever you use a source in any way
without indicating that you have used it. If you quote anything at all, even a phrase, you
must put quotation marks around it, or set it off from your text; if you summarize or
paraphrase an author's words, you must clearly indicate where the summary or paraphrase
begins and ends; if you use an author's idea, you must say that you are doing so. In every
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instance, you must also formally acknowledge the written source from which you took
the material.
Reprinted from Writing: A College Handbook, James A. W Heffernan and John E. Lincoln. By Permission
W. W. Norton & Co., Inc. Copyright 1982 by W. W. Norton & Co. Inc.
If there is anything about plagiarism you do not understand, ask your professor. The
Student Handbook may provide you additional information concerning plagiarism.
Withdrawal policy
See www.csulb.edudivisions/aa/grad_undergrad/senate/documents/policy/2002/02/
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COURSE OUTLINE, READINGS AND QUESTIONS
Lesson 1 (Each work week is Tuesday to the following Monday)
Jan 24 and Jan 31
Review of basic economic concepts
Economic resources
Opportunity cost
Production possibilities curve
Demand and supply
Competition
Profit maximization
Utility Theory
Types of Markets
Readings
Stonebraker’s “Joy of Economics” http://faculty.winthrop.edu/stonebrakerr/book.htm
http://faculty.winthrop.edu/stonebrakerr/book/what_to_produce.htm
Milton Friedman’s “How to Cure Healthcare.” See Content.
Questions
1. What economics principle(s) discussed by Stonebraker should have warned us
that ObamaCare (PPACA) would increase premiums rather than reduce them?
2. Should government protect workers by capping premiums? Why or why not?
Lesson 2
Feb 7 and Feb 14
Sources and uses of health care funds
Flow of funds
Income and ethnicity as determinants of mortality
Cost-Benefit analysis (CBA) is about making choices
Example of marginal analysis
Value, benefits, costs
The value of life
Need versus demand
Demand for medical care
Readings
Chapter 1, 2, 3 in Getzen, Health Economics and Financing, 2010
Hartman M, & et al. (2006). Monitoring Health Spending Increases: Incremental Budget
Analysis Reveal Challenging Tradeoffs, Health Care Financing Review, 28(1); 41-52.
Huskamp, HA, & et al. (2006). Future Directions for the National Health Expenditure
Accounts: Conference Overview, Health Care Financing Review, 28(1); 1-8.
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Thompson, RS, & et al. (1993). Cost Effectiveness Analysis of Bicycle Helmet Subsidies
in a Defined Population, Pediatrics, 91 (5); 902-907 (CLASSIC).
Questions
1. What happened to the health care spending in the 1990s and 2000s, increased or
decreased? List the most important reasons for this trend and discuss?
2. If most college students are poor, why do they spend so much on discretionary goods
such as CDs? Are the ones who go on to medical school richer or poorer than the ones
who take jobs upon graduation?
3. Many experts recommend that people get at least 30 minutes of vigorous exercise three
to five times a week; is the actual participation in exercise less than the amount (a)
needed or (b) demanded. Why do most college students get more exercise in the summer
than the winter? Does need, demand, or differences in opportunity cost of time account
for the fact that most actors get more exercise than most accountants?
4. Which are more elastic, dental visits or visits for the treatment of diabetes? Physician
visits or hospital days? Psychiatry or orthopedics? Why?
5. Who pays for health care? Is there any change in the composition of payers or their
share in the last decade or two?
QUIZ I
Lesson 3
Feb 21 and 28
Methods of covering risks
Risk aversion & adverse selection
Moral hazard
Third party transactions
Fixed premiums, ASO, and self-Insurance
ERISA, taxes and mandated benefits
Readings
Chapters 4, 5 in Getzen, T.E. Health Economics and Financing, 2010
Increased Ambulatory Care Copayments and Hospitalizations among the Elderly,
Trivedi, AN, and et al., NEJM, 2/2/2010; 1-6.
Consumer Cost Sharing in Private Health Insurance: On the Threshold of Change, Goff,
V., The George Washington University NHPF Issue Brief, 2004; 2-19.
Questions
1. When medical care is reimbursed through employer-provided insurance, whose
welfare is ultimately affected when the cost of medical care rises: the owners of the firm
that pays the premiums, the people in government whose revenues are reduced because
insurance benefits are not taxable like wages, or the public at large in their roles of
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workers, consumers, and taxpayers? Is there any difference between short-run and longrun effects?
2. The law now gives a worker who becomes unemployed the right to buy continuing
health insurance coverage after leaving the company. Why might it be rational for a
factory worker who loses their job to give up this legal right to purchase coverage and be
uninsured, even knowing that he or she is at risk for high medical expenditures?
3. Why are the markets for health insurance so much more price-competitive than the
markets for medical care?
4. Does insurance increase or decrease the demand for medical care? Does this represent
a problem for any parties involved in health care? Why?
5. Contact six people (or read required readings to respond) and find out how much they
spent on health care last year. Try to estimate how much they spent out of their own
pocket, and how much was spent by their employer, insurance company, or government.
Did they personally end up paying a larger or smaller percentage of their total health
bills?
QUIZ II
Lesson 4: Managed Care
Mar 6 and Mar 13
Range of managed care plans
Controlling costs
The evolution of an HMO
Ownership & capital markets: signs of failure
Managed competition
Readings
Chapter 10, Managed Care, Getzen TE and Allen, BH, 2010, John Wiley Publishing
(Note: this is not the textbook; to be posted under Content).
Composite Health Plan Quality Scales, Caldis, T., Health Care Financing Review, Spring
2007 28(3); 95-107
Trends in Health Status of Medicare Risk Contract Enrollees, Riley G and Zarabozo, C.
Health Care Financing Review, Winter 2006-2007 28(2); 81-95.
Questions
1. What incentives does a capitated physician have to keep his patients happy? What
incentive does a FFS physician have? If Mr. Jones is a cranky old man who smokes and
drinks so much that his liver and other organs are going downhill, which payment system
provides more incentive to keep Mr. Jones satisfied? Which provides the most incentive
to render extra care? Which provides the most incentive to make sure that the level of
care is optimized?
2. If an HMO reduces the patient’s marginal cost of surgery, hospitalization,
chemotherapy and other expensive items to zero, how can it provide incentives for
reduced utilization?
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3. Does a surplus of hospital beds in an area make it easier or harder to start an HMO? A
surplus of doctors? A surplus of insurance companies?
4. Does capitation payments shift the risks of paying for ill health to hospitals and
physicians? How?
5. How do HMOs use financial contracts to align the interests of patients and doctors?
QUIZ III
Lesson 5: Physicians
Mar 20 and Mar 27 (Spring Break)
Physician payment, incomes, costs
Licensures: quality or profits
Medical education/adjusting physician supply
Price discrimination
Kickbacks, self-dealing & side payments
Practice variations
Readings
Chapters 6, 7 in Getzen, T.E. Health Economics and Financing, 2010
Setting Physicians’ Prices in FFS Medicare: An Economic Perspective, Dowd, B and et
al., Health Care Financing Review, Winter 2006-2007 28(2); 97-111.
Licensing Doctors: Do Economists Agree? Svorney, S. Econ Journal Watch, August
2004 1(2); 279-305.
Performance-based Healthcare – The Coming Transformation of Medical Practice,
Millenson, ML, Business Briefing-Next Generation Healthcare; 28-31.
Innovative Health Reform Models: Pay-for-Performance Initiatives, Glickman, SW &
Peterson, ED. American Journal of Managed Care, 2009; S300-S304.
Questions
1. Do you think that radiologists prefer to be compensated fee-for-service, by relative
value scale, on salary, or as part of a capitated rate? Why? Why might different
specialties prefer different forms of payment?
2. How do agency and information asymmetry lead to licensure? Do agents get more or
less of the gains from trade as the degree of information asymmetry increases? Explain
why and how the strength of licensure is related to the extent of information asymmetry.
3. What advantages does a large physician group have over a solo physician? What
disadvantages?
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4. What organization provides the largest amount of payment to physicians in the United
States? How do they choose to make these payments? Has the form of payment changed
over time? Why?
5. Is medical care “sold” like other goods and services? Explain how irregularities in
health care markets differ from others?
QUIZ IV
Lesson 6: Hospitals
April 3 and Apr 10
Development of the modern hospital
Revenues & costs
Organization: Who controls the hospital and for what ends
Economies of scale
Hospital competitions
Controlling cost through regulation
Readings
Chapters 8, 9 in Getzen, T.E. Health Economics and Financing, 2010
Competition Versus Regulation: Its Effect on Hospitals, Anderson, G, Heyssel, R and
Dickler, R. Health Affairs, 1993, v. 12(1). (CLASSIC)
Strategies for More Efficient Performance Through Hospital Merger, Sinay T and
Campbell, C. Health Care Management Review, 2002, 27(1); 33-49.
The Role of Accountable Care Organizations in Health Care Reform, Shortell, SM,
Arizona State University Health Policy Brief, 2010; 1-21.
Questions
1. Which input accounts for the largest portion of hospital costs? Which input is
responsible for most of the growth in hospital cost per patient day?
2. Over the past hundred years, the major source of hospital revenues has changed three
times. Name these types of payments, and explain why each one gave way to the next.
3. Why do people spend so long waiting to be treated in the emergency room? Would it
be more efficient if there were sufficient doctors available so that they could be treated
right away?
4. Why have quality improvements in health care caused costs to rise while quality
improvements in computers have caused costs to fall?
5. What major factors create economies of scale in hospitals? Diseconomies of scale? Are
most hospitals of optimal size, too small, too large?
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Lesson 7: Long Term Care and Pharmaceuticals
April 17 and Apr 24
Development of the Long Term Care Market
Certificate of Need
CCRC’s & the wealthy elderly
History and Regulation of Pharmaceuticals
Research and development
Competition in Pharmaceutical Markets
Current trends
Readings
Chapters 10, 11 in Getzen, T.E. Health Economics and Financing, 2010
Controlling the Supply of Long Term Care Providers at the State, Wiener JM, Stevenson,
DG and Goldenson SM, Urban Institute Web Site,
http://www.urban.org/url.cfm?ID=308047
Medicaid’s Coverage of Nursing Home Costs: Asset Shelter for the Wealthy or Essential
Safety Net? O’Brien E, Georgetown University Long-Term Financing Project, May
2005’1-13.
Trends and Current Drug Utilization Patterns of Medicaid Beneficiaries, Lied TR, and et.
al, Health Care Financing Review, Spring 2006 27(3); 123-132.
Questions
1. Hospitals compete for doctors, and for the newest technology. How do nursing homes
compete? Does price play more or less of a role? Technology?
2. Marketing accounts for a much larger portion of the cost of pharmaceuticals than the
cost of other forms of care. Why? To whom are most pharmaceutical marketing efforts
targeted?
3. The major form of health insurance coverage for the elderly Medicare, and the elderly
are much heavier users of pharmaceuticals than other groups. It would seem reasonable to
expect that Medicare is the largest source of payment for drugs. Is it?
4. What fraction of the total cost of pharmaceuticals is paid for directly by patients? Does
this mean that price is more or less important than for other types of medical care?
5. When a brand name drug loses patent protection after seventeen years and competing
generic products enter the market, will the price of the brand name drug increase or
decrease? Why?
QUIZ V
Lesson 8: Role of Government
May 1
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To learn what macro health economics is
To understand the multiple roles of government in the US health system
To be able to compare competition and regulation
To understand the economic aspects of Medicare and Medicaid Programs
To describe reasons behind heavy regulation in health care markets
To understand what market failure is and why it happens
To learn about health care policy making process, and winners and losers
Properties of the individual vs. properties of the system
Abstractions & complications
Role of Government
Externalities and public good
Market failure
Pros & Cons of regulation
Readings: Getzen Chapter 14 and 15
FINAL EXAM
Lesson 9: International
May 8
Wide differences between nations
Micro vs. Macro allocation: Health as a national luxury good
International trade in healthcare
Spending money or producing health
The future
Readings
Chapters 17, 18 in Getzen, T.E. Health Economics and Financing, 2010
Differences in Disease Prevalence As a Source of the US-European Health Care
Spending Gap, 2007, Health Affairs Web Exclusive; 678-686.
Cross National Comparison of Health Systems Using OECD, 1999, Uwe Reinhardt, and
et al., 2002, Health Affairs, v. 21(3); 169-181.
Questions
1. As an officer of the World Health Organization, what programs would you fund if you
wished to make the largest impact on health, measured as the increase in life expectancy
multiplied by the number of people affected, for a given budgetary allocation of $100
million?
2. Which aspects of medical care are most international? The most parochial?
3. Will health care be more or less efficient in 2020? Will people spend more or less
money on health care?
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4. What is the largest global health care market? Why?
5. How much is spent per person on health care in China? How much is spent per person
on health care in the US? In the United Kingdom? What are the primary factors
accounting for these differences?
Lesson 10: SUBMIT FINAL EXAM
May 15
SUPPLEMENTAL READINGS
Andrulis, D. P. 1997. ‘The Public Sector in Health Care: Evolution or Dissolution?’
Health Affairs 16(4), 131-9.
Anton, T. J. 1997. ‘New Federalism and Intergovernmental Fiscal Relationships: The
Implications for Health Policy.’ Journal of Health Politics, Policy, and Law,
22(3), 691-720.
Barer, M. L., Lomas, J., and Sanmartin, C. 1996. ‘Re-minding our Ps and Qs: Cost
Controls in Canada.’ Health Affairs, 15(2), 216-34.
Brooks, G. R. and Jones, V. G. 1997. ‘Hospital Mergers and Market Overlap.’ Health
Services Research 31(6), 701-722.
Buchmueller, T. C. and Feldstein, P. J. 1996. ‘Hospital Community Benefits Other than
Charity Care: Implications for Tax Exemption and Policy.’ Hospital & Health
Services Administration 41(4), 461-71.
Buchmueller, T. C. and Feldstein, P. J. 1996. ‘Consumers’ Sensitivity to Health Plan
Premiums: Evidence from a Natural Experiment In California.’ Health Affairs
15(1), 143-51.
Davis, K. 1997. ‘Uninsured in an Era of Managed Care.’ Health Services Research 31(6),
641-649.
Dranove, D., Durkac, A., and Shanley, M. 1996. ‘Are Multihospital Systems More
Efficient?’ Health Affairs 15(1), 100-4.
Enthoven, A. C. and Kronick, R. 1991. ‘Universal Health Insurance through Incentives
Reform.’ Journal of the American Medical Association, 265(19), 2532-6.
Etheredge, L., Jones, S. B., and Lewin, L. 1996. ‘What is Driving Health System
Change?’ Health Affairs 15(4), 93-104.
Finocchio, L. J., Dower, C. M., McMahon, T., Gragnola, C. M., and the Taskforce on
Health Care Workforce Regulation. Reforming Health Care Workforce
Regulation: Policy Considerations for the 21st Century. San Francisco, CA: Pew
Health Professions Commission. 1995.
Frech, H. E. Competition and Monopoly in Medical Care. Washington, D.C.: AEI Press,
1996.
Fuchs V. in Mark Perlman, ed. ‘Some Economic Aspects of Mortality in Developed
Countries,’ The Economics of Health and Medical Care, 1974.
Gardiner, L. R., Oswald, S. L., and Jahera, J. S. 1996. ‘Prediction of Hospital Failure: A
Post-PPS Analysis.’ Hospital & Health Services Administration 41(4), 441-60.
Getzen, T. E. Health Economics Fundamentals and Flow of Funds. New York, NY: John
Wiley & Sons, Inc. 1997.
Goes, J. B. and Zhan, C. 1995. ‘The Effects of Hospital-Physician Integration Strategies
14
on Hospital Financial Performance.’ Health Services Research 30(4), 507-30.
Gold, M. 1997. ‘Markets and Public Programs: Insights from Oregon and Tennessee.’
Journal of Health Politics, Policy, and Law, 22(2), 633-666.
Goldman, D. P., Leibowitz, A., Buchanan, J. L., and Keesey, J. 1997. ‘Redistributional
Consequences of Community Rating.’ Health Services Research 32 (1), 71-86.
Greenberg, W. Competition, Regulation, and Rationing in Health Care. Ann Arbor, MI:
Health Administration Press, 1991.
Grumet, G. W. 1989. ‘Health Care Rationing Through Inconvenience.’ The New England
Journal of Medicine 321(9), 607-611.
Hacker, J. S. and Skocpol, T. 1997. ‘The New Politics of U. S. Health Policy.’ Journal of
Health Politics, Policy, and Law, 22(2), 315-38.
Hsiao, W. C., and et al. 1988. ‘Results, Potential Effects, and Implementation Issues of
the Resource-Based Relative Value Scale.’ JAMA 260(16), 2429-2437.
Herzlinger, R. E., and Krasker, W. S. 1987. ‘Who profits from nonprofits.’ Harvard
Business Review Jan/Feb, 93-106.
Iglehart, J. K. (Ed.) Debating Health Care Reform: A Primer From Health Affairs.
Bethesda, MD: Project HOPE, 1993.
Jacobs, P. The Economics of Health and Medical Care, 4th ed. Rockville, MD: Aspen,
1997.
Jenson, G. A., Morrisey, M. A., Gaffney, S., and Liston, D. K. 1997. ‘The New
Dominance of Managed Care: Insurance Trends in the 1990s.’ Health Affairs
16(1), 125-136.
Lewin, M. E. and Lifoff, E. (eds.) Information Trading: How Information Influences the
Health Policy Process. Washington, DC: National Academy Press, 1997.
Litman, T. J. and Robins, L. S. (eds.) Health Politics and Policy, 3rd ed. Albany, NY:
Delmar Publishers Inc., 1996.
Longest, B. B. Seeking Strategic Advantage Through Health Policy Analysis. Chicago,
IL: Health Administration Press, 1996.
Luke, R. D., Ozcan, Y. A., and Olden, P. C. 1995. ‘Local Markets and Systems: Hospital
Consolidations in Metropolitan Areas.’ Health Services Research 30(4), 555-75.
Marquis, M. S. and Long, S. H. 1996. ‘Reconsidering the Effect of Medicaid on Health
Care Services Use’. Health Services Research 30 (6), 791-808.
McKay, N. L. and Coventry, J. A. 1995. ‘Access Implications of Rural Hospital Closures
and Conversions.’ Hospital & Health Services Administration 40(2), 227-46.
Moran, D. W. 1997. ‘Federal Regulation of Managed Care: An Impulse in Search of a
Theory?’ Health Affairs, 16(6), 7-21.
Morrisey, M. A., Jenson, G. A., and Morlock, R. J. 1994. ‘Small Employers and the
Health Insurance Market.’ Health Affairs 13(4), 149-61.
Nguyen, N. X. and Derrick, F. W. 1997. ‘Physician Behavioral Response to a Medicare
Price Reduction.’ Health Services Research 32 (3), 283-298.
Olden, P. C. 1996. ‘Managing Managed Care Market Competition.’ Medical Group
Management Journal, 43(3), 14-22.
Reinhardt, U. E. 1991. ‘Breaking American Health Policy Gridlock.’ Health Affairs,
10(2), 96-103.
Reinhardt, U. E. 1998. ‘Columbia/HCA: Villain or Victim?’ Health Affairs. 17(2), 30-36.
Stewart, C. T. Healthy, Wealthy, or Wise? Issues in American Health Care Policy.
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Armonk, NY: M. E. Sharpe, 1995.
Sinay, U. T. 1998. ‘Hospital Mergers and Closures: Survival of Rural Hospitals.’ The
Journal of Rural Health 14(4), 357-365.
Sinay, U. T. 1998. ‘Pre-and Post-Merger Investigation of Hospital Mergers.’ Eastern
Economic Journal 24(1), 83-97.
Succi, M. J., Lee, S. D., and Alexander, J. A. 1997. ‘Effects of Market Position and
Competition on Rural Hospital Closures.’ Health Services Research 31(6), 67999.
Thompson, F. J. 1996. ‘The Evolving Challenge of Health Policy Implementation.’ In
Litman, T. J. and Robins, L. S. (eds.) Health Politics and Policy, 3rd ed. Albany,
NY: Delmar Publishers Inc., 1996.
Welch, H. G. 1994. ‘Physician profiling: An Analysis of Inpatient Practice Patterns in
Florida and Oregon.’ The New England Journal of Medicine 330(9), 607-611.
Zwanziger, J. and Melnick, G. 1996. ‘Can Managed Care Plans Control Health Care
Costs?’Health Affairs, 15(2), 185-99.
Halm, Ethan A. NancyAnne Causimo, & David Blumenthal. "Is Gatekeeping Better Than
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16
STUDENT INFORMATION SHEET
HCA 503 – Spring 2012
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