https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeR1IyeDE2WkJ0cHc/edit
PubH 6556
Health and Health Systems
Fall 2013
Credits:
3
Meeting Days:
Tuesdays, September 3 – December 10
Meeting Time:
9:05 – 11:45 am
Meeting Place:
W2-110 WDH
Instructor:
Jon B. Christianson
Office Address:
15-225 Phillips Wangensteen Building
Office Phone:
612-625-3849
Fax:
612-624-2196
E-mail:
chris001@umn.edu
Office Hours:
By Appointment
I.
Course Description
The course provides an overview of the U.S. health care system and current health policy issues. Topics are addressed from a
health care management perspective.
II.
Course Prerequisites
Students must be admitted to the University of Minnesota’s Master in Healthcare Administration Program or have consent of the
instructor.
III. Course Goals and Objectives
Specific goals and learning objectives are listed below for each class session.
IV. Methods of Instruction and Work Expectations
Each topic will be introduced during the assigned class period through a didactic presentation on the part of the instructor. For each
class session, PowerPoint slides and related material will be posted on the Moodle website for downloading and viewing. (To learn
more about Moodle, watch Moodle: Online Orientation for Students and/or visit the Moodle support website at
http://www1.umn.edu/moodle/, which has a link for “Student support” with user guides, help and FAQs.) Significant health care
organization and policy issues will be identified and discussed, referencing the readings for the class period. From time to time, the
class will be asked to read and discuss a short article distributed during class. In most classes, student teams will present policy
“briefs” to the class on pre-assigned topics. Students will be expected to prepare for each class by completing the readings and
assignments prior to class and participating in the discussion of those readings during class.
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V.
Course Text and Readings
1. All suggested readings have links to the article following the cite. Click on the link to access the reading. If you have any
problems accessing assigned readings online, contact Jane Raasch at raasc001@umn.edu. If you do not have a University of
Minnesota Internet ID and password, call 301-HELP and support staff will help you set up an account (or set up your own
account at www.umn.edu/initiate and follow the directions.)
2. The readings for each class session are divided into two parts: “Suggested” readings and “Further” readings. The suggested
readings are organized by subtopic. For some sessions, the list of suggested readings is long, but many individual readings are
quite brief. There are no “Required” readings. The more of the suggested readings that you are able to complete, the better
prepared you will be for your quizzes, assignments, and class discussion; and, the better prepared you will be for your career. In
sessions where there are a large number of suggested readings, you may want to divide responsibility among study group
members, with each member summarizing a subset of readings. The “Further” readings provide additional information on the
topics covered in each session. They are intended to be useful in clarifying areas that you feel are not covered adequately in the
suggested readings, or in providing additional information on topics of particular interest to you. The following sources of
information are useful in keeping up-to-date on current developments in the health care system and in health policy.
Newspapers:
New York Times (liberal perspective)
Wall Street Journal (conservative perspective)
Washington Post (political issues)
Daily Feeds (all free): Kaiser Daily Health Policy Report/Kaiser Health News
AHIP Solutions Smart Brief
Ramlett, Morning Consult
Websites with short “Research Briefs” on Various Health Care Topics:
Center for Studying Health System Change
Urban Institute
MPR (Mathematica Policy Research)
AcademyHealth
VI. Course Outline/Weekly Schedule
Session/Week
1
Sept. 3
2
Sept. 10*
3
Sept. 17
4
5
Sept. 24
Oct. 1
6
7, 8
9
Oct. 8
Oct. 15,
22
Oct. 29
10
11
Nov. 5
Nov. 12
12
Nov. 19
13
Nov. 26
Topics
The U.S. Health Care System and Prospects for Reform
Health System Performance: From Three-Legged Stool to the Triple Aim – Cost and
Population Health
Health System Performance: From Three-Legged Stool to the Triple Aim – Patient
Experience
[Assignment 1 due, 5 pts.]
The Health Policy Process: Crabs in a Bucket?
Care Delivery
The Physician Workforce: Characteristics, Training and Projections of Future Need
Rethinking Primary Care: What is the Future for the Family Doctor?
[Assignment 2 due, 10 pts.]
The Nurse Workforce: “Is There a Nurse in the House?”
The Hospital: From Doctors’ Workshop to “Big Med”
Long-Term Care: Balancing What We Want With What We Will Pay For
[Quiz 1: Material from Sessions 1-8, 30 pts.]
Medical Technology and Devices: At the Cutting Edge
Pharmaceuticals: A Regulatory Rubik’s Cube
Financing
Health Insurance, Uninsurance, and the Private Health Insurance Market: What Works, What
Doesn’t and How Will Health Reform Change It?
Medicaid: Can This “Vast Public Enterprise” Be Sustained?
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14
Dec. 3
Financing Care for Seniors: Down the Medicare Rabbit Hole
[Assignment 3 Due, 10 pts.]
15
Dec. 10
Medicare: A Program at the Brink?
[Quiz 2: Material from Sessions 9-15, 30 pts.]
*For this class, you will listen to an audio lecture synchronized to PowerPoints. The main focus will be on patient safety. There will
be a guest speaker on this topic and you will have a short assignment to complete and submit to the instructor by e-mail prior to the
class.
The U.S. Health Care System and Prospects for Reform
Session 1 – September 3, 2013
Health System Performance: From Three-Legged Stool to the Triple Aim – Cost and Population Health
The U.S. health care system is incredibly complex (some would call it a “non-system”), characterized by a variety of different financing
mechanisms and delivery systems. In first two sessions of the course, we examine how the U.S. health care system performs relative to
components of the Triple Aim: per capita costs, patient experience, and population health. We also compare the performance of the U.S.
health care system to systems in other countries.
Learning Objectives – Session 1
Students should be able to:
1. Discuss the different components of the Triple Aim and the performance of the U.S. health care system relative to:
 Cost per capita: components of costs, drivers of cost growth, variation in costs
 Population health
2. Compare and contrast different views regarding whether, or under what circumstances, health care expenditures that grow at a
faster rate than the rest of the economy should be regarded with concern.
3. Discuss and explain differences between the U.S. and other countries in health care costs and population health
4. Discuss evidence on geographic variation in health care costs in the United States.
Suggested Readings
The Triple Aim
1*. Berwick, D.M., Nolan, T.W., Whittington, J. “The triple aim: Care, health and cost.” Health Affairs 27(3):759-769, 2008.
http://content.healthaffairs.org/content/27/3/759.full.pdf+html
2. Cauchon, D. “Health care spending is transferred out of ICU.” USA Today, March 4, 2013. Available at:
http://www.usatoday.com/story/news/health/2013/03/04/health-care-spending-growth-slows/1963165/
Spending on Health Care
Trends
1* The Henry J. Kaiser Family Foundation. “Health care costs. A primer.” May 2012. Available at:
http://www.kff.org/insurance/upload/7670-03.pdf
2. Barnes, K. “Behind the health spending numbers.” Health Affairs Blog, June 18, 2013. Available at:
http://healthaffairs.org/blog/2013/06/18/behind-the-health-spending-numbers/
3. Roehrig, C. “U.S. health spending as a share of GDP – Where are we headed?” Altarum Institute, July 16, 2013. Available at:
http://www.altarum.org/forum/post/us-health-spending-share-gdp-where-are-we-headed
Geographic Variation in Health Spending
1*. Rau, J. “Medicare spending variations mostly due to health differences, study concludes.” Kaiser Health News, May 28, 2013.
Available at: http://www.kaiserhealthnews.org/Stories/2013/May/28/medicare-state-geographic-variation-costs.aspx
2. Joynt, K.E., Jha, A.K. “The relationship between cost and quality. No free lunch.” Journal of the American Medical Association
307(10):1082-1083, 2012. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=22493&direction=P
Views Regarding Health Spending
1*. Pauly, M.V. “The trade-off among quality, quantity, and cost: How to make it—if we must.” Health Affairs 30(4):574-580, 2011.
http://content.healthaffairs.org/content/30/4/574.full.pdf+html
2. RWJF. “Consumer attitudes on health care costs: Insights from focus groups in four U.S. cities.” January 2013. Available at:
http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf403428
3*. Altman, D., Levitt, L. “We still have a health-care spending problem.” Washington Post, April 21, 2012. Available at:
http://articles.washingtonpost.com/2013-04-21/opinions/38717666_1_health-spending-health-costs-health-care-spending
4. Douthat, R. “Conservatives and health care costs.” New York Times, May 15, 2013. Available at:
http://douthat.blogs.nytimes.com/2013/05/15/conservatives-and-health-care-costs/?_r=0
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Drivers of Growth in Spending
1. Acaramenico. “Poll of emergency physicians shows more than half order tests as protection against being sued.” May 26, 2011
Available at: http://californiaprevailingwage.wordpress.com/2011/05/26/poll-of-emergency-physicians-shows-more-than-halforder-tests-as-protection-against-being-sued/
2*. Rao, A. “IOM report focuses on $750 billion in inefficient health care spending.” Kaiser Health News Blog, September 6, 2012.
Available at: http://capsules.kaiserhealthnews.org/index.php/2012/09/iom-report-focuses-on-750-billion-in-inefficient-health-carespending/
3*. Appleby, J. “Higher prices charged by hospitals, other providers, drove health spending during downturn.” Kaiser Health News,
May 21, 2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/May/21/higher-health-care-prices-hospitals.aspx
4*. Kliff, S. “Over next two decades, obesity could cost us $550 billion.” The Washington Post, September 18, 2012. Available at:
http://www.washingtonpost.com/blogs/wonkblog/wp/2012/09/18/over-next-two-decades-obesity-could-cost-us-550-billion/
5. Porter, E. “Health care’s overlooked cost factor.” New York Times, June 11, 2013. Available at:
http://www.nytimes.com/2013/06/12/business/examinations-of-health-costs-overlook-mergers.html?pagewanted=all
6. Rosenthal, E. “The $2.7 trillion medical bill.” New York Times, June 1, 2013. Available at:
http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-healthexpenditures.html?pagewanted=all
7. Gordon, J. “The medical arms race.” Minnesota Medicine, February 2007. Available at:
http://www.minnesotamedicine.com/PastIssues/PastIssues2007/February2007/FeatureFebruary2007.aspx
8. Fuchs, V.R. “The gross domestic product and health care spending.” New England Journal of Medicine May 22, 2013. Available
at: http://www.nejm.org/doi/full/10.1056/NEJMp1305298
9. Rosenberg, Y. “Do you really need that test? Doctors warn on 90 treatments.” The Fiscal Times, February 21, 2013. Available at:
http://www.thefiscaltimes.com/Articles/2013/02/21/Doctors-Warn-on-90-Overused-Medical-Treatments.aspx#page1
10. Hiatt, K. “9 warning signs of bad care.” US News, February 26, 2013. Available at: http://health.usnews.com/health-news/bestnursing-homes/articles/2013/02/26/9-warning-signs-of-bad-care
11. Pittman, G. “Unnecessary repeat cholesterol tests common: study.” Reuters, July 1, 2013. Available at:
http://www.reuters.com/article/2013/07/01/us-unnecessary-repeat-cholesterol-idUSBRE96015420130701
Population Health
Trends
1. Gardner, A. “America’s health a mixed bag: Report.” Health, February 16, 2011. Available at:
http://news.health.com/2011/02/16/americas-health-a-mixed-bag-report/
2*. Kelly, J. “Boomers live longer, but sicker, than parents.” Pittsburgh Post-Gazette, March 4, 2013. Available at: http://www.postgazette.com/stories/news/health/boomers-live-longer-but-sicker-than-parents-677824/
3*. Winslow, R. “Americans are living longer, but not necessarily healthier, study shows.” The Wall Street Journal, July 10, 2013.
Available at: http://online.wsj.com/article/SB10001424127887324694904578597444105321914.html
4. US Burden of Disease Collaborators. “The state of US health, 1990-2010. Burden of diseases, injuries, and risk factors.” Journal
of the American Medical Association, Published online July 10, 2013. Available at: http://jama.jamanetwork.com/onlineFirst.aspx
5. Pitman, D. “Gains made, but U.S. still lags in life expectancy.” MedPage Today, July 10, 2013. Available at:
http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/40381
Illness-specific Measures
1. Reinberg, S. “U.S. cancer death rate continues to drop.” USA Today, July 8, 2010. Available at:
http://www.usatoday.com/news/health/2010-07-08-cancer-deaths_N.htm
2. HealthDay. “Asthma cases continue to rise in U.S., affecting millions.” May 15, 2012. Available at:
http://consumer.healthday.com/Article.asp?AID=664789
3. USA Today. “Percentage of severely obese adults skyrockets.” October 1, 2012. Available at:
http://www.usatoday.com/story/news/nation/2012/10/01/severely-obese-americans-increasing/1606469/
4. Reuters. “U.S. cholesterol levels decline: Study.” October 16, 2012. Available at:
http://www.reuters.com/article/2012/10/16/health-cholesterol-idUSL3E8LG7C120121016
5. Reinberg, S. “Nearly 30 percent of Americans have high blood pressure: CDC.” WebMD News from HealthDay, April 4, 2013.
Available at: http://www.webmd.com/hypertension-high-blood-pressure/news/20130404/nearly-30-percent-of-americans-havehigh-blood-pressure-cdc
Disparities
1*. HealthDay News. “Health disparities persist in U.S., report shows.” January 13, 2011. Available at:
http://health.usnews.com/health-news/family-health/heart/articles/2011/01/13/health-disparities-persist-in-us-report-shows
2. Kaiser Health News. “Race plays role in diagnosis and treatment.” July 24, 2009. Available at:
http://www.kaiserhealthnews.org/daily-reports/2009/july/24/racial-disparities.aspx?referrer=search
3. Tavernise, S. “The health toll of immigration.” New York Times, May 18, 2013. Available at:
http://www.nytimes.com/2013/05/19/health/the-health-toll-of-immigration.html?pagewanted=all
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4*. Goodell, S., Escarce, J.J. “Racial and ethnic disparities in access to and quality of health care.” Policy Brief 12, The Synthesis
Project, Robert Wood Johnson Foundation, September 2007. Available at: http://www.rwjf.org/en/research-publications/find-rwjfresearch/2007/09/racial-and-ethnic-disparities-in-access-to-and-quality-of-health.html
International Comparisons
Costs/Population Health
1. Baker, S. “Study: US leads in healthcare spending, but ranks last in health.” The Hill’s Healthcare Blog, May 12, 2011. Available
at: http://thehill.com/blogs/healthwatch/public-global-health/160845-study-us-leads-in-healthcare-spending-but-ranks-last-inhealth3. Fox, M. “Survey shows Americans pay a lot more for health care." NationalJournal, March 25, 2012. Available at:
http://www.nationaljournal.com/healthcare/survey-shows-americans-pay-a-lot-more-for-health-care-20120304
4. Laugesen, M.J., Glied, S.A. “Higher fees paid to U.S. physicians drive higher spending for physician services compared to other
countries.” Health Affairs 30(9):1647-1656, 2011. http://content.healthaffairs.org/content/30/9/1647.full.pdf+html
5. Goodwin, J. “Americans have worse health than English peers, study finds.” US News, March 9, 2011. Available at:
http://health.usnews.com/health-news/family-health/boomer-health/articles/2011/03/09/americans-have-worse-health-thanenglish-peers-study-finds
6*. Fuchs, V.R. “How and why US health care differs from that in other OECD countries.” New England Journal of Medicine
309(1):33-34, 2013. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=926163&direction=P
7. Heavey, S. “Obesity, lack of insurance cited in U.S. health gap.” Reuters, January 9, 2013. Available at:
http://www.reuters.com/article/2013/01/09/us-usa-health-ranking-idUSBRE9080ZN20130109
8. Goldhill, D. “Other nations don’t compare to U.S. health care.” Bloomberg, June 20, 2013. Available at:
http://www.bloomberg.com/news/2013-06-20/what-the-world-can-t-tell-us-about-health-care.html
Further Readings
1.
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3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Wayne, A. “Health cost growth slows further even as economy rebounds.” Bloomberg, June 18, 2013. Available at:
http://www.bloomberg.com/news/2013-06-18/health-cost-growth-slows-further-even-as-economy-rebounds.html
Goldhill, D. “Focus on health-care costs causes more spending.” Bloomberg, January 1, 2013. Available at:
http://www.bloomberg.com/news/2013-01-01/focus-on-health-care-costs-causes-more-spending.html
Kaiser Family Foundation. “Assessing the effects of the economy on the recent slowdown in health spending.” April 2013.
Available at: http://kff.org/health-costs/issue-brief/assessing-the-effects-of-the-economy-on-the-recent-slowdown-in-healthspending-2/
Steuerle, G. “A slower rate of health cost growth? What happens when an irresistible force meets an increasingly immovable
object.” Altarum Institute Health Policy Forum, May 10, 2013. Available at: http://www.altarum.org/forum/post/slower-rate-healthcost-growth-what-happens-when-irresistible-force-meets-increasingly
Samuelson, R.J. “Is the health-care spending slowdown for real?” The Washington Post, May 19, 2013. Available at:
http://articles.washingtonpost.com/2013-05-19/opinions/39376698_1_affordable-care-act-affordable-health-coverage-healthaffairs
Lowrey, A. “Slowdown in health costs’ rise may last as economy revives.” The New York Times, May 6, 2013.
Klein, E. “One way Obamacare may already be working.” Bloomberg, May 29, 2013. Available at:
http://www.bloomberg.com/news/2013-05-29/one-way-obamacare-may-already-be-working.html
Eligon, J. “An oil boom takes a toll on health care.” The New York Times, January 27, 2013. Available at:
http://www.nytimes.com/2013/01/28/us/boom-in-north-dakota-weighs-heavily-on-healthcare.html?_r=0&gwh=BE712B27B95AE737019CF8BBC3FD40D7
Philipson, T., Eber, M., Lakdawalla, D.N., Corral, M., Conti, R., Goldman, D.P. “An analysis of whether higher health care
spending in the United States versus Europe is ‘worth it’ in the case of cancer.” Health Affairs 31(4):667-675, 2012. Available at:
http://content.healthaffairs.org/content/31/4/667.full.pdf+html
Lawrence, B.R. “Cutting U.S. health-care costs doesn’t have to be harmful.” The Washington Post online, July 26, 2012.
Available at: http://www.washingtonpost.com/opinions/cutting-us-health-care-costs-doesnt-have-to-bepainful/2012/07/26/gJQA1ZzJCX_story.html
Ledger, K. “Healthiest state?” Minnesota Medicine, May 2012. Available at:
http://www.minnesotamedicine.com/PastIssues/May2012/HealthiestState.aspx
Goldsmith, J. “Barking up the wrong tree: Affordability, not cost growth, is the policy challenge.” Health Affairs Blog, May 7,
2012. Available at: http://healthaffairs.org/blog/2012/05/07/barking-up-the-wrong-tree-affordability-not-cost-growth-is-the-policychallenge/
Healy, M. “Obesity in U.S. projected to grow, though pace slows: CDC study.” LA Times online, May 7, 2012. Available at:
http://articles.latimes.com/2012/may/07/news/la-heb-obesity-projection-20120507
Kenney, G.M., McMorrow, S., Zuckerman, S., Goin, D.E. “A decade of health care access declines for adults holds implications
for changes in the Affordable Care Act.” Health Affairs 31(5):899-908, 2012. Available at:
http://content.healthaffairs.org/content/31/5/899.full.pdf+html
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15. Lowrey, A. “In hopeful sign, health spending is flattening out.” New York times, April 28, 2012, p.A.1. Available at:
http://www.nytimes.com/2012/04/29/health/policy/in-hopeful-sign-health-spending-is-flattening-out.html?pagewanted=all
16. Mahoney, D. “Uncontrolled hypertension deemed pervasive in U.S. adults.” Internal Medicine News, September 4, 2012.
Available at: http://www.internalmedicinenews.com/single-view/uncontrolled-hypertension-deemed-pervasive-in-usadults/e84cc5f65b0596965e8e9b606b653355.html
17. Bipartisan Policy Center. “What is driving U.S. health care spending?” September 2012, Available at:
http://bipartisanpolicy.org/sites/default/files/BPC%20Health%20Care%20Cost%20Drivers%20Brief%20Sept%202012.pdf
18. Carroll, A. “The ‘iron triangle’ on health care: Access, cost, and quality.” JAMA Forum, October 3, 2012. Available at:
http://newsatjama.jama.com/2012/10/03/jama-forum-the-iron-triangle-of-health-care-access-cost-and-quality/
19. Detsky, A.S. “How to control health care costs.” Journal of General Internal Medicine 27(9):1095-1096, 2012. Available at:
http://link.springer.com/content/pdf/10.1007%2Fs11606-012-2119-0.pdf
20. National Institute for Health Care Management. “U.S. health care spending: The big picture.” NIHCM Foundation Data Brief,
May 2012. Available at: http://www.nihcm.org/images/stories/Data_Brief_1_-_Big_Picture_FINAL.pdf
21. Reinhardt, U.E., “Is U.S. health spending finally under control.” New York Times online, January 20, 2012. Available at:
http://economix.blogs.nytimes.com/2012/01/20/is-u-s-health-spending-finally-under-control/
22. Roehrig, C., Turner, A., Hughes-Cromwick, P., Miller, G. “When the cost curve bent – Pre-recession moderation in health care.”
New England Journal of Medicine 367(7):590-593, 2012. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1205958
23. Stein, R. “A dire sign of the obesity epidemic: Teen diabetes soaring, study finds.” NPR, May 21, 2012. Available at:
http://www.npr.org/blogs/health/2012/05/21/153030283/a-dire-sign-of-the-obesity-epidemic-teen-diabetes-soaring-study-finds
24. The Economist. “An incurable disease.” September 29, 2012. Available at: http://www.economist.com/node/21563714
25. Wang, S.S. “Revealing the unexpected dangers of obesity.” The Wall Street Journal, October 29, 2012. Available at:
http://www.nytimes.com/2012/09/23/health/new-system-for-patients-to-report-medical-mistakes.html?_r=0
26. Roehrig, C.S., Rousseau, D.M. “The growth in cost per case explains far more of U.S. health spending increases than rising
disease prevalence.” Health Affairs 30(9):1657-1663, 2011. Available at:
http://content.healthaffairs.org/content/30/9/1657.full.pdf+html
27. Rovner, J. “You really are paying a lot more for health care.” NPR, May 11, 2011. Available at:
http://www.npr.org/blogs/health/2011/05/11/136213104/you-really-are-paying-a-lot-more-for-health-care
28. Reinberg, S.. “Aging population could send cancer costs soaring.” January 12, 2011. Available at:
http://news.health.com/2011/01/12/aging-population-could-send-cancer-costs-soaring/
29. Bernstein, J., Reschovsky, J.D., White, C. “Geographic variation in health care: changing policy directions.” Policy Analysis No.
4. Washington, DC: Center for Studying Health System Change, April 2011
30. Gardner, A. “U.S. found to be losing ground in life expectancy.” HealthDay, June 15, 2011. Available at:
http://health.usnews.com/health-news/family-health/heart/articles/2011/06/15/us-found-to-be-losing-ground-in-life-expectancy
31. Gawande, A. “The cost conundrum: What a Texas town can teach us about health care.” The New Yorker, June 1, 2009.
Available at: http://go.galegroup.com/ps/retrieve.do?sgHitCountType=None&sort=DASORT&inPS=true&prodId=PROF&userGroupName=mnaumntwin&tabID=T003&searchId=R1&resultListType=RESULT_LIST&c
ontentSegment=&searchType=AdvancedSearchForm&currentPosition=1&contentSet=GALE%7CA201451685&&docId=GALE|A
201451685&docType=GALE&role=&docLevel=FULLTEXT
32. Escarce, J.J. “Racial and ethnic disparities in access to and quality of health care.” Research Synthesis Report No. 12. Robert
Wood Johnson Foundation, September 7, 2007. Available at: http://www.rwjf.org/en/research-publications/find-rwjfresearch/2007/09/racial-and-ethnic-disparities-in-access-to-and-quality-of-health.html
33. Banks, J., Marmot, M., Oldfield, Z., Smith J.P. “Disease and disadvantage in the United States and in England.” JAMA
2006;295(17):2037-2045. http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=5022&direction=P
Session 2 – September 10, 2013
Health System Performance: From Three-Legged Stool to the Triple Aim – Patient Experience
Assignment 1 Due
There is widespread concern across political boundaries that patients’ experiences in the health care system leave much to be desired.
Critics cite under use, over use, and inappropriate use of health services. Access to services is a major issue for population subgroups,
and medical care costs continue to be a contributing factor to personal bankruptcies. And, for the last 12 years, the public spotlight has
focused on “preventable” medical errors. Historically, medical errors were attributed to the failures of individuals, but the literature on
patient safety also focuses on creating health care environments that limit the potential for human error. Nevertheless, estimates are that
over 100,000 people die each year from avoidable errors. There is also a growing body of evidence that poor communication between
providers and patients, along with inadequate coordination of care, contribute to poor quality care, medical errors, and patient frustrations
with the health care system.
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Learning Objectives
Students should be able to:
1. Discuss issues and evidence relating to access to care and deficiencies on the quality of health care in the United States
2. Discuss the evidence regarding prevalence of medical errors in the U.S. health care system and their sources.
3. Use terminology related to “medical errors” appropriately.
4. Discuss basic approaches being used in hospitals and other providers to reduce medical errors.
5. Discuss how poor communication and care coordination can affect patient outcomes.
Suggested Readings
Patient Safety and Medical Errors: Concepts, Terminology, and Impact
Overview
1*. Leape, L. “Error in medicine.” Journal of the American Medical Association 272(23):1851-1857, 1994 (Posted on Moodle)
2. “Hospital infections killed 48,000, report shows.” Reuters, February 22, 2010. Available at:
http://www.reuters.com/article/2010/02/22/us-hospitals-infections-usa-idUSTRE61L51D20100222
3*. Van Den Bos, J., Rustagi, K., Gray, T., Halford, M., Ziemkiewicz, E., Shreve, J. “The $17.1 billion problem: The annual cost of
measurable medical errors.” Health Affairs 30(4):596-603, 2011. Available at:
http://content.healthaffairs.org/content/30/4/596.full.pdf+html
4. Young, J. “Hospital errors occur 10 times more than reported, study finds.” Bloomberg.com, April 6, 2011. Available at:
http://www.bloomberg.com/news/2011-04-07/hospital-errors-occur-10-times-more-than-reported-study-finds.html
5. Weber, T., Ornstein, C., Allen, M. “Why can’t medicine seem to fix simple mistakes? ProPublica, July 20, 2012. Available at:
http://www.propublica.org/article/why-cant-medicine-seem-to-fix-simple-mistakes
6. Welch, H.G. “Testing what we think we know.” New York Times online, August 19, 2012. Available at:
http://www.nytimes.com/2012/08/20/opinion/testing-standard-medical-practices.html
7*. Boodman, S.G. “Doctors’ diagnostic errors are often not mentioned but can take a serious toll.” Kaiser Health News, May 6,
2013. Available at: http://www.kaiserhealthnews.org/stories/2013/may/07/doctor-errors-misdiagnosis-more-common-than-knownserious-impact.aspx
8. Ofri, D. “My near miss.” The New York Times, May 28, 2013. Available at:
http://www.nytimes.com/2013/05/29/opinion/addressing-medical-errors.html
Causes of Medical Errors
1*. Volpp, K.G.M., Grande, D. “Residents’ suggestions for reducing errors in teaching hospitals.” New England Journal of Medicine
348(9):851-855, 2003. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMsb021667
2. Johnson, C.K. “Poor infection control at many surgery centers.” MSNBC, June 8, 2010. Available at:
http://www.msnbc.msn.com/id/37577363
3. Sittig, D.F., Singh, H. “Defining health information technology—related errors.” Archives of Internal Medicine 171(14):1281-1284,
2011. Available at: http://archinte.jamanetwork.com/Issue.aspx?journalid=71&issueID=22519&direction=P
4. Schiff, G.D. “Medical error. A 60-year-old man with delayed care for a renal mass.” Journal of the American Medical
Association 305(18):1890-1898, 2011. Available at:
http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=20328&direction=P
5. Richtel, M. “As doctors use more devices, potential for distraction grows.” New York Times, December 15, 2011, p. A.1.
Available at: http://www.nytimes.com/2011/12/15/health/as-doctors-use-more-devices-potential-for-distractiongrows.html?pagewanted=all&_r=0
6*. Couse-Baker, R. “Even a doctor can’t keep his father safe in the hospital.” Cognoscenti, April 5, 2013. Available at:
http://cognoscenti.wbur.org/2013/04/05/medical-errors-ashish-jha
7. Harris, G. “U.S. inaction lets look-alike tubes kill patients.” The New York Times, August 20, 2010. Available at:
http://www.nytimes.com/2010/08/21/health/policy/21tubes.html?pagewanted=all
8. Robertson, J. “Digital health records’ risks emerge as deaths blamed on systems.” Bloomberg, June 25, 2013. Available at:
http://www.bloomberg.com/news/2013-06-25/digital-health-records-risks-emerge-as-deaths-blamed-on-systems.html
9. Smith, K. “For doctors, too much information.” Politico, March 5, 2013. Available at:
http://www.politico.com/story/2013/03/electronic-alert-glut-overloads-doctors-88394.html
10. Sun, L.H. “’Alarm fatigue’ leads hospital caregivers to ignore beeps, posing risks for patients.” Bangor Daily News, July 23, 2013.
Available at: http://bangordailynews.com/2013/07/08/health/alarm-fatigue-leads-hospital-caregivers-to-ignore-beeps-posingrisks-for-patients/
Proposals to Reduce Medical Errors
1*. Gawande, T. “The Checklist.” New Yorker, 83(39):86-95, December 10, 2007. Available at:
http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande
2. Millenson, M.L. “Analysis: Is a new federal patient safety effort doing enough to curb medical errors?” Kaiser Health News,
February 22, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/february/23/millenson-hens.aspx
3. Ledger, K. “Safety first. How anesthesiologists launched the patient-safety movement.” Minnesota Medicine, March 2011.
Available at: http://www.minnesotamedicine.com/PastIssues/PastIssues2011/March2011/SafetyFirst.aspx
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4*. Shaw, G. “Researchers: CPOE averted 17.4 million medication errors in one year.” FierceHealthIT, February 22, 2013. Available
at: http://www.fiercehealthit.com/story/researchers-cpoe-averted-174-million-medication-errors-one-year/2013-02-22
5. Hartocollis, A. “With money at risk, hospitals push staff to wash hands.” The New York Times, May 28, 2013. Available at:
http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?_r=0
6. Southwick, F.S. “Losing my leg to a medical error.” The New York Times, February 19, 2013. Available at:
http://www.nytimes.com/2013/02/20/opinion/losing-my-leg-to-a-medical-error.html?smid=pl-share&_r=0
7. Drolet, B.C., Khokhar, M.T., Fischer, S.A. “The 2011 duty-hour requirement — a survey of residence program directors.” The
New England Journal of Medicine 368(8):694-697, 2013. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1214483
8*. Shekelle, P.G., Pronovost, P.J., Wachter, R.M., et al. “The top patient safety strategies that can be encouraged for adoption
now.” Annals of Internal Medicine 158(5-Part 2):365-368. Available at:
http://annals.org/issue.aspx?journalid=90&issueID=926462&direction=P
Care Coordination and Communication Issues
1. Pham, H.H., Grossman, J.M., Cohen, G., Bodenheimer, T. “Hospitalists and care transitions: The divorce of inpatient and
outpatient care.” Health Affairs 27(5):1315-1327, 2008. Available at:
http://content.healthaffairs.org/content/27/5/1315.full.pdf+html
2. Blendon, R.J., Buhr, T., Cassidy, E.F., Perez, D.J., Sussman, T., Benson, J.M., et al. “Disparities in physician care: Experiences
and perceptions of a multi-ethnic America. Health Affairs 27(2):507-517, 2008. Available at:
http://content.healthaffairs.org/content/27/2/507.full.pdf+html
3. Levinson, W., Pizzo, P.A. “Patient-physician communication. It’s about time.” Journal of the American Medical Association
305(17):1802-1803, 2011. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=20327&direction=P
4*. Schoen, C., Osborn, R., Squires, D., Doty, M., Pierson, R., Applebaum, S. “New 2011 survey of patients with complex care
needs in eleven countries finds that care is often poorly coordinated.” Health Affairs 30(12):2437-2448, 2011. Available at:
http://content.healthaffairs.org/content/30/12/2437.full.pdf+html
How Patients Experience the Health Care System
1. Mayer, M.L. “On being a ‘difficult’ patient.” Health Affairs 27(5):1416-1421, 2008. Available at:
http://content.healthaffairs.org/content/27/5/1416.full.pdf+html
2*. Jauhar, S. “Referral system turns patients into commodities.” The New York Times, May 26, 2009, p.D.5. Available at:
http://www.nytimes.com/2009/05/26/health/26essa.html?scp=12&sq=health%20care&st=cse
2. Colwill, J.M. “A case of ‘medical homelessness’.” Health Affairs 29(5):1067-1070, 2010. Available at:
http://content.healthaffairs.org/content/29/5/1067.full.pdf+html
3. Butler, K. “My father’s broken heart.” New York Times, June 20, 2010, p. 38. Available at:
http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?src=me&ref=homepage
4. Kapadia, R., Scherzer, L. “10 things your hospital won’t tell you.” SmartMoney Magazine, August 11, 2010. Available at:
http://www.smartmoney.com/spending/rip-offs/10-things-your-hospital-wont-tell-you-20059/
5. Dimick, J., Ruhter, J., Sarrazin, M.V., Birkmeyer, J.D. “Black patients more likely than Whites to undergo surgery at low-quality
hospitals in segregated regions.” Health Affairs 32(6):1046-1053, 2013. Available at:
http://content.healthaffairs.org/content/32/6/1046.full.pdf+html
Access to Care
1*. Galewitz, P. “Health care increasingly out of reach for millions of Americans.” Kaiser Health News, May 7, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/may/07/health-affairs-care-increasingly-out-of-reach-for-millions.aspx
2. Pecquet, J. “Report: Americans still struggling with medical debt.” The Hill, March 7, 2012. Available at:
http://thehill.com/blogs/healthwatch/health-insurance/214759-report-americans-still-struggling-with-medical-debt
3. Kenney, G.M., McMorrow, S., Zuckerman, S., Goin, D.E. “A decade of health care access declines for adults hold implications
for changes in the Affordable Care Act.” Health Affairs 31(5):899-908, 2012. Available at:
http://content.healthaffairs.org/content/31/5/899.full.pdf+html
4. HealthDay. “Many lacked preventive care before health reform law: U.S. report.” June 14, 2012. Available at:
http://consumer.healthday.com/Article.asp?AID=665762
5. HealthDay. “Fewer U.S. patients getting weight counseling from doctors.” U.S. News, January 10, 2013. Available at:
http://health.usnews.com/health-news/news/articles/2013/01/10/fewer-us-patients-getting-weight-counseling-from-doctors
Quality of Care
1. Maugh, T.H. “Nearly 70,000 Americans die needlessly each year because they are not given optimal heart failure therapy.” June
6, 2011. Available at: http://www.latimes.com/health/boostershots/la-heb-heart-failure-06062011,0,4047246.story?track=rss
2. Reuters. “Cardiac arrest survival improving in U.S. hospitals: Study.” July 16, 2012. Available at:
http://www.reuters.com/article/2012/07/17/us-heart-idUSBRE86G01F20120717
3. HealthDay. “Many lacked preventive care before health reform law: U.S. report.” June 14, 2012. Available at:
http://consumer.healthday.com/Article.asp?AID=665762
4*. PR Newswire. “U.S. physician groups identify commonly used tests or procedures they say are often not necessary.” April 4,
2012. Available at: http://www.prnewswire.com/news-releases/us-physician-groups-identify-commonly-used-tests-or-proceduresthey-say-are-often-not-necessary-146046345.html
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5.
6.
Abelson, R., Creswell, J. “Hospital chain inquiry cited unnecessary cardiac work.” New York Times online, August 6, 2012.
Available at: http://www.nytimes.com/2012/08/07/business/hospital-chain-internal-reports-found-dubious-cardiacwork.html?pagewanted=all
Mohammed, K.A., Bullard, K.M., Saaddine, J.B., Cowie, C.C., Imperatore, G., Gregg, E.W. “Achievement of goals in U.S.
diabetes care, 1999-2010.” The New England Journal of Medicine, 2013;368(17):1613-1624. Available at:
http://www.nejm.org/doi/pdf/10.1056/NEJMsa1213829
Further Readings
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21.
Seaman, A.M. “Surgeons-in-training dislike new work hours: survey.” Reuters, May 17, 2013. Available at:
http://news.yahoo.com/surgeons-training-dislike-hours-survey-194513540.html
Commins, J. “Diagnostic errors common, costly, and harmful.” HealthLeaders Media, April 23, 2013. Available at:
http://www.healthleadersmedia.com/page-1/QUA-291407/Diagnostic-Errors-Common-Costly-and-Harmful##
PRWeb. “Global computerized physician order entry systems market to reach US$1.5 billion by 2018, according to new report
by Global Industry Analysts, Inc.” July 13, 2012. Available at:
http://www.prweb.com/releases/computerized_physician/order_entry_CPOE_systems/prweb9693652.htm
Kennedy, K. “HHS: Hospitals ignoring requirements to report errors.” USA Today online, July 20, 2012. Available at:
http://www.usatoday.com/news/health/story/2012-07-19/hospitals-preventable-errors-report/56343348/1
Lerner, M. “In new safety test, not all Minnesota hospitals earn A: National report card rates 38 state hospitals for patient safety.”
Star Tribune, June 7, 2012, p. B3. Available at: http://www.startribune.com/lifestyle/health/157309745.html
O’Connell, K. “Two arms, two choices: If only I’d known then what I know now.” Health Affairs 31(8):1895-1899, 2012.
Available at: http://content.healthaffairs.org/content/31/8/1895.full.pdf+html
Andrews, M. “New book offers checklists to help hospital patients.” Kaiser Health News, March 5, 2012. Available at:
http://www.kaiserhealthnews.org/features/insuring-your-health/2012/patient-checklists-michelle-andrews03052012.aspx?referrer=search
Welch, H.G. “Testing what we think we know.” New York Times online, August 19, 2012. Available at:
http://www.nytimes.com/2012/08/20/opinion/testing-standard-medical-practices.html
Pryor, D., Hendrich, A., Henkel, R.J., Beckmann, J.K., Tersigni, A.R. “The quality ‘journey’ at Ascension Health: How we’ve
prevented at least 1,500 avoidable deaths a year — and aim to do even better.” Health Affairs 30(4):604-611, 2011. Available at:
http://content.healthaffairs.org/content/30/4/604.full.pdf+html
Pronovost, P.J., Marsteller, J.A., Goeschel, C.A. “Preventing bloodstream infections: A measurable national success story in
quality improvement.” Health Affairs 30(4):628-634, 2011. Available at:
http://content.healthaffairs.org/content/30/4/628.full.pdf+html
Joyce, J.D., Cioffi, G.A., Petriwsky, J.G., Robinson, J.S. “Legacy health’s ‘big aim’ initiative to improve patient safety reduced
rates of infection and mortality among patients.” Health Affairs 30(4):619-627, 2011. Available at:
http://content.healthaffairs.org/content/30/4/619.full.pdf+html
Crosby, J. “Getting it right (or left); Wrong-site surgeries continue to plague hospitals, but a new campaign hopes to ensure
everyone takes a “timeout” before surgery.” Star Tribune, June 20, 2011, p. D.1. Available at:
http://www.highbeam.com/doc/1G1-259321876.html
Simmons, J. “AHRQ: Hospitals give themselves high marks for patient safety.” FierceHealthcare, March 23, 2011. Available at:
http://www.fiercehealthcare.com/story/ahrq-hospitals-give-themselves-high-marks-patient-safety/2011-03-23
Boodman, S.G. “Effort to end surgeries on wrong patients or body part falters.” Kaiser Health News, June 20, 2011. Available at:
http://www.kaiserhealthnews.org/Stories/2011/June/21/wrong-site-surgery-errors.aspx
McCoy, J. “7 medical error disclosure deterrents.” HealthLeaders Media, February 9, 2011. Available at:
http://www.healthleadersmedia.com/content/PHY-260817/7-Medical-Error-Disclosure-Deterrents.html
Goodman, J.C., Villarreal, P., Jones, B. “The social cost of adverse medical events, and what we can do about it.” Health Affairs
30(4):590-595, 2011. Available at: http://content.healthaffairs.org/content/30/4/590.full.pdf+html
Moisse, K. “HHS announces partnership for patients to save lives, money.” abc News, April 12, 2011. Available at:
http://abcnews.go.com/Health/Wellness/hospital-safety-government-industry-team-reduce-errors/story?id=13355460
Kolata, G. “Sports medicine said to overuse a popular scan.” New York Times, October 29, 2011, p. A.1. Available at:
http://www.nytimes.com/2011/10/29/health/mris-often-overused-often-mislead-doctorswarn.html?pagewanted=all&gwh=9206356E07CA1B10B397D83D480CB224
Terry, T. “Electronic prescriptions have as many errors as written prescriptions.” FierceHealthIT, June 30, 2011. Available at:
http://www.fiercehealthit.com/story/prescription-errors-equal-whether-written-or-electronic/2011-06-30
Wakefield, J.G., McLaws, M-L., Whitby, M., Patton, L. “Patient safety culture: factors that influence clinician involvement in
patient safety behaviours.” Quality and Safety in Health Care 19(6):585-591, 2010. Available at:
http://qualitysafety.bmj.com/content/19/6/585.full.pdf+html
“Study Puts Cost of Medical Errors at $19.5 Billion.” Wall Street Journal (online), August 9, 2010. Available at:
http://blogs.wsj.com/health/2010/08/09/study-puts-cost-of-medical-errors-at-195-billion/
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22. Salamon, M. “Despite efforts, study finds no decline in medical errors.” HealthDay News, November 24, 2010. Available at:
http://news.health.com/2010/11/24/despite-efforts-study-finds-no-decline-in-medical-errors/
23. Bennett, A. “Lessons of a $618,616 death.” Bloomberg Businessweek, March 4, 2010. Available at:
http://www.businessweek.com/magazine/content/10_11/b4170032321836.htm
24. Metzger, J., Welebob, E., Bates, D.W., Lipsitz, S., Classen, D.C. “Mixed results in the safety performance of computerized
physician order entry.” Health Affairs 29(4):655-663, 2010. Available at:
http://content.healthaffairs.org/content/29/4/655.full.pdf+html
25. O’Callaghan, T. “Study: Fatal medication mistakes surge in July.” New York Times, June 2, 2010. Available at:
http://www.nytimes.com/2009/12/17/health/17chen.html?_r=1&pagewanted=print
26. Moffeit, M. “DMN investigates: Lax supervision of residents at U.S. teaching hospitals puts patients at risk.” Dallas Morning
News, December 19, 2010. Available at: http://www.dallasnews.com/health/medicine/20101219-lax-supervision-of-residents-atu.s.-teaching-hospitals-puts-patients-at-risk.ece
27. Kaiser Health News. “Race Plays Role in Diagnosis and Treatment.” July 24, 2009. Available at:
http://www.kaiserhealthnews.org/daily-reports/2009/july/24/racial-disparities.aspx?referrer=search
28. Tong, A. “Hospitals stem mistakes with colored socks and sashes. Simple things send a safety signal.” The Sacramento Bee,
September 14, 2009. p. B.1. Available at:
http://s3.amazonaws.com/external_clips/104582/Hospitals_stem_mistakes_with_colored_socks_a.PDF?1345612636
29. Szabo, L. “Studies: Surgeons could save lives, $20B by using checklist.” USA Today, January 14, 2009. Available at:
http://www.usatoday.com/news/health/2009-01-14-surgery-checklist_N.htm
30. Garbutt, J., Waterman, A.D., Kapp, J.M., Dunagan, W.C., Levinson, W., Fraser, V., Gallagher, T.H. “Lost opportunities: How
physicians communicate about medical errors.” Health Affairs 27(1):246-255, 2008. Available at:
http://content.healthaffairs.org/content/27/1/246.full.pdf+html
31. Skinner, J., Chandra, A., Goodman, D., Fisher, E.S. “The elusive connection between health care spending and quality.” Health
Affairs – Web Exclusive 28(1):w119-w123, published online December 4, 2008. Available at:
http://content.healthaffairs.org/content/28/1/w119.full.pdf+html
32. Koppel, R., Wetterneck, T., Telles, J.L., Karsh, B-T. “Workarounds to barcode medication administration systems: Their
occurrences, causes, and threats to patient safety.” Journal of the American Medical Informatics Association 15(4):408-423,
2008. Available at: http://www.sciencedirect.com/science/journal/10675027/15/4
33. Buerhaus, P.I. “Is hospital patient care becoming safer? A conversation with Lucian Leape.” Health Affairs – Web Exclusive
26(6):w687-w696, published online October 9, 2007. Available at: http://content.healthaffairs.org/content/26/6/w687.full.pdf+html
34. “States making it OK for docs to say ‘sorry’.” MSNBC, April 11, 2007. Available at: http://www.msnbc.msn.com/id/18059841/
35. Pronovost, P.J., Miller, M.R., Wachter, R.M. “Tracking progress in patient safety. An elusive target.” JAMA 296(6):696-699,
2006. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=5031&direction=P
36. Asch, S.M., Kerr, E.A., Keesey, J., Adams, J.L., Setodji, C.M., Malik, S., McGlynn, E.A. “Who is at greatest risk for receiving
poor-quality health care?” New England Journal of Medicine 354(11):1147-1156, 2006. Available at:
http://www.nejm.org/doi/pdf/10.1056/NEJMsa044464
37. Leape, L. “Reporting of adverse events.” New England Journal of Medicine 347(20):1633-1638, 2002. Available at:
http://www.nejm.org/doi/pdf/10.1056/NEJMNEJMhpr011493
Session 3 – September 17, 2013
The Health Policy Process: Crabs in a Bucket?
The government plays a major role in shaping the U.S. health care system and its performance. About half of all health care spending in
the United States flows through government programs, and every aspect of health care is subject to relatively extensive government
oversight. In each subsequent session of the course, key health policy issues will be identified and described. This session provides a
foundation for subsequent sessions. First, a general overview of the public policy process and its key participants is presented. Then, the
politics of health care reform is discussed in the context of the recently passed, and continually challenged, federal health reform
legislation.
Learning Objectives
Students should be able to:
1. Demonstrate an understanding of the political process as it relates to health care.
2. Describe the key components in the recently passed federal health reform legislation.
3. Discuss the role that various health care interest groups played in the passage of the federal health reform legislation and its
implementation to date.
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Suggested Readings
Overview of the Policy Process
1*. Marmor, T.R., Christianson, J.B. “The political market for government health policies.” Chapter 3 in Health Care Policy. A Political
Economy Approach. Beverly Hills, CA: Sage Publications, 1982 (Posted on Moodle)
2. Murray, T.H. “American values and health care reform.” New England Journal of Medicine 362(4):285-287, 2010. Available at:
http://www.nejm.org/doi/pdf/10.1056/NEJMp0911116
3*. Kaiser Family Foundation. “KaiserEDU.org Tutorial: U.S. Congress and health policy.” June 29, 2011. Available at:
http://www.kff.org/us-congress-and-health-policy.cfm
4. Vaida, B., Weaver, C. “Scorecard: How health industry PACs placed their election bets. Spending reflected view on health law.”
Kaiser Health News, November 23, 2010. Available at: http://www.kaiserhealthnews.org/Stories/2010/November/17/healthindustry-pacs-election-bets.aspx
5. Israel, J. “Top health information technology firms prefer ‘revolving door’ lobbyists.” iWatchNews, August 22, 2011. Available at:
http://www.iwatchnews.org/2011/08/22/5859/top-health-information-technology-firms-prefer-revolving-door-lobbyists
6. Reinhardt, U.E. “Is there hope for the uninsured?” Health Affairs – Web Exclusive, pp.w3-376-w3-390, published online August
27, 2003. Available at: http://content.healthaffairs.org/content/early/2003/08/27/hlthaff.w3.376.full.pdf+html
PPACA
1*. Kaiser Family Foundation. “KaiserEDU.org Tutorial – Health reform: An overview.” October 1, 2010. Available at:
http://www.kff.org/healthreform/kEDU_health_reform_overview_100110.cfm
2*. Klein, E. “As health-care reform law turns 1, some clarity on what it does and how it does it.” Washington Post, March 22, 2011,
p. A.12. Available at: http://articles.washingtonpost.com/2011-03-21/business/35260878_1_health-care-reform-law-affordablecare-act-insurance
3. Berwick D.M. “Putting health care on the right track.” Washington Post online Opinions, June 21, 2012. Available at:
http://www.washingtonpost.com/opinions/putting-health-care-on-the-right-track/2012/06/21/gJQAtBGltV_story.html
4. Samuelson, R.J. “Why Obamacare is oversold.” Washington Post, May 9, 2013. Available at:
http://articles.washingtonpost.com/2013-05-09/opinions/39133432_1_affordable-care-act-health-care-uninsured-and-medicaidrecipients
5. Deparle, N-A. “The successes of Obamacare.” Washington Post, May 9, 2013. Available at:
http://articles.washingtonpost.com/2013-05-09/opinions/39133432_1_affordable-care-act-health-care-uninsured-and-medicaidrecipients
6. Keller, B. “Five Obamacare myths.” The New York Times, July 15, 2012. Available at:
http://www.nytimes.com/2012/07/16/opinion/keller-five-obamacare-myths.html?pagewanted=all&_r=0
7. Carroll, A.E., Frakt, A.B., “New evidence supports, challenges, and informs the ambitions of health reform.” Journal of the
American Medical Society 309(24):2600-2601, 2013. Available at:
http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=927181&direction=P
The Supreme Court Decision
1. Brooks, D. “Modesty and audacity.” [Op-Ed] New York Times, June 29, 2012, p. A.25. Available at:
http://www.nytimes.com/2012/06/29/opinion/modesty-and-audacity.html?_r=0
2*. Rau, J., Appleby, J. “Justices uphold individual mandate, set limits on Medicaid expansion.” Kaiser Health News, June 28,
2012. Available at: http://www.kaiserhealthnews.org/stories/2012/june/28/supreme-court-upholds-individual-mandate.aspx
3. Jost, T.S. “The affordable care act largely survives the Supreme Court’s scrutiny – but barely.” Health Affairs 31(8):1659-1662,
2012. Available at: http://content.healthaffairs.org/content/31/8/1659.full
Implementation of PPACA
1*. Schouten, F. “Health care law opponents dominate advertising wars.” USA Today, July 10, 2013. Available at:
http://www.usatoday.com/story/news/politics/2013/07/10/affordable-care-act-ads-nfl-president-obama-republicansattacks/2506633/
2*. Bolton, A. “Government shutdown looms over ObamaCare.” The Hill, July 23, 2013. Available at:
http://thehill.com/homenews/administration/312727-shutdown-looms-over-obamacare
3*. Cheney, K. “House GOP unveils death by 1,000 cuts.” Politico, July 17, 2012. Available at:
http://www.politico.com/news/stories/0712/78627.html
4*. Editorial Board. “Obamacare’s tricky next phase.” The Washington Post, May 19, 2013. Available at:
http://articles.washingtonpost.com/2013-05-19/opinions/39376708_1_health-insurance-health-coverage-obamacare-s
5. Millman, J. “Exchanges, but not as envisioned.” Politico, April 8, 2013. Available at:
http://www.politico.com/story/2013/04/obamacare-health-care-exchanges-states-tout-employee-choice-89719.html
6. Pear, R. “Racing to spread word about new health plans.” The New York Times, April 23, 2013. Available at:
http://www.nytimes.com/2013/04/24/health/racing-to-inform-millions-unaware-of-new-healthcoverage.html?pagewanted=all&_r=0
7. Gold, J. “Worries mount about enrolling consumers in federally run insurance exchanges.” Kaiser Health News, April 7, 2013.
Available at: http://www.kaiserhealthnews.org/stories/2013/april/08/health-insurance-exchanges-marketing.aspx
11
https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeR1IyeDE2WkJ0cHc/edit
8.
Krugman, P. “Insurance and freedom.” The New York Times, April 7, 2013. Available at:
http://www.nytimes.com/2013/04/08/opinion/krugman-insurance-and-freedom.html
9. Brooks, D. “Health chaos ahead.” The New York Times, April 25, 2013. Available at:
http://www.nytimes.com/2013/04/26/opinion/brooks-health-chaos-ahead.html
10. Kessler, D.P. “The coming Obamacare shock.” The Wall Street Journal, April 29, 2013. Available at:
http://online.wsj.com/article/SB10001424127887324874204578441032081716170.html
11. Calmes, J. “New worries for Democrats on health law.” The New York Times, May 6, 2013. Available at:
http://www.nytimes.com/2013/05/07/us/politics/gop-is-readying-a-new-offensive-over-health-law.html?pagewanted=all
12. Kessler, G. “Is Long Beach really limiting the hours of 1,600 workers because of ‘Obamacare’?” The Washington Post, May 6,
2013. Available at: http://www.washingtonpost.com/blogs/fact-checker/post/is-long-beach-really-limiting-the-hours-of-1600workers-because-of-obamacare/2013/05/05/81e9a5b6-b4fe-11e2-9a98-4be1688d7d84_blog.html
13*. Klein, E., Soltas, E. “Wonkbook: House Republicans hate Obamacare. But they also kind of need it.” The Washington Post, May
17, 2013. Available at: http://www.washingtonpost.com/blogs/fact-checker/post/is-long-beach-really-limiting-the-hours-of-1600workers-because-of-obamacare/2013/05/05/81e9a5b6-b4fe-11e2-9a98-4be1688d7d84_blog.html
14*. Samuelson, D., Cunningham, P.W. “Obamacare repeal now about the IRS.” Politico, May 16, 2013. Available at:
http://www.politico.com/story/2013/05/obamacare-repeal-irs-91520.html
15. Carey, M.A. “GOP fears about IRS’ access to medical records disputed.” Kaiser Health News Blog, May 20, 2013. Available at:
http://capsules.kaiserhealthnews.org/?p=19604
16. Bogardus, K. “Labor unions break ranks with White House on Obamacare.” The Hill, May 21, 2013. Available at:
http://thehill.com/business-a-lobbying/300881-labor-unions-break-ranks-on-health-law
17. Weisman, J., Pear R. “Partisan gridlock thwarts effort to alter health law.” The New York Times, May 26, 2013. Available at:
http://www.nytimes.com/2013/05/27/us/politics/polarized-congress-thwarts-changes-to-health-care-law.html?pagewanted=all
18. Esenstadt, A. “Democrats’ 2014 strategy: Own Obamacare.” Politico, June 4, 2013. Available at:
http://www.politico.com/story/2013/06/dems-2014-strategy-own-obamacare-92172.html
19*. Baker, S. “Court challenges could tear down major pieces of Obamacare.” The Hill, June 2, 2013. Available at:
http://thehill.com/blogs/healthwatch/health-reform-implementation/302895-court-challenges-could-tear-down-major-pieces-ofobamacare
Other Efforts to Expand Coverage for the Uninsured
1. Henry J. Kaiser Family Foundation. “Massachusetts health care reform: Six years later.” Issue Brief, May 2012. Available at:
http://www.kff.org/healthreform/upload/8311.pdf
2*. Goldman, D. Leive, A. “Why ‘Medicare-for-all” is not the answer.” Health Affairs Blog, May 14, 2013. Available at:
http://healthaffairs.org/blog/2013/05/14/why-medicare-for-all-is-not-the-answer/
3. Hsiao, W.C. “State-based, single-payer health care — A solution for the United States?” New England Journal of Medicine
364(13):1188-1190, 2011. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1100972
Further Readings
1.
2.
3.
4.
5.
6.
7.
8.
9.
Accenture. “Are you ready? Private health insurance exchanges are looming,” 2013. Available at:
http://www.accenture.com/SiteCollectionDocuments/PDF/Accenture-Are-You-Ready-Private-Health-Insurance-Exchanges-AreLooming.pdf
Goodnough, A. “Critics of health care law outspending its supporters on ads.” The New York Times, June 4, 2013. Available at:
http://www.nytimes.com/2013/06/05/us/politics/critics-of-health-care-law-outspending-its-supporters-onads.html?gwh=36412B4E76FE81E688FB25886FB8FE9F
Baker, S. “HHS delays Obamacare option for small businesses, saying it’s too complicated.” The Hill, May 31, 2013. Available at:
http://thehill.com/blogs/healthwatch/health-reform-implementation/302769-hhs-finalizes-delay-in-obamacare-option-for-smallbusinesses
Baker, S. “Despite talk, no effort in Congress to change Obamacare’s employer mandate.” The Hill, May 19, 2013. Available at:
http://thehill.com/blogs/healthwatch/health-reform-implementation/300489-despite-talk-no-effort-to-change-obamacaresemployer-mandate
Viebeck, E. “Botched Obamacare rollout tops Democratic fears for 2014 election.” The Hill, May 1, 2013. Available at:
http://thehill.com/blogs/healthwatch/health-reform-implementation/297103-botched-obamacare-tops-dem-fears-for-14
Klein, E. “Republicans will clobber Obamacare until they hug it.” Bloomberg, April 24, 2013. Available at:
http://www.bloomberg.com/news/2013-04-24/republicans-will-clobber-obamacare-until-they-hug-it.html
Pittman, D. “Docs must take active role in reform, HHS says,” Medpage Today, February 12, 2013. Available at:
http://www.medpagetoday.com/Washington-Watch/Reform/37336
Vestal, S. “Lack of competition might hamper health exchanges.” Kaiser Health News, April 23, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/april/23/stateline-lack-of-competition-hamper-health-exchanges.aspx
Chen, L. “How Obamacare will distort the health-care market.” Bloomberg, April 7, 2013. Available at:
http://www.bloomberg.com/news/2013-04-07/how-obamacare-will-distort-the-health-care-market.html
12
https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeR1IyeDE2WkJ0cHc/edit
10. Carey, M.A. “How the ‘fiscal cliff’ affects health care: Six questions.” Kaiser Health News, December 4, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/december/05/fiscal-cliff.aspx
11. Dionne Jr., E.J. “A victory for Obama – and for Roberts.” Washington Post online Opinions, June 28, 2012. Available at:
http://www.washingtonpost.com/opinions/ej-dionne-jr-a-win-for-obama--and-roberts/2012/06/28/gJQAlWta9V_story.html
12. Horwitz, J., Levy, H. “Health care economics 101 and the Supreme Court.” Health Affairs Blog, May 23, 2012. Available at:
http://healthaffairs.org/blog/2012/05/23/health-care-economics-101-and-the-supreme-court/
13. Steuerle, C.E. “How much did the Supreme Court settle?” Urban Institute Research of Record, July 2, 2012. Available at:
http://www.urban.org/publications/901516.html
14. Gawande, A. “Something wicked this way comes.” The New Yorker online, June 28, 2012. Available at:
http://www.newyorker.com/online/blogs/comment/2012/06/something-wicked-this-way-comes.html
15. Kessler, G. “Fact checker: Does Romney’s assessment of the economic impact of Obama’s health-care law hold up?”
Washington Post online Politics, June 16, 2012. Available at: http://www.washingtonpost.com/politics/fact-checker-doesromneys-assessment-of-the-economic-impact-of-obamas-health-care-law-hold-up/2012/06/16/gJQAJjsqhV_story.html
16. Daschle, T. “Obama’s 4 major ACA hurdles to go.” Politico, July 8, 2012. Available at:
http://www.politico.com/news/stories/0712/78207.html
17. Gerstein, J., Haberkorn, J. “Supreme Court health care ruling: 6 takeaways.” Politico, June 28, 2012. Available at:
http://www.politico.com/news/stories/0612/77986.html
18. Parker-Pope, T. “What you need to know in the first year.” New York Times, March 30, 2010, p. D.1. Available at:
http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=norm
al&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroups=&s
ortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA222455099
19. Rago, J. “The Massachusetts health-care ‘train wreck’.” The Wall Street Journal, July 7, 2010, p. A.17. Available at:
http://online.wsj.com/article/SB10001424052748704324304575306861120760580.html
20. Pear, R. “Short of repeal, G.O.P. will chip at health law.” New York Times, September 21, 2010, p. A.1. Available at:
http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=norm
al&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroups=&s
ortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA237499337
21. Cafarella, N., Carrk, T. “Myth vs. fact: Health care reform in Massachusetts. The state model for the affordable care act is
working and broadly popular.” Washington, DC: Center for American Progress. April 2011. Available at:
http://www.americanprogress.org/issues/2011/04/mvf_healthcare_mass.html
22. Krugman, P. “Hurray for health reform [Op-Ed]. New York Times, March 19, 2012, p. A.21. Available at:
http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=norm
al&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroups=&s
ortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA283436112
Care Delivery
Session 4 – September 24, 2013
The Physician Workforce: Characteristics, Training and Projections of Future Need
Assignment 2 Due
People are the critical element in any health care delivery system. In this session, we will focus on physicians, particularly on physician
education and aggregate-level supply. There is now a major disagreement about whether there will be a future physician shortage and, if
so, how to address it. There is also concern that health reform will make matters worse. This session presents opposing perspectives on
these issues and discusses the likelihood of a public policy response. Subsequent courses in the MHA program will cover material relating
to physician payment and management of physician practices.
Learning Objectives
Students should be able to:
1. Discuss the points of controversy regarding the prediction of future shortages or surpluses in physician supply in America.
2. Explain the limitations of the present medical education system in expanding physician supply.
3. Compare the positive and negative aspects of meeting U.S. physician shortages through use of foreign medical graduates.
4. Discuss the public policy issues regarding expanding physician supply.
Suggested Readings
Physician Education
1*. Saxton, J. “The medical education of physicians.” Background Paper No. 73, National Health Policy Forum. February 17, 2010.
Available at: http://www.nhpf.org/library/background-papers/BP73_MedicalEducation_02-17-10.pdf
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https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeR1IyeDE2WkJ0cHc/edit
2.
Kaiser Health News. “Medical school costs, loan rates rise sharply.” March 20, 2010. Available at:
http://www.kaiserhealthnews.org/Daily-Reports/2010/March/10/medical-school-cost.aspx
3. Dower, C., O’Neil, E. “Primary care health workforce in the United States.” Robert Wood Johnson Foundation Research
Synthesis Report No. 22, July 2011. Available at: http://www.rwjf.org/files/research/070811.policysynthesis.workforce.rpt.pdf
4. Kavilanz, P. “Med students rush to primary care programs.” CNN Money, March 23, 2011. Available at:
http://money.cnn.com/2011/03/23/news/economy/more_medical_students_pick_family_medicine/index.htm
5. LA Times online. “Medical school enrollment on the rise.” October 24, 2011. Available at:
http://latimesblogs.latimes.com/money_co/2011/10/medical-school-enrollment.html
6*. Dower, C. “Graduate medical education. A debate continues over the size and scope of federal subsidies to support residency
training of the nation’s physicians.” August 16, 2012. Available at:
http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_73.pdf
7. Wayne, D.B., Hauer, K.E. “Counting quality, not hours: Understanding the impact of duty hour reform on internal medicine
residency education.” Journal of General Internal Medicine 27(11):1400-1401, 2012.
http://link.springer.com/content/pdf/10.1007%2Fs11606-012-2185-3
8. Iglehart, J.K. “Financing graduate medical education – mounting pressure for reform.” New England Journal of Medicine
366(17):1562-1563, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1114236
9. Cohen, J. “New med school aims to train primary care docs.” Kaiser Health News, April 2, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/april/02/quinnipiac-medical-school-primary-care.aspx
10*. Ofri, D. “The third year of medical school turns students from altruistic to bitter.” Slate, June 4, 2013. Available at:
http://www.slate.com/articles/health_and_science/medical_examiner/2013/06/medical_school_dark_side_the_third_year_makes
_students_less_empathetic.html
11. Sack, K. “Summer of work exposes medical students to system’s ills.” The New York Times, September 9, 2009. Available at:
http://www.nytimes.com/2009/09/09/health/policy/09medschool.html?_r=0
12. Crosson, F.J., Leu, J., Roemer, B.M., Ross, M.N. “Gaps in residency training should be addressed to better prepare doctors for a
twenty-first century delivery system.” Health Affairs 30(11):2142-2148, 2011. Available at:
http://content.healthaffairs.org/content/30/11/2142.full.pdf+html
Physician Concerns
1*. Ringel, S.P. “Practicing medicine versus pushing paper. A neurologist reflects on the realities of his workday after a patient asks
why doctors complain about payers’ bureaucratic oversight.” Health Affairs 30(6):1200-1202, 2011.
http://content.healthaffairs.org/content/30/6/1200.full.pdf+html
2. Morra, D., Nicholson, S., Levinson, W., Gans, D.N., Hammons, T., Casalino, L.P. “US Physician practices versus Canadians:
Spending nearly four times as much money interacting with payers.” Health Affairs 30(8):1443-1450, 2011.
http://content.healthaffairs.org/content/30/8/1443.full.pdf+html
3. Barr, S. “Few doctors consider themselves rich, survey says.” Kaiser Health News, April 25, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/04/few-doctors-consider-themselves-rich-survey-says/
4. Punke, H. “11 specialties with most satisfied physicians.” Becker’s Hospital Review, April 30, 2013. Available at:
http://www.beckershospitalreview.com/hospital-physician-relationships/11-specialties-with-most-satisfied-physicians.html
Practice Choices
1*. Lee, D. “Physician-hospital links grow. Overhead, reimbursement fuel trend of doctors forgoing autonomy.” Indy.com, March 4,
2010. Available at: http://www.indystar.com/article/20100304/BUSINESS/3040377/Physician-hospital-links-grow
2. Harris, G. “More physicians say no to endless workdays.” New York Times, April 2, 2011, p. A.1.
http://www.nytimes.com/2011/04/02/health/02resident.html?pagewanted=all&_r=0
3*. Burling, S. “Why heart doctors are leaving practice to work for hospitals.” philly.com, January 27, 2012. Available at:
http://mobile.philly.com/health/?wss=/philly/health&id=138095623
4*. Gamble, M. “68% of graduating physicians want sign-on bonus, 29% want hospital practice.” Becker’s Hospital Review, August
16, 2012. Available at: http://www.beckershospitalreview.com/hospital-physician-relationships/68-of-graduating-physicians-wantsign-on-bonus-29-want-hospital-practice.html
Projections of Future Physician Supply
1. Iglehart, J.K. “Grassroots activism and the pursuit of an expanded physician supply.” New England Journal of Medicine
358(16):1741-1749, 2008. http://www.nejm.org/doi/pdf/10.1056/NEJMhpr0800058
2*. Robert Wood Johnson Foundation. “Will the United States have a shortage of physicians in 10 years?” November 2009.
Available at: http://www.academyhealth.org/files/publications/HCFOReportDec09.pdf
3*. Henry J. Kaiser Family Foundation. “Primary care shortage; Background brief.” Available at:
http://www.kaiseredu.org/topics_im.asp?id=1032&imID=1&parentID=70
4. Alliance for Health Reform. “Health care workforce: Future supply vs. demand.” Washington, DC: Author, April 2011. Available
at: http://www.allhealth.org/publications/Medicare/Health_Care_Workforce_104.pdf
5. Wayne, A. “Doctor shortage may swell to 130,000 with cap.” Bloomberg, August 28, 2012. Available at:
http://www.bloomberg.com/news/2012-08-29/doctor-shortage-may-swell-to-130-000-with-u-s-cap.html
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https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeR1IyeDE2WkJ0cHc/edit
6. Dunn, L. “What will the physician workforce look like in 2030?” Becker’s Hospital Review, May 13, 2013. Available at:
http://www.beckershospitalreview.com/hospital-physician-relationships/what-will-the-physician-workforce-look-like-in-2030.html
7. Preidt, R. “Primary care doctors still in short supply in U.S.” MedlinePlus, June 14, 2013. Available at:
http://www.nlm.nih.gov/medlineplus/news/fullstory_137836.html
8. Sanner, A. “Newly insured to deepen primary care doctor gap.” TwinCities.com, June 22, 2013. Available at:
http://www.loganbanner.com/view/full_story/22993974/article-Newly-insured-to-deepen-primary-care-doctor-gap
Options for Increasing Physician Supply
1. Hart, L.G. et al. “International medical graduate physicians in the United States: Changes since 1981.” Health Affairs 26(4):11591169, 2007. http://content.healthaffairs.org/content/26/4/1159.full.pdf+html
2*. Brownlee, S., Goodman D. “Doctors no one needs.” [Op-Ed]. New York Times, December 23, 2009. p. A.31.
http://www.nytimes.com/2009/12/23/opinion/23brownlee.html
3*. Pardes, H., Miller, E.D. “We can’t afford to train fewer doctors.” New York Times, July 12, 2011, p. A.13.
http://online.wsj.com/article/SB10001424052702303544604576434470768158908.html
4. McAllester, M. “America is stealing the world’s doctors.” New York Times online, March 7, 2012. Available at:
http://www.nytimes.com/2012/03/11/magazine/america-is-stealing-foreign-doctors.html?pagewanted=all
5. Association of American Medical Colleges. “Medical school enrollment continues to climb with new diversity gains.” October 24,
2012. Available at: https://www.aamc.org/newsroom/newsreleases/310002/121023.html
6. Editorial. “An Rx for the doctor shortage.” Los Angeles Times, April 21, 2013. Available at:
http://articles.latimes.com/2013/apr/21/opinion/la-ed-medical-professionals-20130421
7*. Caramenico, A. “Med school enrollment growth won’t ease doc shortage.” FierceHealthcare, May 3, 2013. Available at:
http://www.fiercehealthcare.com/story/med-school-enrollment-growth-wont-ease-doc-shortage/2013-05-03
8. Minnesota Medicine. “Willing and able to work.” April 2010. Available at:
http://www.minnesotamedicine.com/PastIssues/PastIssues2010/April2010/PulseWillingandAbletoWorkApril2010.aspx
9. Sanders, B. “Primary physician shortage calls for intervention.” Politico, May 7, 2013. Available at:
http://www.politico.com/story/2013/05/doctors-physician-shortage-calls-for-intervention-91024.html
10. Gold, J. “Immigrant docs help ease California’s primary care shortage.” Kaiser Health News, April 4, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/april/04/california-doctors-primary-care-latin-america.aspx
11. Torrey, E.F., Torrey, B.B. “The US distribution of physicians from lower income countries.” PLoS One 7(3):1-4, 2012. Available
at: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0033076
12. Koleva, G. “Economists show primary care especially unrewarding for women doctors.” Forbes, July 16, 2012. Available at:
http://www.forbes.com/sites/gerganakoleva/2012/07/16/economists-show-primary-care-especially-unrewarding-for-womendoctors/
Public Policy Issues and Concerns About Physician Supply
1. Lowrey, A., Pear, R. “Doctor shortage likely to worsen with health law.” New York Times, July 29, 2012, p. A.1.
http://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.html
2*. Goozner, M. “More doctors on the way, higher costs to follow.” The Fiscal Times, May 4, 2012. Available at:
http://www.thefiscaltimes.com/Articles/2012/05/04/More-Doctors-on-the-Way-Higher-Costs-to-Follow.aspx#page1
3*. Reinhardt, U.E. “Health-care reform and the ‘doctor shortage’.” New York Times online, August 17, 2012. Available at:
http://economix.blogs.nytimes.com/2012/08/17/health-care-reform-and-the-doctor-shortage/
4. Reinhardt, U.E. “From physician glut to physician shortage.” The New York Times, August 31, 2012. Available at:
http://economix.blogs.nytimes.com/2012/08/31/from-physician-glut-to-physician-shortage/
5. Davis, K.L. “Demand for doctors soaring as cuts loom.” Politico, March 5, 2013. Available at:
http://www.politico.com/story/2013/03/demand-for-doctors-soaring-as-cuts-loom-88390.html
6. Ubel, P. “How much money should a cardiologist make?” Forbes, December 7, 2012. Available at:
http://www.forbes.com/sites/peterubel/2012/12/07/how-much-money-should-a-cardiologist-make/
Further Readings
1.
2.
3.
4.
5.
6.
Conover, C. “Are U.S. doctors paid too much?” Forbes, May 28, 2013. Available at:
http://www.forbes.com/sites/theapothecary/2013/05/28/are-u-s-doctors-paid-too-much/
ConsumerReports. “What bugs you most about your doctor.” June 2013. Available at:
http://www.consumerreports.org/cro/magazine/2013/06/what-bugs-you-most-about-your-doctor/index.htm
Hixon, T. “Rebutting the premise that doctors help drive high health care costs.” Forbes, March 24, 2012. Available at:
http://www.forbes.com/sites/toddhixon/2012/03/24/rebutting-the-premise-that-doctors-help-drive-high-health-care-costs/
Novak, S. “Luring students into family medicine.” The New York Times, September 9, 2012. Available at:
http://www.nytimes.com/2012/09/10/us/10iht-educlede10.html?pagewanted=all
Tulenko, K. “America’s health worker mismatch.” The New York Times, September 13, 2012. Available at:
http://www.nytimes.com/2012/09/14/opinion/americas-health-worker-mismatch.html
Viebeck, E. “House Dem floats bill to ward off doctor shortage.” The Hill, September 28, 2012. Available at:
http://thehill.com/blogs/healthwatch/other/259239-house-dem-floats-bill-to-ward-off-doctor-shortage
15
https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeR1IyeDE2WkJ0cHc/edit
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Schwartz, M.D. “Health care reform and the primary care workforce bottleneck.” Journal of General Internal Medicine 27(4):469472, 2012. http://link.springer.com/content/pdf/10.1007%2Fs11606-011-1921-4
Gold, J. “The next frontier for elite med schools: Primary care.” Kaiser Health News, September 23, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/september/24/mt-sinai-primary-care.aspx
Goldstein, A. “Primary-care health panel caught in partisan dispute.” The Washington Post, May 16, 2011, p. A.3. Available at:
http://www.highbeam.com/doc/1P2-28704120.html
Aneja, S., Ross, J.S., Wang, Y., Matsumoto, M., Rodgers, G.P., Bernheim, S.M., Rathore, S.S., Krumholz, H.M. “US cardiologist
workforce from 1995 to 2007: Modest growth, lasting geographic maldistribution especially in rural areas.” Health Affairs
30(12):2301-2309, 2011. Available at: http://content.healthaffairs.org/content/30/12/2301.full.pdf+html
Armstrong, D. “Doctors turn away insured patients on low payments, study finds.” Bloomberg, June 27, 2011. Available at:
http://www.bloomberg.com/news/2011-06-27/doctors-turn-away-insured-on-low-payments.html
Cassel, C. K., Reuben, D.B. “Specialization, subspecialization, and subsubspecialization in internal medicine.” New England
Journal of Medicine 364(12):1169-1173, 2011. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMsb1012647
Grady, D. “Foreign-born doctors give equal care in U.S.” New York Times, August 3, 2010, p. D.7.
http://www.nytimes.com/2010/08/03/health/03doctors.html
Brown, D. “How the new health-care law might make your doctor better informed, more efficient, more responsive and, maybe,
happier.” The Washington Post, May 4, 2010, p. E.1. Available at: http://www.washingtonpost.com/wpdyn/content/article/2010/04/30/AR2010043002007.html
Gold, J. “Hospitals lure doctors away from private practice.” Kaiser Health News, October 13, 2010. Available at:
http://www.npr.org/templates/story/story.php?storyId=130237412
Iglehart, J.K. “Medicare, graduate medical education, and new policy directions.” New England Journal of Medicine 359(6):643650, 2008. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMhpr0803754
Session 5 – October 1, 2013
Rethinking Primary Care: What is the Future for the Family Doctor?
Improving the delivery of primary care is a growing challenge for policymakers, clinicians, and health care managers. The flaws in the
present system are painfully evident, with various alternatives now being adopted in hopes of correcting, or at least, mitigating them. In
this session, we describe the challenges currently facing primary care, with particular focus on new models for organizing the delivery of
care, and the potential expanded role for advanced practice nurses in rethinking primary care.
Learning Objectives
Students should be able to:
1.
Describe the factors leading to current efforts to change primary care delivery in the U.S.
2.
Discuss changes in the workplace and work arrangements for primary care physicians.
3.
Compare and contrast new models for reforming primary care.
4.
Discuss how public policy, and health care reform in particular, is likely to affect primary care.
Suggested Readings
Challenges to Traditional Models of Primary Care Delivery
1*. Bodenheimer, T. and Pham H.H. “Primary care: Current problems and proposed solutions.” Health Affairs 29(5):799-805, 2010.
http://content.healthaffairs.org/content/29/5/799.full.pdf+html
2. Vaughn, B.T., DeVrieze, S.R., Reed, S.D., Schulman, K.A. “Can we close the income and wealth gap between specialists and
primary care physicians?” Health Affairs 29(5):933-940, 2010. http://content.healthaffairs.org/content/29/5/933.full.pdf+html
3. Iglehart, J.K. “Doctor-workers of the world, unite!” Health Affairs 30(4):556-558, 2011.
http://content.healthaffairs.org/content/30/4/556.full.pdf+html
4. Delude, C. “What happened to the family doctor?” Los Angeles Times, June 27, 2011. Available at:
http://articles.latimes.com/print/2011/jun/27/health/la-he-primary-care-doctors-20110627
5*. Iglehart, J.K. “Primary care update – light at the end of the tunnel?” New England Journal of Medicine 366(23):2144-2146, 2012.
http://www.nejm.org/doi/pdf/10.1056/NEJMp1205537
6. Peterson, S.M., Phillips Jr., R.L., Bazemore, A.W., Koinis, G.T. “Unequal Distribution of the U.S. primary care workforce.”
American Family Physician 87(11):1. Available at:
https://www.clinicalkey.com/#!/BrowserCtrl/doBrowseTo/journalIssue/{"facet":["1-s2.0S0002838X13X60101"],"issn":"0002838X","contentType":"Journals"}
7. Sanger-Katz, M. “Why we trust doctors.” NationalJournal, April 19, 2012. Available at:
http://www.nationaljournal.com/features/restoration-calls/why-we-trust-doctors-20120419
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https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeR1IyeDE2WkJ0cHc/edit
Changes in the Workplace for Primary Care Physicians
1. Landon, B.E. “Use of quality indicators in patient care. A senior primary care physician trying to take good care of his patients.”
Journal of the American Medical Association 307(9):956-964, 2012. Available at:
http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=22492&direction=P
2. Chen, P. “Delivering Better Primary Care.” New York Times, May 13, 2010. Available at:
http://www.nytimes.com/2010/05/13/health/13chen.html
3. Becker, A.E. “More physicians turning to hospital-based practice.” Ctmirror, August 15, 2011. Available at:
http://ctmirror.org/story/13550/hospitalists
4. Harris, G. “Family physician can’t give away solo practice.” New York Times, April 23, 2011, p. A.1.
http://www.nytimes.com/2011/04/23/health/23doctor.html?pagewanted=all
5*. Sun, L.H. “Hospitals courting primary-care doctors.” Washington Post, June 20, 2011, p. A.1.
http://articles.washingtonpost.com/2011-06-19/national/35265390_1_primary-care-care-at-lower-costs-medicine
6. Swan, B.A. “After hospital care, the test begins.” Los Angeles Times, May 9, 2013. Available at:
http://articles.latimes.com/2013/may/09/opinion/la-oe-swan-post-hospital-care-20130509
New Models for Primary Care
Patient Centered Medical Homes (PCMHs) and Team Care
1*. Hoff, T. “The shaky foundation of the patient-centered medical home.” American Journal of Managed Care 16(6):e134-e136,
2010. http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=b1ae00b1-d01d-4f57-a3a7c3fa2b2aa56c%40sessionmgr14&vid=4&hid=16
2*. Casalino, L.P. “Analysis & commentary. A Martian’s prescription for primary care: Overhaul the physician’s workday.” Health
Affairs 29(5):785-790, 2010. http://content.healthaffairs.org/content/29/5/785.full.pdf+html
3. Margolius, D., Bodenheimer, T. “Transforming primary care: From past practice to the practice of the future.” Health Affairs
29(5):779-784, 2010. http://content.healthaffairs.org/content/29/5/779.full.pdf+html
4. Berenson, R.A., Devers, K.J., Burton, R.A. “Will the patient-centered medical home transform the delivery of health care?”
Washington, DC: Urban Institute, August 2011. Available at: http://www.urban.org/UploadedPDF/412373-will-patient-centeredmedical-home-transform-delivery-health-care.pdf
5. Adair, R., Christianson, J., Wholey, D., White, K.M., Town, R., Lee, S., et al. “Care guides. Employing nonclinical laypersons to
health primary care teams manage chronic disease.” Journal of Ambulatory Care Management 35(1):27-37, 2012.
http://ovidsp.tx.ovid.com/sp3.8.1a/ovidweb.cgi?WebLinkFrameset=1&S=OHFMFPMFGBDDCDJDNCOKJDIBFLAMAA00&returnUrl=ovidweb.cgi%3f%26TO
C%3dS.sh.18.19.22.25%257c4%257c50%26FORMAT%3dtoc%26FIELDS%3dTOC%26S%3dOHFMFPMFGBDDCDJDNCOKJ
DIBFLAMAA00&directlink=http%3a%2f%2fgraphics.tx.ovid.com%2fovftpdfs%2fFPDDNCIBJDJDGB00%2ffs047%2fovft%2flive%
2fgv031%2f00004479%2f00004479-20120100000004.pdf&filename=Care+Guides%3a+Employing+Nonclinical+Laypersons+to+Help+Primary+Care+Teams+Manage+Chronic
+Disease.&link_from=S.sh.18.19.22.25%7c4&pdf_key=B&pdf_index=S.sh.18.19.22.25
7*. Ghorob, A., Bodenheimer, T. “Sharing the care to improve access to primary care.” New England Journal of Medicine
366(21):1955-1957, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1202775
8. Green, L.V., Savin, S., Lu, Y. “Primary care physician shortages could be eliminated through use of teams, nonphysicians, and
electronic communications.” Health Affairs 32(1):11-19, 2013. Available at:
http://content.healthaffairs.org/content/32/1/11.full.pdf+html
9*. Hausman, S. “Yes, Virginia, there is a medical home.” Kaiser Health News, May 1, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/may/01/medical-homes-virginia.aspx
10. Rao, A. “Doctors transform how they practice medicine.” Kaiser Health News, May 15, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/may/15/doctors-transform-practices-over-financial-lifestylepressures.aspx?referrer=search
11. The Commonwealth Fund. “Primary care: Our first line of defense.” June 12, 2013. Available at:
http://www.commonwealthfund.org/Publications/Health-Reform-and-You/Primary-Care-Our-First-Line-of-Defense.aspx?page=all
12. Frolkis, J.P. “The Columbo phenomenon.” Journal of the American Medical Association 309(22):2333-2334, 2013. Available at:
http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=927088&direction=P
13. Landon, B.E. “Moving ahead with the PCMH: Some progress, but more testing needed.” Journal of General Internal Medicine
28(6):753-755, 2013. Available at: http://link.springer.com/content/pdf/10.1007%2Fs11606-013-2434-0.pdf
Increased Reliance on Advanced Practice Nurses
1. Galewitz, P. “Urgent care centers are booming, which worries some doctors.” The Washington Post, September 17, 2012.
Available at: http://www.washingtonpost.com/national/health-science/urgent-care-centers-are-booming-which-worries-somedoctors/2012/09/17/e87f1a0c-e0cb-11e1-a19c-fcfa365396c8_story.html
2*. Pohl, J.M., Hanson, C., Newland, J.A., Cronenwett, L. “Analysis & commentary. Unleashing nurse practitioners’ potential to
delivery primary care and lead teams.” Health Affairs 29(5):900-905, 2010.
http://content.healthaffairs.org/content/29/5/900.full.pdf+html
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https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeR1IyeDE2WkJ0cHc/edit
3.
Elliott, V.S. “Sharp increase expected in number of nurse practitioners.” amednews.com, July 2, 2012. Available at:
http://www.ama-assn.org/amednews/2012/07/02/bisb0702.htm
4*. Kiff, S. “Nurse practitioners look to fill gap with expected spike in demand for health services.” Washington Post online, May 12,
2012. Available at: http://www.washingtonpost.com/national/health-science/nurse-practitioners-look-to-raise-profile-fill-gap-fromdoctor-shortage/2012/05/12/gIQAHmHYLU_story.html
5. Aizenman, N.C. “Nurses can practice without physician supervision in many states.” The Washington Post, March 24, 2013.
Available at: http://www.washingtonpost.com/national/health-science/nurses-can-practice-without-physician-supervision-in-manystates/2013/03/24/98b241cc-8745-11e2-999e-5f8e0410cb9d_story.html
6. Punke, H. “Hiring of non-physician providers on the rise.” Becker’s Hospital Review, November 2, 2012. Available at:
http://www.beckershospitalreview.com/hospital-physician-relationships/hiring-of-non-physician-providers-on-the-rise.html
7*. Beck, M. “Battles erupt over filling doctors’ shoes.” The Wall Street Journal, February 4, 2013. Available at:
http://online.wsj.com/article/SB10001424127887323644904578271872578661246.html
8. State of Iowa, Iowa Board of Medicine. “Board reminds physicians of responsibilities when supervising up to 5 physician
assistants.” March 11, 2013. Available at:
http://medicalboard.iowa.gov/Board%20News/2013/Board%20offers%20guidance%20on%20supervision%20of%20physician%2
0assistants%20-%2003112013.pdf
9. SullivanCotter and Associates, Inc. “Advancing practice clinician pay – what’s happening and what’s coming.” 2012. Available at:
http://www.sullivancotter.com/sites/default/files/SullivanCotter_2012_APC%20Pay_What's%20Happening%20and%20What's%2
0Coming_0.pdf
10. Bartolone, P. “California weighs expanded role for nurse practitioners.” Kaiser Health News, May 9, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/may/09/california-expanded-role-nurse-practitioners.aspx?referrer=search
11*. Tran, A. “Docs, nurses disagree over expanded nurse roles.” Kaiser Health News Blog, May 15, 2013. Available at:
http://capsules.kaiserhealthnews.org/?p=19536
12. Dill, M.J., Pankow, S., Erikson, C., Shipman, S. “Survey shows consumers open to a greater role for physician assistants and
nurse practitioners.” Health Affairs 32(6):1135-1142, 2013. Available at:
http://content.healthaffairs.org/content/32/6/1135.full.pdf+html
13. Pohl, J., Barksdale, D., Werner, K. “The latest data on primary care nurse practitioners and physicians: Can we afford to waste
our workforce? Health Affairs Blog, June 18, 2013. Available at: http://healthaffairs.org/blog/2013/06/18/the-latest-data-onprimary-care-nurse-practitioners-and-physicians-can-we-afford-to-waste-our-workforce/
The Influence of Public Policy and Health Reform on Primary Care
1. Wang, S.S. “Pilot plan on health an option for states.” Wall Street Journal, June 8, 2010. Available at:
http://online.wsj.com/article/NA_WSJ_PUB:SB10001424052748704749904575293044222043802.html.
2. DoBias, M. “Adapt or else. Whether it wants to or not, the health care system is being forced to reinvent itself.”
NationalJournal.com, March 10, 2011. Available at: http://www.nationaljournal.com/member/magazine/health-reform-forcesindustry-to-reinvent-itself-20110310?mrefid=site_search&page=1
3. Johnson, W. “Family care doctors are in high demand.” CBSnews, February 18, 2012. Available at:
http://www.cbsnews.com/8301-18563_162-57380915/family-care-doctors-are-in-high-demand/
Further Readings
1.
2.
3.
4.
5.
6.
7.
8.
PR Newswire. “Minute clinic recognizes national nurse practitioner week.” November 13, 2012. Available at:
http://www.prnewswire.com/news-releases/minuteclinic-recognizes-national-nurse-practitioner-week-and-invests-in-theeducation-and-advancement-of-clinicians-across-the-us-179148671.html
Fifield, J., Forrest, D.D., Martin-Peele, M., Burleson, J.A., Goyzueta, J., Fujimoto, M., Gillespie, W. “A randomized, controlled trial
of implementing the patient-centered medical home model in solo and small practices.” The Commonwealth Fund, September
10, 2012. Available at: http://www.commonwealthfund.org/Publications/In-the-Literature/2012/Sep/Randomized-Controlled-Trialof-Implementing-PCMH-Model.aspx
Elliott, V.S. “Study quantifies practice boost from physicians delegating tasks.” Amednews.com, November 19, 2012. Available
at: http://www.ama-assn.org/amednews/2012/11/19/bisb1119.htm
Fiegl, C., O’Reilly, K.B. “AMA meeting: Guidance on health care teams approved.” Amednews.com, November 26, 2012.
Available at: http://www.ama-assn.org/amednews/2012/11/26/prsc1126.htm
Korda, H. “Where’s the patient in the patient-centered medical home?” Health Affairs Blog, April 26, 2011. Available at:
http://healthaffairs.org/blog/2011/04/26/where%E2%80%99s-the-patient-in-the-patient-centered-medical-home/
Becker, A.L. “A Hamden doctor explores the changing medical landscape on his own.” TheCTMirror, June 20, 2011. Available at:
http://healthaffairs.org/blog/2011/04/26/where%E2%80%99s-the-patient-in-the-patient-centered-medical-home/
Boult, C., Wieland G.D., “Comprehensive primary care for older patients with multiple chronic conditions. Nobody rushes you
through.” Journal of the American Medical Association 304(17):1936-1943, 2010. Available at:
http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=4535&direction=P
Bohmer, R.M.J. “Managing the new primary care: The new skills that will be needed.” Health Affairs 29(5):1010-1014, 2010.
http://content.healthaffairs.org/content/29/5/1010.full.pdf+html
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https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeR1IyeDE2WkJ0cHc/edit
9.
10.
11.
12.
13.
Nelson, K., Pitaro, M., Tzellas, A., and Lum, A. “Transforming the role of medical assistants in chronic disease management.”
Health Affairs 29(5):963-965, 2010. Available at: http://content.healthaffairs.org/content/29/5/963.full.pdf+html
Vaughn, B.T., DeVrieze, S.R., Reed, S.D., and Schulman, K.A. “Can we close the income and wealth gap between specialists
and primary care physicians?” Health Affairs 29(5):933-940, 2010. Available at:
http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=4535&direction=P
Crabtree, B. F., Nutting, P.A., Miller, W.L., Stange, K.C., Stewart, E.E., Jaén, C.R. “Summary of the national demonstration
project and recommendations for the patient-centered medical home.” Annuals of Family Medicine 8(Suppl 1):S80-S90, 2010.
Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885727/pdf/0080080.pdf
LeBlanc, S. “50 Million New Patients? More Primary Docs a Must.” Fox News, September 13, 2009. Available at:
http://www.foxnews.com/story/0,2933,549762,00.html
Bodenheimer, T., Berenson, R.A., and Rudolf, P. “The primary care—Specialty income gap: Why it matters.” Annals of Internal
Medicine 146(4):301-306, 2007. Available at: http://annals.org/issue.aspx?journalid=90&issueID=20131&direction=P
Session 6 – October 8, 2013
The Nurse Workforce: “Is There a Nurse in the House?”
Nurses have been called the backbone of the U.S. health care system. They work in all health care settings, including hospitals, clinics,
long-term care facilities and insurance plans. Historically, at the aggregate level, maintaining an adequate supply of nurses has been a
perplexing issue. At the micro-level, scope-of-practice and work environment have been particularly important questions for the nursing
profession. This session provides an overview of the nurse workforce, addressing specifically the topics of nurse supply, scope of practice
and work environment.
Learning Objectives
1.
2.
3.
Compare and contrast the various explanations for historical and more recent periods of nursing shortage.
Discuss nurse scope of practice and work force issues from the points of view of nurses and health care managers.
Discuss recent state and federal policy initiatives directed at nursing.
Suggested Readings
Managing the Supply of Nurses
1*. kaiserEDU.org. “Nursing workforce.” Available at: http://www.kaiseredu.org/Issue-Modules/Addressing-the-NursingShortage/Background-Brief.aspx?referrer=search
2*. Dugger, C.W. “U.S. plan to lure nurses may hurt poor nations.” New York Times, May 24, 2006. p. A.1.
http://www.nytimes.com/2006/05/24/world/americas/24nurses.html?pagewanted=all&gwh=406ABEDB7F6145991210844C7D30
2A93
3. Brown, T. “Is there a nurse in the house?” [Op-Ed], New York Times, June 19, 2010. p. A.21.
http://www.nytimes.com/2010/06/19/opinion/19brown.html?gwh=0A5962B0824676E3F9353359C2462BA9
4. Aiken, L.H. “Nurses for the future.” The New England Journal of Medicine 364:196-198, 2011.
http://www.nejm.org/doi/pdf/10.1056/NEJMp1011639
5*. Auerbach, D.I., Buerhaus, P.I., Staiger, D.O. “Registered nurse supply grows faster than projected amid surge in new entrants
ages 23-26.” Health Affairs 30(12):2286-2292, 2011. http://content.healthaffairs.org/content/30/12/2286.full.pdf+html
6. Robertson, T. “Nursing a favored landing spot for dislocated workers.” MPR News, May 6, 2011. Available at:
http://minnesota.publicradio.org/display/web/2011/05/05/dislocated-workers/
7. Ostrom, C.M. “Hospital cuts add to oversupply of health-care workers.” The Seattle Times, November 18, 2012. Available at:
http://seattletimes.com/html/localnews/2019711613_nurses19m.html
8. Georgia Health News. “Nurses without jobs: A sign of the times.” March 11, 2013. Available at:
http://www.georgiahealthnews.com/2013/05/nurses-jobs-sign-times/
9. Nurse.com. “Study: More BSN nurses means lower mortality rates.” March 7, 2013. Available at:
http://news.nurse.com/article/20130307/NATIONAL02/103180008
10. CareFirst. “CareFirst invests another $1 million in nursing shortage.” May 29, 2013. Available at:
https://member.carefirst.com/wps/portal/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hLbzN_Q09LYwN_Fw9DA09fi1BHj6Ag
QwNHM_2CbEdFANmphzQ!/?WCM_GLOBAL_CONTEXT=/wcmwps/wcm/connect/contentmember/carefirst/memberportal/medianews/popup/medianews20130528
Workplace Issues for Nursing
1*. McHugh, M.D., Kutney-Lee, A., Cimiotti, J.P., Sloane, D.M., Aiken, L.H. “Nurses’ widespread job dissatisfaction, burnout, and
frustration with health benefits signal problems for patient care.” Health Affairs 30(2):202-210, 2011.
http://content.healthaffairs.org/content/30/2/202.full.pdf+html
2. Cheung, K. “One-fourth of nurses seek new jobs after dissatisfaction.” FierceHealthcare.com, June 29, 2011. Available at:
http://www.fiercehealthcare.com/story/one-fourth-nurses-seek-new-jobs-after-dissatisfaction/2011-06-29
19
https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeR1IyeDE2WkJ0cHc/edit
3.
Cheung, K.M. “Hospital labor study reveals hidden costs of nurses.” FierceHealthcare.com, June 9, 2011. Available at:
http://www.fiercehealthcare.com/story/hospital-labor-study-reveals-hidden-costs-nurses/2011-06-09
4. Schuster, J.L. “With nurses at risk of compassion fatigue, hospitals try to ease their stress.” The Washington Post, June 10,
2013. Available at: http://articles.washingtonpost.com/2013-06-10/national/39865768_1_burnout-intensive-care-unit-nurses
Rethinking the Role of Nurses
1. “MD shortage? 28 states may expand nurses’ role.” CBSNews.com, April 23, 2010. Available at:
http://www.cbsnews.com/stories/2010/04/13/health/main6392167.shtml
2*. Fairman, J.A., Rowe, J.W., Hassmiller, S., Shalala, D.E. “Broadening the scope of nursing practice.” New England Journal of
Medicine 364:193-196, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1012121
3. Martin, T.W. “Nurses seek expanded role.” The Wall Street Journal, October 2, 2012. Available at:
http://online.wsj.com/article/SB10000872396390443862604578032842310254744.html
4. Villegas, A. “Doctor shortage fuels nurses, push for expanded role.” Kaiser Health News, February 22, 2010. Available at:
http://www.kaiserhealthnews.org/Stories/2010/February/22/nurse-practitioners.aspx
Public Policy Towards Nurse Staffing Ratios
1. Shenoy, R. “Nurses set aside goal on hospital staffing.” MPR News, March 16, 2013. Available at:
http://minnesota.publicradio.org/display/web/2013/03/16/politics/nurses-compromise-on-hospital-staffing
2. Kasperowicz, P. “Dem proposes federal regulation of nurse-to-patient ratios in hospitals.” The Hill, April 17, 2013. Available at:
http://thehill.com/blogs/floor-action/senate/294477-dem-proposes-federal-regulation-of-nurse-to-patient-ratios-in-hospitals
3*. Schultz, D. “Nurses fighting state by state for minimum staffing laws.” Kaiser Health News, April 23, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/april/24/nurse-staffing-laws.aspx
4. Editorial. “Nurse ratios are for hospitals, not legislators, to decide.” TwinCities.com Pioneer Press, February 16, 2013. Available
at: http://www.twincities.com/opinion/ci_22600798/editorial-nurse-ratios-are-hospitals-not-legislators-decide
5. Shekelle, P.G. “Nurse—patient ratios as a patient safety strategy: A systematic review.” Annals of Internal Medicine 158(5-Part
2):404-409, 2013. Available at: http://annals.org/issue.aspx?journalid=90&issueID=926462&direction=P
6. Editorial. “Minnesota responds sensibly on nurse staffing ratios.” Star Tribune, March 28, 2013. Available at:
http://www.startribune.com/opinion/editorials/200523861.html
Further Readings
1.
HealthDay News. “Good news for those worried about U.S. nursing shortage.” USNews, December 5, 2011. Available at:
http://health.usnews.com/health-news/managing-your-healthcare/economics/articles/2011/12/05/good-news-for-those-worriedabout-us-nursing-shortage
2. Wood, D., “Retirees and new graduate nurses: The wild cards impacting the nursing shortage.” NurseZone.com, February 18,
2011. Available at: http://www.nursezone.com/nursing-news-events/more-features/Retirees-and-New-Graduate-Nurses-TheWild-Cards-Impacting-the-Nursing-Shortage_36300.aspx
3. Courchane, C. “With nurse shortage looming, America needs shot in the arm.” The Washington Times, June 6, 2011. Available
at: http://www.washingtontimes.com/news/2011/jun/6/with-nurse-shortage-looming-america-needs-shot-in-/
4. Krischke, M.M. “Decreased interruptions lead to more time at the bedside.” NurseZone.com, March 18, 2011. Available at:
http://www.nursezone.com/Nursing-News-Events/more-news/Decreased-Interruptions-Lead-to-More-Time-at-theBedside_36554.aspx
5. Weber, T. and Omstein, C. “Nurses cited elsewhere kept licenses; many punished in other states will now face disciplinary action
in California.” Los Angeles Times, June 28, 2010. p. A.1. Available at: http://articles.latimes.com/2010/jun/28/local/la-me-advnurses-20100628
6. Raines, L. “Market shift. Sluggish economy, returning workers squeeze health care jobs.” AJC, March 3, 2010. Available at:
http://www.ajc.com/jobs/market-shift-344531.html
7. “Survey: Nurses should have more influence.” UPI.com, January 20, 2010. Available at:
http://www.upi.com/Health_News/2010/01/20/Survey-Nurses-should-have-more-influence/UPI-48131264008452/print/
8. Bovbjerg, R.R., Ormond, B.A., and Pindus, N. The Nursing Workforce Challenge. Public Policy for a Dynamic and Complex
Market. Washington, DC: Urban Institute, August 2009. Available at:
http://www.urban.org/uploadedpdf/411933_professionalnurse.pdf
9. Buerhaus, P.I., Auerbach, D.I., and Staiger, D.O. “The recent surge in nurse employment: causes and implications.” Health
Affairs – Web Exclusive 28(4):w-657-w668 (published online June 12, 2009). Available at:
http://content.healthaffairs.org/content/28/4/w657.full.pdf+html
10. Linden, C. and Suran, M. “Nurses, once in high demand, face job shortages.” Kaiser Health News, August 28, 2009. Available at:
http://www.kaiserhealthnews.org/Stories/2009/August/28/medill-nurses.aspx
11. Smith, A. “Nursing crisis looms as baby boomers age.” CNNMoney.com, December 23, 2009. Available at:
http://money.cnn.com/2009/12/17/news/economy/nursing_shortage/index.htm
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Sessions 7 and 8 – October 15, 22, 2013
The Hospital: From Doctors’ Workshop to “Big Med”
Health care can be delivered in a variety of settings, but care delivered in hospitals (“inpatient care”) has long been the focus of special
attention from policy makers and health care payers. More recently, hospitals have expanded the “outpatient care” they provide. We
discuss trends in hospital use and in the configuration of the hospital industry. We also address financial, care delivery, competitive and
health policy challenges facing hospitals in the present environment. Material relating to the structure, management, and economics of
hospitals will be covered in other courses in the MHA Program, as will issues relating to hospital finance.
Learning Objectives
Students should be able to:
1. Describe recent changes in the configuration of the U.S. hospital industry and the public policy concerns they raise.
2. Describe the various financial challenges facing some U.S. hospitals.
3. Evaluate the competitive threat that specialty hospitals and ambulatory facilities pose for general community hospitals
4. Discuss current changes and challenges in hospital/physician relations.
Suggested Readings
The Configuration of the Hospital Industry
1*. Gawande, A. “Big med.” The New Yorker, August 13, 2012. Available at:
http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande
2. Vogt, W.B. “Hospital market consolidation: Trends and consequences.” Expert Voices. Washington, DC: NIHCM Foundation.
November 2009. Available at: http://nihcm.org/pdf/EV-Vogt_FINAL.pdf
3. Weintraub, A. “In an age of consolidation, some community hospitals struggle to remain independent.” Kaiser Health News,
September 9, 2010. Available at: http://www.kaiserhealthnews.org/Stories/2010/September/09/community-hospitals.aspx
4. Mathews, A.W. “Hospitals put on sick list.” Wall Street Journal, August 10, 2011, p. B.3.
http://online.wsj.com/article/SB10001424053111904480904576498633493157192.html
5*. The Economist. “American hospital companies. Bigger and better. America’s big hospital groups will continue to gobble up
competitors.” April 28, 2011. Available at: http://www.economist.com/node/18621132
6. Grube, M., Kaufman, K., York, R. “Decline in utilization rates signals a change in the inpatient business model.” Health Affairs
blog, March 8, 2013. Available at: http://healthaffairs.org/blog/2013/03/08/decline-in-utilization-rates-signals-a-change-in-theinpatient-business-model/
7. Caramenico, A. “National hospital chains see better M&A value creation.” FierceHealthcare, June 3, 2013, Available at:
http://www.fiercehealthcare.com/story/national-hospital-chains-see-better-ma-value-creation/2013-06-03
8. Doyle, J. “Hospital CEOs see double-digit pay hikes.” St. Louis Post-Dispatch, June 2, 2013. Available at:
http://www.stltoday.com/business/local/hospital-ceos-see-double-digit-pay-hikes/article_431263e2-81c9-5367-b0bdf48885169adb.html
9. Kliff, S. “Hospital chains keep getting bigger.” The Washington Post, June 3, 2013. Available at:
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/03/hospital-chains-keep-getting-bigger/
10. DealBook. “Tenent to acquire Vanguard health systems for $1.8 billion.” The New York Times, June 24, 2013. Available at:
http://dealbook.nytimes.com/2013/06/24/tenet-to-acquire-vanguard-health-systems-for-1-8-billion/?_r=0
Role of the Emergency Department
1*. Fiore, K. “Hospitals already feeling ACA pinch.” MedPage Today, June 28, 2013. Available at:
http://www.medpagetoday.com/Washington-Watch/Reform/40160
2* Goodell, S., DeLia, D., Cantor, J.C. “Emergency department utilization and capacity.” Policy Brief No. 17, RWJ Synthesis Project,
July 2009. Available at: http://www.rwjf.org/en/research-publications/find-rwjf-research/2009/07/emergency-departmentutilization-and-capacity0.html
3*. Schuur, J.D., Venkatesh, A.K. “The growing role of emergency departments in hospital admissions.” New England Journal of
Medicine 367(5):391-393, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1204899
4. Rabin, E., Kocher, K., McClelland, M., Pines, J., Hwang, U., Rathlev, N., et al. “Solutions to emergency department ‘boarding’
and crowding are underused and may need to be legislated.” Health Affairs 31(8):1757-1766, 2012. Available at:
http://content.healthaffairs.org/content/31/8/1757.full.pdf+html
5*. Rabin, R.C. “Statistics: Who visits the emergency room? 20 percent of Americans, insured or not.” New York Times, August
2010, Available at: http://www.nytimes.com/2010/08/10/health/research/10stats.html?_r=0
6. Galewitz, P. “ER use of CT scans rises sharply, raising questions about costs and benefits.” Kaiser Health News, August 10,
2011. Available at: http://capsules.kaiserhealthnews.org/index.php/2011/08/getting-a-ct-scan-at-the-er-becoming-routine/
7. Galewitz, P. “Study: Most seniors’ ER visits could be avoided.” Kaiser Health News Blog, October 5, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/10/study-most-seniors-er-visits-could-be-avoided/
8. Grens, K. “ER crowding tied to higher in-hospital death rates.” Reuters, December 13, 2012. Available at:
http://www.reuters.com/article/2012/12/13/us-er-hospital-deaths-idUSBRE8BC0Z420121213
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9.
Mullins, P.M., Goyal, M., Pines, J.M. “National growth in intensive care unit admissions from emergency departments in the
United States from 2002 to 2009.” Academic Emergency Medicine 20(5):479-486, 2013. Available at:
http://onlinelibrary.wiley.com/doi/10.1111/acem.12134/pdf
10. Morganti, K.G., Bauhoff, S., Blanchard, J.C., Abit, M., Smith, A., Vesely, J.V., et al. “The evolving roles of emergency
departments.” RAND Corporation, 2013. Available at: http://www.rand.org/pubs/research_briefs/RB9715.html
11. Abelson, R. “E.R.’s account for half of hospital admissions, study says.” The New York Times, May 20, 2013. Available at:
http://www.nytimes.com/2013/05/21/business/half-of-hospital-admissions-from-emergency-rooms.html?_r=0
12. HealthDay. “1 in 5 Americans goes to the ER each year.” WCAX.com, May 30, 2013. Available at:
http://www.wcax.com/story/22459623/1-in-5-americans-goes-to-the-er-each-year-cdc
13. Nurse.com. “Report showcases EDs’ central role in U.S. healthcare.” June 13, 2013. Available at:
http://news.nurse.com/article/20130613/NATIONAL02/106240005/0/NATIONAL01
Changing Hospital/Physician Relations
1*. Casalino, L.P., November, A.E., Berenson, R.A., Pham, H.H. “Hospital-physician relations: Two tracks and the decline of the
voluntary medical staff model.” Health Affairs 27(5):1305-1314, 2008. Available at:
http://content.healthaffairs.org/content/27/5/1305.full.pdf+html
2*. O’Malley, A.S., Bond, A.M., Berenson, R.A. “Rising hospital employment of physicians: Better quality, higher costs?” Issue Brief
No. 136, August 2011. Washington, DC: Center for Studying Health System Change. Available at:
http://www.hschange.com/CONTENT/1230/1230.pdf
3. Mathews, A.W. “Doctor, hospital deals probed.” The Wall Street Journal, September 13, 2012. Available at:
http://online.wsj.com/article/SB10000872396390444433504577649523985288422.html
4. Caramenico, A. “Hospitals woo more heart docs with employment.” FierceHealthcare, September 11, 2012. Available at:
http://www.fiercehealthcare.com/story/hospitals-woo-more-heart-docs-employment/2012-09-11
Physicians and Hospitals Competing for Patients
1. Iglehart, J. “The emergence of physician-owned specialty hospitals.” New England Journal of Medicine 352(1):78-84, 2005.
http://www.nejm.org/doi/pdf/10.1056/NEJMhpr043631
2. Kaiser Health News. “Study says lower-cost hospitals don’t have lower quality care for certain illnesses.” February 23, 2010.
Available at: http://www.kaiserhealthnews.org/daily-reports/2010/february/23/hospital-study.aspx?referrer=search
3*. O’Neill, L., Hartz, A.J. “Lower mortality rates at cardiac specialty hospitals traceable to healthier patients and to doctors’
performing more procedures.” Health Affairs 31(4):806-815, 2012. http://content.healthaffairs.org/content/31/4/806.full.pdf+html
Controversy Over Hospital Pricing
1. Pell, M.B. “Huge hospital markups burden patients.” ajc.com, April 20, 2011. Available at: http://www.ajc.com/business/hugehospital-markups-burden-917750.html
2*. Reinhardt, U.E. “Shocked, shocked, over hospital bills.” The New York Times, March 1, 2013. Available at:
http://economix.blogs.nytimes.com/2013/03/01/shocked-shocked-over-hospital-bills/
3. Rau, J. “Behind the fiscal cliff deal, a prolonged hospital finance fight.” Kaiser Health News, January 3, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/january/04/fiscal-cliff-deal-hospital-finance-fight.aspx
4. Meier, B., McGinty, J.C., Creswell, J. “Hospital billing varies wildly, government data shows.” The New York Times, May 8, 2013.
Available at: http://www.nytimes.com/2013/05/08/business/hospital-billing-varies-wildly-us-data-shows.html?smid=pl-share
5. Reinhardt, U.E. “American health care as a source of humor.” The New York Times, May 10, 2013. Available at:
http://economix.blogs.nytimes.com/2013/05/10/american-health-care-as-a-source-of-humor/
Hospitals Strategies to Improve Finances
1. “Cleveland Clinic to provide heart care in Chicago; Johns Hopkins increases primary care in D.C. area.” Kaiser Health News,
July 17, 2010. Available at: http://www.kaiserhealthnews.org/Daily-Reports/2010/July/16/Hospitals-and-health-systems.aspx
2*. Abelson, R. “New fervor for cutting costs among hospitals and insurers.” New York Times, May 24, 2012, p. A.1.
http://www.nytimes.com/2012/05/24/health/hospitals-and-insurers-join-to-cut-health-care-costs.html
3. Graham, J. “Mayo clinic seeks to extend its reach with series of affiliations around the country.” Kaiser Health News, August 24,
2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/August/24/Mayo-Clinic-Extends-Reach.aspx
4*. Carrier, E.R., Dowling, M., Berenson, R.A. “Hospitals’ geographic expansion in quest for well-insured patients: Will the outcome
be better care, more cost, or both?” Health Affairs (31)4):827-835, 2012. Available at:
http://content.healthaffairs.org/content/31/4/827.full.pdf+html
5. Appleby, J. “Hospitals and insurers face growing antitrust scrutiny.” Kaiser Health News, April 5, 2011. Available at:
http://www.kaiserhealthnews.org/Stories/2011/April/05/Hospitals-And-Insurers-Face-Growing-Antitrust-Scrutiny.aspx
6. Mathews, A.W. “Cleveland Clinic, hospital operator forge alliance; community health deal reflects how top medical centers are
leveraging brands.” The Wall Street Journal, March 11, 2013. Available at:
http://online.wsj.com/article/SB10001424127887324096404578354631587446140.html
7. Beck, M. “Squeeze looms for doctors.” The Wall Street Journal, March 14, 2013. Available at:
http://online.wsj.com/article/SB10001424127887324096404578356544137516914.html
8. Rabin, R.C. “Hospitals look to become insurers, as well as providers of care.” Kaiser Health News, August 26, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/august/26/hospital-insurers.aspx
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9.
Gregg, H. “Study: Healthcare reviews, ratings increasingly impact hospitals’ bottom lines.” Becker’s Healthcare Hospital Review,
April 9, 2013. Available at: http://www.beckershospitalreview.com/quality/study-healthcare-reviews-ratings-increasingly-impacthospitals-bottom-lines.html
Rethinking Hospital Reimbursement
1. Goldsmith, J. “Analyzing shifts in economic risks to providers in proposed payment and delivery system reforms.” Health Affairs
29(7):1299-1304, 2010. Available at: http://content.healthaffairs.org/content/29/7/1299.full.pdf+html
2*. Gold, J. “Of ACOs and proton beams: why hospitals ‘live in two worlds.’” Kaiser Health News Blog, June 6, 2013. Available at:
http://capsules.kaiserhealthnews.org/?p=19911
Patient Safety Issues – See Session 2 Readings
Potential Impact of Health Reform Legislation on Hospitals.
1. Appleby, J. “Hospitals and insurers face growing antitrust scrutiny.” Kaiser Health News, April 5, 2011. Available at:
http://www.kaiserhealthnews.org/Stories/2011/April/05/Hospitals-And-Insurers-Face-Growing-Antitrust-Scrutiny.aspx
2. Lipton, E. “Ex-lawmaker still a friend of hospitals.” New York Times, August 5, 2011. Available at:
http://www.nytimes.com/2011/08/06/us/politics/06pomeroy.html?_r=1
3*. Bernstein, N. “Hospitals aren’t waiting for verdict on health care law.” New York Times online, June 10, 2012. Available at:
http://www.nytimes.com/2012/06/11/nyregion/maimonides-medical-center-grapples-with-health-careuncertainty.html?pagewanted=all
4. Aizenman, N.C. “Health law’s rules help hospitals cut patient readmission rate.” The Washington Post, February 27, 2013.
Available at: http://articles.washingtonpost.com/2013-02-27/national/37332837_1_readmissions-providers-medicare-andmedicaid-services
5. Rau, J. “Doctor-owned hospitals prosper under healthcare law.” The Washington Post, April 13, 2013. Available at:
http://articles.washingtonpost.com/2013-04-13/national/38509331_1_hospitals-health-law-kaiser-health-news
Further Readings
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Kelly, M. “Life-saving medical machinery prone to malware?” Venture Beat, October 17 2012. Available at:
http://www.fiercehealthcare.com/story/hospitals-woo-more-heart-docs-employment/2012-09-11
American College of Cardiology’s CardioSource. “New American College of Cardiology Practice census shows continued trend
towards hospital integration.” September 10, 2012. Available at: http://www.cardiosource.org/News-Media/Media-Center/NewsReleases/2012/09/Leg-Conf.aspx
Toland, B. “Highmark announces intent to affiliate with Erie’s Saint Vincent.” Pittsburgh Post-Gazette, October 16, 2012.
Available at: http://www.post-gazette.com/stories/business/news/highmark-to-announce-affiliation-agreement-with-eries-saintvincent-657759/
Shinkman, R. “The hidden costs of hospital employee health.” FierceHealthFinance, October 16, 2012. Available at:
http://www.fiercehealthfinance.com/story/hidden-costs-hospital-employee-health/2012-10-16
Simmons, J. “GAO looks at ways to reduce, divert ED use.” FierceHealthcare, May 11, 2011. Available at:
http://www.fiercehealthcare.com/story/gao-looks-ways-reduce-divert-ed-use/2011-05-11
Robinson, J.C. “Hospital market concentration, pricing, and profitability in orthopedic surgery and interventional cardiology.”
American Journal of Managed Care 17(6):e241-e248, 2011. Available at:
http://www.ajmc.com/articles/AJMC_11jun_Robinson_e241_248/#sthash.FBsYgiBz.dpuf
Shinkman, R. “Doctors, hospitals increasingly enter co-management arrangements.” Fierce HealthFinance, April 26, 2011.
Available at: http://www.fiercehealthfinance.com/story/doctors-hospitals-increasingly-enter-co-management-arrangements/201104-26
Andrews, M. “Some hospitals turn to post-discharge clinics to help hold down readmissions.” Kaiser Health News, December
20, 2011. Available at: http://www.kaiserhealthnews.org/features/insuring-your-health/michelle-andrews-on-readmissions.aspx
Goozner, M. “Monopolies threaten health care cost controls.” The Fiscal Times, February 3, 2011. Available at:
http://www.thefiscaltimes.com/Articles/2011/02/03/Monopolies-Threaten-Health-Care-Cost-Controls.aspx#page1
Galewitz, P. “Hospitals promoting bargain CT scans for smokers.” Kaiser Health News, August 16, 2011. Available at:
http://www.kaiserhealthnews.org/Stories/2011/August/16/Hospitals-Promoting-Bargain-CT-Scans-For-Smokers.aspx
Rabin, R.C. “Study finds fewer emergency rooms as need rises.” New York Times, May 18, 2011, p. A.13. Available at:
http://www.nytimes.com/2011/05/18/health/18hospital.html?gwh=8BE0A11C4D3D1AD5267D93AE06A90C58
Reuters. “Who’s packing ERs? Not the uninsured.” May 19, 2010. Available at:
http://www.reuters.com/article/idUSTRE64I78X20100520
Vitez, M. “One hospital’s simple measure to defeat infections.” March 8, 2010. Available at:
http://www.philly.com/philly/news/homepage/20100308_One_hospital_s_simple_measure_to_defeat_infections.html
Abelson, R. “Bills stalled, hospitals fear rising unpaid care.” New York Times, February 9, 2010, p. B.1. Available at:
http://www.nytimes.com/2010/02/09/health/policy/09hospital.html?hpw
Harris, G. “Hospital shows a way to save: Doctors get salaries, not fees.” New York Times, July 25, 2009. p. A.1. Available at:
http://www.nytimes.com/2009/07/25/health/policy/25doctors.html?gwh=82AC68F2C1954CC2C75891B91A912ACC
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16. DeLia, D., Cantor, J. “Emergency department utilization and capacity.” Robert Wood Johnson Foundation, The Synthesis Project
Policy Brief No. 17, July 2009. Available at: http://www.rwjf.org/en/research-publications/find-rwjf-research/2009/07/emergencydepartment-utilization-and-capacity0.html
17. Galewitz, P. “U.S. emergency rooms find ways to fix what ails them; mindful of complaints, innovative hospitals aim to cut
crowding, delays.” USA Today, December 15, 2008. p. D.9. Available at: http://usatoday30.usatoday.com/news/health/2008-1214-emergency-rooms_N.htm?csp=34
18. Goodell, S. and Casalino, L.P. “Physician self-referral and physician-owned specialty facilities.” Robert Wood Johnson
Foundation, The Synthesis Project Policy Brief No. 15, June 2008. Available at:
http://www.rwjf.org/files/research/062408.policysynthesis.physreferral.brief.pdf
Session 9 – October 29, 2013
Long-Term Care: Balancing What We Want With What Will Pay For
Quiz 1: Material from Sessions 1-8
Demands on our present system for delivering long-term care are expected to intensify as the “baby boom” generation ages. Traditional
financing models are being challenged, as are existing models for delivering long-term care. At the same time, improving quality and
reducing fraud and abuse continue to be thorny issues, and provisions included in the federal health reform legislation relating to long-term
care have been abandoned.
Learning Objectives
Students should be able to:
1. Describe the different types of long-term care and the characteristics of the people who receive this care.
2. Discuss the different mechanisms, public and private, that finance long-term care.
3. Compare and contrast delivery models for long-term care.
4. Discuss factors that affect the quality of long-term care, including the potential for patient abuse in long-term care settings.
Suggested Readings
Overview of Long-Term Care and the Nursing Home Industry
1*. The Kaiser Commission on Medicaid and the Uninsured. “Overview of nursing facility capacity, financing, and ownership in the
United States in 2011.” The Henry J. Kaiser Family Foundation, June 2013. Available at: http://kff.org/medicaid/factsheet/overview-of-nursing-facility-capacity-financing-and-ownership-in-the-united-states-in-2011/
2*. Greene, K. “Long-term-care insurance gap hits seniors.” The Wall Street Journal, July 1, 2013. Available at:
http://online.wsj.com/article/SB10001424127887323475304578501820197828966.html
3*. Georgetown University, Long-Term Care Financing Project. “National spending for long-term care.” Fact Sheet, January 2007.
Available at: http://ltc.georgetown.edu/pdfs/natspending2007.pdf
4*. El Nasser, H. “Fewer seniors live in nursing homes; improved health, more options for care cited.” USA Today, September 27,
2007. p. A.1. http://usatoday30.usatoday.com/printedition/news/20070927/1a_bottomstrip27_dom.art.htm
5. Greene, K. The cost of living longer. The Wall Street Journal, October 26, 2012. Available at:
http://online.wsj.com/article/SB10001424052970203937004578079184108523030.html
6. Higgs, R. “Nursing-home, assisted-living costs rise.” Cleveland.com, April 30, 2009. Available at:
http://www.cleveland.com/medical/index.ssf/2009/04/nursinghome_assistedliving_cos.html
7. Seewer, J. “Aging baby boomers face home health care challenge.” YAHOO News, August 12, 2012. Available at:
http://news.yahoo.com/aging-baby-boomers-face-home-health-care-challenge-162044207--finance.html
8. Pruitt, A.D. “Health-care owners shun nursing homes.” The Wall Street Journal, April 30, 2013. Available at:
http://dailyhealthguide.net/health-care-owners-shun-nursing-homes-wall-street-journal/
Long-Term Caregivers
1*. Hagerty, J.R. “As America ages, shortage of help hits nursing homes.” The Wall Street Journal, April 14, 2013. Available at:
http://online.wsj.com/article/SB10001424127887324392804578360712470799082.html
2. Tran, A. “Obama administration mulls rule to give home health aides better wages.” Kaiser Health News, April 29, 2013.
Available at: http://www.kaiserhealthnews.org/stories/2013/april/29/home-health-aides-better-wages-rules.aspx
3. Fox, S., Duggan, M., Purcell, L. “Family caregivers are wired for health.” Washington, DC: PewResearchCenter, June 20, 2013.
Available at: http://www.pewinternet.org/Reports/2013/Family-Caregivers.aspx
Issues Relating to Fraud, Abuse and Poor Quality
1*. Pear, R. “Oversight of nursing homes is criticized.” New York Times, April 22, 2007. p. 1.20.
http://www.nytimes.com/2007/04/22/health/22nursing.html?_r=0
2. Duhigg, C. “At many homes, more profit and less nursing.” New York Times, September 23, 2007. p. 1.1.
http://www.nytimes.com/2007/09/23/business/23nursing.html?pagewanted=all
3. Rosofsky, I, “Escape from the nursing home.” New York Times, January 17, 2007. p. A.19.
http://www.nytimes.com/2007/01/17/opinion/17rosofsky.html
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https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeR1IyeDE2WkJ0cHc/edit
4.
Bayne, M. “A room with a grim view: The ‘ambient despair’ that marks life in assisted living.” Health Affairs 31(7):1633-1635,
2012. http://content.healthaffairs.org/content/31/7/1633.full.pdf+html
5*. The Washington Post, APNewsBreak: Fed watchdog report says Medicare paid $5.1B to nursing homes offering poor care.”
February 27, 2013. Available at: http://news.yahoo.com/medicare-paid-5-1b-poor-130312778.html
6. The New York Times. “State rewards home care firms once rebuked.” June 24, 2013. Available at:
http://www.nytimes.com/2013/06/24/nyregion/reinventing-long-term-care-and-endorsing-firms-accused-offraud.html?pagewanted=all
Proposals for Reform
1*. Jaffe, S. “Facing a tight deadline, long-term care panel holds first meeting.” Kaiser Health News, June 28, 2013. Available at:
http://www.kaiserhealthnews.org/Stories/2013/June/28/long-term-care-commission.aspx
2. Raphael C. “Long-term care: Preparing for the next generation,” The Commonwealth Fund, July 21, 2008. Available at:
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=695882
3*. Koren, M.J. “Person-centered care for nursing home residents: The culture-change movement.” Health Affairs 29(2):312-317,
2010. http://content.healthaffairs.org/content/29/2/312.full.pdf+html
4. Bergal, J. Feds say nursing homes overbilled Medicare by $1.5 billion. Kaiser Health News, November 15, 2012. Available at:
http://www.kaiserhealthnews.org/Stories/2012/November/15/nursing-homes-inspector-general-medicare.aspx
5*. Konetzka, R.T., Werner, R.M. “Applying market-based reforms to long-term care.” Health Affairs 29(1):74-80, 2010.
http://content.healthaffairs.org/content/29/1/74.full.pdf+html
6. Meier, D.E., Lim, B., Carlson, D.A. “Raising the standard: Palliative care in nursing homes.” Health Affairs 29(1):136-140, 2010.
http://content.healthaffairs.org/content/29/1/136.full.pdf+html
7. Graham, J. “Ohio Medicaid program raises stakes for nursing homes.” Kaiser Health News, August 14, 2012. Available at:
http://www.kaiserhealthnews.org/Stories/2012/August/15/ohio-medicaid-nursing-homes.aspx
8. Mayer, C.E. “Calculating a long-term care policy: Will it cover your needs, can you pay for it and can you afford not to have it?”
Kaiser Health News, January 23, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/january/24/calculating-along-term-care-policy.aspx
9. Gugliotta, G. “Tennessee cuts Medicaid benefit funding for some long-term care patients.” Kaiser Health News, July 29, 2012.
Available at: http://www.kaiserhealthnews.org/stories/2012/july/29/tennessee-medicaid-long-term-care.aspx?referrer=search
10. Castle, N.G. “The nursing home compare report card: Consumers’ use and understanding.” Journal of Aging & Social Policy
21(2):187-208, 2009. Available at: http://www.tandfonline.com/doi/pdf/10.1080/08959420902733272
Long-Term Care Provisions in the Health Reform Legislation
1. Pollack, H. “Long-term care: Another tough subject for the next round of reform.” Kaiser Health News, December 22, 2010.
Available at: http://www.kaiserhealthnews.org/Columns/2010/December/122310pollack.aspx
2. New York Times. “It didn’t add up.” [Editorial], October 18, 2011. Available at: http://www.nytimes.com/2011/10/19/opinion/theclass-program-didnt-add-up.html
Further Readings
1.
2.
3.
4.
5.
6.
7.
8.
9.
Comarow, A. “U.S. news’ best nursing homes – 2013.” msn.com, 2013. Available at:
http://healthyliving.msn.com/diseases/caregiving/us-news-best-nursing-homes-2013
Available at: Graham, J. “Medicare studying plans to pay nursing homes based on quality.” Kaiser Health News, August 14,
2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/August/15/medicare-nursing-homes-quality.aspx
Reinhard, S.C., Kassner, E., Houser, A., Mollica, R. “Raising expectations: A state scorecard on long-term services and
supports for older adults, people with physical disabilities, and family caregivers.” Executive Summary. AARP, September 2011.
Available at: http://assets.aarp.org/rgcenter/ppi/ltc/ltss_scorecard.pdf
New York Times. “It didn’t add up.” [Editorial], October 18, 2011. Available at: http://www.nytimes.com/2011/10/19/opinion/theclass-program-didnt-add-up.html
Pollack, H. “Long-term care: Another tough subject for the next round of reform.” Kaiser Health News, December 22, 2010.
Available at: http://www.kaiserhealthnews.org/Columns/2010/December/122310pollack.aspx
Stevenson, D.G. and Grabowski, D.C. “Private equity investment and nursing home care: Is it a big deal?” Health Affairs
27(5):1399-1408, 2008. Available at: http://content.healthaffairs.org/content/27/5/1399.full.pdf+html
“How will boomers pay for long-term care?” Forbes.com, July 20, 2007. Available at:
http://www.forbes.com/2007/07/19/longterm-health-care-biz-cx_0720oxford.html
Gawande, A. “Rethinking old age.” New York Times, May 24, 2007. p. A.27. Available at:
http://query.nytimes.com/gst/fullpage.html?res=9E03E3DD1630F937A15756C0A9619C8B63
Kane, R.L., Arling, G., and Mueller, C. “Rewarding quality in nursing homes.” The Commonwealth Fund, May 11, 2007. Available
at: http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2007/May/Rewarding-Quality-in-NursingHomes.aspx
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Session 10 – November 5, 2013
Medical Technology and Devices: At the Cutting Edge
As health care spending continues to grow in this country, more and more attention is being paid to the use of new technologies as both a
driver of cost and value. Some policy analysts emphasize the contribution of medical technology to cost increases, while others argue that,
from a long run perspective, new technologies can save costs and/or improve quality of care and patient quality of life. This is often a “front
page” debate, stimulated by rapid advances in surgical and diagnostic techniques, but also by questions about conflicts of interest between
physicians and medical device companies as well as questionable marketing practices and conflicts between medical device companies
and the FDA. Issues relating to medical technology are of critical importance to Minnesota because this state long has been an incubator
for new technologies and medical device companies are major employers in the state. In this class session we discuss how medical
technology “fits” in the current health care system and describe regulatory and market issues relating to medical devices.
Learning Objectives
Students should be able to:
1. Describe the process of new medical technology development in the U.S. from discovery to commercial product.
2. Discuss patient, provider and regulatory issues relating to the introduction of new medical devices and their integration into
medical care treatment.
3. Discuss provisions of health care reform that may affect the medical device industry directly and indirectly.
Suggested Readings
Overview of the Medical Device Industry
1*. Kaiser Family Foundation. “How changes in medical technology affect health care costs.” March 2007. Available at:
http://www.kff.org/insurance/snapshot/chcm030807oth.cfm
2*. Robinson, J.C. “Value-based purchasing for medical devices.” Health Affairs 27(6):1523-1531, 2008.
http://content.healthaffairs.org/content/27/6/1523.full.pdf+html
3. Curfman, G.D., Redberg R.F. “Medical devices – balancing regulation and innovation,” New England Journal of Medicine
(Online), August 10, 2011. Available at: http://www.nejm.org/doi/full/10.1056/NEJMp1109094
4. Sorenson, C., Drummond, M., Burns, L.R. “Evolving reimbursement and pricing policies for devices in Europe and the United
States should encourage greater value.” Health Affairs 32(4):788-796, 2013. Available at:
http://content.healthaffairs.org/content/32/4/788.full.pdf+html
5. Hollmer, M. “Medtronic, Boston Scientific battle in declining cardiac device market.” FierceMedical Devices, May 7, 2013.
Available at: http://www.fiercemedicaldevices.com/story/medtronic-boston-scientific-battle-declining-cardiac-device-market/201305-07
6. Garde, D. “Devicemakers plot paths out of CRM funk.” FierceMedical Devices, March 4, 2013. Available at:
http://www.fiercemedicaldevices.com/special-reports/2012s-top-5-cardiac-rhythm-management-companies
Concerns About Conflicts of Interest Involving Medical Device Manufacturers and Physicians, and Other Controversial Practices
1. Boden, W.E. and Diamond, G.A. “DTCA for PTCA – Crossing the line in consumer health education?” New England Journal of
Medicine 358(21):2197-2200, 2008. http://www.nejm.org/doi/pdf/10.1056/NEJMp0801433
2. Carreyrou, J. “Senators request probe of surgeons,” Wall Street Journal (Online), June 9, 2011.
http://online.wsj.com/article/SB10001424052702304778304576373592455703056.html
3. Reinberg, S. “Many may get unneeded implantable defibrillators.” Health.com, January 4, 2011. Available at:
http://news.health.com/2011/01/04/many-may-get-unneeded-implantable-defibrillators/
4. Carreyrou, J., McGinty, T. “Taking double cut, surgeons implant their own devices.” Wall Street Journal online, October 8, 2011.
Available at: http://online.wsj.com/article/SB10001424053111904106704576582621677354508.html
5*. Meier, B., Thomas K. “Troubling flaws in heart device shake industry.” New York Times, April 7, 2012, p. A.1.
http://www.nytimes.com/2012/04/07/health/flaws-in-st-jude-heart-defibrillator-shake-the-industry.html?pagewanted=all
6. Weaver, C. St. Jude riata heart-device flaws known for years. The Wall Street Journal, October 10, 2012. Available at:
http://online.wsj.com/article/SB10000872396390444223104578036752346768278.html
7. Meier, B. “Outside review of clinical data finds a spinal treatment’s benefit overstated.” The New York Times, June 17, 2013.
Available at: http://www.nytimes.com/2013/06/18/business/infuse-a-spinal-treatment-found-no-better-than-olderremedy.html?pagewanted=all
8*. Meier, B. “Doctors who don’t speak out.” The New York Times, February 15, 2013. Available at:
http://www.nytimes.com/2013/02/17/sunday-review/the-hip-replacement-case-shows-why-doctors-often-remain-silent.html
9. Andrews, M. “Questions arise about robotic surgery’s cost, effectiveness.” Kaiser Health News, April 23, 2013. Available at:
http://www.kaiserhealthnews.org/features/insuring-your-health/2013/042313-michelle-andrews-robotic-surgery.aspx
10. BusinessWire. “Three large health systems and UnitedHealthcare launch SharedClarity, a new venture to study long-term
effectiveness of medical devices.” April 9, 2013. Available at:
http://www.businesswire.com/news/home/20130409005531/en/Large-Health-Systems-UnitedHealthcare-Launch-SharedClarityVenture
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11. Carreyrou, J. “Warning over doctor-run groups.” The Wall Street Journal, March 26, 2013. Available at:
http://online.wsj.com/article/SB10001424127887323466204578384793253488174.html
The Medical Device Industry and the FDA
1. Harris, G. and Halbfinder, D.M. “F.D.A. reveals it fell to a push by lawmakers.” New York Times, September 25, 2009. p. A.1
http://www.nytimes.com/2009/09/25/health/policy/25knee.html?pagewanted=all&_r=0 .
2. Meier, B. “F.D.A. seeks better data from tests of devices.” New York Times, December 30, 2009. p. B.1.
http://www.nytimes.com/2009/12/30/business/30device.html?_r=0
3. Meier, B. “,” New York Times, December 17, 2010, p. B.1.
http://www.nytimes.com/2010/12/17/business/17hip.html?pagewanted=all
4. Zuckerman, D.B., Brown, P., Nissen, S.E. “Medical device recalls and the FDA approval process.” Archives of Internal Medicine
171(11):1006-1011, 2011. http://archinte.jamanetwork.com/Issue.aspx?journalid=71&issueID=5819&direction=P
5*. Economist, The. “Left to their own devices.” 400(8750):71-73, 2011.
http://go.galegroup.com/ps/retrieve.do?sgHitCountType=None&sort=DASORT&inPS=true&prodId=PROF&userGroupName=mnaumntwin&tabID=T003&searchId=R2&resultListType=RESULT_LIST&c
ontentSegment=&searchType=AdvancedSearchForm&currentPosition=5&contentSet=GALE%7CA266486808&&docId=GALE|A
266486808&docType=GALE&role=
6*. Kaiser Health News. “Study: Expedited Medical Device Reviews Account for Majority of Recalls.” February 15, 2011. Available
at: http://www.kaiserhealthnews.org/Daily-Reports/2011/February/15/medical-devices.aspx
7. Gottlieb, S. “How the FDA could cost you your life.” Wall Street Journal, October 3, 2011, p. A.17.
http://online.wsj.com/article/SB10001424052970204831304576597200095602270.html
8*. Meier, B. Remedy is elusive as metallic hips fail at a fast rate.” New York Times online, September 30, 2011. Available at:
http://www.nytimes.com/2011/10/01/health/01hip.html?pagewanted=all
9. Kolata, G. “Stroke therapy device fails in study.” Star Tribune online, September 7, 2011. Available at:
http://www.startribune.com/lifestyle/129423093.html?refer=y
10. Carroll, L. “Shocking ending: Implanted defibrillators can bring misery to final hours.” Vitals on NBCNEWS.com, October 10,
2011. Available at: http://vitals.nbcnews.com/_news/2011/10/10/8212715-shocking-ending-implanted-defibrillators-can-bringmisery-to-final-hours?lite
11. Challoner, D.R., Vodra, W.W. “Medical devices and health – creating a new regulatory framework for moderate-risk devices.”
New England Journal of Medicine (Online), August 10, 2011. Available at: http://www.nejm.org/doi/full/10.1056/NEJMp1109150
12. Resnic, F.S., Normand, S-L.T. “Postmarketing surveillance of medical devices – filling in the gaps.” New England Journal of
Medicine 366(10):875-877, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1114865
13. Norman, B. “FDA user fee bill appears safe from GOP poison pills.” Politico, May 6, 2012. Available at:
http://www.politico.com/news/stories/0512/75966.html
14. Hollmer, M. “Budget battles hold new FDA user fees hostage.” FierceMedicalDevices, March 4, 2013. Available at:
http://www.fiercemedicaldevices.com/story/budget-battles-hold-new-fda-user-fees-hostage/2013-03-04
15. Editorial. “Move forward on medical device tracking.” Star Tribune, June 21, 2013. Available at:
http://www.startribune.com/opinion/editorials/212405031.html
Health Care Reform and the Medical Device Industry
1*. Spencer, J. “Med-tech firms fight tax on devices.” Star Tribune, September 8, 2011, p. D.1. Available at:
http://www.startribune.com/business/129425158.html
2. Barr, S. “Dream of a medical ‘price list’ dies in Florida legislature.” Kaiser Health News Blog, January 20, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/01/dream-of-a-medical-price-list-dies-in-florida-legislature/
3. Bayh, E. Evan Bayh: ObamaCare’s tax raid on medical devices. The Wall Street Journal, September 27, 2012. Available at:
http://online.wsj.com/article/SB10000872396390444620104578012281306687070.html
4. Rao, A. “New website will disclose health industry payments to doctors.” Kaiser Health News Blog, April 23, 2013. Available at:
http://capsules.kaiserhealthnews.org/?p=18765
Further Readings
1.
2.
3.
4.
5.
Donnelly, L. et al. “Experts call for transparency over medical devices.” The Telegraph, May 7, 2013. Available at:
http://www.telegraph.co.uk/health/healthnews/10042607/Experts-call-for-transparency-over-medical-devices.html
Thomas, K. Unpredictable danger looms close to the heart. The New York Times, September 7, 2012. Available at:
http://www.nytimes.com/2012/09/08/business/patients-with-st-jude-medicals-defibrillator-wires-face-adilemma.html?pagewanted=all
Walsh, J. “A flawed device brings a tough choice for Riata patients.” Star Tribune online, March 10, 2012. Available at:
http://www.startribune.com/business/142118413.html?refer=y
Silverman, E. “Commercial support for CME dives, again.” Pharmalot.com, July 30, 2012. Available at:
http://www.pharmalot.com/2012/07/commercial-support-for-cme-dives-again/
Barr, S. “Dream of a medical ‘price list’ dies in Florida legislature.” Kaiser Health News Blog, January 20, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/01/dream-of-a-medical-price-list-dies-in-florida-legislature/
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6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
Cortez, M.F. St. Jude faces boon-or-bust verdict on heart-plus studies. Bloomberg, October 24, 2012. Available at:
http://www.bloomberg.com/news/2012-10-24/st-jude-faces-boon-or-bust-verdict-on-heart-plug-studies.html
Gormley, B., Maltby, E. Medical start-ups challenged by health-care reform. The Wall Street Journal, October 31, 2012. Available
at: http://online.wsj.com/article/SB10001424052970203400604578074870506887766.html
Institute of Medicine of the National Academies. “Medical Devices and the Public’s Health. The FDA 510(k) clearance process at
35 years.” Report Brief, July 2011. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2011/Medical-Devices-andthe-Publics-Health-The-FDA-510k-Clearance-Process-at-35Years/510k%20Clearance%20Process%202011%20Report%20Brief.pdf
Pecquet, J. “Dems slam FDA critics ahead of medical device hearing.” The Hill, July 20, 2011. Available at:
http://thehill.com/blogs/healthwatch/medical-devices-and-prescription-drug-policy-/172521-dems-slam-fda-critics-ahead-ofmedical-device-hearing
Pollack, A. “Medical treatment, out of reach.” New York Times, February 10, 2011, p. B.1. Available at:
http://www.nytimes.com/2011/02/10/business/10device.html?pagewanted=all
Baker, S. “Report faults FDA oversight of device recalls.” The Hill’s Healthcare Blog, June 21, 2011. Available at:
http://thehill.com/blogs/healthwatch/medical-devices-and-prescription-drug-policy-/167681-report-faults-fda-oversight-of-devicerecalls
Snowbeck, C. “U.S. charges Guidant over device woes – Firm allegedly gave FDA a false report on defibrillators.” St. Paul
Pioneer Press, February 26, 2010. Available at: http://infoweb.newsbank.com/iwsearch/we/InfoWeb?p_product=NewsBank&p_theme=aggregated5&p_action=doc&p_docid=12E236032D50A5A0&p_docnum=9
3&p_queryname=1
Tanner, L. “Medical device problems hurt 70,000+ kids annually.” msnbc.com, July 26, 2010. Available at:
http://www.msnbc.msn.com/id/38413252/ns/health-childrens_health/t/medical-device-problems-hurt-more-kids-annually/#
Mundy, A. and Favole, J.A. “FDA memo hints at curbs to approval process for medical devices.” Wall Street Journal, February
18, 2010. Available at: http://online.wsj.com/article/SB10001424052748704398804575071791464778482.html
Hillman, B.J., Goldsmith, J. “Imaging: The self-referral booms and the ongoing search for effective policies to contain it.” Health
Affairs 29(12):2231-2236, 2010. Available at: http://content.healthaffairs.org/content/29/12/2231.full.pdf+html
Pauly, M.V. and Burns, L.R. “Price transparency for medical devices.” Health Affairs 27(6):1544-1553, 2008. Available at:
http://content.healthaffairs.org/content/27/6/1544.full.pdf+html
Meier, B. “Hip device phaseout followed FDA data request.” New York Times, March 23, 2012, p. B.1. Available at:
http://www.nytimes.com/2012/03/23/business/fda-asked-depuy-for-safety-data-just-before-hip-implants-phaseout.html
Meier, B. Panel says Medtronic edited product studies. The New York Times, October 25, 2012. Available at:
http://www.nytimes.com/2012/10/25/business/senate-panel-says-medtronic-edited-studies.html?_r=0
Meier, B. “Fight over medical device rules, sight unseen.” New York Times, July 28, 2011, p. A.1. Available at:
http://www.nytimes.com/2011/07/28/health/28institute.html?_r=2&adxnnl=1&seid=auto&smid=tw-nytimesbusiness
Meier, B. “Tipping the odds for an implant maker.” New York Times, April 3, 2011, p. A.1. Available at:
http://query.nytimes.com/gst/fullpage.html?res=9502E2DF1E30F930A35757C0A9679D8B63
Meier, B. “When heart devices fail, who should be blamed?” New York Times, April 21, 2010. p, B.1. Available at:
http://www.nytimes.com/2010/04/21/business/21device.html?hpw
Meier, B. “Ads for medical devices are under scrutiny.” New York Times, September 17, 2008. p, C.12, Available at:
http://www.nytimes.com/2008/09/17/business/17device.html
Meier, B. “Growing debate as doctors train on new devices.” New York Times, August 1, 2006, p. A.1. Available at:
http://www.nytimes.com/2006/08/01/business/01train.html?pagewanted=all
Session 11 – November 12, 2013
Pharmaceuticals: A Regulatory Rubik’s Cube
There are a number of similarities between pharmaceuticals and medical devices in the way they are developed, brought to market, and
regulated. However, there are important differences as well. In monetary terms, the pharmaceutical market is much larger than the
medical device market, and pharmaceutical firms pursue different marketing approaches. Managing pharmaceutical costs poses
significant issues for health care payers, as does the regulation of pharmaceuticals by the Food and Drug Administration (FDA). The
pharmaceutical industry “cut a deal” with supporters of health reform that now seems to have unraveled.
Learning Objectives
Students should be able to:
1. Describe the pharmaceutical “supply chain” and public policy issues relating to the marketing of pharmaceuticals.
2. Discuss contrasting views pertaining to the proliferation of prescription drugs and the growth in pharmaceutical expenses.
3. Explain what a pharmacy benefit management company is and describe the products and services it provides.
4. Compare and contrast the nature and significance of different regulatory issues relating to pharmaceuticals.
5. Discuss how the pharmaceutical industry may be affected by health reform.
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Suggested Readings
Overview of the Pharmaceutical Industry and the Role of Prescription Drugs in the Health Care System
1*. Kleinke, J. “The price of progress: prescription drugs in the health care market,” Health Affairs 20(5):43-60, 2001.
http://content.healthaffairs.org/content/20/5/43.full.pdf+html
2. Hobson, K. “Spending more on drugs doesn’t mean spending less on other care.” Wall Street Journal, June 10, 2010. Available
at: http://blogs.wsj.com/health/2010/06/10/spending-more-on-drugs-doesnt-mean-spending-less-on-other-care/
3. Mogul, F. “Big-name drugs are falling off the ‘patient cliff’.” Kaiser Health News, October 24, 2011. Available at:
http://www.kaiserhealthnews.org/stories/2011/october/24/big-name-drugs-are-falling-off-the-patent-cliff.aspx?referrer=search
4. Mathews, A.W. “Combined Express Scripts/Medco may face off against UnitedHealth unit.” WSJ blogs, July 21, 2011.
Available at: http://blogs.wsj.com/health/2011/07/21/combined-express-scriptsmedco-may-face-off-against-unitedhealth-unit/
5. Johnson, L.A. “Growth in prescription drug spending slows.” boston.com, April 19, 2011. Available at:
http://www.boston.com/business/healthcare/articles/2011/04/19/growth_in_prescription_drug_use_continues_to_slow_13032150
87/
6. Anonymous. “Push to spur more drugs for deadly rare diseases.” USA Today News online, April 25, 2011. Available at:
http://www.usatoday.com/news/health/healthcare/health/healthcare/story/2011/04/Push-to-spur-more-drugs-for-deadly-rarediseases---/46504330/1
7. Japsen, B. “Walgreen and Express Scripts reach deal.” New York Times, July 20, 2012, p. B.2.
http://www.nytimes.com/2012/07/20/business/walgreen-and-express-scripts-settle-their-dispute.html
8*. Mann, D. “Half of heart patients make mistakes with their meds: Study.” USNews, July 3, 2012. Available at:
http://health.usnews.com/health-news/news/articles/2012/07/03/half-of-heart-patients-make-mistakes-with-their-meds-study
9. Andrews, M. “Patients share of expensive specialty drugs is rising.” Kaiser Health News, May 7, 2012. Available at:
http://www.npr.org/blogs/health/2012/05/08/152245452/why-your-drug-copay-could-change
10. Express Scripts. “Express Scripts study reveals keys to controlling specialty drug costs.” PRNewswire, March 7, 2013. Available
at: http://www.prnewswire.com/news-releases/express-scripts-study-reveals-keys-to-controlling-specialty-drug-costs195839241.html
11. Thomas, K. “U.S. drug costs dropped in 2012, but rises loom.” The New York Times, March 18, 2013. Available at:
http://www.nytimes.com/2013/03/19/business/use-of-generics-produces-an-unusual-drop-in-drugspending.html?pagewanted=all&_r=0
12. Huh, J., DeLorme, D.E., Reid, L.N., An, S. “Direct-to-consumer prescription drug advertising: History, regulation and issues.”
Minnesota Medicine, March 2010. Available at:
http://www.minnesotamedicine.com/PastIssues/PastIssues2010/March2010/ClinicalJisuMarch2010.aspx
13. Ross, J.S., Kravitz, R.L. “Direct-to-consumer television advertising: Time to turn off the tube?” Journal of General Internal
Medicine 28(7):862-864, 2013. Available at: http://link.springer.com/content/pdf/10.1007%2Fs11606-013-2424-2.pdf
14. Tran, A. “Study: Per capita Rx spending fell for the first time in 2012.” Kaiser Health News Blog, May 9, 2013. Available at:
http://capsules.kaiserhealthnews.org/?p=19289
15. Thomas, K. “Pills tracked from doctor to patient to aid drug marketing.” The New York Times, May 16, 2013. Available at:
http://www.nytimes.com/2013/05/17/business/a-data-trove-now-guides-drug-company-pitches.html?pagewanted=all
16. Avorn, J. “Healing the overwhelmed physician.” The New York Times, June 11, 2013. Available at:
http://www.nytimes.com/2013/06/12/opinion/healing-the-overwhelmed-physician.html?hp
17. Johnson, L.A. “Study: Wiser medication use could cut health costs.” Fox News, June 20, 2013. Available at:
http://www.foxnews.com/health/2013/06/20/wiser-medication-use-could-cut-health-costs/
Pharmaceutical Pricing
1. Beasley, D. “U.S. branded drug prices soar as generic pressure rises.” Reuters, March 23, 2011. Available at:
http://www.reuters.com/article/2011/03/23/us-branded-drug-prices-idUSTRE72M57X20110323
2. Carey, M.A. “Drug industry rebates: The sequel.” Kaiser Health News, July 15, 2011. Available at:
http://capsules.kaiserhealthnews.org/index.php/2011/07/drug-maker-rebates-the-sequel/
3. Thomas, K. Brand-name drug prices rise sharply, report says. The New York Times, November 28, 2012. Available at:
http://www.nytimes.com/2012/11/29/business/cost-of-brand-name-prescription-medicines-soaring.html
4. Martin, T.W. “Drugstores press for pricing data.” The Wall Street Journal, March 27, 2013. Available at:
http://content.healthaffairs.org/content/31/4/780.full.pdf+html
5. Viebeck, E. “Drugs cheapest at Costco, priciest at CVS, study finds.” The Hill, March 29, 2013. Available at:
http://thehill.com/blogs/healthwatch/medical-devices-and-prescription-drug-policy-/290945-drugs-cheapest-at-costco-priciest-atcvs-study-finds
6. Viebeck, E. “Liberal groups push for lower Medicare drug prices.” The Hill, February 14, 2013. Available at:
http://thehill.com/blogs/healthwatch/medicare/283077-liberal-groups-push-for-lower-medicare-drug-prices
7. Pollack, A. “Cancer physicians attach high drug costs.” The New York Times, April 25, 2013. Available at:
http://www.nytimes.com/2013/04/26/business/cancer-physicians-attack-high-drug-costs.html?partner=rss&emc=rss
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8.
Reuters. “Analysis: Drugmakers face more scrutiny of discordant U.S. prices.” May 10, 2013. Available at:
http://www.reuters.com/article/2013/05/10/us-usa-health-drugs-analysis-idUSBRE9490MH20130510
Drug Shortages
1*. Wilson, D. “Deepening drug shortages.” Health Affairs 31(2):263-266, 2012.
http://content.healthaffairs.org/content/31/2/263.full.pdf+html
2*. Thomas, K. Drug shortages persist in U.S., harming care. The New York Times, November 16, 2012. Available at:
http://www.nytimes.com/2012/11/17/business/drug-shortages-are-becoming-persistent-in-us.html?pagewanted=all
3*. Thomas, K. Lapses at big drug factories add to shortages and danger. The New York Times, October 17, 2012. Available at:
http://www.nytimes.com/2012/10/18/business/drug-makers-stalled-in-a-cycle-of-quality-lapses-andshortages.html?pagewanted=all
4. Mettner, J. “Running short.” Minnesota Medicine, October 2011. Available at:
http://www.minnesotamedicine.com/PastIssues/PastIssues2011/October2011/RunningShort.aspx
5. Anand, G., Shah, S., McKay, B. “Shortage of drugs threaten TB fight.” The Wall Street Journal, June 6, 2013. Available at:
http://online.wsj.com/article/SB10001424127887323469804578523262257381332.html
Controversial Practices in the Pharmaceutical Industry
1. Rubin, R. “Pfizer fined record $2.3b for illegal marketing in off-label drug case.” USA Today, September 3, 2009. Available at:
http://www.usatoday.com/money/industries/health/2009-09-02-pfizer-fine_N.htm
2. Harris, G. “Drug maker hid test data, files indicate.” New York Times, July 13, 2010, p. A.1
http://www.nytimes.com/2010/07/13/health/policy/13avandia.html?_r=3&hp .
3*. Bartz, D. “US sees jump in “pay-for-delay” drug settlements.” Reuters, July 27, 2010. Available at:
http://www.reuters.com/article/idUSN2712034820100727
4*. “When a drug fails.” New York Times, July 26, 2010, P. A.22
5*. Wilson, D. “Pfizer gives details on payments to doctors.” New York Times, April 1, 2010. p. B.2
http://www.nytimes.com/2010/04/01/business/01payments.html
6. Wolston, M. “An MS patient loses trust when she finds out her doctor is paid by drug companies.” Health Affairs 30(12):24492452, 2011. http://content.healthaffairs.org/content/30/12/2449.full.pdf+html
7. Editorial. “Drug company payoffs.” New York Times, July 6, 2010. Available at:
http://www.nytimes.com/2010/07/07/opinion/07wed2.html
8. Kesselheim, A.S., Murtagh, L., Mello, M.M. “’Pay for delay’ settlements of disputes over pharmaceutical patents.” New England
Journal of Medicine 365(15):1439-1445, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMhle1102235
9. Meier, B., Thomas, K. “Insurers pay big markups as doctors dispense drugs.” New York Times online, July 11, 2012. Available
at: http://www.nytimes.com/2012/07/12/business/some-physicians-making-millions-selling-drugs.html?pagewanted=all
10*. Los Angeles Times. CVS Caremark has become a frequent subject of government probes. October 24, 2012. Available at:
http://articles.latimes.com/2012/oct/24/business/la-fi-cvs-caremark-20121024
11. Reuters. “U.S. Files 2nd lawsuit accusing Novartis of kickbacks.” April 26, 2013. Available at:
http://online.wsj.com/article/SB10001424127887323469804578523262257381332.html
12. Elliott, C. “Useless studies, real harm.” The New York Times, July 28, 2011. Available at:
http://www.nytimes.com/2011/07/29/opinion/useless-pharmaceutical-studies-real-harm.html?_r=2
Relationship between Pharmaceutical Industry and the FDA
1. Pecquet, J. “Dems: FDA should be able to recall drugs.” The Hill, May 27, 2010. Available at: http://thehill.com/business-alobbying/100375-dems-fda-should-be-able-to-recall-drugs
2. Alexander, G.C., O’Connor, A.B., Stafford, R.S. “Enhancing prescription drug innovation and adoption.” Annals of Internal
Medicine 154:833-837, 2011. http://annals.org/issue.aspx?journalid=90&issueID=20233&direction=P
3*. Boldrin, M., Swanidass, S.J. “A new bargain for drug approvals.” Wall Street Journal, July 27, 2011, p. A.15
http://online.wsj.com/article/SB10001424052702303812104576441610360466984.html .
4. Ponnuru, R. “Too much FDA meddling means not enough drugs.” Bloomberg View, June 21, 2011. Available at:
http://www.bloomberg.com/news/2011-06-21/too-much-fda-intervention-equals-too-few-drugs-ramesh-ponnuru.html
5. Gever, J. “Clinical notes: FDA turns up heat on compounders.” MedPage Today, April 14, 2013. Available at:
http://www.medpagetoday.com/InfectiousDisease/PublicHealth/38438
6. Pittman, D. “FDA to poll docs on impact of DTC ads.” MedPage Today, April 19, 2013. Available at:
http://www.medpagetoday.com/Washington-Watch/FDAGeneral/38582
7. Caroll, J. “Bristol-Myers gains FDA’s ‘breakthrough’ track in race for hep C drug approval.” Fierce Biotech, April 25, 2013.
Available at: http://www.fiercebiotech.com/story/bristol-myers-gains-fdas-breakthrough-track-race-hep-c-drug-approval/2013-0425
Health Reform and the Pharmaceutical Industry
1. “Pharmaceutical companies offer $80 billion toward health care reform.” PBS NewsHour, June 22, 2009. Available at:
http://www.pbs.org/newshour/updates/health/jan-june09/pharma_06-22.html
2. Frates, C. “PhRMA quietly spends big in 2010.” POLITICO.com, November 10, 2010. Available at:
http://www.politico.com/news/stories/1110/44917.html
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3.
4.
5.
Van Dyke, A. “Sebelius, health industry leaders meet in Kansas City to talk drug development.” Kansas City Business Journal,
July 6, 2010. Available at: http://www.bizjournals.com/kansascity/stories/2010/07/05/daily7.html
Kendall, B. “White House seeks to speed up generic drugs’ path to market.” Wall Street Journal, February 15, 2011, p. D.2.
Available at: http://online.wsj.com/article/SB10001424052748703584804576144610898923424.html
Lipton, E., Sack K. “Fiscal footnote: Big senate gift to drug maker.” The New York Times, January 19, 2013. Available at:
http://www.nytimes.com/2013/01/20/us/medicare-pricing-delay-is-political-win-for-amgen-drug-maker.html
Further Readings
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Langreth, R. “Drugmakers open new front against cancer with next generation of experimental drugs.” The Washington Post,
May 12, 2013. Available at: http://www.bloomberg.com/news/2013-05-13/human-immune-boosting-cancer-drugs-seenextending-lives.html
Gottlieb, S. “Why we should be spending more on pricey cancer drugs.” Forbes, June 10, 2013. Available at:
http://www.forbes.com/sites/scottgottlieb/2013/06/10/why-we-should-spend-more-on-pricey-cancer-drugs/
Newcomer, L.N. “Changing physician incentives for cancer care to reward better patient outcomes instead of use of more costly
drugs.” Health Affairs 31(4):780-785, 2012. Available at: http://content.healthaffairs.org/content/31/4/780.full.pdf+html
ABCNews. New study highlights dangers of over-medicated seniors. August 23, 2012. Available at:
http://abcnews.go.com/Health/study-highlights-dangers-medicated-seniors/story?id=17060793
Stynes, T. Express Scripts earnings rise 21%. The Wall Street Journal, November 5, 2012. Available at:
http://online.wsj.com/article/SB10001424052970204349404578101353030937738.html
Terhune, C. “U.S. spending on genetic tests jumps.” Los Angeles Times, March 12, 2012, p. A.4. Available at:
http://news.zurichna.com/article/fea92e233d6de94b59a120cfe6a0c158/us-spending-on-genetic-tests-jumps
Ahmed, R. India revokes Roche patent. The Wall Street Journal, November 3, 2012. Available at:
http://online.wsj.com/article/SB10001424052970204846304578096483954249650.html
Andrews, M. “Why your drug copay could change.” NPR health blog, May 8, 2012. Available at:
http://www.npr.org/blogs/health/2012/05/08/152245452/why-your-drug-copay-could-change
Reuters, Drug shortage led to spike in kids’ infections. October 11, 2012. Available at: http://news.yahoo.com/drug-shortage-ledspike-kids-infections-204333255.html
Reuters. Bayer CEO decries pressure to lower drug prices. September 19, 2012. Available at:
http://www.reuters.com/article/2012/09/19/us-bayer-dekkers-idUSBRE88I1HR20120919
Reuters. Drop in hospital visits seen with lower drug copay. October 3, 2012. Available at:
http://www.reuters.com/article/2012/10/03/us-drop-drug-idUSBRE8921AP20121003
Pollack, A. New drugs for Lipids set off race. The New York Times, November 5, 2012. Available at:
http://www.nytimes.com/2012/11/06/business/new-drugs-for-lipids-set-offrace.html?gwh=EA0CDFB609598B0CE03A72AA05D1D5E8&_r=0
President’s council of advisors on science and technology releases report on innovation in drug discovery and development.
September 25, 2012. Available at: http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast_fda_release_final.pdf
Bach, P.B., Salta, L.B., Wittes, R.E. In cancer care, cost matters. The New York Times, October 14, 2012. Available at:
http://www.nytimes.com/2012/10/15/opinion/a-hospital-says-no-to-an-11000-a-month-cancer-drug.html
Pittman, D. Fewer drugs in short supply. MedPage Today, September 24, 2012. Available at:
http://www.medpagetoday.com/Washington-Watch/FDAGeneral/34935
Bloomberg, Arizona sues McKesson over allegations of inflated drug prices. September 20, 2012. Available at:
http://www.bloomberg.com/news/2012-09-19/arizona-sues-mckesson-alleging-it-inflated-drug-prices.html
Drug Channels. Pharmacy ownership: Getting less profitable. October 23, 2012. Available at:
http://www.drugchannels.net/2012/10/pharmacy-ownership-getting-less.html
Editorial. “Some legal clarity on generic drugs.” New York Times, July 18, 2012, p. A.26. Available at:
http://www.nytimes.com/2012/07/18/opinion/some-legal-clarity-on-generic-drugs.html?_r=0
Editorial. “Why do drug shortages persist?” USA Today, May 16, 2012. Available at:
http://www.usatoday.com/news/opinion/editorials/story/2012-05-16/drug-shortages-FDA/55028206/1
Kolata, G. Cancer study points to tighter pairing of drugs and patients. The New York Times, September 9, 2012. Available at:
http://www.nytimes.com/2012/09/10/health/research/for-a-lung-cancer-drug-treatment-may-be-within-reach.html
Kresge, N. Roche $5.7 billion tumor drug sales hinge on rival tests. Bloomberg, September 23, 2012. Available at:
http://www.bloomberg.com/news/2012-09-23/roche-5-7-billion-tumor-drug-sales-hinge-on-rival-tests.html
Meier, B. “F.D.A. won’t order doctors to get pain-drug therapy.” New York Times online, July 9, 2012. Available at:
http://www.nytimes.com/2012/07/10/health/fda-rejects-mandatory-training-in-painkillers-for-doctors.html
Whalen, J. Gene-therapy approval marks major milestone. The Wall Street Journal, November 2, 2012. Available at:
http://online.wsj.com/article/SB10001424052970203707604578095091940871524.html
Whoriskey, P. As drug industry’s influence over research grows, so does the potential for bias. The Washington Post, November
24, 2012. Available at: http://articles.washingtonpost.com/2012-11-24/business/35511825_1_drug-companies-avandia-steven-enissen
31
https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeR1IyeDE2WkJ0cHc/edit
25. Wilson, D. “Drug firms face billions in losses in ’11 as patents end.” New York Times, March 6, 2011. Available at:
http://www.nytimes.com/2011/03/07/business/07drug.html?pagewanted=all
26. Pecquet, J. “Kohl urges trade officials to be wary of drug industry consolidation.” The Hill’s Healthcare Blog, May 19, 2011.
Available at: http://thehill.com/blogs/healthwatch/medical-devices-and-prescription-drug-policy-/162153-kohl-urges-trade-officialsto-be-wary-of-drug-industry-consolidation
27. Pollack, A. “New drugs fight prostate cancer, but at high cost.” New York Times, June 28, 2011, p. A.1. Available at:
http://www.nytimes.com/2011/06/28/health/28prostate.html
28. Mishori, R. “Some doctors insist on brand-name drugs even when cheaper generics are available.” Washington Post online,
July 11, 2011. Available at: http://www.washingtonpost.com/national/some-doctors-insist-on-brand-name-drugs-even-whencheaper-generics-are-available/2011/06/13/gIQAmC0L9H_story.html
29. Lippmann, R. “How the merger of two health care giants may affect your wallet.” NPR, August 17, 2011. Available at:
http://www.npr.org/blogs/health/2011/08/17/139680770/how-the-merger-of-two-health-care-giants-may-affect-yourwallet?ps=sh_sthdl
30. Loftus, P. “Pfizer to cut R&D, step up buybacks.” Wall Street Journal, February 2, 2011, p.23, Available at:
http://online.wsj.com/article/SB10001424052748703445904576117902803504210.html
31. Loftus, P., Thomas, G. “Health & Wellness: FDA sued over generic Lipitor release.” Wall Street Journal, March 22, 2011, p. D.2.
32. Editorial. “The shortage of vital drugs.” New York Times, August 26, 2011, p. A.26. Available at:
http://www.nytimes.com/2011/08/26/opinion/the-shortage-of-vital-drugs.html
33. Gatesman, M.L., Smith, T.J. “The shortage of essential chemotherapy drugs in the United States.” New England Journal of
Medicine 365(18):1653-1655, 2011. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1109772
34. Harris, G. “U.S. scrambling to ease shortage of vital medicine.” New York Times online, August 19, 2011. Available at:
http://www.nytimes.com/2011/08/20/health/policy/20drug.html?pagewanted=all
35. Duncan, D.W. “New drugs at lower costs—investing in growth.” The Fiscal Times, April 6, 2011. Available at:
http://www.thefiscaltimes.com/Articles/2011/04/06/New-Drugs-at-Lower-Costs.aspx#page1Carpenter, D. “Free the F.D.A.” New
York times online, December 13, 2011. Available at: http://www.nytimes.com/2011/12/14/opinion/free-the-fda.html?_r=1
36. CBO. “Potential effects of a ban on direct-to-consumer advertising of new prescription drugs.” Economic and Budget Issue Brief,
May 2011. Available at: http://www.cbo.gov/ftpdocs/121xx/doc12164/5-25-PrescriptionDrugAdvertising.pdf
37. Chabner, B.A., “Drug shortages – a critical challenge for the generic-drug market.” New England Journal of Medicine
365(23):2147-2148, 2011. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1112633
38. Clark, C. “Price gouging spikes drug costs up to 4500%, purchasing group says.” HealthLeaders Media, August 17, 2011.
Available at: http://www.healthleadersmedia.com/page-1/MAR-269856/Price-Gouging-Spikes-Drug-Costs-Up-to-4500Purchasing-Group-Says##
39. Baker, S. “AARP: Generics keep getting cheaper.” The Hill, July 21, 2011. Available at:
http://thehill.com/blogs/healthwatch/medical-devices-and-prescription-drug-policy-/172783-aarp-says-generics-keep-gettingcheaper
40. Hirschler, B. “Drug R&D spending fell in 2010, heading lower.” Reuters, June 26, 2011. Available at:
http://www.reuters.com/article/2011/06/26/pharmaceuticals-rd-idUSL6E7HO1BL20110626
41. Kavilanz, P. “FDA: Another tainted drug crisis seems inevitable.” CNN Money.com, March 14, 2011. Available at:
http://money.cnn.com/2011/03/14/news/economy/us_drug_safety_challenges/index.htm
42. Baker, S. “FTC: ‘pay-for-delay’ settlements up 60 percent.” The Hill’s Healthcare Blog, May 3, 2011. Available at:
http://thehill.com/blogs/healthwatch/medical-devices-and-prescription-drug-policy-/159085-ftc-pay-for-delay-settlements-up-60
43. Bate, R. “Beware of risks of generic drugs: Copies aren’t always as good as the original—especially when ingredients are
sourced in China.” Wall Street Journal (Online), July 6, 2011. Available at:
http://online.wsj.com/article/SB10001424052702303339904576406163574698214.html
44. Singer, N. “A fight over how drugs are pitched.” New York Times, April 24, 2011, p. B.1. Available at:
http://www.nytimes.com/2011/04/25/business/25privacy.html?pagewanted=all
45. Whalen, J. “FDA scientist attacks Avandia safety.” Wall Street Journal, June 11, 2010. p. B.4
46. Bakalar, N. “Study sees a slant in articles on drug.” New York Times, April 13, 2010. p. D.7. Available at:
http://www.nytimes.com/2010/04/13/health/13diab.html
47. Harris, G. “Research ties diabetes drug to heart woes.” New York Times, February 20, 2010, p. A.1. Available at:
http://www.nytimes.com/2010/02/20/health/policy/20avandia.html?pagewanted=all&gwh=1B20072821AC5BD6C92D94B065C04
1F9
48. Rockoff, J. “Prescription-drug sales rise 5.1%; revenue, usage increase as drug makers, retailers offer discounts on co-pays.”
Wall Street Journal, April 2, 2010, p. B.4
49. Herbert, B. “This is reform?” New York Times, August 18, 2009, p. A.23. Available at:
http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=norm
al&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroups=&s
ortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA206181609
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https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeR1IyeDE2WkJ0cHc/edit
50. Martinez, B. and Johnson, A. “Drug makers, hospitals raise prices --- double-digit increases in pharmaceutical, other costs come
as Washington gears up for a fight.” The Wall Street Journal, April 15, 2009, p. B.1. Available at:
http://search.proquest.com/docview/399044208/fulltext/13EE1258E455CA3C752/1?accountid=14586
51. Shrank, W.H., Porter, M.E., Jain, S.H., Choudhry, N. “A blueprint for pharmacy benefit managers to increase value.” American
Journal of Managed Care 15(2):87-93, 2009. Available at:
http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=3&sid=344b0ee4-f46f-42d0-adec347cccf52d38%40sessionmgr14&hid=26
52. Rampell, C. “Marketing drugs to consumers.” December 2, 2009. Available at:
http://economix.blogs.nytimes.com/2009/12/02/marketing-drugs-to-consumers/
53. NACS Online. “Pharmaceutical industry backs health care reform” August 17, 2009. Available at:
http://www.nacsonline.com/NACS/News/Daily/Pages/ND0817094.aspx
54. “When a drug costs $300,000.” New York Times, March 23, 2008, p. WK.8. Available at:
http://www.nytimes.com/2008/03/23/opinion/23sun3.html?gwh=8AC468FFFA76E84B4F5221DF8CC85358
Financing
Session 12 – November 19, 2013
Health Insurance, Uninsurance, and the Private Health Insurance Market: What Works, What Doesn’t and
How Will Health Reform Change It?
The private market for health insurance is under enormous stress. Premiums have increased substantially over the past decade and
employers, who are major actors in this market, appear to be re-examining their traditional roles. One result is that an increasing number of
people who previously purchased insurance in the private sector are uninsured. In this session we describe the nature of health insurance,
how the health insurance market has evolved over time, the design of different health insurance products and the strengths and
weaknesses of the current private health insurance system. The efforts of health plans to control costs and improve quality, as well as the
theoretical aspects of health insurance, are addressed in subsequent MHA courses.
Learning Objectives
Students should be able to:
1. Discuss the logical foundations for health insurance.
2. Contrast the characteristics of different types of health insurance benefit designs.
3. Describe the strengths and weaknesses of the current private health insurance system.
4. Discuss how health reform will affect the private health insurance market.
Suggested Readings
History and Current State of Private Health Insurance
1*. Blumenthal, D. “Employer-sponsored health insurance in the United States – Origins and implications,” New England Journal of
Medicine 355(1):82-88, 2006. http://www.nejm.org/doi/pdf/10.1056/NEJMhpr060703
2*. Blumenthal, D. “Employer-sponsored insurance – riding the health care tiger.” New England Journal of Medicine 355(2):195202, 2006. http://www.nejm.org/doi/pdf/10.1056/NEJMhpr060704
3*. Henry J. Kaiser Family Foundation. “How private health coverage works: A primer, 2008 update. Available at:
http://www.kff.org/insurance/7766.cfm
4. Fronstin, P. “Employment-based health benefits: Trends in access and coverage, 1997-2010.” EBRI Issue Brief #370, April
2012. Available at: http://www.ebri.org/pdf/briefspdf/EBRI_IB_04-2012_No370_HI-Trends.pdf
5. Muligan, C.B. Employer-provided health insurance and the market. The New York Times, November 21, 2012. Available at:
http://economix.blogs.nytimes.com/2012/11/21/the-future-of-employer-provided-health-insurance/
6. Archer, D. “Private insurance is bankrupting Americans: Is Congress paying attention?” Health Affairs Blog, June 26, 2012.
Available at: http://healthaffairs.org/blog/2012/06/26/private-insurance-is-bankrupting-americans-is-congress-paying-attention/
7. Smialek, J. “Obamacare competition has roots in economist’s passion.” Bloomberg, May 30, 2013. Available at:
http://www.bloomberg.com/news/2013-05-30/obamacare-competition-has-roots-in-economist-s-passion.html
8. Collins, S.R., Robertson, R., Garber, T., Doty, M.M. “Insuring the future. Current trends in health coverage and the effects of
implementing the Affordable Care Act.” Commonwealth Fund, April 2013. Available at:
http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2013/Apr/1681_Collins_insuring_future_biennial_
survey_2012_FINAL.pdf
9. “Employers plan aggressive response to shifting health care landscape, Towers Watson/National Business Group on health
survey finds.” Towers Watson, March 7, 2013. Available at: http://www.towerswatson.com/en/Press/2013/03/Employers-PlanAggressive-Response-to-Shifting-Health-Care-Landscape-TW-NBGH-Survey-Finds
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10. National Institute for Health Care Management. “Spending for private health insurance in the United States.” January 2013.
Available at: http://nihcm.org/images/stories/Spending_for_Private_Health_Insurance_Rev.pdf
11. Andrews, M. “Large companies are increasingly offering workers only high deductible health plans.” Kaiser Health News, March
26, 2013. Available at: http://www.kaiserhealthnews.org/features/insuring-your-health/2013/032613-michelle-andrews-on-highdeductible-plans-and-large-employers.aspx
Characteristics of Organizations Providing Private Health Insurance and the Products They Offer
1*. Nussbaum, A. “WellPoint’s Kleinman sees health insurer ‘oligopoly’ fed by U.S. overhaul.” Bloomberg.com, June 24, 2010.
Available at: http://www.bloomberg.com/news/2010-06-24/wellpoint-s-kleinman-sees-health-insurer-oligopoly-fed-by-u-soverhaul.html
2. Johnson, A. “WellPoint aims to diversity.” Wall Street Journal online, January 27, 2011. Available at:
http://online.wsj.com/article/SB10001424052748703293204576105604272858170.html
3. Hancock, J. “Health savings account membership up 18 percent.” Kaiser Health News blog, May 30, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/05/health-savings-account-membership-up-18-percent/
4*. Kulkarni, S.S. “Quick facts about high-deductible health plans.” Kaiser Health News, April 27, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/april/27/high-deductible-health-plans.aspx?referrer=search
5. Baker, S. “Insurers: Hospital prices rising steeply.” The Hill, March 18, 2013. Available at:
http://thehill.com/blogs/healthwatch/health-insurance/288705-insurers-hospital-prices-rising-steeply
Strengths and Weaknesses of the Current Private Health Insurance Market
1*. Abelson, R. “Health insurers profit as many postpone care.” New York Times, May 14, 2011, p. A.1
http://www.nytimes.com/2011/05/14/business/14health.html?_r=0
2. Pear, R. “Health care premiums soar as coverage shrinks.” New York Times, March 5, 2011, p. A.13.
http://www.nytimes.com/2011/03/05/health/policy/05cost.html?_r=1&hp
3*. Kaiser Commission on Medicaid and the Uninsured. “Five facts about the uninsured.” September, 2011. Available at:
http://www.kff.org/uninsured/upload/7806-04.pdf
4. Andrews, M. “With high deductible health plans, it pays to shop around for care.” Kaiser Health News, May 20, 2013. Available
at: http://www.kaiserhealthnews.org/stories/2013/may/19/with-high-deductible-plans-it-pays-to-shop-around-for-care.aspx
Potential Impact of Health Reform
1*. “Ezra Klein’s Wonkbook.” The Washington Post, July 24, 2013. Available at:
http://view.ed4.net/v/VP6EHT/BMA0WF/WT6XV0Z/HFNG26/
2. Darling, H. “Health care reform: perspectives from large employers.” Health Affairs 29(6):1220-1224, 2010. Available at:
http://content.healthaffairs.org/content/29/6/1220.full.pdf+html
3. Brennan, T.A., Studdert, D.M. “How will health insurers respond to new rules under health reform.” Health Affairs 29(6):11471151, 2010. Available at: http://content.healthaffairs.org/content/29/6/1147.full.pdf+html
4. Pear, R. “Health insurers to be required to justify rate increases over 10 percent.” New York Times, December 22, 2010, p. A.21.
Available at: http://www.nytimes.com/2010/12/22/health/policy/22insure.html?_r=0
5. Johnson, A. “Reforms prod insurers to diversify.” Wall Street Journal, May 12, 2011, p. B.1. Available at:
http://online.wsj.com/article/SB10001424052748703643104576291022457851278.html
6. Pecquet, J. “Healthcare lobbying cools down one year after reform law’s passage. The Hill’s Healthcare Blog, April 21, 2011.
Available at: http://thehill.com/blogs/healthwatch/lobbying/157231-healthcare-lobbying-cools-down-one-year-after-reform-lawspassage
7. Pecquet, J. “Employers unlikely to drop coverage because of health law, survey finds.” The Hill, August 2, 2011. Available at:
http://thehill.com/blogs/healthwatch/health-insurance/174961-employers-unlikely-to-drop-coverage-because-of-health-lawsurvey-finds
8. Terhune, C. “California insurance commissioner chides Blue Shield over rates.” Los Angeles Times, March 7, 2013. Available at:
http://articles.latimes.com/2013/mar/07/business/la-fi-mo-blue-shield-rates-20130307
9. Galewitz, P. “Health insurers see big opportunities in health law’s Medicaid expansion.” Kaiser Health News, March 8, 2013.
Available at: http://www.kaiserhealthnews.org/stories/2013/march/08/molina-health-care-florida-medicaid-managed-care.aspx
10. Fisher, N. “Employers dropping health care coverage could benefit health care quality and cost.” Forbes, February 20, 2013.
Available at: http://www.forbes.com/sites/aroy/2013/02/20/employers-dropping-health-care-coverage-could-benefit-health-carequality-and-cost/
11. Appleby, J. “Insurers’ efforts to delay health law compliance could affect premiums, benefits for millions.” Kaiser Health News,
April 5, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/april/05/health-law-insurance-deadlines.aspx
12. Maltby, E., Needleman, S.E. “Some small businesses opt for the health-care penalty.” The Wall Street Journal, April 8, 2013.
Available at: http://online.wsj.com/article/SB10001424127887323916304578401413507987532.html
13*. Klein, E. “The six ways Obamacare changes insurance premiums.” The Washington Post, June 3, 2013. Available at:
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/03/the-six-ways-obamacare-changes-insurance-premiums/
14. Bernasek, A. “Why a health insurance penalty may look tempting.” The New York Times, June 22, 2013. Available at:
http://www.nytimes.com/2013/06/23/business/why-a-health-insurance-penalty-may-look-tempting.html
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Further Readings
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Bridgeforth, S. “Employers and employees agree on the value of voluntary benefits.” Preduential, March 5, 2013. Available at:
http://news.prudential.com/article_display.cfm?article_id=6526
Sonier, J., Bried, B., Au-Yeung, C., Auringer, B. “State-level trends in employer-sponsored health insurance. A state-by-state
analysis. Robert Wood Johnson Foundation, April 2013. Available at:
http://www.rwjf.org/content/dam/farm/reports/reports/2013/rwjf405434
Abelson, R. “Health insurance companies get in shape for 2014.” The New York Times, February 5, 2013. Available at:
http://www.nytimes.com/2013/02/06/business/florida-blue-and-other-health-insurers-prepare-for-newregulations.html?pagewanted=all&gwh=833B26A78906F2CC635B132B5FF568C6
Abelson, R., Greenhouse, S. Small employers weigh impact of providing health insurance. The New York Times, November 30,
2012. Available at: http://www.nytimes.com/2012/12/01/business/small-employers-weigh-impact-of-providing-healthinsurance.html?pagewanted=all
Galewitz, P. Quality of community health centers varies widely. Kaiser Health News, October 31, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/november/01/community-health-centers-quality-varies-widely.aspx
Hall, S.D. Survey: Most employers won’t drop health coverage. FierceHealthPayer, August 29, 2012. Available at:
http://www.fiercehealthpayer.com/story/survey-most-employers-wont-drop-health-coverage/2012-08-29
Hancock, J. “The new normal in health insurance: High deductibles.” Kaiser Health News, June 3, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/june/04/high-deductible-health-insurance.aspx?referrer=search
Kaiser Health News. Analysis: Health exchanges and the litigation landscape. November 20, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/november/29/health-law--litigation-and-exchanges.aspx
Kaiser Health Reform Source. How small business owners get health insurance. September 28, 2012. Available at:
http://policyinsights.kff.org/2012/september/how-small-business-owners-get-health-insurance.aspx
Robertson, R., Stremikis, K., Collins, S.R., Doty, M.N., Davis, K. Realizing health reform’s potential: Jobs without benefits: The
health insurance crisis faced by small businesses and their workers. November 2012. Available at:
http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Oct/1640_Robertson_jobs_without_benefits_
small_businesses.pdf
Stawicki, E. Biz groups push for answers on Minnesota exchange. Kaiser Health News, September 6, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/september/06/minnesota-insurance-exchange-businesses.aspx
Cheung, K.M. “Three-quarters of Fortune 50 firms in booming health industry.” FierceHealthcare, June 9, 2011. Available at:
http://www.fiercehealthcare.com/story/three-quarters-fortune-50-firms-booming-health-industry/2011-06-09
Colliver, V. “Insurer wants focus on what drives up health costs.” SFGate.com, March 19, 2011. Available at:
http://www.sfgate.com/news/article/Insurer-wants-focus-on-what-drives-up-health-costs-2388258.php
Editorial. “Watching the health insurers.” Los Angeles Time online, April 26, 2011. Available at:
http://articles.latimes.com/2011/apr/26/opinion/la-ed-insurance-20110426
Mendes, E. “U.S. employer-based health coverage continues to decline.” Gallup, March 4, 2011. Available at:
http://www.gallup.com/poll/146492/employer-based-health-coverage-continues-decline.aspx
“Only one in six employers favor a universal health care system funded by tax dollars.” PRWeb, April 20, 2011. Available at:
http://www.prweb.com/releases/UnitedBenefitAdvisors/HealthCare/prweb8320280.htm
Baicker, K. and Chandra, A. “Myths and misconceptions about U.S. health insurance.” Health Affairs – Web Exclusive
27(6):w533-w543, October 21, 2008. Available at: http://content.healthaffairs.org/content/27/6/w533.full.pdf+html
Henry J. Kaiser Family Foundation. “Tax subsidies for health insurance. An issue brief. July 2008. Available at:
http://www.kff.org/insurance/7779.cfm
Session 13 – November 26, 2013
Medicaid: Can This “Vast Public Enterprise” Be Sustained?
The Medicaid program has been characterized as an “after thought” in the passage of legislation creating Medicare. It has grown steadily
over the years to become the largest state-federal collaborative program and one of the top two expenditure categories in most state
budgets. When the economy weakens and state tax revenues decline, the number of individuals eligible for Medicaid typically increases,
creating financial challenges for states. The passage of health reform promises to place substantial new strains on state Medicaid
programs while the Supreme Court decision offers states options. In this class session we discuss the status of Medicaid and related
programs designed to serve the poor and uninsured, as well as their likely futures under health reform and federal budget-balancing
efforts.
Learning Objectives
Students should be able to:
1. Discuss the distribution of funding and administrative responsibilities between the states and the federal government under
Medicaid.
2. Describe the relative importance of different categories of expenditures under Medicaid.
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3.
4.
5.
Describe the experience of Medicaid programs in contracting with managed care organizations.
Discuss how economic downturns and state efforts to respond to budget crises have affected Medicaid programs.
Discuss how health reform could affect Medicaid programs.
Suggested Readings
How Medicaid Is Structured and Financed
1*. Iglehart, J. “Medicaid revisited – skirmishes over a vast public enterprise,” New England Journal of Medicine 356(7):734-740,
2007. http://www.nejm.org/doi/pdf/10.1056/NEJMhpr066650
2*. National Health Policy Forum. “Medicaid financing,” The Basics, The George Washington University, Washington, DC, January
15, 2009, pp 1-4. Available at: http://www.nhpf.org/library/details.cfm/2528
3. Iglehart, J.K. “Medicaid at a crossroads.” New England Journal of Medicine 364:1585-1587, 2011.
http://www.nejm.org/doi/pdf/10.1056/NEJMp1103305
4. Tran, A. “Expanding Medicaid didn’t lead to big health gains in Oregon, study finds.” Kaiser Health News, May 1, 2013. Available
at: http://capsules.kaiserhealthnews.org/?p=19086
5. Klein, E., Soltas, E. “Wonkbook: Everything you need to know about the Oregon health study.” The Washington Post, May 2,
2013. Available at: http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/02/wonkbook-everything-you-need-to-knowabout-the-oregon-health-study/
6. Lowrey, A. “Medicaid access increases use of care, study finds.” The New York Times, May 1, 2013. Available at:
http://www.nytimes.com/2013/05/02/business/study-finds-health-care-use-rises-with-expanded-medicaid.html?_r=0
7. Pugh, T. “Most doctors still reject Medicaid as program expansion nears.” McClatchy Washington Bureau, May 13, 2013.
Available at: http://www.mcclatchydc.com/2013/05/13/191105/most-doctors-still-reject-medicaid.html
Expenditures Under Medicaid and the Impact of Recession on Medicaid Programs
1. Rowland, D. “Health care and Medicaid – Weathering the recession.” New England Journal of Medicine, 360(13):1273-1276,
2009. http://www.nejm.org/doi/pdf/10.1056/NEJMp0901072
2. Shinkman, R. “Providers may face Medicaid payment cuts in 33 states.” Fierce HealthFinance.com, June 6, 2011. Available at:
http://www.fiercehealthfinance.com/story/providers-may-face-medicaid-payment-cuts-33-states/2011-06-06
3. Morgan, D. “Analysis: Medicaid cuts may limit care for new 2014 enrollees.” Reuters, August 11, 2011. Available at:
http://www.reuters.com/article/2011/08/11/us-usa-health-medicaid-idUSTRE77A5DB20110811
4*. Galewitz, P., Fleming, M. “13 states cut Medicaid to balance budgets.” Kaiser Health News, July 24, 2012. Available at:
http://www.kaiserhealthnews.org/Stories/2012/July/25/medicaid-cuts.aspx
5*. Reuters. “Fewer jobs means more spending on U.S. Medicaid.” May 4, 2012. Available at:
http://www.reuters.com/article/2012/05/04/us-usa-states-medicaid-idUSBRE8431IQ20120504
Medicaid Contracting with Managed Care Plans
1*. Frakt, A., Carroll, A.E., Pollack, H.A., Reinhardt, U. “Our flawed but beneficial Medicaid program.” New England Journal of
Medicine 364:e31, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1103168
2*. Iglehart, J.K. “Desperately seeking savings: States shift more Medicaid enrollees to managed care.” Health Affairs 30(9):16271629, 2011. http://content.healthaffairs.org/content/30/9/1627.full.pdf+html
3. Galewitz, P. “Health law expected to boost Medicaid enrollees in managed care.” Kaiser Health News, November 12, 2010.
Available at: http://www.kaiserhealthnews.org/Stories/2010/November/12/health-law-medicaid-managed-care.aspx
4*. Forbes. Benefits and challenges of Medicaid managed care. October 18, 2012. Available at:
http://www.forbes.com/fdc/welcome_mjx.shtml
5. Nussbaum, A., Wayne, A. “WellPoint deal shows Medicaid prospects trump court view.” Bloomberg, July 10, 2012. Available
at: http://www.bloomberg.com/news/2012-07-10/wellpoint-deal-shows-medicaid-prospects-trump-court-view.html
6. Thompson, B., McLean, J. “Kansas’ great hope: Managed care will tame Medicaid costs.” Kaiser Health News, February 6, 2013.
Available at: http://www.mcclatchydc.com/2013/05/13/191105/most-doctors-still-reject-medicaid.html
7. American Health Insurance Plans. “Innovations in Medicaid managed care: Highlights of health plans’ programs to improve the
health and well-being of Medicaid beneficiaries.” March 2013. Available at: http://www.ahip.org/MedicaidInnovationsBook/
Policy Proposals for Reforming Medicaid
1*. Sommers, B.D., Epstein, A.E. “Why states are so miffed about Medicaid — Economics, politics, and the “woodwork effect.”” New
England Journal of Medicine 365:100-102, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1104948
2. Holahan, J. “Restructuring Medicaid through a swap: An alternative to a block grant.” Urban Institute Health Policy Center,
April, 2011. Available at: http://www.urban.org/uploadedpdf/412327-restructuring-medicaid-through-swap.pdf
3*. New York Times Editorial. “The Ryan plan for Medicaid. A good deal for the federal government would be a very bad deal for the
states.” May 1, 2011, p. WK.9.
http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=norm
al&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroups=&s
ortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA255130314
4. Pecquet, J. “Pending Medicaid rate regulation raises GOP concerns.” The Hill, March 16, 2011. Available at:
http://thehill.com/blogs/healthwatch/medicaid/150237-pending-medicaid-rate-regulation-raises-gop-concerns
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5.
Editorial. “The rush to abandon the poor.” New York Times, July 18, 2012, p. A.26.
http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=norm
al&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroups=&s
ortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA296741950
6. Howard, P., Sykes, R. Medicaid is broken—let the states fix it. The Wall Street Journal, October 10, 2012. Available at:
http://online.wsj.com/article/SB10000872396390443982904578046161332775362.html
7. Kaiser Commission on Medicaid and the Uninsured. “Emerging Medicaid accountable care organizations: The role of managed
care.” May 2012. Available at: http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8319.pdf
8. Hancock, J. “The Arkansas Medicaid model: What you need to know about the ‘private option’.” Kaiser Health News, May 1,
2013. Available at: http://www.kaiserhealthnews.org/stories/2013/may/02/arkansas-medicaid-private-option-faq.aspx’
9. Baker, S. “Republicans propose Medicaid caps.” The Hill, May 1, 2013. Available at:
http://thehill.com/blogs/healthwatch/medicaid/297301-republicans-propose-medicaid-caps
10. Takach, M., Buxbaum, J. “Care management for Medicaid enrollees through community health teams.” The Commonwealth
Fund, May 21, 2013. Available at: http://www.commonwealthfund.org/Publications/Fund-Reports/2013/May/CareManagement.aspx
PPACA and Medicaid
1. Jost, T.S., Rosenbaum, S. “The Supreme Court and the future of Medicaid.” New England Journal of Medicine online, July 25,
2012. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1208219
2. Frakt, A. “Gaming out the new Medicaid option.” JAMA Forum, July 19, 2012. Available at:
http://newsatjama.jama.com/2012/07/19/gaming-out-the-new-medicaid-option/
3. Kaiser Health News. “What will the states do on Medicaid?” June 28, 2012. Available at:
http://www.kaiserhealthnews.org/Stories/2012/June/28/what-will-states-do-on-medicaid.aspx
4. Samuelson, R. “The Medicaid albatross.” Real Clear Politics, July 23, 2012. Available at:
http://www.realclearpolitics.com/articles/2012/07/23/the_medicaid_albatross_114865.html
5. Somashekhar, S. “Medicaid shapes up as major battleground.” Washington Post online, August 14, 2012. Available at:
http://www.washingtonpost.com/politics/medicaid-shapes-up-as-major-battleground/2012/08/14/c9b8d164-e592-11e1-8f6258260e3940a0_story.html
6. Kaiser Commission on Medicaid and the Uninsured. Faces of the Medicaid expansion: Profiles of uninsured adults who could
gain coverage. November 2012. Available at: http://www.kff.org/medicaid/8385.cfm
7*. Somashekhar, S. “GOP governors’ endorsements of Medicaid expansion deepen rifts within party.” The Washington Post, June
2, 2013. Available at: http://articles.washingtonpost.com/2013-06-02/national/39697956_1_medicaid-expansion-medicaid-plangop-governors
8*. Aizenman, N.C. “Health-care law could backfire for thousands on Medicaid.” The Washington Post, April 6, 2013. Available at:
http://articles.washingtonpost.com/2013-04-06/national/38327847_1_medicaid-program-childless-adults-poverty
9. Pear, R. “States’ policies on health care exclude some of the poorest.” The New York Times, May 24, 2013. Available at:
http://www.nytimes.com/2013/05/25/us/states-policies-on-health-care-exclude-poorest.html?pagewanted=all
10. Henneberry, J., Gifford, K.D. “Medicaid expansion: What’s at stake for 2014 and beyond?” National Institute for Health Care
Management, April 2013. Available at: http://www.nihcm.org/images/stories/Medicaid_Expansion__Whats_at_Stake_for_2014_and_Beyond.pdf
11. Klein, E. Soltas, E. “Wonkbook: The terrible deal for states rejecting Medicaid.” The Washington Post, June 4, 2013. Available at:
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/04/wonkbook-the-terrible-deal-for-states-rejecting-medicaid/
12. Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured. “Characteristics of uninsured low-income adults.”
August 2012. Available at: http://kff.org/health-reform/fact-sheet/characteristics-of-uninsured-low-income-adults/
13. Wayne, A., Mildenberg, D. “Working poor losing Obamacare as states resist Medicaid.” Bloomberg, June 25, 2013. Available at:
http://www.bloomberg.com/news/2013-06-25/working-poor-losing-obamacare-as-states-resist-medicaid.html
Further Readings
1.
2.
3.
4.
5.
Kellermann, A.L., Weinick, R.M. “Emergency departments, Medicaid costs, and access to primary care – understanding the
link.” New England Journal of Medicine 366(23): 2141-2143, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1203247
Aizenman, N.C. State lawmakers gird for battle over Medicaid. December 2, 2012. Available at:
http://articles.washingtonpost.com/2012-12-02/national/35584820_1_medicaid-expansion-medicaid-rolls-state-lawmakers
Alfred, R. Medicaid provider to terminate contract with state. October 17, 2012. Available at:
http://www.vcstar.com/news/2012/oct/17/medicaid-provider-to-terminate-contract-with/
Angeles, J. “How health reform’s Medicaid expansion will impact state budgets.” Center on Budget and Policy Priorities, July
25, 2012. Available at: http://www.cbpp.org/cms/index.cfm?fa=view&id=3801
Bernstein, N. With Medicaid, long-term care of elderly looms as a rising cost. The New York Times, September 6, 2012.
Available at: http://www.nytimes.com/2012/09/07/health/policy/long-term-care-looms-as-rising-medicaidcost.html?pagewanted=all&gwh=B1F9D581D1BEFF5095F1E3383662CD14
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6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
Carey, M.A. “FAQ: Ryan’s plan would make key changes in Medicaid, too.” Kaiser Health News, August 14, 2012. Available at:
http://www.kaiserhealthnews.org/Stories/2012/August/15/medicaid-ryan-faq.aspx
Cowen, T. The new tug of war over Medicaid. The New York Times July 14, 2012. Available at:
http://www.nytimes.com/2012/07/15/business/medicaids-new-tug-of-war-economicview.html?gwh=E558BF2424118B33B125C6CF5BFBFB79
Decker, S.L. “In 2011 nearly one-third of physicians said they would not accept new Medicaid patients, but rising fees may help.”
Health Affairs 31(8):1673-1679, 2012. Available at: http://content.healthaffairs.org/content/31/8/1673.full.pdf+html
Galewitz, P. “Study: Nearly a third of doctors won’t see new Medicaid patients.” Kaiser Health News, August 6, 2012. Available
at: http://www.kaiserhealthnews.org/Stories/2012/August/06/Third-Of-Medicaid-Doctors-Say-No-New-Patients.aspx
Galewitz, P. GOP plan would cut Medicaid by $1.7 trillion, study says, KHN Blog, October 23, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/10/gop-plan-would-cut-medicaid-by-1-7-trillion-study-says/
Goodnough, A. “Lines are drawn over opting out of Medicaid plan.” New York Times, July 13, 2012, p. A.1. Available at:
http://www.nytimes.com/2012/07/13/health/policy/in-florida-a-fight-brews-over-governors-vow-to-opt-out-of-medicaidexpansion.html?pagewanted=all&_r=0&gwh=773D13624922754D8D4F1BF241A9E670
Kenen, J., Norman, B. “Paul Ryan’s Medicaid changes may be bigger.” August 16, 2012. Available at:
http://www.politico.com/news/stories/0812/79795.html
Levey, N.N. “Medicaid could be scaled back sharply under GOP plans.” Los Angeles Times online, July 30, 2012. Available at:
http://www.latimes.com/news/nationworld/nation/la-na-medicaid-rollback-20120731,0,1410769.story
Smith, M.D. “The Supreme Court’s Medicaid surprise.” JAMA Forum, July 6, 2012. Available at:
http://newsatjama.jama.com/2012/07/06/jama-forum-the-supreme-courts-medicaid-surprise/
The New York Times. New York’s Medicaid reforms. September 17, 2012. Available at:
http://www.nytimes.com/2012/09/18/opinion/new-yorks-medicaid-reforms.html?gwh=1E20B72A1A0A842EEF8A2F4CE72499F5
Walker, S. “Our obsolete approach to Medicaid.” New York Times, April 22, 2011, p. A.23. Available at:
http://www.nytimes.com/2011/04/22/opinion/22walker.html?gwh=51BFB1F675D980918916E7CB149E834F
Radnofsky, L., Weaver, C. States seek a middle ground on Medicaid. The Wall Street Journal, September 18, 2012. Available at:
http://articles.washingtonpost.com/2012-12-02/national/35584820_1_medicaid-expansion-medicaid-rolls-state-lawmakers
Rosenbaum, S. “Medicaid and access to health care – a proposal for continued inaction? New England Journal of Medicine
365(2):102-104. 2011. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1106046
Carroll, A. “Don’t cut Medicaid, fund it better.” CNN.com, March 15, 2011. Available at: http://articles.cnn.com/2011-0315/opinion/carroll.medicaid.budget_1_medicaid-low-income-medicare-beneficiaries-spending?_s=PM:OPINION
Galewitz, P. “Insurers clash with health providers as states expand Medicaid managed care.” Kaiser Health News, April 26,
2011. Available at: http://www.kaiserhealthnews.org/Stories/2011/April/27/Insurers-Providers-States-Expand-Medicaid-ManagedCare.aspx
Hobson, K. “GPhA report: Generics offer big Medicaid savings opportunity.” Wall Street Journal, July 26, 2010. Available at:
http://blogs.wsj.com/health/2010/07/26/gpha-report-generics-offer-big-medicaid-savings-opportunity/
Palmeri,C., Wechsler, P. “Medicaid pushes U.S. states off ‘cliff’ as governors seek cuts.” Bloomberg.com, December 21, 2010.
Available at: http://www.bloomberg.com/news/2010-12-22/medicaid-demands-push-states-toward-cliff-even-as-governors-cutbenefits.html
Sack K. and Pear R. “States consider Medicaid cuts as use grows.” New York Times, February 19, 2010, p.A-1. Available at:
http://www.nytimes.com/2010/02/19/us/politics/19medicaid.html?gwh=669AE48751561FC9553D3D323F4EE3A9
The Henry J. Kaiser Family Foundation. “Explaining health care reform: questions about Medicaid’s role.” Issue Brief, April
2010. Available at: http://www.kff.org/healthreform/upload/7920-02.pdf
Session 14 – December 3, 2013
Financing Care for Seniors: Down the Medicare Rabbit Hole
Assignment 2 Due
Medicare is one of the largest single items in the federal budget. Changes in Medicare expenditures have ripple effects on other
government programs and major impacts on the health care delivery system. The alleged cost-shifting to private payers that occurs due to
Medicare “underpayments” is only one of many ongoing policy issues. In this session we describe the structure of the Medicare program,
some of the challenges it has faced since its inception, and how Medicare has affected, and been affected by, changes in the greater
health care system.
Learning Objectives
Students should be able to:
1. Compare the Medicare Trust Funds A and B with respect to the way they are funded and the coverage they provide.
2. Describe the benefit coverage under Medicare and compare it to typical private insurance benefit coverage.
3. Discuss the structure and evolution of Medicaid Part C.
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4.
5.
Describe how the Medicaid Part D prescription drug benefit is structured.
Compare and contrast how hospitals and physicians are paid under Medicare.
Suggested Readings
The Structure of the Medicare Program
1*. Henry J. Kaiser Foundation. “Medicare. A primer. 2010. Available at: http://www.kff.org/medicare/upload/7615-03.pdf
2. Henry J. Kaiser Family Foundation. “Health care on a budget. The financial burden of health spending by Medicare households.”
June 2011. Available at: http://www.kff.org/medicare/8171.cfm
3. Rosenblatt, B. Understanding Medicare. Figuring out the Part D. market. The Medicare NewsGroup, November 29, 2012.
Available at: http://www.medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicareblog/2012/11/29/figuring-out-the-part-d-market
4. Brandon, E. “10 things to know about Medicare.” U.S. News & World Report, May 10, 2013. Available at:
http://money.msn.com/retirement/10-things-to-know-about-medicare
5. Kaiser Family Foundation. “Medicare spending and financing.” November 2012. Available at: http://kff.org/medicare/factsheet/medicare-spending-and-financing-fact-sheet/
6. Hendrickson, M. “Did you really pay for your Medicare benefits?” Forbes, March 7, 2013. Available at:
http://www.forbes.com/sites/markhendrickson/2013/03/07/did-you-really-pay-for-your-medicare-benefits/
7. Kaiser Family Foundation. “Medicare advantage 2013 spotlight: Enrollment market update.” June 2013. Available at:
http://kaiserfamilyfoundation.files.wordpress.com/2013/06/8448.pdf
Issues Facing Medicare
Hospitals
1. Kenen, J. “Medicare eyes hospice savings.” Politico, October 17, 2011. Available at:
http://www.politico.com/news/stories/1011/66177.html
2*. Rau, J. “Medicare to add hospital efficiency, patient safety to payment formula.” KHN Blog, April 24, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/04/medicare-to-add-hospital-efficiency-patient-safety-to-payment-formula/
3*. Abelson, R., Creswell, J., Palmer, G.J. Medicare bills rise as records turn electronic. The New York Times, September 21, 2012.
Available at: http://www.nytimes.com/2012/09/22/business/medicare-billing-rises-at-hospitals-with-electronicrecords.html?pagewanted=all
4. Rau, J. “Medicare spotlights hospitals with especially costly patients. Kaiser Health News, May 9, 2012. Available at:
http://www.kaiserhealthnews.org/Stories/2012/May/09/Medicare-Hospitals-Costly-Patients.aspx
5. Rau, J. “Medicare to penalize 2,211 hospitals for excess readmissions.” Kaiser Health News, August 13, 2012. Available at:
http://www.kaiserhealthnews.org/Stories/2012/August/13/medicare-hospitals-readmissions-penalties.aspx
6. Rau, J. “Panel tells Congress Medicare is unfairly penalizing hospitals serving the poor.” Kaiser Health News, June 14, 2013.
Available at: http://www.kaiserhealthnews.org/stories/2013/june/14/medpac-hospital-readmissions-poor-congress.aspx
7*. Pear, R., Abelson, R. “Hospitals fear they’ll bear brunt of Medicare cuts.” The New York Times, December 18, 2012. Available at:
http://www.nytimes.com/2012/12/19/business/medicare-cuts-how-deep-and-where.html?ref=business&_r=1&
8. Goldhill, D. “The high costs of Medicare’s low prices.” The Washington Post, March 10, 2013. Available at:
http://articles.washingtonpost.com/2013-03-10/opinions/37605696_1_medicare-beneficiaries-private-insurers-health-care
9. Kowalczyk, L. “Hospital charges bring a backlash.” The Boston Globe, March 11, 2013. Available at:
http://www.bostonglobe.com/lifestyle/health-wellness/2013/03/10/patients-surprised-high-medical-bills-challenge-hospitaloverhead-charges/EY2x6jKTiPLiGXpSCyskKM/story.html
Physicians
1. Carey, M.A. “FAQ: The ‘doc fix’ dilemma.” Kaiser Health News, February 17, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2011/december/15/faq-doc-fix.aspx
2. Schulte, F., Eaton, J., Donald, D. Doctors, others billing Medicare at higher rates. The Washington Post, September 15, 2012.
Available at: http://articles.washingtonpost.com/2012-09-15/national/35496252_1_data-codes-medicare
3*. Carey, M.A. “FAQ on Medicare doctor pay: Why is it so hard to fix?” Kaiser Health News, February 10, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2011/december/15/faq-doc-fix.aspx
4. Kliff, S. “Obama’s new fiscal cliff offer would repeal the ‘doc-fix’.” The Washington Post, December 18, 2012. Available at:
http://www.washingtonpost.com/blogs/wonkblog/wp/2012/12/18/obamas-new-fiscal-cliff-offer-would-repeal-the-doc-fix/
5. Pittman, D. “Uniform quality measures sought for an SGR repeal.” MedPage Today, May 7, 2013. Available at:
http://www.medpagetoday.com/PracticeManagement/Reimbursement/38959
6. Baker, S. “GOP floats permanent ‘doc-fix’ bill.” The Hill, May 28, 2013. Available at:
http://thehill.com/blogs/healthwatch/medicare/302165-gop-floats-permanent-doc-fix-bill
Pharmaceuticals and Devices
1. “Medical equipment prices highlight some of Medicare’s difficulties,” July 21, 2009. Available at:
http://www.medicalnewstoday.com/articles/158369.php
2. “Specialty drugs force high Medicare out-of-pocket costs.” March, 2010. Available at: http://www.advfn.com/news_SpecialtyDrugs-Force-High-Medicare-Out-Of-Pocket-Costs_41779029.html
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3*. Hoadley, J. “Medicare Part D spending trends: Understanding key drivers and the role of competition.” KFF Medicare Policy
Issue Brief, May, 2012. Available at: http://www.kff.org/medicare/upload/8308.pdf
Health Plans
1*. Gold, M. “Medicare Advantage: Facts, fallacies, and the future.” Health Affairs Blog, March 14, 2011. Available at:
http://healthaffairs.org/blog/2011/03/14/medicare-advantage-facts-fallacies-and-the-future
2. Kliff, S. Does Medicare Advantage cost less? Or does it cost more? The Washington Post, August 22, 2012. Available at:
http://www.washingtonpost.com/blogs/wonkblog/wp/2012/08/22/does-medicare-advantage-cost-less-or-does-it-cost-more/
3. Baker, S. “Insurers ready to battle Medicare cuts.” The Hill, March 6, 2013. Available at:
http://thehill.com/blogs/healthwatch/medicare/286419-insurers-ready-to-battle-medicare-cuts
4. Pittman, D. “More $$$ going to Medicare advantage plans.” MedPage Today, April 2, 2013. Available at:
http://www.medpagetoday.com/PublicHealthPolicy/Medicare/38202
5. Norman, B., Haberkorn, J. “CMS reverses course on cuts.” Politico, April 3, 2013. Available at:
http://www.politico.com/story/2013/04/insurance-medicare-advantage-cuts-health-care-89569.html
6. “The liberal Medicare advantage revolt.” The Wall Street Journal, March 29, 2013. Available at:
http://online.wsj.com/article/SB10001424127887323501004578388980625858300.html
Further Readings
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Congressional Budget Office. “CBO’s May 2013 Medicare baseline.” May 14, 2013. Available at:
http://www.cbo.gov/sites/default/files/cbofiles/attachments/44205_Medicare_0.pdf
Overland, D. “Medicare advantage poised for strong membership growth.” FierceHealthPayer, May 17, 2013. Available at:
http://www.fiercehealthpayer.com/story/medicare-advantage-plans-see-50-increase-membership/2013-05-17
Kaiser Family Foundation: “Medigap: Spotlight on enrollment, premiums, and recent trends.” April 2013. Available at:
http://kff.org/medicare/report/medigap-enrollment-premiums-and-recent-trends/
Wayne, A. “Humana rises as U.S. reverses Medicare rate cut decision.” Bloomberg, April 2, 2013. Available at:
http://www.bloomberg.com/news/2013-04-01/humana-among-insurers-winning-u-s-medicare-payment-rise.html
Government Accountability Office. Medicare physician payment: Private-sector initiatives can help inform CMS quality and
efficiency incentive efforts.” December 26, 2012. Available at: http://www.gao.gov/products/GAO-13-160
Lowes, R. “Bill would repeal SGR, phase out Medicare fee-for-service.” Medscape News, May 9, 2012. Available at:
http://www.medscape.com/viewarticle/763589?src=mpnews&spon=16
Bloomberg. AMA, physician groups outline payment reforms to finance committee. October 17, 2012. Available at:
http://www.bna.com/ama-physician-groups-n17179870268/
Rau, J. Are Medicare’s new quality incentives large enough to change hospital behavior? Kaiser Health News, September 4,
2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/September/04/incentives-on-hospital-quality
Hancock, J. How is your Medicare drug plan like your cable company? KHN Blog, September 12, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/09/how-is-your-medicare-drug-plan-like-your-cable-company/
Greene, K. Lowering your Medicare bill. Wall Street Journal, October 26, 2012. Available at:
http://online.wsj.com/article/SB10001424052970203937004578077293381706414.html
Marte, J. Medicare open-enrollment: Find the right drug plan. The Wall Street Journal, October 13, 2012. Available at:
http://articles.marketwatch.com/2012-11-08/finance/34421801_1_coverage-gap-medicare-plans-drug-plans
Pew Research Center. Medicare voucher plan remains unpopular. August 21, 2012. Available at: http://www.peoplepress.org/2012/08/21/medicare-voucher-plan-remains-unpopular/
Porter, E. Rationing health care more fairly. The New York Times, August 21, 2012. Available at:
http://www.nytimes.com/2012/08/22/business/economy/rationing-health-care-more-fairly.html?pagewanted=all
Tran, A. Seniors satisfied with Medicare, anxious about future, survey finds. KHN Blog, October 18, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/10/seniors-satisfied-with-medicare-anxious-about-future-survey-finds/
Miller, M. The real Medicare villain. The Washington Post, August 24, 2012. Available at:
http://articles.washingtonpost.com/2012-08-24/opinions/35493016_1_health-care-rich-nations-medicare
Feder, J., Zuckerman, S., Lallemand, N.C., Biles, B. Why premium support? Restructure Medicare Advantage, not Medicare.
Urban Institute, September 2012. Available at: http://www.urban.org/UploadedPDF/412662-Why-Premium-Support-RestructureMedicare-Advantage-Not-Medicare.pdf
Davis, K., Stremikis, K., Doty, M.M., Zezza, M.A. “Medicare beneficiaries less likely to experience cost- and access-related
problems than adults with private coverage.” Health Affairs 31(8):1866-1875, 2012. Available at:
http://content.healthaffairs.org/content/31/8/1866.full.pdf+html
Rau, J. “Hospitals’ readmission rates still too high, government says.” Washington Post online, July 19, 2012. Available at:
http://www.washingtonpost.com/politics/hospitals-readmission-rates-still-too-high-governmentsays/2012/07/19/gJQAZIqdwW_story.html
Viebeck, El. “lawmakers propose a permanent ‘doc fix’.” The Hill, May 9, 2012. Available at:
http://thehill.com/blogs/healthwatch/medicare/226413-reps-propose-a-permanent-doc-fix40
https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeR1IyeDE2WkJ0cHc/edit
20. Klepper, B. “A legal challenge to CMS’ reliance on the RUC.” Health Affairs Blog, August 9, 2011. Available at:
http://healthaffairs.org/blog/2011/08/09/a-legal-challenge-to-cms-reliance-on-the-ruc/
21. Alonso-Zaldivar, R. “AP newsbreak: Medicare’s drug coverage gap shrinks.” YAHOO News, November 27, 2011. Available at:
http://news.yahoo.com/ap-newsbreak-medicares-drug-coverage-gap-shrinks-140356865.html
22. Kaiser Health News. “With rate cut looming, doctors threaten to stop accepting Medicare patients.” February 26, 2010. Available
at: http://www.kaiserhealthnews.org/Daily-Reports/2010/February/26/Medicare-Cuts-and-Other-Payment-Issues.aspx
23. Appleby, J. “Administration unexpectedly expands bonus payments for Medicare Advantage plans.” Kaiser Health News,
November 16, 2010. Available at: http://www.kaiserhealthnews.org/Stories/2010/November/16/Medicare-Advantagebonuses.aspx
24. Bott, D.M., Kapp, M.C., Johnson, L.B., Magno, L.M. “Disease management for chronically ill beneficiaries in traditional
Medicare.” Health Affairs 28(1):86-98, 2009. Available at: http://content.healthaffairs.org/content/28/1/86.full.pdf+html
25. Hargrave, E., Hoadley, J., Thompson, J. “Coverage and pricing of drugs that can be covered under Part B and Part D.” MedPAC,
October 2007. Available at: http://www.medpac.gov/documents/Oct07_PartB_D_contractor_JS.pdf
26. Altman, D. “The new Medicare prescription-drug legislation,” New England Journal of Medicine 350(1): 9-10, 2004. Available at:
http://www.nejm.org/doi/pdf/10.1056/NEJMp038224
Session 15 – December 10, 2013
Medicare: A Program at the Brink
Quiz 2: Material from Sessions 9-15
Health reform, the rising national debt, and changing population demographics have focused attention on slowing the growth of Medicare
expenditures. Both political parties have “plans” for the Medicare program; Medicare “reform” was an important topic in the past
presidential election and likely will remain a contentious issue in upcoming national elections as well.
Learning Objectives
Students should be able to:
1. Discuss the challenges that enrollment growth poses for Medicare.
2. Describe proposals for Medicare reform.
3. Explain how health reform and the growing federal government debt could affect Medicare.
Suggested Readings
The Medicare Solvency Issue
1. Pizzi, R. “Chronic conditions drive Medicare spending growth.” February 18, 2010. Available at:
http://www.healthcarefinancenews.com/news/chronic-conditions-drive-medicare-spending-growth
2. Galewitz, P., Carey, M.A. “Gloomier-than-expected forecast for Medicare.” Kaiser Health News, May 13, 2011. Available at:
http://www.kaiserhealthnews.org/Stories/2011/March/13/medicare-trustees-report-2024.aspx
3*. Serafini, M.W. “An even bleaker prognosis for Medicare?” KHN Blog, April 24, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/04/an-even-bleaker-prognosis-for-medicare/
4*. Wasson, E., Baker S. “Social security on track for insolvency in 2033, Medicare in 2026. The Hill, May 31, 2013. Available at:
http://thehill.com/blogs/on-the-money/budget/302719-social-security-insolvent-by-2033
5. Goodman, J.C., Kotlikoff, “Medicare by the scary numbers.” The Wall Street Journal, June 24, 2013. Available at:
http://online.wsj.com/article/SB10001424127887323393804578555461959256572.html
6. Lawrence B.R. “The illusion of health-care ‘trust funds.’” The Washington Post, October 18, 2012. Available at:
http://articles.washingtonpost.com/2012-10-18/opinions/35502037_1_trust-fund-medicare-trustees-health-care
The Impact of Health Reform on Medicare
1. Kliff, S. “Romney’s right: Obamacare cuts Medicare by $716 billion. Here’s how.” Washington Post online, August 14, 2012.
Available at: http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/08/14/romneys-right-obamacare-cuts-medicare-by-716billion-heres-how/
2. Pasternak, S. “End-of-life care constitutes third rail of U.S. health care policy debate.” Medicare Newgroup, June 3, 2013.
Available at: http://medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicare-blog/2013/06/03/endof-life-care-constitutes-third-rail-of-u.s.-health-care-policy-debate
Medicare and the Federal Budget
1. Goldstein, A. “Medicare funds to last longer than earlier forecast, report says.” The Washington Post, August 6, 2010. p. A.6.
http://www.washingtonpost.com/wp-dyn/content/article/2010/08/05/AR2010080500643.html
2. Cohn, J. “GOP budget: Time travel back to when seniors couldn’t afford health care — guest opinion.” Kaiser Health News, April
26, 2011. Available at: http://www.kaiserhealthnews.org/Columns/2011/April/042611cohn.aspx
3. Pear, R. “Agreement on debt talks: Health groups dislike proposals.” New York Times online, July 12, 2011. Available at:
http://www.nytimes.com/2011/07/13/us/politics/13health.html
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4.
Klein, E. “Paul Ryan’s budget keeps Obama’s Medicare cuts. Full stop.” Washington Post online, August 14, 2012. Available
at: http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/08/14/ryans-budget-keeps-obamas-medicare-cuts-full-stop/
5. Fairchild, C. “Simpson says Medicare to squeeze out government spending.” Bloomberg.com, August 13, 2012. Available at:
http://www.bloomberg.com/news/2012-08-13/simpson-says-medicare-to-squeeze-out-government-spending.html
6*. Serafini, M.W. “FAQ: Obama v. Ryan on controlling federal Medicare spending.” Kaiser Health News, May 3, 2012. Available
at: http://www.kaiserhealthnews.org/stories/2012/may/04/obama-ryan-controlling-federal-medicare-spending-faq.aspx
7*. Carey, M.A. “FAQ: Decoding the $716 billion in Medicare reductions.” Kaiser Health News, August 17, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/august/17/faq-716-billion-medicare-reductions.aspx
8. Carey, M.A. “3 hill panels examining changes to Medicare.” Kaiser Health News, February 25, 2013. Available at:
http://capsules.kaiserhealthnews.org/?p=17172
9. Reinhardt, U.E. “Medicare spending isn’t out of control.” The New York Times, December 21, 2012. Available at:
http://economix.blogs.nytimes.com/2012/12/21/medicare-spending-isnt-out-of-control/?_r=0
10*. Kaiser Family Foundation. “Medicare and the federal budget: Comparison of Medicare provisions in recent federal debt and
deficit reduction proposals.” March 2013. Available at: http://kaiserfamilyfoundation.files.wordpress.com/2013/04/8124-02-2.pdf
11. Tyson, L.D. “Evidence vs. ideology in the Medicare debate.” The New York Times, August 24, 2012. Available at:
http://economix.blogs.nytimes.com/2012/08/24/evidence-vs-ideology-in-the-medicare-debate/?_r=0
Alternatives for Medicare Reform
1. Wilensky, G.R. “Reforming Medicare — Toward a modified Ryan plan.” New England Journal of Medicine 364:1890-1892, 2011.
http://www.nejm.org/doi/pdf/10.1056/NEJMp1104425
2*. Rosenthal, M.B. “Hard choices — Alternatives for reining in Medicare and Medicaid spending.” New England Journal of Medicine
364: 1887-1890, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1104428
3. Appleby, J., Carey, M.A., McGinley, L. “CBO: Seniors would pay much more for Medicare under Ryan plan.” Kaiser Health
News, April 5, 2011. Available at: http://www.kaiserhealthnews.org/Stories/2011/April/06/CBO-Seniors-Pay-More-MedicareRyan-Plan.aspx
4. Cohn, J. “Analysis: Medicare, liberals and the lesser of two evils.” Kaiser Health News, August 15, 2011. Available at:
http://www.kaiserhealthnews.org/Stories/2011/August/15/medicare-super-committee-cohn-analysis.aspx
5. Miller, M. “Paul Ryan’s path to nowhere.” Washington Post online, March 21, 2012. Available at:
http://www.washingtonpost.com/opinions/paul-ryans-budget-to-nowhere/2012/03/21/gIQAe8qYRS_story.html
6. Samuelson, R.J. “Flunking the Medicare debate.” Washington Post online, March 21, 2012. Available at:
http://www.washingtonpost.com/opinions/how-partisan-language-poisons-the-medicaredebate/2012/03/21/gIQARTtwRS_story.html
7. Antos, J. “The Ryan plan: The cliffs notes version of Republican health reform.” Health Affairs Blog, March 21, 2012. Available
at: http://healthaffairs.org/blog/2012/03/21/the-ryan-plan-the-cliffs-notes-version-of-republican-health-reform/
8*. Serafini, M.W. “FAQ: How Paul Ryan proposes to change Medicare.” Kaiser Health News, August 11, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/august/11/faq-paul-ryan-house-republican-medicare-plan.aspx?referrer=search
9. Brookings Institute. “Why the Medicare fight matters to Americans over 55.” August 20, 2012. Available at:
http://www.brookings.edu/research/opinions/2012/08/20-ryan-medicare-aaron
10. Orszag, P.R. “Paul Ryan is thoughtful, handsome and misguided.” Bloomberg.com, August 11, 2012. Available at:
http://www.bloomberg.com/news/2012-08-11/paul-ryan-is-thoughtful-handsome-and-misguided.html
11. Gruber, J. “Proposal 3: Restructuring cost sharing and supplemental insurance for Medicare.” In: Greenstone, M., Harris, M., Li,
K., Adam Looney, Patashnik, J. (eds.) 15 Ways to Rethink the Federal Budget. Brookings, February 2013, pp. 23-26. Available
at: http://www.brookings.edu/~/media/research/files/papers/2013/02/thp%20budget%20papers/thp_15waysfedbudget_prop3.pdf
12. Berenson, R., Holahan, J., Zuckerman, S. “Can Medicare be preserved while reducing the deficit? Timely analysis of immediate
health policy issues.” Urban Institute, March 2013. Available at: http://www.urban.org/UploadedPDF/412759-Can-Medicare-BePreserved-While-Reducing-the-Deficit.pdf
13. Guterman, S., Zezza, M.A., Schoen, C. “Paying for value: Replacing Medicare’s sustainable growth rate formula with incentives
to improve care.” The Commonwealth Fund Issue Brief, March 2013. Available at:
http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2013/Mar/1678_Guterman_paying_for_value_ib.pd
f
14. Rau, J. “IOM panel raises concerns about lowering Medicare pay for high spending areas.” Kaiser Health News, March 22, 2013.
Available at: http://www.kaiserhealthnews.org/Stories/2013/March/22/IOM-panel-pans-idea-of-lowering-Medicare-pay-to-highspending-areas.aspx?p=1
15. Emanuel, E.J., Liebman, J.B. “Cut Medicare, help patients.” The New York Times, August 22, 2011. Available at:
http://www.nytimes.com/2011/08/23/opinion/cut-medicare-help-patients.html?pagewanted=all&_r=0
16. Gregg, J. “Opinion: A way out of the Medicare maze.” The Hill, April 8, 2013. Available at:
http://thehill.com/opinion/columnists/judd-gregg/292237-opinion-a-way-out-of-the-medicare-maze
17. Viebeck, E. “Unified Medicare benefit would save billions, study says.” The Hill, May 6, 2013. Available at:
http://thehill.com/blogs/healthwatch/medicare/298019-unified-medicare-benefit-would-save-billions-study-says
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18. Davis, K., Schoen, C., Guterman, S. “Medicare essential: An option to promote better care and curb spending growth.” The
Commonwealth Fund, May 6, 2013. Available at: http://www.commonwealthfund.org/Publications/In-theLiterature/2013/May/Medicare-Essential.aspx
Prospects for Near Term Changes in Medicare
1. Serafini, M.W. “AARP arming for Medicare battle.” Kaiser Health News, March 19, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/march/19/aarp-medicare-battle.aspx?referrer=search
2. Calmes, J., Pear, R. “Talk of Medicare changes could open way to budget pact.” The New York Times, March 28, 2013.
Available at: http://www.nytimes.com/2013/03/29/us/politics/common-ground-in-washington-for-medicarechanges.html?pagewanted=all
3*. Porter, E. “Medicare needs fixing, but not right now.” The New York Times, February 26, 2013. Available at:
http://www.nytimes.com/2013/02/27/business/medicare-needs-fixing-but-not-right-now.html?pagewanted=all
4. Editorial. “Raising Medicare age creates more problems.” Shreveport Times, March 25, 2013. Available at:
http://www.shreveporttimes.com/article/D2/20130326/OPINION03/303260056
5. Edsall, T.B. “The war on entitlements.” The New York Times, March 6, 2013. Available at:
http://opinionator.blogs.nytimes.com/2013/03/06/the-war-on-entitlements/
6. Harwood, J. “A complex role for Medicare in the standoff in Washington.” The New York Times, February 24, 2013. Available at:
http://www.nytimes.com/2013/02/25/us/politics/medicare-is-at-the-heart-of-the-fiscal-fight.html?pagewanted=all
7. Levin, Y. “Old and rich? Less help for you.” The New York Times, February 19, 2013. Available at:
http://www.nytimes.com/2013/02/20/opinion/old-and-rich-less-help-for-you.html?gwh
8. Holzer, H.J., Sawhill, I. “Payments to elders are harming our future.” The Washington Post, March 8, 2013. Available at:
http://articles.washingtonpost.com/2013-03-08/opinions/37561450_1_federal-budget-entitlement-programs-debt-to-gdp-ratio
9. Hiltzik, M. “The five biggest lies about entitlement programs.” Los Angeles Times, March 8, 2013. Available at:
http://articles.latimes.com/2013/mar/08/business/la-fi-hiltzik-20130310
10. White, C. “Medicare spending limits: Issues and implications.” KKF Issue Brief, March 2013. Available at:
http://kaiserfamilyfoundation.files.wordpress.com/2013/03/8428.pdf
11*. Carey, M.A. “Five ways the President’s budget would change Medicare.” Kaiser Health News, April 15, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/april/15/medicare-and-obama-budget.aspx
Further Readings
1.
2.
3.
4.
5.
Taylor, A.. “CBO: Deficit estimate for 2012 hiked to $1.2T after payroll tax cut, jobless benefits.” YAHOO News, March 13,
2012. Available at: http://news.yahoo.com/cbo-deficit-estimate-2012-hiked-1-2t-192323423.html
Klein, E. “The GOP’s Medicare confusion.” The Washington Post, November 29, 2012. Available at:
http://www.washingtonpost.com/blogs/wonkblog/wp/2012/11/29/the-gops-medicare-confusion/
Krugman, P. “Republicans and Medicare.” New York Times, February 12, 2010. p. A.31. Available at:
http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=norm
al&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroups=&s
ortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA218792481
Newhouse, J.P., Garber, A.M. “Geographic variation in Medicare services.” New England Journal of Medicine 368(16):14651468, 2013. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1302981
Huesch, M. “How ideas from private industry help combat Medicare fraud, waste, and abuse.” Health Affairs Blog, May 23, 2013.
Available at: http://healthaffairs.org/blog/2013/05/23/how-ideas-from-private-industry-help-combat-medicare-fraud-waste-andabuse/
VII. Evaluation and Grading
Grades will be determined based on aggregated responses to short essay questions on class material (2 quizzes, 30 pts. each),
three individual assignments (5, 10 and 10 pts.) and one group assignment (15 pts.). In the quizzes, students will be asked to
answer short essay questions based on the material assigned from the previous classes and discussed in those classes. Forty
minutes will be allocated for this purpose, with the student receiving a grade of 0-30 points. Each quiz must be taken during the
scheduled period, unless prior permission to postpone the quiz has been obtained from the instructor. The student will receive a
grade of zero for any quiz missed without prior arrangement or medical excuse. The student will receive a grade of zero on any
assignment not submitted as scheduled, unless prior arrangements have been made for late submission. The group project will
require preparation of a policy briefing for the CEO of a hypothetical health care system. The briefing will address the potential
implications of a specific public policy proposal or piece of legislation on the system. Thirty minutes will be allocated for the group to
present a PowerPoint analysis to the class and respond to class questions. The group also will draft a brief memo to the CEO
summarizing points made in the presentation. The topics for the briefing will be assigned one week before the scheduled time of the
briefing, to assure timeliness.
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Grading Scale
An A/F letter grade will be determined based on the following:
A = 93-100%
Represents outstanding achievement relative to the level necessary to meet course requirements
A- = 90-92.99%
B+ = 87-89.99%
B = 83-86.99%
B- = 80-82.99%
C+ = 77-79.99%
C = 73-76.99%
C- = 70-72.99%
D+ = 65-69.99%
D = 60-64.99%
F = < 59.99%
Represents achievement that is significantly above the level necessary to meet course requirements
Represents achievement that meets the minimum course requirements
No credit. Signifies work was below level of achievement that represents minimum threshold to obtain
credit or work was not completed and there was no agreement between instructor and student that the
student would be awarded an I.
The instructor reserves the right to adjust final grades “upward” based on the overall distribution of points for the class. That is,
students may receive a higher grade than expected based on their overall point total, but not a lower grade.
Course Evaluation
Beginning in fall 2008, the SPH will collect student course evaluations electronically using a software system
called CoursEval: www.sph.umn.edu/courseval. The system will send email notifications to students when
they can access and complete their course evaluations. Students who complete their course evaluations
promptly will be able to access their final grades just as soon as the faculty member renders the grade in
SPHGrades: www.sph.umn.edu/grades. All students will have access to their final grades through OneStop
two weeks after the last day of the semester regardless of whether they completed their course evaluation or
not. Student feedback on course content and faculty teaching skills are an important means for improving our
work. Please take the time to complete a course evaluation for each of the courses for which you are
registered.
Incomplete Contracts
A grade of incomplete “I” shall be assigned at the discretion of the instructor when, due to extraordinary
circumstances (e.g., documented illness or hospitalization, death in family, etc.), the student was prevented
from completing the work of the course on time. The assignment of an “I” requires that a contract be initiated
and completed by the student before the last official day of class, and signed by both the student and
instructor. If an incomplete is deemed appropriate by the instructor, the student in consultation with the
instructor, will specify the time and manner in which the student will complete course requirements.
Extension for completion of the work will not exceed one year (or earlier if designated by the student’s
college). For more information and to initiate an incomplete contract, students should go to SPHGrades at:
www.sph.umn.edu/grades.
University of Minnesota Uniform Grading and Transcript Policy - A link to the policy can be found at
onestop.umn.edu.
VIII. Other Course Information and Policies
Grade Option Change (if applicable)
For full-semester courses, students may change their grade option, if applicable, through the second week of
the semester. Grade option change deadlines for other terms (i.e. summer and half-semester courses) can
be found at onestop.umn.edu.
Course Withdrawal
Students should refer to the Refund and Drop/Add Deadlines for the particular term at onestop.umn.edu for
information and deadlines for withdrawing from a course. As a courtesy, students should notify their
instructor and, if applicable, advisor of their intent to withdraw.
Students wishing to withdraw from a course after the noted final deadline for a particular term must contact
the School of Public Health Office of Admissions and Student Resources at sph-ssc@umn.edu for further
information.
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Student Conduct Code
The University seeks an environment that promotes academic achievement and integrity, that is protective of
free inquiry, and that serves the educational mission of the University. Similarly, the University seeks a
community that is free from violence, threats, and intimidation; that is respectful of the rights, opportunities,
and welfare of students, faculty, staff, and guests of the University; and that does not threaten the physical or
mental health or safety of members of the University community.
As a student at the University you are expected adhere to Board of Regents Policy: Student Conduct Code.
To review the Student Conduct Code, please see:
http://regents.umn.edu/sites/default/files/policies/Student_Conduct_Code.pdf.
Note that the conduct code specifically addresses disruptive classroom conduct, which means "engaging in
behavior that substantially or repeatedly interrupts either the instructor's ability to teach or student learning.
The classroom extends to any setting where a student is engaged in work toward academic credit or
satisfaction of program-based requirements or related activities."
Use of Personal Electronic Devices in the Classroom
Using personal electronic devices in the classroom setting can hinder instruction and learning, not only for
the student using the device but also for other students in the class. To this end, the University establishes
the right of each faculty member to determine if and how personal electronic devices are allowed to be used
in the classroom. For complete information, please reference:
http://policy.umn.edu/Policies/Education/Education/STUDENTRESP.html.
Scholastic Dishonesty
You are expected to do your own academic work and cite sources as necessary. Failing to do so is
scholastic dishonesty. Scholastic dishonesty means plagiarizing; cheating on assignments or examinations;
engaging in unauthorized collaboration on academic work; taking, acquiring, or using test materials without
faculty permission; submitting false or incomplete records of academic achievement; acting alone or in
cooperation with another to falsify records or to obtain dishonestly grades, honors, awards, or professional
endorsement; altering, forging, or misusing a University academic record; or fabricating or falsifying data,
research procedures, or data analysis. (Student Conduct Code:
http://regents.umn.edu/sites/default/files/policies/Student_Conduct_Code.pdf) If it is determined that a student has
cheated, he or she may be given an "F" or an "N" for the course, and may face additional sanctions from the
University. For additional information, please see:
http://policy.umn.edu/Policies/Education/Education/INSTRUCTORRESP.html.
The Office for Student Conduct and Academic Integrity has compiled a useful list of Frequently Asked
Questions pertaining to scholastic dishonesty: http://www1.umn.edu/oscai/integrity/student/index.html. If you
have additional questions, please clarify with your instructor for the course. Your instructor can respond to
your specific questions regarding what would constitute scholastic dishonesty in the context of a particular
class-e.g., whether collaboration on assignments is permitted, requirements and methods for citing sources,
if electronic aids are permitted or prohibited during an exam.
Makeup Work for Legitimate Absences
Students will not be penalized for absence during the semester due to unavoidable or legitimate
circumstances. Such circumstances include verified illness, participation in intercollegiate athletic events,
subpoenas, jury duty, military service, bereavement, and religious observances. Such circumstances do not
include voting in local, state, or national elections. For complete information, please see:
http://policy.umn.edu/Policies/Education/Education/MAKEUPWORK.html.
Appropriate Student Use of Class Notes and Course Materials
Taking notes is a means of recording information but more importantly of personally absorbing and
integrating the educational experience. However, broadly disseminating class notes beyond the classroom
community or accepting compensation for taking and distributing classroom notes undermines instructor
interests in their intellectual work product while not substantially furthering instructor and student interests in
effective learning. Such actions violate shared norms and standards of the academic community. For
additional information, please see: http://policy.umn.edu/Policies/Education/Education/STUDENTRESP.html.
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Sexual Harassment
"Sexual harassment" means unwelcome sexual advances, requests for sexual favors, and/or other verbal or
physical conduct of a sexual nature. Such conduct has the purpose or effect of unreasonably interfering with
an individual's work or academic performance or creating an intimidating, hostile, or offensive working or
academic environment in any University activity or program. Such behavior is not acceptable in the
University setting. For additional information, please consult Board of Regents Policy:
http://regents.umn.edu/sites/default/files/policies/SexHarassment.pdf
Equity, Diversity, Equal Opportunity, and Affirmative Action
The University will provide equal access to and opportunity in its programs and facilities, without regard to
race, color, creed, religion, national origin, gender, age, marital status, disability, public assistance status,
veteran status, sexual orientation, gender identity, or gender expression. For more information, please
consult Board of Regents Policy: http://regents.umn.edu/sites/default/files/policies/Equity_Diversity_EO_AA.pdf.
Disability Accommodations
The University of Minnesota is committed to providing equitable access to learning opportunities for all
students. Disability Services (DS) is the campus office that collaborates with students who have disabilities to
provide and/or arrange reasonable accommodations.
If you have, or think you may have, a disability (e.g., mental health, attentional, learning, chronic health,
sensory, or physical), please contact DS at 612-626-1333 to arrange a confidential discussion regarding
equitable access and reasonable accommodations.
If you are registered with DS and have a current letter requesting reasonable accommodations, please
contact your instructor as early in the semester as possible to discuss how the accommodations will be
applied in the course.
For more information, please see the DS website, https://diversity.umn.edu/disability/.
Mental Health and Stress Management
As a student you may experience a range of issues that can cause barriers to learning, such as strained
relationships, increased anxiety, alcohol/drug problems, feeling down, difficulty concentrating and/or lack of
motivation. These mental health concerns or stressful events may lead to diminished academic performance
and may reduce your ability to participate in daily activities. University of Minnesota services are available to
assist you. You can learn more about the broad range of confidential mental health services available on
campus via the Student Mental Health Website: http://www.mentalhealth.umn.edu.
Academic Freedom and Responsibility: for courses that do not involve students in research
Academic freedom is a cornerstone of the University. Within the scope and content of the course as defined
by the instructor, it includes the freedom to discuss relevant matters in the classroom. Along with this
freedom comes responsibility. Students are encouraged to develop the capacity for critical judgment and to
engage in a sustained and independent search for truth. Students are free to take reasoned exception to the
views offered in any course of study and to reserve judgment about matters of opinion, but they are
responsible for learning the content of any course of study for which they are enrolled.*
Reports of concerns about academic freedom are taken seriously, and there are individuals and offices
available for help. Contact the instructor, the Department Chair, your adviser, the associate dean of the
college, or the Vice Provost for Faculty and Academic Affairs in the Office of the Provost. [Customize with
names and contact information as appropriate for the course/college/campus.]
* Language adapted from the American Association of University Professors "Joint Statement on Rights and
Freedoms of Students".
Template update 9/2013
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