DRAFT
Class Syllabus
Lafayette College INDS 245:
Social and Ethical Issues in Health Care: UK and US
for
EUSA Study Abroad Course in London
20 May to 13 July 2013
Instructor Information
A. Name
B. Day and Time
C. Location
D. Telephone
E. Email
F. Webpage
G. Office Hours
Stephen E. Lammers, PhD, and Alan W. Childs, PhD
See course chronology. Course begins on Thursday, 23
May, concluding on Friday, 14 June.
TBD
TBD
Prof. Lammers (lammerss@lafayette.edu), Prof. Childs
(childsa@lafayette.edu)
www.lafayette.edu
TBD, and by appointment
Course Description
In order to understand the delivery of health care in any society, the historical,
political, economic, social and cultural context needs to be examined. Many factors
affect the implementation of a health care system as it evolves to meet the needs of
individual citizens as well as the nation as a whole. These interests often produce
conflicts as well as unintended consequences. All of this involves ethical and
political questions that cannot be easily resolved. This course attempts to examine
these issues by comparing the history of the implementation of health care in two
societies, seeming related by history and culture, but having evolved quite different
approaches to answering the question of how to attend to the health of their citizens.
Course Objectives
The students in this course will come to understand how health care needs are
understood in different societies and, given those different understandings, how
different societies attempt to meet those needs. The extended case study for the
course will be the societies of the UK and the US. Students will read selected
materials on the factors that shape a nation’s choices in developing and delivering a
health care system. Video materials will be part of the course. Students will
respond to these materials through written and oral presentations. They will also
adopt the roles of various stakeholders within each society in order to gain an
insight as to the conflicts inherent in these decisions, and discuss these positions
with the seminar as a whole. Students will also prepare a comparative analysis that
will result in a formal group presentation back on the Lafayette campus
Course Methodology
The course will be made up of 12 class sessions, each approximately four hours in
duration. The first week in London, the class will meet on Thursday and Friday,
then for the next two weeks the class will meet each Monday, Tuesday, Thursday
and Friday. There will be two class meetings during the final week of class. The
students will have readings from a novel, a course text, and journal articles. These
readings and videos are designed to develop their thinking and their knowledge of
the core aspects of this course. Class sessions will involve brief lectures from the
faculty to establish the issues, but most of the class will involve the students asking
and answering questions about the assigned materials. The course will also have
guest speakers. There will also be group work where students will be assigned to
work together to research and then report on the political positions that have been
taken on health care in both societies, as well as another group assignment
investigating the positions of various stakeholders (e.g. physicians, patients) within
each society. In addition to these group presentations, each student will write
several reaction papers on questions that will be posed to them by the instructors.
There will also be several quizzes on the topical readings, and a final examination on
the core issues of the course.
Course evaluation weights:
Group Presentations: 10%
Reaction Papers: 20%
Quizzes: 10%
Final Project Presentation: 20%
Final Exam: 25%
Overall Class and Field trip Participation: 15%
Course Texts
Shriver, L. (2010). So Much For That. HarperCollins Books
David A. Rochefort and Kevin P. Donnelly (2012), Foreign Remedies,
Routledge.
Additional readings as indicated in the chronology below. Full
bibliographical information at end of syllabus
Course Chronology
Week One
Class 1: Introduction to the fundamental issues in health and health care
Thursday, 23 May, 9:00 am to 1:00pm
Viewing “Sicko”
Read Shriver, So Much For That, in preparation for this class.
Discussion of “Sicko”
Comparison and contrast of “Sicko” with Shriver
Political Party Group Assignment
Museum of London visit: 2pm
Class 2: Lecture: How Health Care Got That Way in the US!
Friday, 24 May, 9:00 am to 1:00 pm
Discussion of “Sicko” and the Shriver novel.
In class work on Political Party Group Assignment and development of
presentations
Individual assignment: evaluation of “Sicko” and Shriver. To help you develop your
critique, we have provided the following questions. Analysis is required; simply
repeating points of the authors is not acceptable.
a. What do Shriver and Moore see as the major problems with health care in the United
States? Note where they agree and where they differ. In the same fashion, what do they see
as the successes?
b. Do either express any ideas as to how health care might be improved? What are the y?
c. What do you see as the "take away points" of Shriver and Moore?
Due Sunday evening, May 26, at 9pm, London time. 750 word limit, uploaded to the
Moodle link
Class visit: Wellcome Library and Museum, Euston Road, 2pm.
Week Two
Class 3:
Monday, 27 May, 9:00am to 1:00pm
View Reid video: “Sick Around the World”; discussion of Reid video.
Political Parties Presentations-these presentations will be assessed by the
instructors and by the participants in each group. The reports of these groups will
be posted on the website as a resource for members of the seminar.
Presentation and discussion on outcomes in the US relative to other modern
societies
For this class read Rochefort and Donnelly, pp. 7-19; also read the articles by
Whalen, Brown, and Navarro
Formation of groups for presentation on campus: The professors will develop a list
of approved topics. Students will play various roles within each group.
Group discussion and report to class.
Class 4:
Tuesday, 28 May, 9:00 to 1:00 pm
Initial lecture on UK healthcare system, how it got that way and what is being done
by the current governing coalition to reform the NHS.
Read Martin Roland, “English NHS Embarks on Controversial and Risky MarketStyle Reforms in Heath Care
See also the King’s Fund analysis of the Conservative reforms of the NHS
Discussion of UK system
Group Activity: Wednesday, May 29.
Visit to Ethox Centre, Oxford University
Tour of Oxford University
After the tour and presentation you will have time for exploration of Oxford on your
own.
The alternative to the Oxford visit is a visit to Cambridge, tour of the university,
punting on the Cam, and a visit to an experimental hospital in Cambridgeshire.
Class 5:
Thursday, 30 May, 9:00 to 1:00 pm
Affordable Care Act in the United States: Read the Kaiser Permanente summary of
the act.
Discussion of the Affordable Care Act after the Supreme Court decision and
November election in the United States. Some readings TBD will be selected based
upon the decisions.
Comparison of the two reform movements
Rochefort and Donnelly, pp. 20-57
Visit to Borough Market
Class 6:
Friday, 31 May, 9:00 to 1:00 pm
Read Klein and Callahan for class
How are the insights of Klein and Callahan incorporated, or not, into the reform
movements in the UK and the US
Class discussion of challenges within both health care systems
Rochefort and Donnelly, pp. 58-74,
Reaction paper 2: Compose a 750 word essay on the challenges of healthcare
reform in the US. Why is reform easier (or more difficult) in the UK? Use the
materials we have read, viewed, or discussed as evidence for your argument.
Due Sunday, June 2, at 9pm, London time, on the Moodle site.
Week Three
Class 7:
Monday, 3 June, 9:00 to 1:00 pm
Continue discussion of the two health care systems.
Read the Banks and Martinson articles in preparation.
After class we will go to the Imperial War Museum to learn how the British
experience of war had an impact on the medical care system.
Class 8:
Tuesday, 4 June, 9:00 to 1:00 pm
Presentation group work in class-determination of topic
Rochefort and Donnelly, pp. 58-74.
Discussion of implementation of health care reforms in both systems.
Reports of various stakeholder groups on what they are doing to further the reforms
or to seek a modification of reforms in their respective societies. These reports will
be posted on the website as a resource for all members of the seminar.
Group Activity: Wednesday, 5 June
Bath: Roman Baths
Stonehenge-visit after hours
Class 9:
Thursday, 6 June, 9:00 to 1:0 pm
Justice and scarcity in health care
Class 10:
Friday, 7 June, 9:00 to 1:00 pm
Round One presentation of posters for on-campus presentations
Critique by all classmates and faculty
Work on poster development
Continuation of discussion of scarcity
In preparation read the Verhey article
Reaction paper 3
Compose a 750 word essay on scarcity and justice in health care systems. How
should scarce resources be distributed?
Due Sunday, June 9, at 9pm, London time, on the Moodle site.
Week Four
Class 11:
Monday, 10 June, 9:00 to 1:00 pm
Round Two presentation of posters for on-campus presentations
Critique by classmates and faculty
Discussion of final examination
Group Activity
Wednesday, June 12
Greenwich Maritime Museum and Observatory
We will travel to Greenwich by boat, return by light railway or bus.
Class 12:
Thursday, 13 June, 9:00 to 1:00 pm
Round Three presentations of posters for on-campus presentations
Critique by classmates and faculty.
Final examination
Course readings: All are available on the Moodle site
Banks et al. (2006) Disease and Disadvantage in the United States and England.
JAMA 295,17 May 3, 2006 2037-45.
Benoit, Cecilia (2003). The politics of health care policy: the United States in
comparative perspective. Perspectives in Biology and Medicine 46,4 Autumn 592-599.
Callahan, Daniel (2008). Curbing Medical Costs. America 198,8 March 10, 2008, 9-12.
King’s Fund (2011) The Health and Social Care Bill
http://www.kingsfund.org.uk/current_projects/the_health_and_social_care_bill/ref
orming_the_health_bill/index.html
Kaiser Family Foundation (2011). Summary of the New Health Reform Law
http://www.kff.org/healthreform/upload/8061.pdf
Klein, R. et al (1996)., Managing Scarcity: Priority Setting and Rationing in the NHS
33-48, 66-81.
Martinson, Melissa, et al. (2011). Health Across the Life Span in the United States
and England. Am. J. Epidemiol 173,8 858-65.
Navarro, Vincente (2003). The Inhuman State of U.S. Healthcare. Monthly Review
55,4, Sept. 56-63.
Roland, Martin (2012). English NHS Embarks on Controversial and Risky MarketStyle Reforms in Heath Care. NEJM 364:14, April 17, 2012 1360-66.
Verhey, Allen (2002). Technology and Tragedy: An Evangelical Theology of Care.
Covenants of Life 127-45.
Whalen, James P. (2003). Health Care in America: Lost Opportunities Amid Plenty.
Qualitative Health Reseach, 13, 6, July 857-870.