NEW YORK UNIVERSITY
ROBERT F. WAGNER GRADUATE SCHOOL OF PUBLIC SERVICE
EXEC-GP.1830.01
INTRODUCTION TO HEALTH POLICY AND MANAGEMENT FOR NURSE
LEADERS. FALL 2013
Prof. Victor G. Rodwin
victor.rodwin@nyu.edu
Class Meetings: Tuesdays, 4:30-6:10 PM
Payson House
425 E. 70th st. at York
Wagner/NYU, 295 Lafayette St.
Puck Bld. 2nd Fl
212-998-7459
Office Hours Tuesdays 1:30pm-3:30pm
COURSE SYLLABUS
This introductory course is designed to familiarize nursing leaders with the broader context of the
health care system within which they work. It emphasizes basic concepts and ideas concerning the distribution
of health and illness in society, the organization of the health care system, and the relationship of one to the
other. Class readings cover major topics in the study of health and health care delivery. They review the
determinants of health; the nature of health disparities; historical developments in public health; the financing
of health care systems; the quality, cost and accessibility of health care services; and the prospects for health
care delivery system improvement and reform. We will examine these topics and concepts from a range of
diverse perspectives including economics, sociology, anthropology, politics and ethics. In addition, we will
emphasize the challenges of meeting the varied (and often conflicting) needs and motivations of health care
system stakeholders; and the ways in which the United States health care system differs from those of other
wealthy nations.
In the course of the semester, I will ask you to learn about New York City’s Take Care New York
policy so that you may integrate the academic readings in this class with the policy context in which all of you
are working.
CLASS READINGS
Every week, I expect you to come to class prepared to comment on the required readings and
participate in the discussion of major class themes. The textbook, edited by Kovner and Knickman, focuses on
the organization and financing of health care delivery in the United States. In addition, there are two required
books to read (one by Groopman; the second, a choice of the book by Nestle or Shilts) and articles designed to
extend the materials in the textbook and expose students to other views. Groopman’s book provides a clinical
perspective on health care, often not appreciated by managers and policy wonks. Nestle highlights the political
nature of a major public health issue, obesity and nutrition policy. Shilts provides historical case study
material on the evolution of the AIDS epidemic and the importance of public health infrastructure. These
books should be available at Bobst Library, most medical libraries, and the NYU Professional Bookstore.
Most articles listed on this syllabus can be downloaded from the NYU Classes site for this course.
You should also be prepared to find additional background materials, on your own.
REQUIRED TEXTBOOK
Kovner, A. and Knickman, J., ed. Health Care Delivery in the United States (10th Edition). New York:
Springer Press (2011).
ADDITIONAL BOOKS AND JOURNALS
I encourage students to browse recent issues of well-respected journals, e.g., American Journal of Public
Health; Journal of the American Medical Association; New England Journal of Medicine; The Journal of
Health Politics, Policy and Law, and Health Affairs. Kovner and Knickman’s book also contains be helpful
websites and references.
Groopman, J. How Doctors Think. New York: Houghton Mifflin (2007).
Nestle, M.
Food Politics. Berkeley: UC Press (2002).
Shilts, R.
And the Band Played On. New York: St Martin’s Press (1988).
CLASS TOPICS AND READINGS
PART A: INTRODUCTION
Class I. September 3: Health, Disease and Community
• Discussion of course readings and class requirements.
• Clinical and other perspectives
• Definitions of health and illness. What does it mean to speak of the “social production of disease?”
• How are health status and health care related?
Required reading
Textbook:
Chapter 5: Russo, P. Population Health
Book:
Groopman, J. How Doctors Think, Introduction and Ch. 1.
Articles:
1. Schroeder, S. We Can Do Better—Improving the Health of the American People. New England
Journal of Medicine. September 20, 2007. 357:1221-8.
2. Robert Wood Johnson Foundation Commission to Build a Healthier America 2009. Beyond
Health Care: New Directions to a Healthier America. Executive Summary, pp. 9-25
PART B: DISTRIBUTION OF HEALTH, DISEASE AND PUBLIC HEALTH PROBLEMS
Class II. September 10th: Introduction to Epidemiological Perspectives
• Descriptive vs. analytic methods
• Social factors and disease
• How do we assess and measure health status?
Required reading
Textbook:
Chapter 6: Levitan, L. Rhodes, S. and Chang C. Public Health: Policy, Practice and Perceptions
Chapter 7: Orleans, C. and Cassidy, E. Health and Behavior, pp. 125-149.
Articles:
1. Banks, J. Marmot, M. Oldfield, Z. and Smith, J. Disease and Disadvantage in the United States
and England. JAMA. 295 (17) 2006:2037-2045.
2. Fuchs, V. A Tale of Two States. In Who Shall Live: Health Economics and Social Change. NY:
Basic Books, 1974.
3. Rodwin, V. Croce-Galis, M. Population Health in Utah and Nevada: An Update on Victor Fuchs’
Tale of Two States. In Conrad, P. ed. Sociology of Health and Illness. NY Worth, 2000(?).
4. Mokdad, A. et. al. Actual Causes of Death in the U.S. 2000. JAMA, March 10, 2004. 291:10.
5. Marmot, M. Status Syndrome: A Challenge to Medicine. JAMA, March 15, 2006. 295:11.
6. Social Determinants of Health: The Solid Facts.The World Health Organization, optional
Class III. September 17: Health Disparities and Urban Health
• How do such factors as age, gender, race, poverty, occupation and lifestyle affect mortality risk?
• Are these relationships consistent across nations and cities?
• Is there an urban health penalty?
Required reading
1. Adler, N. and Rehkopf, D. U.S. Disparities in Health: Descriptions, Causes and Mechanisms.
Annual Review of Public Health. 2008.29:235-252.
2. Williams, D. and Jackson P. Social Sources of Racial Disparities in Health. Health Affairs .2005.
24(2):325-334.
3. Horton, R., The Infected Metropolis. Lancet.
4. Vlahov, G. & Galea, S. Urbanization, Urbanicity, and Health. Journal of Urban Health. 2002.
79(4): S1-S12.
5. House, J. Understanding Social Factors and Inequalities in the Health. J. of Health and Social
Behavior. 2002. 43(2) 125-142.
Class IV. September 24: Public Health and Policy
• Public health vs. medicine
• Ethical and historical perspectives
• Public health and the built environment
Required reading
1. McKinlay, J. and McKinlay, S. The Questionable Contribution of Medical Measures to the Decline
of Mortality in the United States in the Twentieth Century. MMFQ, 1977, Summer.
2. Frumkin, H. Urban sprawl and Public Health. Public Health Reports. 2002. 117, May-June: 201217.
3. Colgrove, J. The McKeown Thesis: A Historical Controversy and Its Enduring Influence.
AJPH.2002 92(5): 725-729.
4. Roberts, M. and Reich, M. Ethical analysis in public health. The Lancet .2002 (359), March 23.
Class V. October 1: Public Health Case Studies: AIDS and Take Care New York
• Public health infrastructure
• Public health and social justice
• Public health and politics
R. Shilts, And the band played on
Take Care New York. See NYCDHMH web site
Class VI. October 8: Public Health Case Studies : Food Politics
• Public health infrastructure
• Public health and social justice
• Public health and politics
Required reading (either book):
Nestle, M. Food Politics.
Take Care New York. See NYCDHMH web site
October 15th – No class – Fall Recess
PART C: HEALTH CARE ORGANIZATION, FINANCING
Class VII. October 22: The U.S. Health System and Role of Government in International Perspective
• History, trends, and characteristics
• What social, medical, and technological factors have shaped the current health care arrangements?
• What is the role of government in U.S. health care?
• How does the US health care system compare to that of other wealthy nations?
**First Paper due. Submit for all to read on NYU Classes by midnight the night before this class**Late
papers will be penalized by one-half letter grade for each day late.
Required reading
Textbook:
1. Ch. 1: The Current U.S. Health Care System.
2. Ch. 2: Sparer, M. Health Policy and Health Reform.
3. Ch. 4: Frogner, Waters, Anderson. Comparative Health Systems
Class VIII. October 29: Cost Containment and Managed Care
• Cost containment vs. efficiency
• Strengths and weaknesses of managed care
• Alternative mechanisms for financing health care
Required reading:
Textbook:
1. Ch. 3: Knickman, J. Health Care Financing.
2. Ch. 12: White, H. Health Care Costs and Value.
Articles:
1. Cutler, D. Analysis and Commentary: How Health Care Reform Must Bend
the Cost Curve. Health Affairs 2010. 29(6):1131-1135.
2. Bodenheimer, T. Coordinating Care – A Perilous Journey through the Health Care
System. NEJM 2007.358 (10): 1064-1071.
Class IX. November 5: The Performance of Health Care Systems
• Dimensions of health care system performance
• On the basis of what criteria should health care systems be assessed?
• Equity criteria and social justice
Required reading:
Textbook:
1. Ch. 8: Billings, J. and Cantor, J. and Clinton, C. Access to Care.
2. Ch. 11: Clancy, C. and Lloyd, R. High Quality Health Care.
Articles:
1. Schoen, C. Davis, K. How, S. and Schoenbaum, S. U.S. Health System Performance: A National
Scorecard. 2006. Health Affairs (DO1 10.1377/hlthaff.25.w457).
2. Goodman, Musgrave and Herrick. Lives at Risk: Single Payer National Health Insurance Around
the World. New York: Rowman and Littlefield, 2004. Ch. 2 and 4.
3. Schoen, C., R. Osborn, D. Squires, MM. Doty, R. Pierson, and S. Applebaum. 2010. How
Health Insurance Design Affects Access To Care And Costs, By Income, In Eleven Countries.
Health Affairs 29(12): 2323–2334.
PART D. HEALTH CARE DEMANDS, NEEDS AND CHALLENGES
Class X. November 12: Quality Assessment and Quality Assurance
• How do we measure and monitor the quality of health care services?
• How do we assess the effectiveness and appropriateness of care?
• What is the role of trust in assuring quality of medical care and how has quality evolved over time?
Required reading:
Textbook:
1. Ch. 16: Kropf, R. Health Information Technology.
2. Ch. 11: Clancy, C. and Lloyd, R. High Quality Health Care.
Articles:
1. Mechanic, D. The Functions and Limitations of Trust in the Provision of Medical Care. Journal of
Health Politics, Policy and Law. 1998.23 (4): 661-686.
2. Bodenheimer, T., Wagner, E., Grumbach, K. Improving Primary Care for Patients with Chronic
Illness: The Chronic Care Model, Part 2. J. of the American Medical Association. 2002. 288:
1909-1914.
3. Landrigan, D. et. al. Temporal Trends in Rates of Patient Harm Resulting from Medical Care.
NEJM. 2010.362:2124-2134.
Class XI. November 19: How Could the Health Care System Respond to Changing Health Care Needs?
• The need for long-term care and alternative modes of delivery
• Chronic illness and aging
• Perspectives on the future of medical care organization
Required reading:
Textbook:
1. Ch. 9: Caronna, C. and Ong, M. Organization of Medical Care.
2. Ch. 10: McCarthy, D. Integrative Models and Performance.
3. Ch. 8: Anderson, G. and. Knickman, J. Chronic Care.
Articles:
1. Shoven, J. New Age Thinking: The aging of the world’s population won’t be the crisis we fear.
Foreign Policy, Jan/Feb 2008.
2. Gawande, A. Letting Go: What Should Medicine Do When It Can’t Save Your Life? The New
Yorker, Aug. 2, 2010.
3. Gilsdorf, K. As Drug Marketing Pays Off, My Mother Pays Up. Health Affairs.2004. 23(1):2082012.
4. Steinman, M. Landenfeld, S. and Baron, R. Industry Support of CME –Are We At a Tipping
Point? NEJM. 2012. 366(12):10-69-1069-1071.
Class XII. November 26: The Role of Patients in Health Care: Trends and Issues
**Second Paper** Submit for all to read on NYU Classes by midnight the night before this class.
Papers will be penalized by one-half letter grade for each day late.
• Issues of patient compliance
• The relationship of patients, physicians, and the health care system
• Information and consumer issues
Required reading
Book:
Groopman, J. How Doctors Think, Chapter of your choice and Epilogue and Afterword (pp. 260-279).
Articles:
1. Zola, I. Medicine as an Institution of Social Control. The Sociology Review. 1972. 20(4):487-504.
2. Sepulcha, K and Mulley, A. A Perspective on the Patient’s Role in Treatment Decisions. Medical
Care Research and Review 2009. 66 (1 suppl):3S-8S.
XIII. December 3 (last class): Health Care Reform
Articles: (Read #1-4+ your choice of #5-10)
1. Side-by-Side Comparison of Major Health Care Reform Proposals, Kaiser Family Foundation.
http://www.kff.org/healthreform/sidebyside.cfm
2. Krugman and Wells. The health care crisis and what to do about it? New York Review of Books.
3. Grassley, C. Health Care Reform – A Republican View. NEJM (361) 25, 2009.
4. Brown, L. The Amazing Noncollapsing U.S. Health Care System—Is Reform Finally at Hand?
NEJM, January 24, 2008; 358:4.
5. Brown, Lawrence D. 2011. “The Elements of Surprise: How Health Reform Happened”
Journal of Health Politics, Policy and Law 36(3): 419-427.
6. Peterson, Mark A. 2011. “It Was a Different Time: Obama and the Unique Opportunity for
Health Care Reform” Journal of Health Politics, Policy and Law 36(3): 429-436.
7. White, Joseph. 2011. “Muddling Through the Muddled Middle” Journal of Health Politics,
Policy and Law 36(3): 443-448.
8. Jonathan Oberlander “Throwing Darts: Americans' Elusive Search for Health Care Cost
Control” Journal of Health Politics, Policy and Law 36(3): 477-484 (2011).
9. Thompson, Frank J. 2011. “The Medicaid Platform: Can the Termites Be Kept at Bay?”
Journal of Health Politics, Policy and Law 36(3): 549-554.
10. Marmor, Theodore R. 2011. “Health Reform 2010: The Missing Philosophical Premises in the
Long-Running Health Care Debate” Journal of Health Politics, Policy and Law 36(3): 567-570.
COURSE REQUIREMENTS
In addition to attending and participating in classes, you must submit two short papers and complete a
group project. These requirements are described below. The papers should be based on class readings and
whatever additional reading you have done on a health care system in the country you have chosen to compare
with the United States.
Course grades will be calculated as follows.
% Final Grade
Date Due
Group Presentations 10% Oct. 1 and 8
Paper I
25%
Oct. 21st
Paper II
25%
November 25th
Group Project
35%
December 10th
Class Participation
5%
Paper I (Book Review) – Please write an 4 page concise essay in which you review the book you have read
for class V. Show how your understanding of required class articles supports the statements you make in
reviewing this book. More details will be posted on NYU Classes before the end of September.
Paper II – This concise paper will require a thoughtful, and well-organized discussion of questions posed. It
should not be based on new research. Rather, it will provide you with an opportunity to reflect upon the
required readings. Once again, the paper should be 4 pages in length. You should present a carefully organized
essay with arguments supported with footnotes that refer to required readings for this class. If you need more
space, you may include appendices. Once again, I shall provide more details on this assignment before the
end of October. And again, these papers should be posted on NYU Classes so that all can read and discuss.
Team Report - This project will require a thoughtful and well-organized discussion of the concepts and
themes covered in this course, and how they can be applied to New York City’s Take Care New York policy.
Each team (from 4-5 students) must produce a final written report (15 pages double-spaced, not including
references, tables, appendices). These reports will be scheduled for presentation over the final four sessions of
the class (Nov. 19 - Dec. 10). You should begin forming teams from the start of the class. I will provide
opportunities for mini-team debates to accompany class lectures and discussion so that you can begin thinking
about what team you would like to join.
To prepare for this project, please look over the web site of the NYC Department of Health and
Mental Hygiene. Read the Department’s policy paper: Take Care New York and updates on this theme. The
assignment is for your team to write a report about how your hospital or unit within a larger hospital could
assist in implementing recommended policies in this policy paper. You paper will be evaluated based on how
well you assimilate the concepts raised in the class readings. Due date: December 10.