Course Syllabus and Outline
HMP 602 881
School of Public Health
University of Michigan, Ann Arbor
Course Information
Course Number and Section: HMP 602 881 W14
Course Title: Survey of the US Health Care System
Prerequisites
Graduate standing.
Course Description
HMP 602 provides an overview of major issues in the organization of a health services system. The
following topics are covered in this three credit-hour course:
1. The role of values in the development of health care policy;
2. The medical care process;
3. The health status of populations and the need for, access to, and use of health services
(including racial and ethnic disparities in health and health care);
4. The current supply and distribution of, and policy issues related to, the professions comprising
the health workforce (including physicians, the field of nursing, and PAs/NPs);
5. The current supply and distribution of—and policy issues related to—health facilities and
programs (including regionalization and hospitals/integrated systems);
6. Health care financing, including managed care, private health insurance, and government
programs (including Medicare, Medicaid and the Affordable Care Act of 2010 [Health Reform]).
7. Health care costs and cost containment;
8. Quality of care and quality assurance (including strategies to improve quality of care);
9. The current and emergent issues related to long term care, including population trends and
long-term care institutions (such as nursing homes, home health care, and other programs);
10. The drug industry
This knowledge is considered critical to the development of effective health management and health
policy. The learning objectives for the course are to develop a greater proficiency in each of these ten
aspects.
Course Components:
1
CTools
CTools [https://ctools.umich.edu] is the online course management system used for CFPH
courses. CTools is a UM web-based tool that requires authentication. To access your course
and many other UM computing services you need to log in with your uniqname and Kerberos
password.
The syllabus, videos, narrated presentations, readings, forums and miscellaneous course
materials are located in your course’s CTools site.
Student orientation materials and additional resources are also located in CTools in the
CFPH.StudentCenter site which can be referred to throughout your time in the program.
To Do Lists
Weekly To Do lists will be posted in the CTools course site which will provide you with the
weekly course schedule, required readings and assignments, and links to recorded lectures and
relevant resources. To Do lists are drawn from the Course Summary Schedule at the end of this
document.
Synchronous Saba Centra Meetings
Weekly synchronous, online class meetings will be held using a web conferencing technology
called Saba Centra. Participation in the online class sessions is required. The topics covered in
these meetings are listed in the Course Summary Schedule at the end of this document. [This
software is often referred to as simply ‘Centra’]. These meetings will either expand on material
in the video lectures or address new material that was not covered elsewhere.
Dr. Lichtenstein will conduct weekly required 90-minute (one and a half hour) Centra meetings.
The synchronous Saba Centra meetings will be recorded and posted within 48 hours of taping
for those students who are unable to participate or wish to revisit lecture material. This is not a
substitute for attendance as participation greatly facilitates learning the material.
A wired, high-speed internet connection and USB headset with microphone are required for
your full participation. Please refer to the Technical Requirements page for headset
specifications [http://www.sph.umich.edu/distance/requirements.html].
Asynchronous Forum Discussions
2
You will have an opportunity to post your thoughts and opinions about various topics in the
course and react to those of your classmates. Initial topics and/or questions will be posted by
the instructor. You are encouraged to read and react to these items as well as to items posted
by your classmates.
These written, asynchronous discussions provide an opportunity for you to engage site
resources, other students and Dr. Lichtenstein. They allow for free expression of convergent
and divergent ideas. They also allow time for reflective thinking and the development of ideas
over time. Forums are accessed using the Forums Tool in the left hand menu bar of the CTools
course site. The discussions are moderated by the instructor and feedback on the quality of
input is given.
Time Commitment
Plan to participate in the course each day, following the course schedule. It’s difficult to predict how
much time you will need to spend in this course each day. Some of you will be more comfortable
working online than others. This course is not designed as an independent study course. Interaction
with fellow students and instructional faculty and staff is an important component of this collaborative
learning environment.
This distance learning program is based on a shared learning community, which encourages you to share
in the learning process with your colleagues. Some of the CFPH program is based on group work where
you will be expected to contribute your own knowledge, experience and effort to the group. It takes
some practice and skill with technology to be successful working in a ‘virtual group’. As you go through
the semester, be alert for announcements and email messages that prompt you on what to do next.
Readings
Required readings will be available in CTools, the course management system used for your course. The
readings can be read online or printed individually. You will be responsible for the material in all of the
required readings and exams will include questions covering the major points made in some of them.
Evaluation/Grading
Examination I
Examination II
Examination III
Participation in Centra & Forum
30% of grade
30% of grade
30% of grade
10% of grade
Participation
3
All students will be expected to participate in the Forums and Centra sessions and 10% of your grade will
be based on participation. If you feel reluctant to participate “live” on Centra, you can contribute to the
Forum discussions by doing the readings and/or applying your own experiences/backgrounds to the
material.
Exams
Three examinations will be given. Each exam will be approximately 1.5 hours in length. The exams will
be available on the CTools site using the Test Center tool. The exams focus on your knowledge of the
ten learning objectives of the class. Each exam will be worth 30% of your grade. Content for the
examinations will come from lecture videos, Centra meetings, and the required readings.
A range of dates will be given during which the exams may be taken with a remote proctor. This will
allow you to take the test at a convenient time. Exams will be proctored on campus for those wishing
and able to travel to campus.
Remote Proctored Exam Information
Students who are unable to travel to the UM Ann Arbor campus for testing must designate an
appropriate remote proctor and testing site.
Who can be approved to serve as a proctor? An acceptable proctor is someone with no conflict of
interest in upholding UM’s Academic Integrity Policy. Relatives, friends, spouses, neighbors, and coworkers are not acceptable proctors. Examples of acceptable proctors are:
• Human Resources Department staff in the company where the student is currently employed
• Direct supervisor at the place of employment, providing the setting is suitable for academic
testing.
• An employee in an educational administrator's office or community college library, university, or
high school
• Librarian or staff member at a public library
• An employee at a recognized professional learning center
• An officer of higher rank than the student, if in the military
• An employee at a college, university, or private testing center (in this case, the testing center
director should be listed as your proctor)
It is your responsibility to identify an acceptable proctor and confirm arrangements regarding the
scheduling and administration of the exam directly with the proctor. If an appropriate proctor cannot be
arranged with the necessary internet access for student testing, a paper-based exam may be provided.
The proctor must meet the School of Public Health staff approval. A copy of the Academic Integrity
Policy will be included with the testing materials. Both the student and the proctor must review, sign
and return the policy with the examination and a copy of the proctor’s photo ID. A student in violation
of the Academic Integrity Policy is subject to disciplinary action.
Exam Registration Database:
4
Whether you plan to take your exams on campus or with a remote proctor, you must register your plans
and proctor information in the CFPH Program’s Exam Registration Database.
[https://www.sph.umich.edu/iscr/cfph-exams/]. Plans must be registered at least two weeks before
each exam to allow the CFPH Program adequate time to communicate with your proctor.
Exam or Assignment Conflicts
If you think you need an accommodation for different abilities or a disability, please let us know at your
earliest convenience. Some aspects of this course, such as the assignments, in-class activities, or the way
we teach may be modified to facilitate your participation and progress. As soon as you make us aware of
your needs we can work with you, the Office of Services for Students with Disabilities, or the Adaptive
Technologies Computing Site to help determine appropriate accommodations. We will treat any
information about your disability confidentially and with discretion.
Persons who have religious or cultural observations or personal needs that conflict with class,
assignments or exams should let instructors know by Friday, January 24th. We encourage you to honor
your cultural and religious holidays. However, if we do not hear from you by January 24th we will
assume that you plan to follow the schedule without change.
Academic Conduct
The conduct of all students taking this course should be consistent with that expected of a public health
professional. Courtesy, honesty, and respect should be shown by students toward fellow students,
faculty, visitors to the course, and administrative support staff. Similarly, students should expect me, as
the instructor, to treat them fairly; to exhibit respect for their ideas and opinions; and to strive to assist
them in maximizing the value of their experience in this course and, more generally, in their SPH
education.
“Student academic misconduct” refers to behavior that includes plagiarism, cheating on exams or
assignments, fabrication of data, falsification of records or official documents, intentional misuse of
equipment or materials (including library materials), or aiding and abetting the perpetration of such
acts. The three examinations are to be written “in class” and no notes, electronic devices or other aids
may be ever used during an exam.
Academic misconduct of any kind is unacceptable. Detected violations of proper academic conduct will
be dealt with firmly. For example, any form of cheating on an assignment or exam will result in the
student's failing that assignment or exam, with no opportunity to make up the work. If a student is
determined to have violated proper academic conduct twice during the course, he or she will fail the
course and his or her behavior will be reported to the student's department chair and to the Associate
Dean for Academic Affairs. I expect other students to notify me if they observe, or otherwise detect,
academic misconduct on the part of another student or students. Such disclosures will be held in strict
confidence.
Academic Well-being
5
Physical, psychological, and emotional well-being is vital for effective learning. Students are
encouraged to contact the University's office for Services for Students with Disabilities (SSWD;
http://www.umich.edu/~sswd) or the office for Counseling and Psychological Services (CAPS;
http://www.umich.edu/~caps). Any student who feels that he/she may need special accommodation for
any sort of disability or wishes to discuss any relevant and/or confidential information is encouraged to
make an appointment with the Instructor.
Course Withdrawal
Late registration and withdrawal deadlines are posted on the University’s Academic Calendar
[http://www.ro.umich.edu/calendar/]. Students are advised to check for late registration fees or tuition
penalties before making a change to course registration. Should you need to withdraw from the course
or the term, please email a request to CFPHinquiries@umich.edu and a CFPH Program staff member will
assist you.
Course Communication
To ensure that your questions are answered as promptly as possible, please follow the communications
guidelines below:
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•
•
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CTools Forum: A special section of the discussion board has been set up with discussion topics
and for general questions/answers about the course. This area will be regularly monitored by
the instructors .You are strongly encouraged to participate in the Forums.
Personal email to the instructor and graduate student instructors: For all emails, please allow 48
hours for response time. Answers to frequently asked questions may be posted via a CTools
Announcement rather than sent via email.
Technical Support: Do not contact the Instructor regarding technical issues. Questions
regarding technical support should be sent to cfph-help@umich.edu .
CTools Announcements: The instructor may post announcements via CTools that will be
delivered to your UM Email account as well as displayed in the CTools course site
Announcements section.
University of Michigan Email: To ensure security and the privacy of each student, please use
your UM email to communicate with your instructor and classmates. UM Email is accessed via
http://email.umich.edu. To have your UM email forwarded to another account, please see
http://www.itcs.umich.edu/itcsdocs/s4384/ .
Technical Support
If you encounter any technical difficulties regarding the course content or accessing University
resources, please send an email to cfph-help@umich.edu. This account is monitored prior to and during
all synchronous Saba Centra session as well as during regular business hours.
Technical Requirements
6
In addition to meeting the recommended system requirements, students must understand basic
computer and Internet usage to ensure a successful learning experience. Please review the
requirements at http://www.sph.umich.edu/distance/requirements.html
General Guidelines and Suggestions
Assignment Deadlines: Assignments are due at 11:59 p.m. Eastern Standard/Daylight Time unless
otherwise stated by your instructor and/or the course syllabus and schedule.
Late assignments: To benefit the most from this course, you should complete assignments by the due
date. Instructors may reduce points or not accept assignments posted after the deadline.
Backing up work: Technology is not 100% reliable. Plan ahead for unexpected interruptions. We
recommend the following:
•
•
•
•
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Compose assignment and discussion responses in Word or another text editor, save them, then
copy and paste them into the appropriate area.
Keep a backup copy of all assignments, forum discussions or questions you post to the course
site. Always check the forum areas after you have posted to make sure that your message is
displayed. (Sometimes there is a short delay before messages are displayed by CTools)
Download and/or print out assignments before you plan to work on them. That way, if your
Internet connection is slow, or if you temporarily cannot reach the course site, you will have the
assignments in hard copy or on your hard drive and can continue to work. Online readings
should also be downloaded and saved or printed out ahead of time so you have them at your
disposal when you are ready to read them.
If you can’t reach the course site, don’t panic. Wait a few minutes and try again. Notices of
planned maintenance are posted to the CTools gateway home page, so be sure to make a note
of these announcements.
Before contacting central UM ITS Help, it is best to first send an email to cfph-help@umich.edu.
If the CFPH staff can resolve an issue for you directly it will be faster.
Frequently Asked Questions (FAQ’s)
A list of FAQs is located at http://www.sph.umich.edu/distance/faqs.html.
Course Evaluations
Instructors may conduct mid-course surveys or gather informal feedback from you throughout the
course. Electronic final course evaluations will be available through CTools towards the end of the
semester.
We strongly encourage you to submit all evaluations as requested. Your opinion helps us to make
necessary changes throughout the semester, and to plan better for future cohorts in the CFPH program.
7
Readings and Competencies
Week 1: Introduction and Overview
Required Readings:
Introduction
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Davis, K., Schoen, C., Schoenbaum, SC. & Stremikis, K. (2010). “Mirror, mirror on the
wall: how the performance of the U.S. health care system compares internationally,
2010 update.” Commonwealth Report.
http://www.commonwealthfund.org/Content/Publications/FundReports/2010/Jun/Mirror-Mirror-Update.aspx
•
Berwick, DM, Nolan, TW, and Whittington, J. (2008) “The Triple Aim: Care, Health, and
Cost.” Health Affairs 27(3):759–769.
http://content.healthaffairs.org.proxy.lib.umich.edu/cgi/content/full/27/3/759?maxtos
how=&hits=10&RESULTFORMAT=&fulltext=the+triple+aim&searchid=1&FIRSTINDEX=0
&resourcetype=HWCIT
•
Lantz, Paula M., Richard L. Lichtenstein, and Harold Pollack. (Sept/Oct 2007). “Health
Policy Approaches to Population Health: The Limits of Medicalization.” Health Affairs
26(5): 1253-1257. http://content.healthaffairs.org/content/26/5/1253.full.pdf+html
Health Reform
•
Kaiser Family Foundation. (2013). Summary of the Affordable Care Act. (SKIM)
http://kaiserfamilyfoundation.files.wordpress.com/2011/04/8061-021.pdf
•
Pollack, Harold A. (2011) “Prevention and Public Health.” Journal of Health Politics,
Policy and Law, 2011; 36(3): 515-520.
http://web.ebscohost.com.proxy.lib.umich.edu/ehost/pdfviewer/pdfviewer?sid=38deb
ba9-91f9-4db0-b920-7855db25f869%40sessionmgr12&vid=1&hid=20
Required Video to Watch
•
Watch the video: My Right Knee, which features a wonderful presentation made by Don Berwick,
the President of The Institute for HealthCare Improvement (IHI). Berwick raises a series of
important issues about how healthcare is provided in the US today. We will refer to many of these
issues throughout the course.
8
Required Exercise:
•
Read the Exercise on Values linked to on the To Do Week 1 and Week 2 pages in CTools, which deals
with the horrible case of baby Jubilee Holloway, and write a two page paper that answers the
question asked in that exercise. This paper is required, but it will not be graded. Your paper should
deal with your thoughts about what makes a society strong, not the details of the case or its legal
implications. The assignment will be uploaded to the Assignment tool in the course CTools site.
Competencies:
1. Examine why we are learning about the Health Care System
2. Understand the scope of this course—what is and is not included in the course content
3. Review the major trends and terminology in the current US Health Care System
4. Appreciate the role of costs, quality and access in the US Health Care System
9
Week 2: Overview (continued) and Social Values in Medical Care
Required Readings:
Values
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Sullum, J. “The Tyranny of Public Health.” Medical Sentinel. Volume 4, May/June 1999, pp. 100-102.
http://www.jpands.org/hacienda/article20.html
•
Hall MA. (2012). Supreme Court arguments on the ACA – a clash of two world views. NEJM, 366(16):
1462-3. http://www.nejm.org.proxy.lib.umich.edu/doi/full/10.1056/NEJMp1201848
Competencies:
1. Recognize the central role of social values in health policy
2. Examine how societal values are related to the provision of care on an individual and societal level
3. Distinguish between Libertarian and Egalitarian value positions
10
Week 3: The Medical Care Process: Health Status
Required Readings:
•
Koh, HK. (2010). “A 2020 vision for healthy people.” NEJM.
http://www.nejm.org/doi/pdf/10.1056/NEJMp1001601
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Epstein, H. (2003). "Enough to make you sick?" The New York Times. October 12, 2003.
http://www.nytimes.com/2003/10/12/magazine/ghetto-miasma-enough-to-make-yousick.html?scp=1&sq=enough%20to%20make%20you%20sick&st=cse
•
Woolf SH, Braveman P. (2011). Where health disparities begin: the role of social and economic
determinants—and why current policies may make matters worse. Health Affairs, 30(10): 1852-9.
http://content.healthaffairs.org.proxy.lib.umich.edu/content/30/10/1852.full.pdf+html
Competencies:
1. Define health status and need for health care
2. Examine different approaches to measuring health status
3. Discuss the determinants of health status
4. Examine how the health status of individuals relates to their social environments
5. Define health disparities and identify the primary determinants of these disparities
11
Week 4: The Medical Care Process: Use of Services
Required Readings:
Utilization of Services
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Eisenberg, JM. (2002). "Physician Utilization. The State of Research About Physicians’ Practice
Patterns." Medical Care. 40(11): 1016-1035. *(READ 1016-1024; SKIM 1024-1035).
http://www.jstor.org.proxy.lib.umich.edu/stable/pdfplus/3767817.pdf
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Betancourt, Joseph R. and Roderick King. (2003) “Unequal Treatment: The Institute of Medicine
Report and Its Public Health Implications, Guest editorial.” Public Health Reports 118: 287-292.
http://www.jstor.org.proxy.lib.umich.edu/stable/pdfplus/4598854.pdf?acceptTC=true
•
Wennberg, JE., Fisher, ES., and Skinner, JS. (2002). "Geography and the Debate Over Medicare
Reform." Health Affairs. 21(2):W96-W114. *(Only pages W96-W104 are required).
http://content.healthaffairs.org/content/early/2002/02/13/hlthaff.w2.96.full.pdf
•
Gawande, A. (2009). “The Cost Conundrum: What a Texas Town Can Teach us About Health
Care.” The New Yorker. June 1, 2009.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all
Competencies:
1. Understand the predictors of health care utilization
2. Determine reasons why utilization might differ in geographic regions
3. Examine why utilization differs among different populations
4. Understand the role that provider and system factors play in the use of services
5. Understand the existence of, and reasons for, “unequal treatment” in the US health care system
12
Week 5: Health Care Financing: Health Insurance
Required Readings:
Overview
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Knickman, J.R. (2011). "Health Care Financing." In Jonas and Kovner's Health Care Delivery in the
United States. Tenth Edition. Edited by Kovner, A.R., and Knickman, J.R. New York: Springer
Publishing Company. pp. 47-66. https://ctools.umich.edu/access/content/group/64acb35ebca6-4787-922b-9dcb29ca74f2/Week%205%3A%20Health%20Care%20Financing%20Health%20Insurance/Knickman%20%20Health%20Care%20Financing.pdf
Private Health Insurance
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Morrisey, M.A. (2008) “History of Health Insurance in the United States” in Health
Insurance. Chicago: Health Administration Press, 2008, pp. 3-20.
https://ctools.umich.edu/access/content/group/64acb35e-bca6-4787-922b9dcb29ca74f2/Week%205%3A%20Health%20Care%20Financing%20Health%20Insurance/Morrisey%20%20History%20of%20Health%20Insurance%20in%20the
%20United%20States.pdf
•
Kaiser Family Foundation. (2008). How private health insurance works: A Primer – 2008 Update.
http://www.kff.org/insurance/upload/7766.pdf
Competencies:
1. Understand historical factors determining how private health insurance was shaped in the United
States
2. Examine the effects that insurance has on patient/consumer behavior
3. Examine populations with—and without—access to health insurance in the United States
4. Define managed care and assess different models of managed care
13
Weeks 6 & 7: Health Care Financing: Public Programs
Required Readings:
Medicare
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Kaiser Family Foundation. (2010). Medicare, a primer (2010). The Foundation.
http://www.kff.org/medicare/upload/7615-03.pdf.
•
Kaiser Family Foundation. (November 2012) “Medicare Spending and Financing.”
http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/
Medicaid
•
Kaiser Family Foundation. (2013) Medicaid: A Primer – Key Information on the Nation’s
Health Coverage Program for Low-Income People. March 1, 2013.
http://kaiserfamilyfoundation.files.wordpress.com/2010/06/7334-05.pdf
•
Iglehart JK. (2012). Expanding eligibility, cutting costs – a Medicaid update. NEJM,
366(2): 105-7.
http://www.nejm.org.proxy.lib.umich.edu/doi/full/10.1056/NEJMp1113561
•
Levey, Noam N. “Medicaid Opposition Underscores States’ Healthcare Disparities.” LA
Times, May 18, 2013.
http://www.latimes.com/news/nationworld/nation/la-na-medicaid-expansion20130519,0,5679842.story
Health Reform
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Kaiser Family Foundation. (2013). Summary of new health reform law (2010). The
Foundation. April 23, 2013. http://www.kff.org/healthreform/8061.cfm *THIS ARTICLE
ALSO APPEARED IN THE “INTRODUCTION” READING LIST; RE-READ ONLY IF NECESSARY
•
Kaiser Family Foundation. (2013). “The Affordable Care Act Three Years PostEnactment.” http://kaiserfamilyfoundation.files.wordpress.com/2013/04/84291.pdf
•
The Kaiser Family Foundation. (2010) “Health Reform and Communities of Color:
Implications for racial and ethnic health disparities.” Facts on Health Reform. The
Foundation. September, 2010. http://www.kff.org/healthreform/upload/8016-02.pdf
14
Competencies:
1. Understand the historical development of Medicare, Medicaid, and CHIP
2. Understand the differences between Medicare and Medicaid in terms of social values, populations
covered, benefits covered, and the administration of the programs
3. Identify historical attempts to achieve universal coverage in the United States, as well as the
stakeholders proposing—and opposing—such coverage
4. Understand the major sections of the “Affordable Care Act of 2010” and how these will likely
impact the US health care system.
15
Week 8: The Health Care Workforce: Physicians
Required Readings:
General
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Kocher R, Sahni NR. (2011). Rethinking health care labor. NEJM, 365(15): 1370-2.
http://www.nejm.org.proxy.lib.umich.edu/doi/pdf/10.1056/NEJMp1109649
Physicians
•
Kocher, R, Emanuel, EJ and. DeParle, NM. “The Affordable Care Act and the Future of
Clinical Medicine: The Opportunities and Challenges.” Ann Intern Med October 19, 2010
153:536-539; published ahead of print August 23, 2010.
http://www.annals.org/content/153/8/536.full.pdf+html
•
Bodenheimer, T. and Hoangmai, HP. (2010). “Primary care: current problems and
proposed solutions.” Health Affairs, 29(5): 799-805.
http://content.healthaffairs.org.proxy.lib.umich.edu/cgi/reprint/29/5/799
•
Mullan, F. (2002). "Some thoughts on the white-follows-green law." Health Affairs.
21(1):158-159.
http://content.healthaffairs.org.proxy.lib.umich.edu/cgi/content/full/21/1/158
Competencies:
1. Understand the overall composition of the health care workforce.
2.
Identify various methods for determining the adequacy of supply of various health professionals.
3. Understand the role and function of physicians within the larger health care system
4. Understand the impact of various laws and reports on the supply of physicians in the US
5. Examine factors influencing a perceived shortage or surplus of physicians
6. Determine the socio-demographic composition of physicians and how that influences the practice
of medicine
7. Assess the extent of the mal-distribution of physicians by specialty and geographic area in the US
16
Week 9: The Health Care Workforce: Nursing
Required Readings:
Nursing
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Aiken, LH. (2011) “Nurses for the Future. N Engl J Med 2011; 364:196-198
http://www.nejm.org/doi/pdf/10.1056/NEJMp1011639
•
Auerbach, David I, et al. (April 2013) “The Nursing Workforce in an Era of Health Care
Reform.” NEJM 368(16): 1470-1473.
http://www.nejm.org/doi/pdf/10.1056/NEJMp1301694
•
Frellick, M. (2011) “A Path to Nursing Excellence: Quality and staff recruitment gains
offset Magnet’s pricey application process.” Hospitals and Health Networks. April 2011:
41.
http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Articl
e/data/04APR2011/0411HHN_FEA_workforce&domain=HHNMAG
NPs, PAs, and Other Non-Physician Clinicians
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“When the Doctor Is Not Needed.” New York Times Editorial, December 15, 2012.
http://www.nytimes.com/2012/12/16/opinion/sunday/when-the-doctor-is-notneeded.html?pagewanted=all&_r=0
•
Cassidy, Amanda. “Nurse Practitioners and Primary Care.” Health Affairs, Health Policy
Briefs, updated May 15, 2013.
http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=92
•
Coplan B, Mayer JE. (2011). Physician assistants—one less doctor(ate) in the house.
JAMA, 305(24): 2571-2.
http://jama.jamanetwork.com.proxy.lib.umich.edu/article.aspx?articleid=646693
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Competencies:
1. Understand the nature of the nursing profession and the role of nurses in the US Health Care
System
2. Recognize the different educational pathways that lead to the RN designation and how these have
changed over time.
3. Identify the factors that are leading to the shortage of nurses in the US.
4. Discuss the impact of the nursing shortage on the quality of care provided by nurses
5. Identify the health professions that fall under the term “Non-Physician Clinicians” and the scope of
practice of these providers
6. Differentiate between the training and practice requirements of nurse practitioners (NPs) and
physician assistants (PAs)
7. Define the demographic and practice characteristics of NPs and PAs
8. Examine these health professions as complements to, and substitutes for, physicians
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Weeks 10 and 11: Health Facilities and Programs: Hospitals
Required Readings:
Hospitals and Integrated Delivery Systems
•
Gourevitch, MN., Caronna, CA., and Kalkut, G. (2005). "Acute Care." In Jonas and Kovner's
Health Care Delivery in the United States. Eighth Edition. Edited by Kovner, A.R., and
Knickman, J.R. New York: Springer Publishing Company. pp. 191-218. (SKIM).
https://ctools.umich.edu/access/content/group/64acb35e-bca6-4787-922b9dcb29ca74f2/Weeks%2010%20_%2011%3A%20Health%20Facilities%20Hospitals/Gourevitch%20%20%20Acute%20Care.pdf
•
Kaiser Family Foundation. (2012, March). Community health centers: the challenge of growing to
meet the need for primary care in medically underserved communities [Policy brief].
http://www.kff.org/uninsured/upload/8098-02.pdf
•
Rau, Jordan. “Test for Hospital Budgets: Are the Patients Pleased?” New York Times, Health
section, November 7, 2011.
http://www.nytimes.com/2011/11/08/health/patients-grades-to-affect-hospitals-medicarereimbursements.html?pagewanted=all&_r=0
•
Young, Gary J. et al. (April 2013) “Provision of Community Benefits by Tax-Exempt U.S. Hospitals.”
NEJM 368(16): 1519-1527. http://www.nejm.org/doi/pdf/10.1056/NEJMsa1210239
Hospital-Physician Relationships
•
Kocher R, Sahni NR. (2011). Hospitals’ race to employ physicians – the logic behind a
money-losing proposition. NEJM, 364(19): 1790-3.
http://www.nejm.org.proxy.lib.umich.edu/doi/full/10.1056/NEJMp1101959
•
Matthews AW. (2012, January 23). Can accountable-care organizations improve health
care while reducing costs? The Wall Street Journal.
http://online.wsj.com/article/SB10001424052970204720204577128901714576054.html
Competencies:
1. Understand the hierarchy of health services facilities, i.e. primary, secondary, and tertiary levels of
care
2. Recognize the extent to which regionalization has occurred in the US
3. Identify the classifications that are used to describe hospitals in the US (e.g. ownership, function,
teaching status, size, location, etc.)
4. Understand how the role of the community hospital has evolved in the US health care system
5. Examine the internal organization of community hospitals and relationships between the hospital
Board, the Medical Staff and the Executive Office
6. Understand how hospital-physician alignment in community hospitals has changed over the years
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Week 12: Long-Term Care
Required Readings:
Long-Term Care
•
Kaye, HS, Harrington, C & LaPlante, MP (2010). “Long-term care: who gets it, who provides it,
who pays, and how much?” Health Affairs, 29(1): 11-21.
http://content.healthaffairs.org.proxy.lib.umich.edu/cgi/reprint/29/1/11
•
Vladeck BC. (2011). The continuing paradoxes of nursing home policy. JAMA, 306(16): 1802-3.
http://jama.jamanetwork.com.proxy.lib.umich.edu/article.aspx?articleid=1104540
•
Moeller, Philip. “Green House Building New Senior Living Model.” US News & World Report,
Money section, April 4, 2013.
http://money.usnews.com/money/blogs/the-best-life/2013/04/04/green-house-building-newsenior-living-model
•
Gazelle, G. (2007) "Understanding Hospice—An Underutilized Option for Life's Final Chapter." N
Engl J Med 357:321-324.
http://content.nejm.org/cgi/content/full/357/4/321
Competencies:
1. Define long-term care and contrast it with acute care
2. Identify the array of programs that comprise the long-term care continuum
3. Understand societal changes in the needs for long-term care
4. Identify differences between institutions that provide long-term care such as nursing homes and
home health agencies
5. Assess efforts to expand the long-term care continuum beyond the nursing home
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Week 13: Quality of Health Care
Required Readings
•
Bodenheimer, T.S. and Grumbach, K. Chapter 10, “Quality of Health Care” in
Understanding Health Policy: A Clinical Approach. Sixth Edition. New York: Lange
Medical Books, 2012, pp. 115-120.
https://ctools.umich.edu/access/content/group/64acb35e-bca6-4787-922b9dcb29ca74f2/Week%2013%3A%20Quality%20of%20Health%20Care/Bodenheimer%20
%20Chapter%2010%20Quality%20of%20Health%20Care%20-%20Copy.pdf
•
Wyszewianski, Leon. “Basic Concepts of Healthcare Quality,” in Ransom, E.R. et al. (Eds).
The Healthcare Quality Book, October 2011.
https://ctools.umich.edu/access/content/group/64acb35e-bca6-4787-922b9dcb29ca74f2/Week%2013%3A%20Quality%20of%20Health%20Care/Wyszewianski%20
%20Draft%20of%20Revision%20of%20Basic%20Concepts%20of%20Healthcare%20Quali
ty.pdf
•
Womack, J.P., Byrne A.P., et al. (2005). “Innovation Series: Going Lean in Health Care.”
Institute for Healthcare Improvement, pp. 1-20.
https://ctools.umich.edu/access/content/group/64acb35e-bca6-4787-922b9dcb29ca74f2/Week%2013%3A%20Quality%20of%20Health%20Care/Womack%20J%20
P%20%20Innovation%20Series%20Going%20Lean%20in%20Health%20Care.pdf
Competencies:
1. Examine different definitions and interpretations of health care quality
2. Determine how quality can be assessed differently by different stakeholders
3. Understand Donabedian’s three approaches to assessing quality: structure, process and outcomes
4. Examine the relationship between quality and cost of care
5. Understand challenges and constraints to provision and receipt of high quality care
6. Examine various approaches to improving quality of care and reducing medical errors
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Week 14: The Drug Industry
Required Readings:
•
Avorn J. (2011). Learning about the safety of drugs – a half-century of evolution. NEJM,
365(23): 2151-3.
http://www.nejm.org.proxy.lib.umich.edu/doi/full/10.1056/NEJMp1110327
•
Wazana, A. (2000). “Physicians and the Pharmaceutical Industry: Is a Gift Ever Just a
Gift?” JAMA, Vol 283, No. 3. January 19, 2000.
http://jama.ama-assn.org/content/283/3/373.full.pdf+html
Competencies:
1.
2.
3.
4.
Identify different institutional entities in the pharmaceutical industry
Assess the role that regulation plays in protecting the public’s health
Understand the phases of drug development and the role that the FDA plays
Understand direct-to-consumer (DTC) and other types of pharmaceutical marketing
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