PH 116: Introduction to the U.S. Health System
Fall 2015
Prof. Theodore Brown
Office Hours: Monday 11:00 – 1:00 and by appointment
368 Rush Rhees (x52051)
email: Theodore_Brown@urmc.rochester.edu
Michael Healey
Office hours: times and locations by appointment
Email: mhealey3@u.rochester.edu
Leslie Laam
Office hours: times and locations by appointment
Email: Leslie_Laam@urmc.rochester.edu
Micah Segelman
Office hours: times and locations by appointment
Email: Micah_Segelman@urmc.rochester.edu
Assistant Teachers
Chiziterem Onyekwere (conyekwe@u.rochester.edu)
Victoria Stepanova (Victoria.Stepanova@rochester.edu)
PUBLIC HEALTH REFERENCE LIBRARIAN: Judith Briden
(jbriden@library.rochester.edu)
COURSE DESCRIPTION:
This course examines the organization, financing and functioning of the United States
health care system. It incorporates both historical perspectives and the insights of
international comparisons. Among the topics covered are the economics and organization
of health systems, access to care, U.S. health policy and politics including the historical
struggle for health reform, health systems in international perspective, and disability and
disability politics. The course relies heavily on Leiyu Shi and Douglas Singh, Delivering
Health Care in America: A Systems Approach, 6th edition, but it also uses T.R. Reid’s
The Healing of America and other materials on Blackboard, including book chapters and
journal articles, primary and secondary historical sources, and videos and documentary
films. Course requirements are midterm and final exams, a 10-page research paper, and
participation in weekly small group discussions.
TEXTS:
Leiyu Shi and Douglas Singh, Delivering Health Care in America: A Systems Approach,
6th edition (Jones & Bartlett) [Shi & Singh]
T.R. Reid, The Healing of America: A Global Quest for Better, Cheaper, and Fairer
Health Care (Penguin Books) [Reid]
Additional readings and other course materials available on Blackboard
REQUIREMENTS:
In addition to class lectures on Mondays and Wednesdays, students will attend small
group discussion sessions on Fridays. Students will be assigned to specific groups and are
expected to participate actively in the Friday sessions. Group assignments will be posted
on Blackboard and announced in class.
Students will write a 10 page term paper on a topic of their choice. When choosing a
topic, students must discuss the topic in depth with their small group leader. A set of
guidelines and deadlines for the term paper will be distributed by the third week of class.
These guidelines must be strictly followed.
EVALUATION:
Grades will be based on student performance on two exams, a midterm worth 20% of the
final grade, and a final worth 35% of the final grade. The term paper grade will also
represent 35% of the final grade. The last 10% of the grade will be based on participation
and performance in the small groups. Small group instructors may make additional
assignments that will count towards the small group grade.
ACADEMIC HONESTY:
All assignments and activities associated with this course must be performed in
accordance with the University of Rochester’s Academic Honesty Policy. More
information is available at: www.rochester.edu/college/honesty(index.html)
Labor Day (no class), Monday, September 7
Fall Break (no class), Monday, October 5
MIDTERM EXAMINATION: Monday, October 21, in class
Schedule of Lectures
Aug. 31
Sept. 2
Sept. 9
Sept. 14
Sept. 16
Sept. 21
Sept. 23
Sept. 28
Sept. 30
Oct. 7
Oct. 12
Oct. 14
Oct. 19
Oct. 21
Oct. 26
Oct. 28
Nov. 2
Nov. 4
Nov. 9
Nov. 11
Nov. 16
Nov. 18
Nov. 23
Nov. 25
Nov. 30
Dec. 2
Dec. 7
Dec. 9
Introduction and Orientation
The Population Perspective
Challenging “Common Sense”
An Overview of the U.S. Health System
Financing the U.S. Health System –I
Financing the U.S. Health System – II
Financing the U.S. Health System - III
Cost and Access in the U.S. – I
Cost and Access in the U.S. - II
Struggles for National Health Insurance – I
Struggles for National Health Insurance – II
Struggles for National Health Insurance – III
Struggles for National Health Insurance – IV
Midterm Exam
International Comparisons – I
International Comparisons - II
International Comparisons - III
International Comparisons - IV
International Comparisons - V
International Comparisons - VI
U.S. Health Policy & Politics - I
U.S. Health Policy & Politics - II
U.S. Health Policy & Politics - III
Disability and Disability Politics: Overview
Disability and Disability Politics: A Conversation with Teresa Carroll
Disability and Disability Politics: Mental Illness
Disability and Disability Politics: Grassroots Activism
The U.S. Health System in Long Perspective
Readings
Aug. 31
Shi & Singh, 40-55
Sept. 2
Shi & Singh, 55-62, 416-429
Sept. 9
McKinlay & McKinlay, “Medical Measures and the Decline of Mortality”
Cochrane et. al., “Health Service ‘Input’ and Mortality ‘Output’ in
Developed Countries”
Sept. 14
Shi & Singh, 2-31
Sept. 16
Shi & Singh, 196-207
Sept. 21
Shi & Singh, 214-226
Sept. 23
Shi & Singh, 226-240
Sept. 28
Shi & Singh, 464-490
Sept. 30
Shi & Singh, 62-68
Oct. 7
Shi & Singh, 82-101
Rubinow, “Labor Insurance”
Oct. 12
Winslow, “Public Health at the Crossroads”
Derickson, “Health for Three-Thirds of the Nation”
Shi & Singh, 101-105
Oct. 14
Birn et al., “Struggles for National Health Reform in the United States”
Oct. 19
Vladeck, “Medicare and the Politics of Incrementalism”
Oct. 26
Birn et al., Textbook of International Health, 583-616
Oct. 28
Reid, 1-65
Nov. 2
PBS Frontline video: “Sick Around the World”
Nov. 4
Reid, 66-125
Nov. 9
Reid, 126-162, 165-182
Nov. 11
Reid, 205-243
Nov. 16
Shi & Singh, 259, 299-300, 337-343, 513-521
Nov. 18
Reid, 163-164, 183-185, 244-251
Nov. 23
Shi & Singh, 110-114, 545-551
Nov. 25
Shi & Singh, 378-387, 389-394, 399-408
Buck v. Bell, 274 U.S. 200 (1927)
Nov. 30
Film: When Billy Broke His Head
Dec. 2
Winerip, “Bedlam on the Street”
Dec. 7
Hoffman, “Health Care Reform and Social Movements in the United
States”
Dec. 9
Vladeck, “Universal Health Insurance in the United States: Reflections on
the Past, the Present, and the Future”