NYU Wagner - New York University

Robert F. Wagner Graduate School of Public Service
P11.2852: Comparative Analysis of Health Systems in Wealthy Nations
Spring, 2015
Thursdays: 6:45PM-8:25PM
Room: Waverly 566A
Office: Puck Bldg, 2nd fl. 295 Lafayette St., Rm. 3006
Admin. Assistant: Christopher Harris
[email protected]
(212) 998-7416
Prof. Victor G. Rodwin
[email protected]
(212) 998-7459
We tend to be ethnocentric in our views of health care organization and policy. A look abroad,
however, can provide insights about problems at home. In spite of differences in the organization and
financing of their health care systems, most countries share a number of common problems with the
United States. First, is the question of deciding - or not explicitly deciding - what proportion of GNP
should be devoted to health and welfare. Second, is the problem of agreeing on appropriate criteria to
allocate health and social service expenditures. Third, is the problem of how to implement established
policies: through regulation, promotion of competition, budgeting, or reimbursement incentives
directed at health care providers.
The readings, lectures and class discussions will focus on the organization and financing of
health systems in wealthy nations. We begin with a discussion of conventional health system models
around the world and alternative perspectives for studying them and evaluating their performance. We
will discuss how so much of the literature draws on selective evidence to evaluate health care systems
in the U.S. and abroad. Finally, and this is the heart of the class, we will study a range of different
approaches to the empirical analysis of health system performance in selected nations, and examine the
extent to which the available evidence supports or refutes widely shared views of different health care
In completing the assignments for this class, I will ask students to become "experts" about a
health system of their choice outside the United States but in a wealthy nation belonging to the
Organization for Economic Cooperation and Development (OECD). The class assignments will focus
on assessing the performance of health systems with respect to a range of indicators and available data.
Students with special interests in so-called BRIC nations (Brazil, Russian Federation, India and China)
may also focus their final research project on these countries but the mid-term exercise will focus on
the 11 wealthy nations for which the Commonwealth Fund has published a wide range of survey data.
Analyze conceptual and methodological issues in the study of health systems
Identify common problems and differences among diverse health systems
Highlight key features of health systems in OECD nations and other countries.
Assess the impact of globalization on health system development
Analyze the U.S. health system from a comparative perspective
Examine the uses of comparative analysis in learning from abroad
Introduction to Health Policy and Management (P11.1830), Micro-Economics (P11.1018),
Introduction to Public Policy (P11.1022). Highly recommended classes: Current Issues in Health Policy
(P11.2836), Health Economics and Payment Systems (P11.1832).
A mid-term exercise in which you evaluate the performance of a health care system based on
key articles about the health care system you have selected and survey data from eleven wealthy
nations published by the Commonwealth Fund (4 pages summarizing what you have found
accompanied by Appendices with back-up materials). A final 5 minute presentation summarizing your
full semester’s research on the health care system you have chosen to study, including its performance
and a research dossier with another 4 page summary and accompanying back up materials).
The mid-term exercise must focus on one of the eleven nations for which the Commonwealth
Fund has published their survey data: Australia, Canada, France, Germany, the Netherlands, New
Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The final research
dossier may focus on any nation you choose to study.
The mid-term exercise (due on March 26th) will count for 30% the grade. The oral presentation
(May 14) will count for 20 percent of the grade and the research dossier (due May 14) will count for
40% of the grade. Class participation will count for 10% of the grade.
1. T.R. Reid, The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care.
Penguin, 2010.
Lynne Payer, Medicine and Culture. New York. Henry Holt, 1988.
Optional Book:
1. T. Marmor, Freeman, R. and Okma, K. Comparative Studies and the Politics of Modern Medical
Care. New Haven, YUP, 2009.
Health Systems Around the World – Jan. 29
Required Reading:
T.R. Reid, The Healing of America: A Global Quest for Better, Cheaper and Fairer
Health Care. Chapters 1-7.
Required Movie:
Front Line: Sick Around America
Converging Themes and Challenges – Feb. 5
Required Reading:
T.R. Reid, The Healing of America: A Global Quest for Better, Cheaper and Fairer
Health Care. Chapters 7-13.
Optional Reading:
Thomson S, Osborn R, Squires D, eds. International Profiles of Health Care Systems. New
York, Commonwealth Fund.
Keep as resource for health systems that interest you most.
Assignment: Come to class prepared to discuss: What are common challenges faced by health
care systems discussed by T.R. Reid? What questions does T.R. Reid raise, which you would
like to explore further?
Themes, Challenges, Methods, Data – Feb. 12
Required Reading:
L. Brown., “Comparing hHealth sSystems in fFour cCountries: Lessons for the United States.
American J. of Public Health. 93,2003.
T. Marmor, R. Freeman and K. Okme., “Comparative perspectives and policy learning in the
world of health care.” Journal of Comparative Policy Analysis (7), 4: 331 – 348, 2005.
Lynne Payer, Medicine and Culture. New York. Henry Holt, 1988.
Due: Your announcement, under NYU Classes Forum, of what country you will study for midterm and final research.
4. A World Health Organization (WHO) Perspective and its Critics -- Discrete Components
of Performance vs. Composite Scores: February 19
Required Reading
World Health Organization, The World Health Report 2000. Health System Performance
(Glance at report. It is downloadable from WHO at
http://whqlibdoc.who.int/publications/2003/9241562455.pdf) and read the following article
summary of conceptual framework in report).
Frenk, J and Murray, C. A Framework for Assessing the Performance of Health Systems.
Bulletin of the World Health Organization, 2000, 78 (6) 731
P. Musgrove. Judging Health Systems: Reflections on WHO’s Methods. Lancet 361:1817-1820,
J. Coyne, P. Hilsenrath, V. Navarro. The World Health Report 2000: Can Health Care Systems
Be Compared Using a Single Measure of Performance? American Journal of Public Health
(92)1, 2002.
5. An International Perspective on Common Challenges: Primary Care – February 26
Guest: Visiting Wagner Scholar, Cathy Schoen
Required Reading:
C. Schoen et. al. A Survey of Primary Care Doctors in Ten Countries Shows Progress in Use of
Health Information Technology, Less in Other Areas. Health Affairs, 2012.
C. Schoen et. al. A Survey of Primary Care Physicians in Eleven Countries, 2009: Perspectives
on Care, Costs and Experiences. Health Affairs Web Exclusive.DOI.10.1377, 2009.
Osborn, R. et al. International Survey of Older Adults Finds Shortcomings In Access,
Coordination, And Patient-Centered Care, Health Affairs 33: 12, 2014
E. Nolte and M. McKee, Caring for people with chronic conditions: A health system perspec
tive (http://www.euro.who.int/__data/assets/pdf_file/0006/96468/E91878.pdf). Ch. 1 and 4
6. Comparative Analyses Based on OECD Health Data -- March 5
U.E. Reinhardt, P.S. Hussey, and G. F. Anderson. U.S. Health Spending in an International
Context. Health Affairs (23) 3, 2004.
G. Anderson, et. al. It’s the Prices, Stupid: Why the United States is so Different from Other
Countries. Health Affairs (23) 3, 2003.
J. Oberlander and J. White. Public Attitudes Toward Health Care Spending Aren’t the Problem;
Prices Are. Health Affairs (28)5, 2009.
The Dutch NHI System – Guest Lecture: Kieke Okme, March 12.
Required Reading:
Okma & Crivelli. (2013). Swiss and Dutch “consumer-driven health care”: Ideal model or
reality? Health Policy, 109(2), 105-112.
Marmor, T. R et al (2009). Comparative studies and the politics of modern medical care. New
Haven: Yale University Press. Chapter 5.
SPRING RECESS: Monday, March 16 - Friday, March 19, 2011
Commonwealth Fund Surveys: Special Session with Cathy Schoen: March 26
Mid-Term Exercise Due
9. The French National Health Insurance System -- April 2
Required Reading:
M. Steffen, The French Health Care System: Liberal Universalism. JHPPL (35)3, 2010.
V. Rodwin. The Health Care System Under French National Health Insurance: Lessons for
Health Reform in the United States. AJPH (January, 2003)
V. Rodwin and C. Lepen. French Health Care Reform. NEJM (351)22, 2004.
10. The Canadian Health Care System -- Guest lecture: Theodore Marmor, April 9.
Required Reading:
R.B. Deber. Health Care Reform: Lessons from Canada. AJPH. 93, 2003.
Marmor, T. R et al (2009). Comparative studies and the politics of modern medical care. New
Haven: Yale University Press. Chapter 3.
Health Care in Crisis: The Drive for Health Reform in Canada and the United States | Wilson
Optional: Canada HiT:
Okma, K. G., & Marmor, T. R. (2013). Comparative studies and healthcare policy: Learning
and mislearning across borders. Clinical Medicine, 13(5), 487-491
11. The British Health Care System -- April 16
Required Reading:
R. Klein. The Troubled Transformation of Britain's National Health Service. NEJM (355)
4:409-15, 2006.
N. Timmons. Letter from Britain. Across the Pond: Great New Waves of Health Reform. Health
Affairs (29)12, 2010.
12. Health Care Systems in BRIC nations (Brazil Russia, India China) – April 23
April 30 and May 7th: No Class
13: Final Class Presentations in lieu of Final Exam: May 14th
2. H. Aaron and W. Schwartz (with M. Cox). Can We Say No? The Challenge of Rationing
Health Care. Washington D.C.: Brookings, 2005.
3. C. Altenstetter and J. Bjorkman, eds., Health Policy Reform, National Variations and
Globalization. New York: St. Martin’s Press, 1997.
4. O. Anderson, The Health Services Continuum in Democratic States. Ann Arbor, MI: Health
Administration Press, 1989.
5. P. Basch, Textbook of International Health. Oxford: Oxford University Press, 1999.
6. A. Bennett, and O. Adams, Looking North: What Can We Learn from Canada’s Health Care
System? San Francisco: Jossey-Bass, 1993.
7. R. Blank and V. Burau. Comparative Health Policy. 2nd Edition. New York,
Palgrave MacMillan, 2007.
8. D. Callahan and A. Wasunna. Medicine and the Market: Equity vs. Choice.Baltimore. Johns
Hopkins, 2006.
9. J. Campbell and N. Ikegami, The Art of Balance in Health Policy: Maintaining Japan’s Low-Cost
Egalitarian System. New York: Cambridge University Press, 1998.
10. Commonwealth Fund Commission on a High-Performance Health System: Reports available
11. J. De Kervasdoué, J. Kimberly, and V. Rodwin, eds., The End of an Illusion: The Future of Health
Policy in Western Industrialized Nations. Berkeley: University of California Press, 1984.
12. A. Ellenweig, Analyzing Health Systems: A Modular Approach. New York: Oxford University
Press, 1992.
13. European Observatory on Health Systems and Policies.
14. P. Dutton, Differential Diagnoses: A Comparative History of Health Care Policies and Solutions in
the United States and France. Ithaca: Cornell U. Press, 2007.
15. European Observatory on Health Systems and Policy Series: See Health in Transition (HiT) Case
Studies on European health systems:
Also see book publications:
16. M. Field, ed., Success and Crisis in National Health Systems. New York: Routledge, 1989.
17. D. Fox, Health Policies, Health Politics. Princeton, NJ: Princeton University Press, 1986.
18. R. Freeman, The Politics of Health in Europe. Manchester and New York: Manchester University
Press, 2000.
19. W. Glaser, Health Insurance in Practice: International Variations in Financing, Benefits, and
Problems. San Francisco: Jossey-Bass, 1991.
20. L. Graig, Health of Nations: An International Perspective on U.S. Health Care Reform.
Washington, DC: CQ Press, 1999.
21. M. Gusmano, V. Rodwin, and D. Weisz. Health Care in World Cities: New York, Paris and
London. Baltimore, Johns Hopkins U. Presss, 2010.
22. Health Affairs, Pursuit of Health Systems Reform (Special Issue), 10, Fall 1991.
23. Health Affairs, Global Health Financing (26)4, 2007.
24. J. Hurst, The Reform of Health Care: A Comparative Analysis of Seven OECD Countries. Paris:
OECD, 1992.
25. E. Immergut, Health Politics: Interests and Institutions in Western Europe. New York: Cambridge
University Press, 1992.
26. Investing in Health: World Bank Development Report. Washington, DC: World Bank, 1993.
27. M. Jerome-Forget, J. White, and J. Weiner, eds., Health Care Reform through Internal Markets:
Experience and Proposals. Washington, DC: Brookings Institute for Research on Public Policy,
28. Johnson, J. and Stoskopf, C. Comparative Health systems: Global Perspectives. Jones and Bartlett,
29. Journal of Health Policy, Politics and Law, “Comparative Health Policy” Special Issue, 17,
Winter, 1992.
30. R. Klein, The New Politics of NHS, third edition. London: Longman, 1995.
31. M. Lassey, W. Lassey, and M. Jinks, Health Care Systems Around the World. Upper Saddle River,
NJ: Prentice Hall, 1997.
32. H.M. Leichter, A Comparative Approach to Policy Analysis: Health Care Policy in Four Nations.
Cambridge: Cambridge University Press, 1979.
33. J. Lemco, ed. National Health Care: Lessons for the United States and Canada. Ann Arbor:
University of Michigan Press, 1994.
34. T. Marmor, Understanding Health Care Reform. New Haven: Yale University Press, 1994.
35. J. Merrill, The Road to Health Care Reform. New York: Plenum, 1994.
36. Okma, K. and Crivelli, L. Six Countries, Six Reform Models: The Healthcare Reform Experience of
Israel, The Netherlands, New Zealand, Singapore, Switzerland and Taiwan. World Scientific, 2009.
37. Payer, L. Medicine and Culture. New York. Henry Holt, 1996.
38. Powell, F. and Wessen, A. eds. Health Care Systems in Transition: An International Perspective.
Sage Publications, 1999.
39. OECD, Towards High-Performing Health Systems. September, 2004. Available online:
40. OECD, Towards High-Performing Health Systems. August, 2004. Available online:
41. M. Raffel, ed., Health Care Reform in Industrial Countries. University Park, PA: Pennsylvania
State University Press, 1997.
42. V. Rodwin, The Health Planning Predicament: France, Quebec, England and the United States.
Berkeley: University of California Press, 1984.
43. V. Rodwin and contributors. Universal Health Insurance in France: How Sustainable? Washington
D.C.: Embassy of France, 2007. Downloadable on line:
44. M. Roemer, National Health Systems of the World (Vols. 1 and 2). New York: Oxford, 1991.
45. Romanov Commission (on Canadian Health Care Reform) Website:
46. R. Saltman, and C. Van Otter, Planned Markets and Public Competition: Strategic Reform in
Northern Europe Health Systems. Philadelphia: Open University Press, 1992.
47. R. Saltman, and C. Van Otter, Implementing Health Care Reform. Bristol. PA: Open University
Press, 1995.
48. R. Saltman and J. Figueras, European Health Care Reform. Cophenhagen: World Health
Organization, 1997.
49. R. Saltman, R. Busse and J. Figueres. Social Health Insurance Systems in Western Europe.
European Observatory on Health Systems. OUP, 2004.
50. C.H. Tuohy. Accidental Logics: The Dynamics of Change in the Health Care Arena in the United
States, Britain and Canada. New York, 1999.
51. A. Wall, ed., Health Care Systems in Liberal Democracies. London. Routledge, 1996.
52. J. White, Competing Solutions: American Health Care Proposals and International Experience.
Washington, DC: Brookings, Institution, 1995.
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