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
christopher.harris@nyu.edu
(212) 998-7416
Prof. Victor G. Rodwin
victor.rodwin@nyu.edu
(212) 998-7459
COURSE DESCRIPTION
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
systems.
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.
LEARNING OBJECTIVES
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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
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PREREQUISITES
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).
COURSE REQUIREMENTS
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.
GRADING
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.
REQUIRED BOOKS
1. T.R. Reid, The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care.
Penguin, 2010.
2.
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.
ADDITIONAL READINGS IN SYLLABUS ARE ALL POSTED ON NYU CLASSES
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OUTLINE OF COURSE TOPICS AND READINGS
I.
1.
INTRODUCTION
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
http://www.pbs.org/wgbh/pages/frontline/sickaroundamerica/view/
2.
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?
3.
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.
II.
COMPARISONS OF HEALTH SYSTEM PERFORMANCE
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
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(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,
2003.
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.
III.
CASE STUDIES
7.
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.
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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
8.
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
Center
Optional: Canada HiT:
http://www.euro.who.int/en/home/projects/observatory/publications/health-system-profiles-hits/full-list-ofhits/canada-hit-2005
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.
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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
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