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 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 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 2 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 3 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 4 (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. 5 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. 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