Professor: Carleen H. Stoskopf, Sc.D.

cstoskopf@sph.sc.edu

777-4781 (O); 736-1791 (H)

Office hours: By appointment

Course Overview

Advanced Topics in Health Policy and Management I (HADM 845) is course with a format based on readings, case studies, and discussion. It requires full participation of all students in both class preparation and in discussion for maximum benefit. We will meet in room 115 (HADM conference room).

Course Objectives:

1. Students will acquire an understanding of the determinants of health in populations.

2. Students will acquire a basic knowledge of current health and health spending statistics.

3. Students will become familiar with the various health care financing mechanisms: Insurance, Managed Care, Medicare, and Medicaid.

• Students will become knowledgeable regarding current issues in health care service delivery and financing such as issues surrounding the uninsured, children, and mental health.

5. Students will be exposed to various health services research techniques as they are used in the literature.

Course Texts and Materials:

1. Evans R, Barer ML, Marmor TR. Why some people are Health and Others are

Not, Aldine de Gruyter, New York, 1994.

• Kindig D. Purchasing Population Health: Paying for Results, University of Michigan Press, 1997.

• Reading packet. Readings are assigned for each session, in addition to the books above. These journal articles are the basis for class discussion. They are to be read prior to coming to class. Each student will be assigned specific readings to present in each session Students may decide to do additional reading about the session topic to broaden their level of expertise in the subject. In leading a discussion, students may want to give preliminary information on the topic (short lecture of no more than 10 minutes), compare and contrast differences of opinion between different authors, summarize major research findings, discuss major policy implications, review some tables and graphs from articles, and engage other class mates in dialogue on the reading and entertain any questions the class might have. Leading a class discussion at this level develops skills in analytical and critical thinking. This should not be a rehash of the article! Pick the three or four most salient points. You might want to talk about the research method(s) if it is unusual. What have we learned from this set of readings? What are the implications for our national health care policy? Do any of the findings surprise you? What are the unanswered questions?

Grading: Students will be graded on the presentation of their readings and their organization and leadership of the their assigned sessions, as well as in class discussion and participation of other sessions. I will grade these discussions on preparedness, the ability to discern the salient points of the readings, the discernment of author differences and similarities on issues, presentation of meaningful data in the articles, and the ability to pose good questions for discussion. Forty (40) percent of the course grade will be based on this class participation.

Two papers will be assigned. The first paper is described in the August 23^rd session and is based on the book, Why Are Some People Health and Others Are Not. The second paper is based on the book, Purchasing Population Health by David Kindig. This assignment is described in more detail in the October 30^th session. Each paper is worth 30 percent of your grade.

August 23 Thursday, 3:00 - 5:30 PM

Class Introduction: Overview of the class format and discussion of the first assignment.

Assignment:

You will read Robert Evan's book, Why Some People are Healthy and Others Are Not, parts I and II (pp. 1- 216). Write a ten-page paper on your own circumstances and experiences, addressing your cultural heritage and values, political and economic systems, individual and population genetic weaknesses and strengths, environmental exposures, physical and biological factors, and learned behaviors that affect your health. You should start with yourself individually, your family, and then expand this analysis to the population of which you are a part. Which of these factors have impacted the type of health care delivery system of which you are a part? How? Why? This assignment is due on September 13th. There will be an in-class discussion of your papers on that day.

September13 Thursday, 4:30 PM - 7:00 PM

Readings:

Health Affairs Vol 19, No. 3, May/June, 2000, pp. 269-276:

"Rediscovering the Social Determinants of Health," by David Mechanic.

Assignment due: Paper on the determinants of health

Presentation and discussion of students' papers on Evan's book.

Review of syllabus and course assignments and grading.

September 20 Thursday, 3:30 - 5:30 PM

Health Care Spending and Outcomes; Nationally and Internationally

Readings:

Health Affairs Vol.18, No. 3, May/June, 1999, pp. 178-192:

"Health Spending, Access, and Outcomes, Trends in Industrialized Countries" by Gerald Anderson and Jean-Pierre Poullier.

Health Affairs Vol.18, No. 3, May/June, 1999, pp. 193-205:

"Health Care Financing and Delivery in Developing Countries" by George Schieber and Akiko Maeda

Health Affairs Vol.19, No. 3, May/June, 2000, pp.150-157:

"Health Spending and Outcomes: Trends in OECD countries, 1960-1998. By Gerard Anderson, Jeremy Hurst, Peter Hussey, and Melissa Jee-Hughes.

Health Affairs Vol. 20, No. 3, May/June 2001, pp. 10-20:

"The Public Versus the World Health Organization on Health System Performance," by Robert J. Blendon, Minah Kim, and John M. Benson.

Health Affairs Vol. 20, No. 3, May/June 2001, pp. 219-232:

"Comparing Health Ssytem Performance in OECD Countries," by Gerard Anderson and Peter Sotir Hussey.

September 25 and October 2: Tuesdays, 5:30 - 8:00 PM

Health Insurance

Student presenters: Keith Shah and Melanie Matney

Readings:

Health Affairs Vol. 20, No. 1, January/February 2001, pp.178-183:

"How A Changing Workforce Affects Employer-Sponsored Health Insurance," by Gregory Acs and Linda J. Blumberg.

Health Affairs Vol. 20, No. 4, pp. 196-208:

"Embraceable You: How Employers Influence Health Plan Enrollment," by jon R. Gabel, Jeremy D. Pickreign, Heidi H. Whitmore, and Cathy Schoen.

Health Affairs Vol.18, No. 3, May/June, 1999, pp. 144-150:

"Trends: Class and Benefits at the Workplace" by Jon Gabel, et al.

Health Affairs Vol.18, No. 3, May/June, 1999, pp. 161-166:

"Recent Trends in Self-Insured Employer Health Plans" by M. Susan Marquis and Stephen H. Long.

Health Affairs Vol. 18, No. 2, March/April, 1999, pp. 176-181:

"Cost of Tax-Exempt Health Benefits in 1998" by John Sheils and Paul Hogan

Health Affairs Vol. 18, No. 4, July/August 1999, pp.112-117:

"Changing the Employer-Sponsored Health Plan System: The Views of Employees in Large Firms" by Judith R. Lave, et al.

Health Affairs Vol. 19, No. 5, September/October, 2000, pp. 152-157.

"Withering on the Vine: The Decline of Indemnity Health Insurance" by Gabel, Ginsburg, Whitmore, and Pickreign.

October 9 Tuesday, 5:30-8:00 PM

Small Group Markets

Guest Speaker: Sudha Xirasagar

Readings:

Health Affairs Vol. 18, No. 3, May/June, 1999, pp. 151-160:

"Trends: Health Insurance Reform in the Small Group Market" By Rick Curtis, et al.

Yia-Wun Liang, student presenter.

Health Affairs Vol. 20, No. 1, January/February 2001, pp. 154-163:

"Have Small-Group Health Insurance Purchasing Alliances Increased Coverage?" by Stephen H. Long and M. Susan Marquis. Kevin Bennett, student presenter.

In Inquiry Vol. 36, No. 1, Spring, 1999, pp. 30-43:

"Who Gains and Who Loses with Community Rating for Small Business?" By Joan L. Buchanan and M. Susan Marquis. Melanie Matney, student presenter.

In Health Affairs Vol. 18, No. 4, July August, 1999, pp. 105-111:

"Pooled Purchasing: Who are the Players?" By Stephen Long and M. Susan Marquis. Katherine Leith, student presenter.

October 18 and 25th Thursdays, 3:30 - 5:30 PM

Managed Care

Student presenters: Katherine Leith and Abeer Al-Rashed

Readings:

Health Affairs Vol. 16, No. 6, November/December, 1997, pp. 75-84:

"HMO Market Structure and Performance" by D.R. Wholey, et al.

Health Affairs Vol. 19, No. 4, July/August, 2000, pp. 139-148:

"On the 'Efficiency' of Managed Care Plans" by Kip Sullivan.

Health Affairs Vol. 19, No. 3, May/June, pp. 121-128:

"HMO Market Penetration and Costs of Employer-Sponsored Health Plans," by Laurence C. Baker, Joel C.Cantor, Stephen H. Long, and M. Susan Marquis.

Inquiry 37:146-161 and 134-145:

"How Consumer Assessments of Managed Care Vary Within and Among Markets" by Zaslavsky, Landon, Beaulier, and Cleary.

Health Affairs Vol. 16, No. 3, May/June, 1997, pp. 209-217:

"Satisfaction and Choice: A View from the Plans." by Ralph Ullman, Jerrold W. Hill, Eileen C. Scheye, and Randall K. Spoeri.

Health Affairs Vol.15, No.3, Fall, 1996, pp. 110-123:

"Consumer Protection and Managed Care: The Need for Organized Consumers," by Marc A. Rodwin.

Health Affairs Vol. 9, No. 4, July/August 2000, pp.65-75:

"Barriers to Care Among Racial/Ethnic Groups Under Managed Care" by Phillips, Mayer, and Aday.

Health Affairs Vol 15, No. 3, Fall 1996, pp. 124-133.

"Physician Earnings in a Changing Managed Care Environment" by Simon and Born.

Inquiry Vol. 37, Summer 2000, pp. 134-145:

"Measuring the Effects of Managed Care on Physicians' Perceptions of their Personal Financial Incentives" by Mitchell, Hadley, Sulmasy, and Bloche.

Health Services Research 35:3 (August 2000) pp.707-734:

"Measuring the 'Managedness' and Covered Benefits of Health Plans" by Grembowski, et al.

Health Affairs Vol.18., No. 2, March/April, 1999, pp. 7-24:

"The Future of Managed Care Organization" by James C. Robinson

October 30 Tuesday, 5:30-8:00 PM

Integration and Consolidation of the Health Care System

Student presenter: Yia-Wun Liang

Readings:

Health Affairs Vol. 15, No. 1, Spring 1996, pp.7-22:

"Vertical Integration and Organizational Networks in Health Care" by J.C. Robinson and L.P. Casalino.

Health Care Management Review Vol. 18, No. 4, 1993, pp. 7-20:

"Trends and Models in Physician-Hospital Organizations" by L.R. Burns and D.P. Thorpe.

Health Services Research Vol. 33, No. 5, pp. 1403-1419:

"Increasing Consolidation in Healthcare Markets: What are the Antitrust Policy Implications?" By Deborah Haas-Wilson and Martin Gaynor.

Assignment:

David Kindig gives us a scenario for the year 2015 in his book, Purchasing Population Health: Paying for Results. After reading his book, write a five to ten-page critique of his ideas for the future based on rewarding community health outcomes and the incentive that will drive us to this model in the next century. Are his assumptions correct? Will his proposed incentives work? Will there be resistence to this type of model and from which stakeholders? This assignment is due on December 4th.

November 8 Thursday, 3:30 - 5:30 PM

Delivering Mental Health Services

Guest Professor: Dr. Judy Shinogle

Readings:

Health Affairs Vol. 20, No. 4, July/August 2001, pp. 58-67:

"Full Parity: Steps Toward Treatment Equity for Mental and Addictive Disorders," by Devin D. Hennessy and Howard H. Goldman. Melanie Matney, student presenter.

Health Affairs Vol. 19, No.4, July/August 2000, pp. 108-120:

"Spending on Mental Health and Substance Abuse Treatment, 1987-1997" by Mark, et al.

Katherine Leith, student presenter.

Health Affairs Vol. 19, No.4, July/August 2000, pp. 244-256:

"Health Care Use and At-Work Productivity Among Employees with Mental Disorders" by Berndt et al. Abeer Al-Rashed, student presenter.

Health Affiars, Vol. 17, No. 2, March/April, 1998, pp.40-52:

"Costs and Use of Mental Health Services Before and After Managed Care" by William Goldman, et al. Kevin Bennett, student presenter.

Health Affiars, Vol. 17, No. 2, March/April, 1998, pp. 53-69:

"Costs and Incentives in A Behavioral Health Carve-Out" by Ching-To Albert Ma and Thomas G. McGuire. Yia-Wun Liang, student presenter.

Health Affairs Vol. 18, No. 2, March/April, 1999, pp. 67-78:

"Behavioral Health Benefits in Employer-Sponsored Health Plans" by Jeffrey A. Buck, et al. Keith Shah, student presenter.

November 15 Thursday, 3:30 - 5:30 PM

The Uninsured

Guest Professor: Dr. Saundra Glover

Readings:

In Health Affairs Vol. 18, No. 2, March/April, 1999, pp. 30-47, 213-219:

"Explaining the Decline in health Insurance Coverage, 1979-1995" by Richard Kronick and Todd Gilmer. Keith Shah, student presenter.

Inquiry 35: 250-265 (Fall 1998):

"State-Sponsored Programs for the Uninsured: Is There Adverse Selection?" By Elizabeth H. Kilbreth, et al. Katherine Leith, student presenter.

Health Affairs Vol. 19, No.4, July/August 2000, pp. 171-177:

"The Nonpoor Uninsured In California, 1998," by Jill M Yegian, David G Pockell, Mark D. Smith and Eleanor K Murray. Yia-Wun Liang, student presenter.

Health Affairs Vol. 19, No.4, July/August 2000, pp. 197-199:

"Self-Care Among the Uninsured: You Do What You Can Do," by Nancy Vuckovic. Melanie Matney, student presenter.

Health Affairs Vol. 20, No. 1, pp. 240-246:

"Patterns of Insurance Coverage Within Families With Children," by Karla L. Hanson. Abeer Al-Rashed, student presenter.

November 27 Tuesday, 5:30 - 8:00 PM

Medicaid and CHIP (Children's Health Insurance Program)

Student presenter: Kevin Bennett

Readings:

Health Affairs Vol. 18, No. 2, March/April, 1999, pp. 233-238, 201-212;

"How are Safety-Net Providers Faring Under Medicaid Managed Care?" by Colleen M Grogan and Michael K. Gusmano.

Health Affairs, Vol. 18, No. 1, January/February 1999, pp. 223-230:

"Reversal of Fortune: Commercial HMOs in the Medicaid Market" by Michael J. McCure, et al.

Inquiry 35:369-379 (Winter, 1998):

"Health Insurance Among Children: The Role of Expanded Medicaid Coverage" by Kenneth E. Thorpe and Curtis S. Florence.

Health Affairs Vol. 18, No. 2, March/April, 1999, pp.48-63, 64-66:

"Challenges in Securing Access to Care for Children" by Neal Halfon, et al.

"How Will we Know if CHIP is Working?" By Trish Riley.

December 4 Tuesday, 5:30 - 8:00 PM

Medicare

Student presenter: Katherine Leith

Assignment due: Critique of Kindig's book

Readings:

Health Affairs Vol. 18, No. 1, January/February 1999, pp. 48-62.

"Medicare Reform: Who Pays and Who Benefits?" By Mark McClellan and Jonathan Skinner.

Health Affairs Vol. 17, No. 6, November/December 1998, pp.170-180:

"Disparities In Access to Medicare Managed Care Plans" by Timothy D. McBride.

In Health Affairs Vol. 19, No. 5, September/October 2000, 30-43.

"Who Really Wants Price Competition in Medicare Managed Care" by Nichols and Reischauer

Health Affairs Vol.20, No.3, May/June 2001, pp. 199-203:

"Is the Informed-Choice Policy Approach Appropriate for Medicare Beneficiaries?" by Judith H. Hibbard, Paul Lovic, Ellen Peters, Melissa L. Finucane, and Marin Tusler.

Health Affairs Vol. 17, No. 6, November/December 1998, pp. 181-193:

"Can Medicare Beneficiaries Make Informed Choices?" By Judith H Hibbard, et al.

Health Affairs Vol.20, No.3, May/June 2001, pp. 204-211:

"Providing Care at the End of Life: Do Medicare Rules Impede Good Care?" by Haiden A. Huskamp, Melinda Beeuwkes Buntin, Virginia Wang, and Joseph P. Newhouse.

Health Affairs Vol.20, No.4, July/August 2001, pp. 188-195:

"Medicare Beneficiaries' Costs of Care In the Last Year of Life," by Chritopher Hogan, June Lunney, Jon Gabel, and Joanne Lynn.

Inquiry Vol. 34, No. 2, Summer 1997, pp.106-116:

"The Impact of Policy Standardization on the Medigap Market" by T. Rice, et al.

Class Participants:

Name E-mail Home Work Cell

Keith Shah Keithshah@hotmail.com 462-0482 264-4108 864-356-8126

Kevin Bennett BennetKJ@mailbox.sc.edu 750-7273

Katherine Leith Leith@sc.edu 419-8807 777-5620

Abeer Al-Rashed abeerashed@hotmail.com 929-0681

Yia-Wun Liang Liang6262@hotmail.com 739-6833

Melanie Matney melanie.matney@palmettohealth.org 296-2251