PHP 310 COURSE SYLLABUS, SPRING 2018

PHP 310 Syllabus, Spring 2018

General Information
Course Director and Co-Director
Course Director: Ira Wilson
Email: ira_wilson@brown.edu
Twitter: ibwilson_health

Course Co-Director: Ron Aubert

Email: ronald_aubert@brown.edu

Course description
PHP310 is an introductory-level course designed to provide an overview of the U.S. health care
delivery system. The course focuses on the ways in which health care is structured and how the
different components of the system interact with one another. For pedagogical purposes, the
course is divided into 3 parts: how health care is financed, how the delivery system works, and
how the health care system is regulated. As you might anticipate, however, financing, delivery,
and regulation of health care are not actually separable, and one of the interesting parts of
class is learning about the many ways in which they interact.
As an introductory course, PHP310 characterizes the U.S. health care system as it currently
exists and operates, but it also often draws upon the historical roots of a given aspect or
practice of the health care system in order to better understand it. However, because of the
many changes produced by the Patient Protection Act and Affordable Care Act (the ACA or
Obamacare), passed in March of 2010, this class will also necessarily have a strong “current
events” focus. Even though the Trump administration and Republicans failed to pass any
legislation to repeal and/or replace the ACA, they have very successfully rolled back key aspects
of the Bill through administrative actions, and their promises to be more action in Congress
related to health care this spring (2019). PHP310 is intended to be complementary to, but not
substantially overlap with, the content that is covered in PHP320 (Introduction to Public
Health).
PHP310 is designed to help students learn how to think about health care in the US, not what to
think about health care in the US. It does not, in general, take a point of view or advocate for
one kind of change versus another. If there is a dominant theme or perspective, it is that good
data and valid research findings should guide policy, and that every solution creates new
problems. Students will leave this course having some new tools and new kinds of knowledge
that will enable them to think with more sophistication about these problems and trade-offs.

Course Format
LECTURES: There will be 3 lectures a week: Monday, Wednesday and Friday, at noon, in Upper Salomon.
Powerpoints of lectures will generally be available at the time of the lecture.

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POLLING: During class we will use software from Reef-Education.com that allows you to participate in
class polling through your phone or your PC.
SECTIONS: There are six section meetings during the course. The goal of sections is to provide a small
group (about 25 students) in which to discuss both questions related to lectures and issues raised by the
section assignments. There will be 15-20 sections, and they will be scheduled at different times of the
week. Most students should not have a problem finding a section time that works for them. On-line sign
up for these sections will be available shortly after the course begins.
Note that you should upload your section assignment in CANVAS by the time of your section meeting.
EXAMS: There will be 2 mid-term exams and 1 final exam. There will be a section meeting the week
after each exam, which will allow you to discuss your exam with your TA's.

Readings
There are 2 required books for the course:
 Leiyu Shi & Douglas A. Singh. Delivering Health Care In America: A Systems Approach
(Seventh Edition). Burlington, MA: Jones and Bartlett Publishers, 2019. (Note: I'm not
sure why the data of publication for this is listed as 2019, because it is available now)
This is an excellent reference text that includes new information about the Affordable
Care Act (Obamacare).
 Ezekiel J Emanuel, Reinventing American Health Care. New York: Public Affairs, 2014.
This is a new book for the course, and does an excellent job explaining how our health
care system works (and doesn't work), and how the ACA is designed to improve it.

Readings not from the book are shown in CANVAS under the lecture that they pertain to. There
are PDFs that can be downloaded. Readings should be done prior to the class or section which
they are listed for.

Quizzes on Readings
There are short quizzes (5 questions) on the readings for each of the lectures. You have to get 4/5 right
to “pass,” but you can take the quiz as many times as you need to. There are 33 lecture, and 33 quizzes
to take. These are required and count 10% toward the final grade.

Evaluation
Final grades will be based on your performance on:
 Two in class mid-terms (17.5% each)
 Final exam (35%)
 Quizzes on Readings (10%)
 Section attendance and participation (20%). Section assignments are graded as no credit (0
points) and "check" (2 points), for a total of 10 points. Both attendance and participation in
section is expected, and contribute a total of 20 points to the final grade.

MID-TERM EXAMS: The two mid-term exams will be based on lectures (including guest speakers),
section content, and readings. You are expected to be familiar with all of these. The first mid-term exam
covers the material that has been covered prior to that exam (health care financing); and the second
mid-term exam covers the material covered between the first and second exams (the delivery system).
Because in some cases questions are used from year to year, your tests will not be returned to you. You

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may review the results of your test with your TA in section the week after the test. Under no
circumstances should a student copy or photograph exam questions.

FINAL EXAM: The final exam is cumulative and will be held during the scheduled exam time for this
course (May 10, 2019, 2pm, Exam Group 5).

SECTIONS: Attendance at all sections is mandatory, as are the one-page section assignments. Section
assignments are to be turned in on-line (through CANVAS) by the time of your section meeting. Please
attend only the section that you are assigned to. Athletes please sign up for sections that do not meet
on Friday if at all possible.

IN CLASS POLLING: Polling is not used for evaluation, but has an important teaching purpose. Please be
prepared to participate in in-class polling using software from Reef-Education.com.

NOTE ABOUT FINAL GRADES: Final grades will be based on the percent of the total points earned by
each student. Assignment of final grades will be as shown below. Please note that an 89.9% is a B, not
an A. There will be no bargaining or haggling about final grades.
90% or higher A
80% to 89.9% B
70% to 79.9% C
Less than 70% NC

Frequently asked questions

Is attendance required at lectures? It is expected that you will attend class, but attendance will not be
taken. Lectures will be video taped.

What do I do if I have a disability that affects my participation in the class? Brown University is
committed to full inclusion of all students. Please inform me or Cara Sammartino if you have a disability
or other condition that might require accommodations or modification of any of these course
procedures. You may speak with me or Cara after class or during office hours. For more information
contact Student and Employee Accessibility Services at 401-863-9588 or SEAS@brown.edu. NB: Please
contact either me or Cara during the first two weeks of class so that we can best anticipate and meet
any need you may have.

What do I do if I cannot pass a section assignment in on time? Email your section leader if there is a
problem with a section assignment. HOWEVER, as a general rule you will not get full credit for late
assignments. You are adults and have plenty of advance notice about these assignments. Exceptions will
not be routinely granted.

What do I do if I cannot complete an assignment or go to an exam because I am sick? Any and all
excuses related to illness require that you contact someone in the Dean's office (401-863-9800). The
Dean's office will then contact me making me aware that you have been excused for a medical reason.
This approach is in accordance with University policy about illnesses that impact your ability to complete
assignments on time.

What do I do if I cannot take an exam on the day it is offered? Email Cara Sammartino and arrange to
take the exam at an alternative time. Please do this at least 2 weeks before the exam.

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Can I audit this course? Yes. The expectation is that you attend the lecture, but NOT sections or exams,
and you do not have to do any of the papers.

Can I take the final on a different day? No. The Dean of Students does not allow any changes to final
exam dates.

Expected course time commitments

Total time spent in and out of class for this course is expected to be ~180 hours. Over the 13 weeks of
this course students will spend 2.5 hours a week in class, and 6 hours over the 13 weeks in section, or
about 39 hours total. Although specific out-of-class time investments may vary for individual students, a
reasonable estimate to support this course’s learning outcomes is 150 hours total, or on average,~11
hours weekly over a 13-week term. Out-of-class preparation will regularly include about 8 hours a week
of reading, and on average 3 hours a week of integrating reading and lecture materials, preparing for
section, and preparing for examinations.

Course Readings for each Lecture

Lecture 1, Wed Jan 23, 2019: Introduction to PHP 310 (Wilson)

REQUIRED READING
1. This Victor Fuchs article from the New England Journal of Medicine in 2012 describes trends in US
health care in the last 50 years. The article summarizes several of the key themes in the course.
After the first two parts of the course (financing and providers) I suggest that you go back and read
it again. It will make much more sense after we have covered these topics. Fuchs Major Trends in
the US Health Economy since 1950 NEJM March 2012.pdf
2. Emanuel book, Intro, pages 1-13.
3. This short NEJM paper compares the performance of the US health care system to others in the
developed world, and speculates about how the US might improve. 2017 Schneider et al From First
to Last NEJM.pdf

Lecture 2, Friday Jan 25, 2019: Introduction to the Health Care System (Wilson)

REQUIRED READING
1. Shi and Singh, Chapter 1 (pages 1-22, 34-37), and Chapter 2 (pages 46-72).
2. Wilson and Cleary, Linking Clinical Variables with Health-Related Quality of Life. Wilson Cleary
Linking Clinical Variables to HRQL JAMA 1995.pdf
3. The picture of health, from the Urban Institute. http://apps.urban.org/features/picture-of-
health/index.html (Links to an external site.)Links to an external site., with a video
introduction, http://apps.urban.org/features/picture-of-health/video.html (Links to an external
site.)Links to an external site..
4. This 9-page from the Kaiser Family Foundation reviews the role of social determinants in the
promotion of health and health equity. 2018 May KFF IB The Role of Social Determinants in
Promoting Health and Health Equity.pdf

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Lecture 3, Monday Jan 28, 2019: Values, Beliefs, and Health

REQUIRED READING
1. A short article (Links to an external site.)Links to an external site. from Jan 20, 2013 Sunday NYT on
how drug manufacturers and law makers interact.
2. Shi and Singh, Chapter 2 (pages 72-86)
3. Emanuel book, Ch 1 (pages 17-33).
4. NYT Editorial, Krugman, “Why markets can’t cure healthcare” The New York Times, July, 25,
2009: Krugman health care and markets.pdf
5. WSJ Editorial, Mackey, “The Whole Foods Alternative to Obamacare” Wall Street Journal, Aug 11,
2009: The Whole Foods Alternative to Obamacare.pdf
6. Excellent, short (2-page), article by one of the US's most eminent health economists, Victor Fuchs,
reflecting on differences between the US and other OECD countries. Fuchs US & OECD differences
JAMA 2013.pdf
7. Recent, David Brooks NYT editorial in markets in health care. Brooks Do Markets Work in Health
Care NYT Jan 13 2017-1.pdf . Or Link (Links to an external site.)Links to an external site.
8. Arthur Brooks (President of the American Enterprise Institute); 15 min TED talk (Links to an external
site.)Links to an external site. on how conservatives and liberals can collaborate.
9. Atul Gawande's very quick and readable New Yorker article (Links to an external site.)Links to an
external site. on whether health care is a right.

Lecture 4, Wednesday, Jan 30, 2019: Health Insurance Principles, Part 1

REQUIRED READING
1. This 5 minute cartoon (Links to an external site.)Links to an external site. explains some basic facts
about how health insurance works.
2. This 12 minute video (Links to an external site.)Links to an external site. presentation is an
introduction to how the US Healthcare System works. NOTE that all of the videos in this Khan
Academy series are excellent, and several will be assigned during the course.
3. Emanuel, Ch 2 (Pages 34-67)
4. Shi and Singh, Chapter 1 (pages 2-10), and Chapter 6 (217-232).
5. Austin Frakt makes the argument in a NYT article (Links to an external site.)Links to an external
site. that health insurance is good for financial health.
6. Brief summary of lessons learn from Oregon Health Insurance Experiment. 2014 JPAL Summary of
Oregon Medicaid Experiment Jan 2014.pdf

Lecture 5, Friday, Feb 1, 2019: Health Insurance Principles, Part 2

REQUIRED READING
1. This short article describes what it is like for an educated and well-off woman and her family trying
to purchase insurance on the private, individual market. Dubinsky NYT article 2-19-11 on Health
Insurance.pdf
2. This 13 minute video (Links to an external site.)Links to an external site. Kahn Academy video
describes the basics of private insurance. All the Kahn Academy videos are good; feel free to look at
others
3. Short NY Times article (Links to an external site.)Links to an external site., Patients' Costs Skyrocket;
Specialists' Incomes Soar, NYT Jan 18, 2014.

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4. Short article (1.5 page) on the lack of price transparency in US healthcare. Reinhardt The Disruptive
Innovation of Price Transparency in Health Care JAMA Nov 2013.pdf
5. Short article in NYT (Links to an external site.)Links to an external site. by Kate Zernike article
explaining how tax subsidies help pay for private/commercial health insurance.
6. Shi and Singh, Chapter 3 (pages 95-130). This chapter provides excellent and very necessary
historical context for the more current day topics we will discuss in lecture.

Lecture 6, Monday, February 4, 2019: Private Insurance and the ACA

REQUIRED READING
1. NYT article by Bagley and Frakt: The problem with one-size fits all health insurance (Links to an
external site.)Links to an external site..
2. This NYT article by Sanger-Katz (Links to an external site.)Links to an external site. explains how
adverse selection impacts the Obamacare health exchanges.
3. This NYT article by Abelson (Links to an external site.)Links to an external site. discusses the
importance of cost in patients' insurance choices. Or in PDF: Abelson NYT Aug 2016.pdf
4. Jama article. Reinhardt Why are Health Insureres Losing Money on Obamacare Jama Oct 2016.pdf

5. See this Healthcare Triage blog, and view the 7 minute video (Links to an external site.)Links to an
external site., which suggests how exchanges could be "fixed" using principles that have previously
received bipartisan support in the Medicare program.
6. Do high-deductible plan make the health care system better? See this NPR Marketplace story (Links
to an external site.)Links to an external site..
7. I recommend that you go here (Links to an external site.)Links to an external site.and spend 30 mins
exploring to get a feel for how the Obamacare marketplace works. (Links to an external site.)Links
to an external site.

Lecture 7, Wednesday, February 6, 2019: Managed Care

REQUIRED READING
1. Wall Street Journal Article: “A Device to Kill Cancer, Lift Revenue”: December 7, 2010. WSJ prost CA
IMRT treatment.pdf
2. NYT article: Medicare payments surge for stents to unblock blood vessels in limbs. Creswell Abelson
NYT Medicare Payments Surge for Stents to Unblock Blood Vessels in Limbs Jan 29, 2015.pdf
or Link (Links to an external site.)Links to an external site.
3. Jan 20, 2014 Boston Globe article about "narrow networks" in the NH health exchange. Tracy NYT
Narrow Networks in NH Marketplace plans Jan 20 2014.pdf or Link (Links to an external
site.)Links to an external site.
4. Sanger-Katz NYT The Big Problem With High Health Care Deductibles Feb 5 2016.pdf
or Link (Links to an external site.)Links to an external site.
5. Shi and Singh, Chapter 9 (pages 359-393). Note that this is a particularly useful chapter.
6. This is a short description of the problems with narrow insurance networks (Links to an external
site.)Links to an external site..
7. From CMS, what people should know about narrow provider networks (Links to an external
site.)Links to an external site.

Lecture 8, Friday, February 8, 2019: Medicare 1

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REQUIRED READING
1. Please read these excellent, short documents.
o 2017 Nov KFF IB Overview of Medicare.pdf
o 2018 June KFF Issue Brief. 2018 June KFF IB Facts on Medicare Spending and
Financing.pdf
2. View this 15 minute Kahn Academy video (Links to an external site.)Links to an external
site. on Medicare.
3. Shi and Singh, Chapter 6 (pages 232-241)

Lecture 9, Monday, February 11, 2019: Medicare 2

REQUIRED READING
1. Take this Medicare quiz (Links to an external site.)Links to an external site.
2. Excellent, recent (Nov, 2018) NEJM article on Medicare Advantage. 2018 Neuman Jacobson MA
Checkup NEJM.pdf.
3. Excellent, recent (July, 2018) NEJM article on the Math of Entitlement Reform. 2018 Chernew Frakt
Entitlement spending in health NEJM.pdf
4. Excellent, recent (Oct, 2018) KFF Fact Sheet on Medicare Part D. 2018 Oct KFF Fact Sheet Overview
of Part D.pdf
5. Emanuel book, Ch 3 (pages 68-94)

Lecture 10, Wednesday, February 13, 2019: Medicaid 1

REQUIRED READING
1. The textbook has a very short section on Medicaid in Ch 6, pages 242-247.
2. 2017 Jan Fact Sheet Medicaid Pocket Primer.pdf
3. This paper from the Commonwealth Fund compares Medicaid with Private Insurance. 2017 CWF IB
Comparing Medicaid with Private Insurance.pdf
4. This 2017 NYT editorial (Links to an external site.)Links to an external site. reviews some common
misconceptions and misunderstandings about Medicaid and the elderly.

Lecture 11, Friday, February 15, 2019: Medicare 2

REQUIRED READING
1. This booklet (Links to an external site.)Links to an external site. has a series of stories about different
patients with Medicaid that help you to get a clearer sense of who has Medicaid and how it helps
them.
2. This 2016 KFF report (Links to an external site.)Links to an external site. describes how different
aspects of Medicaid vary across states.
3. Recent (April, 2018) KFF Issue Brief: 10 Things to Know About Medicaid. 2018 April IB 10-Things-to-
Know-about-Medicaid-Setting-the-Facts-Straight.pdf
4. Recent (Dec, 2018) KFF Issue Brief: Medicaid Work Requirements in Arkansas. 2018 Nov IB
Medicaid-Work-Requirements-in-Arkansas.pdf

Monday, February 18, 2019: PRESIDENT’S DAY, NO CLASS

Lecture 12, Wednesday, February 20, 2019: The Uninsured

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REQUIRED READING
1. This recent (Dec, 2017) KFF "Primer" summarizes much of what I would like you to learn from the
first 1/3 of this course. 2017 Dec The Uninsured A Primer.pdf
2. This recent (June, 2018) KFF Issue Brief examines uninsurance rates in states that did not expand
Medicaid. 2018 June KFF IB Uninsured in States that do not Expand Medicaid.pdf
3. This "Issue Brief" examines coverage by race and ethnicity. KFF IB Health Ins Coverage by Race &
Ethnicity Oct 2016.pdf
4. This is a short column from the NYT's Upshot on the successes and failures of the ACA, Margot
Sanger-Katz, Feb 5, 2017. 2017 Feb 5 Sanger-Katz Grading Obamacare NYT-1.pdf or Link (Links to
an external site.)Links to an external site.
5. This recent (Dec, 2017) NEJM article by Brown Political Science Prof James Morone discusses
Medicare for All. 2017 Morone Medicare for All NEJM.pdf

EXAM 1, Friday, February 22, 2019

Lecture 13, Monday February 25, 2019: Introduction to the Delivery System

REQUIRED READING
1. Shi and Singh, ch 4 (p 137-167)
2. Emanuel, Ch 4, (pages 95-124). The 5 problems that are identified in this chapter pull together a
number of the themes emphasized in the course so far.
3. Zeke Emanuel editorial from NYT Feb 25, 2018 on hospitals (Links to an external site.)Links to an
external site..
4. Oct 2018 NYT article in the role of rural hospitals (Links to an external site.)Links to an external
site. and the risks that ensue when they close.

Lecture 14, Wednesday, Feb 27, 2019: Primary Care 1

REQUIRED READING
1. The is a wonderful Jan 2017 New Yorker article by Atul Gawande that is very much about primary
care. See full article, Gawande The Heroism of Incremental Care full article Jan 2017.pdf or here is
the link to the New Yorker article (Links to an external site.)Links to an external site..
2. Recent NEJM commentary (short, 2 pages). Koven The Doctor's New Dilemma NEJM Feb 24
2016.pdf
3. July 2018 perspective (short, 2 pages) on the rewards of being a physician, which can easily be lost,
missed or forgotten in the face of the challenges of current practice. 2018 Rosenbaum Twitter
Tailwinds Little Capsules of Gratitude NEJM.pdf
4. This is a nice description of the building blocks of effective primary care. Bodenheimer et al 10
Building Blocks of High Performing Primary Care Ann Fam Med 2014.pdf
5. Shi and Singh, Ch 7, pages 273-282 only.

Lecture 15, Friday, March 1, 2019: Primary Care 2

REQUIRED READING

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1. This is an excellent summary of the current problems in primary care and proposed solutions; read it
carefully. Bodenheimer and Pham Primary Care Current Problems and Proposed Solutions Health
Affairs 2010.pdf
2. This 2016 NEJM article discusses the role of nurses in the primary care workforce. 2016
Bodenheimer Bauer Nurses in Primary Care NEJM.pdf
3. This short, October 2018 Kaiser Health News piece reviews the important role that foreign medical
graduates (Links to an external site.)Links to an external site. have in our health care system.
4. This November 2018 Health Affairs Blog reviews the challenges and opportunities (Links to an
external site.)Links to an external site. for change in primary care in the US. Is is the first of a 2-part
series; the second part is #1 of the NON-REQUIRED reading below.

Lecture 16, Monday March 4, 2019: The Patient Centered Medical Home

REQUIRED READING
1. This 4 minuteYouTube video explains the idea behind PCMHs.
2. This 4-page article is a very helpful summary of several of the themes that I hope to communicate in
series of lectures on primary care. Kilo and Wasson, both innovators in practice redesign in the US,
describe the history of practice design in the US in a way that will help you understand Patient
Centered Medical Homes. Kilo and Wasson Practice Redesign and the Patient-Centered Medical
Home Health Affairs 2010.pdf
3. This short (1.5 pages) JAMA commentary describes efforts made over the last 15 years by the Group
Heath Cooperative of Puget Sound innovate in their primary care. It is a nice summary of the
challenges to providing high quality primary care as experienced by a large and integrated care
system with a strong organizational commitment to primary care. Larson and Reid The Patient-
Centered Medical Home Movement Why Now JAMA 2010.pdf
4. This 3-page NEJM article describes 7 features of the care system in Grand Junction, CO, that have
made it a high quality, low cost, care locale. Bodenheimer and West Low Cost Lessions from Grand
Junction CO NEJM Oct 2010.pdf
5. Emanuel, Chapter 5 (pages 127-158)

Lecture 17, Wednesday March 6, 2019: Long Term Care and Nursing Homes (Thomas)

REQUIRED READING
1. Shi and Singh, Chapter 10 (pages 399-420). Note that this chapter is a well written and
comprehensive overview.
2. Concise 2015 review article on long-term services and supports written by Dr. Thomas. Thomas and
Applebaum LTSS PPAR 2015.pdf

Lecture 18, Friday March 8, 2019: End of Life and Palliative Care in America (Rudolph)

REQUIRED READING
1. Useful Infographic. EOL_Demographics.JAMA.2016.pdf
2. Trends in some measures of care of the chronically ill at the end of life (2.5
p). Dartmouth.Atlas_EOL_brief_061213.pdf

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3. Quantity and quality of life: duties of care in life-limiting illness, by Atul Gawande (2.5 p). Note that
there is a wonderful full length treatment of this topic, also by Adul Gawande, below under Non-
Required Readings. Gawande.JAMA_2016.pdf
4. Improving quality of care for serious illness: findings and recommendations of the Institute of
Medicine (IOM) Report on Dying in America, by James Tulsky, 2015 (1.5
pages). IOM.Report_Tulsky_JAMAInternalMedicine_2015.pdf
5. IOM Report: a call to action for nursing homes, 2015. IOM_Call.for.Action_Unroe_JAMDA_2014.pdf

Lecture 19, Monday March 11, 2019: Ambulatory Care

REQUIRED READING
1. Shi and Singh, Chapter 7 (pages 269-308).
2. This 2-page JAMA opinion piece (2013) is a very nice summary of how options for ambulatory
services for low acuity conditions is changing. Mehrotra Low Acuity Conditions JAMA Viewpoint
2013.pdf
3. This is an interesting 2 page NEJM commentary on how emergency departments have (and haven't)
changed over the last 50 years. Kellermann The ER 50 Years On NEJM 2011.pdf

Lecture 20, Wednesday, March 13, 2019: Hospitals (TBA)

REQUIRED READING
1. Shi and Singh, Chapter 8 (pages 315-353).
2. The article discusses a very important topic -- market concentration in health care. 2017 Fulton
Health Care Market Concentration HA.pdf
3. This Nov 14, 2018 NYT article on hospital mergers (Links to an external site.)Links to an external
site. touches on a number of important themes.

Lecture 21, Friday, March 15, 2019: Mental Health

REQUIRED READING
1. This 2016 Kaiser Health News article is a story about the struggles of a family to care for their
daughter, who developed mental illness as an adolescen (Links to an external site.)Links to an
external site.t.
2. Shi & Singh, Ch 11 (pages 441-444)
3. Why is mortality high in persons with mental illness? This is an easy to read, 2016 NEJM
paper. Rosenbaum Mortality Gap in Mental Illness NEJM 2016.pdf
4. This 2018 paper analyzes the Spring 2015 American College Health Association-National College
Health Assessment survey. Please read it for the main themes, not the methods or the detailed
results. 2018 Liu_Mental_Health_Suicide_College Depress Anxiety.pdf
5. Please spend 20-30 minutes looking at the charts in this document that details rates of different
types of mental illness, by state, in the US. You are not responsible for any of the details, but try to
get a sense of the epidemiology of mental health problems in the US and state-level variations. 2017
MH in America Full.pdf

Lecture 22. Monday, March 18, 2019: Why are prescription drug costs so high? (Aubert)

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REQUIRED READING To Be Decided

SECOND EXAM: Wednesday March 20, 2019

Friday, March 22, 2019: Day before spring break, NO CLASS

Monday March 26 to Friday March 30 NON CLASS, SPRING BREAK

Lecture 23, Monday, April 1, 2019: Introduction into Regulation and Quality

REQUIRED READING
1. Jonas textbook Eighth Edition 2017 Ch 4.pdf
2. Short piece on why health care regulation is complex. Field Why is Health Care Regulation so
Complex P&T 2008.pdf

Lecture 24, Wednesday, April 3, 2019: Quality Measurement 1

REQUIRED READING
1. Shi and Singh, Chapter 12 (pages 487-529).
2. This very recent NEJM article makes a strong argument in favor of measuring health outcomes, and
not processes of care, in the pursuit of a higher quality health care system. Porter ME et al
Standardizing Patient Outcomes Measurment NEJM 2016-1.pdf

Lecture 25, Friday, April 5, 2019: Quality Measurement 2

REQUIRED READING
1. This New Yorker article was widely read by policymakers in Washington when it came out In 2009,
and President Obama recommended it to those interested in health care reform. Please read it
carefully; it is a fun read. Gawande The Cost Conundrum New Yorker 2009.docx
2. This is a 2015 New Yorker article, again by Atul Gawande, about overtreatment, with a follow up on
McAllen TX at the end. Very readable and interesting. Link (Links to an external site.)Links to an
external site.

Lecture 26, Monday, April 8, 2019: ACOs and Pay for Performance

REQUIRED READING
1. Please read this Kaiser Family Foundation Report, published in February 2016. It is about 25 pages
long. Please read the Executive Summary carefully. In the sections that describe Medical Homes,
ACOs, and Bundled Payments, I am most concerned that you understand 1) what these 3 types of
reforms are, 2) conceptually, how they should improve quality and reduce cost, and 3) what the
early data show about their impact. KFF Primer on Payment and Delivery System Reform in
Medicare Feb 2016-1.pdf
2. This Feb 2018 JAMA Viewpoint describes some of the complexities of implementing ACOs "on the
front lines." 2018 Ganguli Ferris Accountable Care at the front lines JAMA.pdf

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3. This Dec 2018 JAMA Viewpoint suggests that there are basic flaws in the ways in which Pay-For-
Performance reimbursement models work. 2018 Khuller Wulfson Casalino Professionalism,
Performance and the Future of Physician Payment Incentives JAMA.pdf
4. The Kaiser Family Foundation has created a tremendous resource on Medicare Delivery System
Reform. Go to the site, and spend 20-30 minutes exploring. Click in the 3 FAQ links on the home
page on Medicare ACOs (Links to an external site.)Links to an external site., Medicare Medical Home
Models (Links to an external site.)Links to an external site., and Medicare Bundled Payment
Models (Links to an external site.)Links to an external site. as a way to insure that you understand
these models and what the early evidence says about their effectiveness.

Lecture 27, Wednesday, April 10, 2019: Federal Agencies (TBA)

REQUIRED READING
1. Shi and Singh, Ch 13 (pages 537-561).
2. CMS_Organizational_Chart.pdf (Links to an external site.)Links to an external site.

Lecture 28, Friday, April 12, 2019: Quality Improvement and the EHR (Sarkar)

REQUIRED READINGS
1. This 2017 paper discusses some of the challenges the health IT still has to address and overcome in
order to provide the value that many believe it can. 2017 Adler-Milstein et al Crossing the health IT
chasm JMIA.pdf
2. This 2017 paper also discusses the as of yet unrealized potential of health IT to transform our health
care system, and makes some suggestions about future directions. 2017 Mandl Kohane 21st Cent
Health IT NEJM.pdf
3. This 2018 New Yorker article by Atul Gawande is titled, Why Physicians Hate Their Computers (Links
to an external site.)Links to an external site..

Lecture 29, Monday, April 15, 2019: Health Care Disparities (Alexander-Scott)

REQUIRED READINGS
1. This is a brief introduction to the topic. KFF IB Disparities in Health and Health Care Aug 2016.pdf
2. This is a more detailed treatment of disparities, with data on disparities by racial and ethnic
group. KFF Chartpack Key Health Care Facts by Race and Ethnicity June 2016.pdf
3. This reading is 5 pages of testimony (Links to an external site.)Links to an external site. submitted by
Samantha Artiga, Director, Disparities Policy Project, The Henry J. Kaiser Family Foundation, to
Congress in March of 2017.
4. Listen to this 7-minute Sept 2018 video on Black Maternal Mortality (Links to an external site.)Links
to an external site..

Lecture 30, Wednesday, April 17, 2019: Current Politics of Health Care Reform

REQUIRED READING
1. Emanuel book, Ch 6 (pages 159-187). Here the challenges of enacting the ACA are described.
2. Two NEJM Perspectives (April and September, 2017) by Jonathan Oberlander describing the
Republicans difficulties during the first year of the Trump administration trying to repeal and/or
replace the ACA.

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o 2017 April Oberlander Republicans Health Care Reform Muddle NEJM.pdf

o 2017 Sept Oberlander Reps Health Care Quagmire NEJM.pdf

Lecture 31, Friday, April 19, 2019: The Role of the States in Health Care Regulation

REQUIRED READING
1. Shi and Singh, you have already read Ch 13, but please review pages 541-550.
2. This is a 15-page chapter from a book edited by Jim Morone on the federal-state relationship in
health. Morone book ch 6 on federalism.pdf
3. Review Chapter 4 from Jonas' Introduction to the US Health Care System, which was previously
assigned for the lecture on Introduction to Quality and Regulation (April 2).

Lecture 32, Monday, April 22, 2019: Womens’ and Reproductive Health

REQUIRED READING
1. How the ACA has helped women gain insurance and improved their ability to get health care (Links
to an external site.)Links to an external site.
2. This article, published in the Lancet in 2002 reviews the scope and magnitude of violence against
women globally. 2002 Watts Zimmerman Violence against Women Lancet.pdf
3. Chapter 19 of Jim Morone’s 2013 textbook (Health, Politics, and Policy, 5th edition,
2013), “Reproductive Health,” by Deborah R. McFarlane, is a nice, short summary of the history and
politics of reproductive health in the US. Morone Ch 19.pdf

Lecture 33, Wednesday, April 24, 2019: Health Care Costs in the US

REQUIRED READING
1. Shi and Singh, Ch 14 (pages 565-590).
2. Politico Pro Datapoint a-brief-history-of-us-health-care-spending Sept 2016.pdf
3. Jan 2018 Frakt and Carroll NYT article (Links to an external site.)Links to an external site. on why
health care costs are more in the US than in European countries.
4. In this Sept 2018 JAMA article, eminent health economist Victor Fuchs discusses the efficiency of
medical care in the US. 2018 Fuchs Is US Medical Care Inefficient JAMA.pdf

FINAL EXAM, MAY 10, 2019, 2PM

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