Health Care Policy Fall, 2002

Professor Gunnar Almgren

Class Meeting Times: Thursdays 1:30-4:20 P.M. , SWS 230

Office: SW 127L

Office Hours: Thursdays 8:30 AM or by appointment Phone: 685-4077, e-mail mukboy@u.washington.edu

Web Homepage: http://faculty.washington.edu/mukboy/home/almgren.htm

The intent of this course is to acquaint future social work professionals in health care with the organization of the U.S. health care system, the historical development and current structure of health care policy at the state and national level, the basic features and professional challenges posed by managed care, and contemporary policy issues as they relate to the values and political agenda of the social work profession.

The course begins by providing an overview of alternative frameworks for health policy analysis, followed by an historical review of the organization of American medicine and health care policy from a political economy perspective. The course content then shifts to a more in-depth analysis of the role of race and social class in determining access to both health and health care. The next part of the course content then embarks on a comparative cross-national analysis of the development, organization, and financing of the health care system in the United States, with particular attention to the values, beliefs, social institutions, public policies, and specific actions of government that have shaped its structure. The course then embarks on a specific examination of the structure, processes, and policy implications of managed care and the "corporatization" of American health care. The next two weeks of the course then considers two special areas of policy focus: long term care and an examination of contemporary debates concerning the role of distributive justice in determining the limits of medical intervention.

The final weeks of the course consider current national and local policy trends in the financing of health care, with special emphasis on implications for the poor. Because we are in the midst of a vigorous and critical national debate on pharmaceutical benefits and pricing practices, we conclude the course with a consideration of this issue and its policy implications.

The learning objectives of the course are as follows:

Readings In order to strike a balance possible between availability of course material and prohibitive expense, I have used a combination of two softcover texts, and a list of selected papers and reports I have made available on my instructional website, and some readings on 4 hour reserve at the SSW library. I will also, from time to time, recommend source materials be reviewed on the web. The required texts are:

Schamess and Lightburn, Humane Managed Care? (1998 NASW Press), available through University Bookstore at $29.95 (used $22.50).

Bodenheimer and Grumbach. Understanding Health policy : A Clinical Approach. New York : London : Lange Medical Books/McGraw-Hill, 2002. Available through University Bookstore at $34.95.

Although the assigned readings for the first class session do not need to be read in advance, it is expected that students will have read the assigned readings in advance of all other class sessions. You will probably find the readings vary greatly to extent that they are easy or difficult to grasp. The most informative readings are sometimes conceptually abstract and require close analysis from the reader. The best advice is to avoid trying to read all of the assigned articles in one sitting and be willing to bring up points that seem confusing during class discussion. There is a tremendous amount of material related to health care policy, and I have endeavored to be selective and keep the expectations reasonable and consistent with graduate level work.

Internet Resources: Over the past few years, various organizations concerned with health care policy have established websites for the dissemination and exchange of information and commentary. In fact, many of the selected readings and reports I have made available on my instructional website are far more timely and relevant than current professional journal articles. You will find on my instructional website several health policy links that collectively many of the issues of core relevance to health policy.

There are three assignments in the course which collectively are 100% of the course grade. All three assignments are designed to contribute to your learning.

Assignment #1 Discussion Questions (20% course grade)

At various times throughout the quarter I will be handing out discussion questions that are based on some of that week’s assigned readings. Handwritten responses to the questions are entirely acceptable, as long as the writing is neat and legible. The questions will always be due at the end of the following week’s class and will be used as a basis for in-class discussion of the readings. Grading will be based upon the extent to which the responses show mastery of the reading material and evidence of critical thinking.

Assignment #2 Small Employer Survey Project (50% of grade, due December 16th)

The most determinant structural feature of U.S. healthcare system is its status as primarily an employment based health care insurance system. Although many employers spend a significant proportion of their revenue on employee health insurance, small employers are not required by law to provide their employees with health care insurance and larger employers can avoid the costs of contributing to health care insurance by using temporary and part-time employees. Minorities and women are particularly harmed by these practices in that they are far more likely to work for small employers, or on a part-time basis for large employers.

This assignment requires you to survey the businesses you most often patronize in order to gain information on three issues that are fundamental to health care access issues:

1. The extent to which the business provides or participates in the provision of health care coverage for their employees.
2. What type of constraints (e.g. relevant state and federal labor laws, labor contracts) are operating that compel the employer to provide health care insurance.
3. What, from the business owner’s point of view, is the most realistic and equitable means providing health care insurance coverage for employees and their families.

A second part of this assignment requires you to summarize your findings and identify the major policy implications. By the second week in class, I will hand out a specific set of guidelines and helpful suggestions for this assignment.

Assignment #3 Final Paper (30% of grade, due December 16th)

There are two options for the final paper. The choice of the option depends upon the knowledge base and learning goals of the individual student. Students who have little familiarity with the entitlements and limitations of medicare, medicaid, Washington State Basic Health Plan, and laws governing health care decision-making may find "Option #1 -The Policy Treasure Hunt" to be more consistent with their current career preparation priorities. On the other hand, Option #2 may be better suited to students who feel they have at least of working knowledge of key public laws and programs and want to explore a specific health care policy issue in more depth (e.g. Are government price controls of pharmaceuticals a necessary step to the expansion of pharmaceutical benefits?). Students will have a few weeks to think about their personal learning goals and then will need to inform me of which option they would prefer by the fourth week of class. As a part of making this decision, students to may want to discuss with me how either of these assignments could be used to further their personal learning goals.

By the fourth week of the quarter I will distribute four sample cases and 1-2 questions on each case that will require the student to do some research on applicable health care policy. I will also guide the student to source materials or agencies for answers. The cases will be relevant to policy and program issues both at the state and federal level, and will address such issues as the eligibility for medicaid assistance, medicare coverage, and the right to make particular kinds of health care decisions. The purpose of the assignment is to provide some in-depth learning of health care policy and public program issues as they are likely to come up in everyday professional practice in health care settings. The completed questions are will be due by December 14th, though students are strongly encouraged to not to wait until the last week of the quarter to work on this assignment.

Students may choose to do a focused research paper on a chosen aspect of health care policy that is of particular interest to the student (e.g. accessibility of health care to undocumented farm workers or as mentioned previously the issue of government price controls for pharmaceuticals). The purpose of this assignment is to provide the student with an opportunity to an in-depth exploration of an important health care policy issue. The result of this assignment is a research paper of modest length (10 or so pages), to be handed in by December 16th.

Grading standards applied in this course will be consistent with those described in the University Handbook (Chapter 11, Section 1). Assignments that are graded at or above a 3.7 will need to be completed by the due date, reflect high standards of organization, include consideration of the key issues, and demonstrate graduate level critical thinking skills. Although the two major assignments do not need to be handed in until December 18th, I would be glad to review rough drafts/works in progress at any point prior to the last week of class if any student would like feedback prior to the final due date.

If you would like to request academic accommodations due to a disability, please contact Disabled Student Services, 448 Schmitz, 206-543-8924 (V/TTY). If you have a letter from Disabled Student Services indicating you have a disability that requires academic accommodations, please present the letter to me so we can discuss the accommodations you might need for this class.

No. 9 Bedetti, Duchan, Schoen and Shikles (1999). Can't Afford to Get Sick: A Reality for Millions of Working Americans . The Commonwealth Fund.

No. 10 Racial and Ethnic Disparities in Access to Health Care. UCLA Center for Health Policy Research and the Henry T. Kaiser Foundation.

No. 14. Canada's Healthcare System. Health Care Policy Division. Health Canada.

No. 15. Anderson, Gerald (1998). Multinational Comparisons of Health Care : Expenditures, Coverage, and Outcomes. Center for Hospital Finance and Management Johns Hopkins University

Schamess and Lightburn. Humane Managed Care?:

No 25 Guyer, Jocelyn (2000). Health Care after Welfare: An Update of Findings from State-Level Leavel Studies. Center on Budget and Policy Priorities. (read Executive Summary and Chapter VI, summary and conclusions).

No 29 Goozner, Merrill. (2000) The Price Isn't Right. The American Prospect. Vol 11 (20)

No 30 Calfee, John. (1999) Why Pharmaceutical Price Controls Are Bad for Patients. American Enterprise Institute for Public Policy Research.

No 31 Haase and Aldrich (2000). An Outpatient Prescription Drug Benefit for Medicare. The Century Foundation.

*No 33 Fuchs, James, Mays and Schaefer (2000) Analyzing Options to Cover Prescription Drugs for Medicare Beneficiaries. The Henry J. Kaiser Foundation.

No 34 The Best Value in Medicine Today: How Prescription Drugs Account for a Fraction of the Health Care Cost Increases While Helping to Offset Other Health Care Costs. PhRMA Policy Papers June 2002.