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University of FloridaCollege of Public Health & Health Professions Syllabus

Course Number: HSA 7905 (credit hours: 3)Course Name: Advanced Health Economics

Semester: 2019 springClass Times: N/AClass Room: N/A

Delivery Format: Advanced Independent StudyCourse Website available in Canvas

Instructor Name: Jinhai (Stephen) Huo, PhD, MD, MsPHRoom Number: HPNP 3111Phone Number: 352-273-5335Email Address: JHuo@ufl.eduOffice Hours: By appointmentPreferred Course Communications (e.g., email, office phone): Email

Prerequisites: HSA 6436 Health Economics

PURPOSE AND OUTCOME

Course Overview

Students are expected to gain competency in using economic theory and research methods to examine questions of efficiency and equity in health care.

Course Objectives and Goals

Upon completion of the course, students should be able to: Be familiar with the major questions that economics addresses in the health care area.

Understand the major economic theories and empirical techniques used to conduct economic analyses.

Be able to critically review the professional literature in health economics.

Be able to present research ideas and summaries of the research of others to colleagues.

Instructional Methods

Independent Study

Disclaimer

This syllabus represents my current plans and objectives. As we go through the semester, those plans may need to change to enhance the class learning opportunity. Such changes, communicated clearly, are not unusual and should be expected.

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DESCRIPTION OF COURSE CONTENT

Topical Outline/Course Schedule

Week Date(s) Topic(s)1 Jan 7 Course Orientation and Introduction

2 Jan 14 Demand for Health

3 Jan 21 Martin Luther King Jr. Day

4 Jan 28 Behavioral Economics

5 Feb 4 Demand for Health Care Services

6 Feb 11 Disparities in Access to Health Care Services

7 Feb 18 Medical Practice Variation

8 Feb 25 Comparative Effectiveness Research

9 Mar 4 Spring Break

10 Mar 11 Value Based Healthcare and Pay-for-Performance

11 Mar 18 Healthcare Reform; Concepts and Models

12 Mar 25 Healthcare Reform The Patient Protection and Affordable Care Act

13 Apr 1 Economic Development and Population Health in Low Income Countries

14 Apr 8 Term Papers

15 Apr 15 Term Papers

16 Apr 22 Final Project Due

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Course Materials and Technology

Textbooks: None

Other Reading: (All reading materials below are accessible through Canvas, Google Scholar, and Google on campus)

Week 1 Course Orientation and Introduction

Required Readings:

* Arrow, K. "Uncertainty and the Welfare Economics of Medical Care." American Economic Review. December 1963, 53(1):941-973. (End at bibliography, do not read the appendix section)

* Rice, T. and Unruh, L. The Economics of Health Reconsidered, third edition, 2009, pp. 1-7, 291-316, 356-370, 371-373.

Optional Readings:

Kenneth J. Arrow, K. (2009) Some Developments in Economic Theory since 1940: An Eyewitness Account. Annual Rev. Economics, 2009. 1:1–16

Iglehart, John K. “Grasping the Role of Technology: A Conversation with Ron Dollens” Health Affairs Web Exclusive, June 2005, w5 296- w5 313.

Dranove, D. and Satterthwaite, M.A. “The Industrial Organization of Health Care Markets,” in, Handbook of Health Economics, vol. 1B, A.J. Culyer and J.P. Newhouse, eds., Elsevier, Amsterdam. 2000, pp. 1094-1103 and 1111-1135.

Maynard, A. and K. Bloor. Our Certain Fate: Rationing In Health Care. Office of Health Economics, London, November 1998. pp. 7-48.

Fuchs, V. "Economics, Values, and Health Care Reform." American Economic Review, March 1996, 86:1-24.

Fuchs V.R. The Health Economy, Introduction, Chapters 1 and 2. Harvard University Press, Cambridge, MA, 1986, pp. 1-46.

Reinhardt, U. "A Social Contract for 21st Century Health Care: Three-Tier Health Care with Bounty Hunting." Health Economics, 1996, 5:479-499.

Aaron H. Serious and Unstable Condition: Financing America's Health Care. The Brookings Institute, Washington, DC, 1991.

Williams A. "Health Economics: The Cheerful Face of the Dismal Science?" Health and Economics, Alan Williams/Editor, MacMillan Press, London, 1987, pp. 1-11.

Newhouse J. "An Iconoclastic View of Health Cost Containment." Health Affairs, Vol. 12, Supplement, 1993, 152-171.

Week 2 Demand for Health

Required Readings:

* Grossman, M. “On the Concept of Health Capital and the Demand for Health." Journal of Political Economy, March/April 1972, 223-255.

* Grossman, M. “The demand for health, 30 years later: a very personal retrospective and prospective reflection.” Journal of Health Economics 23 (2004) 629–636.

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* Leibowitz, A. “The demand for health and health concerns after 30 years.” Journal of Health Economics 23 (2004) 663–671

* Cutler, D., Lleras-Muney, A. “Understanding Differences in Health Behaviors by Education” Journal of Health Economics 29 (2010) 1-28.

Optional Readings:

Shin-Yi Chou, Michael Grossman, Henry Saffer “An economic analysis of adult obesity: results from the Behavioral Risk Factor Surveillance System.” Journal of Health Economics 23 (2004) 565–587

Grossman M. “The Human Capital Model of the Demand for Health, Working Paper 7078. National Bureau of Economic Research, Cambridge MA, April 1999.

Murphy, M. and R. Topel “The value of health and longevity”. Journal of Political Economy, 114, No. 5 (2006) 871-904.

Ulf-G. Gerdtham, Johnson, Magnus “New estimates of the demand for health: Results based on a Categorical Health Measure and Swedish Micro Data. Social Science and Medicine 49, 1999, pp. 1325-1332.

U.-G. Gerdtham, M. Johannesson, L. Lundberg, and D. Isacson. “The demand for health: Results from new measures of health capital. European Journal of Political Economy, 15, 1999, pp.501-521.

Zweifel, P. and F. Breyer. Health Economics. Oxford University Press, New York, 1997, Chapters 3 and 4, pp. 52-126.

Folland, S., Goodman, A., Stano, M. The Economics of Health and Health Care, Prentice-Hall, Englewood Cliffs N.J., 2001, Chap. 7, pp. 137-152. ON RESERVE IN LIBRARY

Corman H., Grossman M. "Determinants of Neonatal Mortality Rates in the U.S.: A Reduced Form Model." Journal of Health Economics, 4(3), September 1985, pp. 213-236.

Wagstaff A., "The demand for health: Some new empirical evidence." Journal of Health Economics 1986, 5, 195-234.

Leigh J.P. “Direct and Indirect Effects of Education on Health.” Social Science and Medicine 1983, 17, 227-234.

Muurinen J. "Demand for Health." Journal of Health Economics, 1982:1, 5-28.

Grossman M. "The Demand for Health after a Decade." Journal of Health Economics, 1982, 1:1-3.

Grossman M. The Demand for Health: A Theoretical and Empirical Analysis, N.B.E.R., the Occupational Paper 119, 1972.

Smith, J. "Healthy Bodies and Thick Wallets: The Dual Relation Between Health and Economic Status.” Journal of Economic Perspectives 13(2):145-166.

Fuchs V, “Poverty and Health: Asking the Right Questions.” In Who Shall Live? Health, Economics, and Social Change, World Scientific, Singapore, pp. 165-176. 1998.

Week 3 Martin Luther King Jr. Day

Week 4 Behavioral Economics

Required Readings:

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* Frank RG. Behavioral Economics and Health Economics. NBER Working Paper No. 10881. November 2004.

* Charness G, Gneezy U. Incentives to Exercise. Econometrica. 2009; 77(3):909-931.

* Mehrotra, A., Sobero, M., Damberg, C. “Using the Lessons of Behavioral Economics to Design More Effective Pay-for-Performance Programs” Am J Manag Care. 2010; 16(7):497-503 * Halpern SD, Ubel PA, Asch DA. Harnessing the Power of Default Options to Improve Health Care. New England Journal of Medicine. 2007; 357(13):1340-1344.

Optional Readings:

Kahneman D, Tversky A. Prospect Theory: An Analysis of Decision under Risk. Econometrica. 1979; 47(2):263-291.

Tversky A, Kahneman D. Loss Aversion in Riskless Choice: A Reference-Dependent Model. The Quarterly Journal of Economics. November 1, 1991 1991; 106(4):1039-1061.

Becker G, Murphy K. A Theory of Rational Addiction. Journal of Political Economy. 1988; 96(4):675-700.

Volpp KG, Troxel AB, Pauly MV, et al. A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation. New England Journal of Medicine. 2009; 360(7):699-709.Kahneman D, Tversky A. Choices, values, and frames. American Psychologist. 1984; 39(4):341-350.

Fagerlin A, Zikmund-Fisher BJ, Ubel PA. How making a risk estimate can change the feel of that risk: shifting attitudes toward breast cancer risk in a general public survey. Patient Education and Counseling. 2005; 57(3):294-299.

Week 5 Demand for Health Care Services

Required Readings:

* Martin, A., Lassman, D., Whittle, L. et al., 2011. “Recession Contributes To Slowest Annual Rate Of Increase In Health Spending In Five Decades”. Health Affairs. 30(1): 11-22.

* Manning et al., "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment." The American Economic Review, June 1987:77(3). pp. 251-277.

* Finklestein, et al. (2011) “The Oregon Health Insurance Experiment: Evidence from the First Year”. NBER Working Paper No. w17190 * Picone et al (2004) "The effect of risk and time preference and expected longevity on Demand for Medical Tests", Journal of Risk and Uncertainty 28:1, pp 39-53 .

Optional Readings:

Contoyannis, P. et al. (2005) “Estimating the price elasticity of expenditure for prescription drugs in the presence of non-linear price schedules: an illustration from Quebec, Canada”, Health Economics 14: 909-923.

Kenkel, Donald S. “The demand for preventive medical care”, Applied Economics 26, pp. 313-325, 1994.

Newhouse JP. "Controlled Experimentation as Research Policy, 1991." Health Services Research: Key to Federal Policy, Eli Ginzberg/Editor, pp. 161-194.

Newhouse, J.P., 1993. Free for All: Lessons from the RAND Health Insurance Experiment, Harvard University Press, Cambridge, MA.

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Coffey RM. "The Effect of Time Price on the Demand for Medical Care Services." The Journal of Human Resources, 1982:18(3), 407-424.

O'Grady, K. F., et al., "The Impact of Cost Sharing on Emergency Department Use." The New England Journal of Medicine, August 22, 1985:313, 484-490.

Duan N et al., "A Comparison of Alternative Models for the Demand for Medical Care." Journal Business Economic Statistics, 1983, 1:115-127.

Keeler EB, Rolph JE. "The Demand for Episodes of Treatment in the Health Insurance Experiment", Journal of Health Economics, December 1988:7(4), 337-367.

Welch, BL. Hay JW et al., "The Rand Health Insurance Study: A Summary Critique". Medical Care, 1987:25(2), pp. 148-156.

Newhouse, J. P., Manning, W. G., et al., "The Findings of the Rand Health Insurance Experiment -- A Response to Welch et al". Medical Care, 1987:25(2), pp. 157-179.

Hillman, A. L. et al. “Financial Incentives and Drug Spending in Managed Care.” Health Affairs, 1999, 18(2):189-200.

Folland, S., Goodman, A., Stano, M. The Economics of Health and Health Care, Fourth Edition, Prentice-Hall, Upper Saddle River, N.J., 2004, Chap. 9, pp. 176-198. ON RESERVE IN LIBRARY

Hsieh, C, Lin, S. “Health Information and the Demand for Preventive Health Care among the Elderly in Taiwan.” The Journal of Human Resources, 1997, 32(2):308.

Week 6 Disparities in Access to Health Care Services

Required Readings:

* Hebert PL, Sisk JE, Howell EA, “When Does a Difference Become a Disparity? Conceptualizing Racial and Ethnic Disparities in Health” Health Affairs, 2008:27(2), pp. 374-382

* Le Cook B, Macguire TG, Zuvekas SH, “ Measuring Trends in Racial/Ethnic Health Care Disparities” Medical Care Research and Review, 2009:66(1), pp. 23-48 * Fiscella K, “ Health Care Reform and Equity: Promise, Pitfalls, and Prescriptions”. Annals of Family Medicine, 2011:9(1), pp. 78-84

Optional Readings:

Institute of Medicine of the National Academies. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: National Academies Press; 2003

Lurie N, Dubovich T, Health Disparities and Access to Health, JAMA. 2007; 297:1118-1121.

JB Kirby, G Taliaferro, SH Zuvekas Explaining racial and ethnic disparities in health care Medical care, 44(5) suppl: I-64-I-72, May 2006.

Headen, A. E., Jr., N. A. Masia, et al. (2006). “Effects of Medicaid access restrictions on statin utilization for patients treated by physicians practising in poor and minority neighbourhoods.” Pharmacoeconomics 3: 41-53.

Waldman, H. B. and S. P. Perlman (2006). “Children with special health care needs: Results of a national survey.” Journal of Dentistry for Children 73(1): 57-62.

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LaVeist TA, Gaskin D, Richard P, “Estimating the Economic Burden of Racial Health Inequalities in the United States”. International Journal of Health Services: Planning, Administration, Evaluation, 2011:41(2), pp.231-238

Goddard M, “ Access to Health Care Services- an English Policy Perspective” Health Economics, Policy, and Law, 2009:4, pp.195-208

Jones RG, Trivedi AN, Ayanian JZ, “ Factors Influencing the Effectiveness of Interventions to Reduce Racial and Ethnic Disparities in Health Care” Social Science and Medicine, 2010:70(3), pp. 337-341

Williams JA, Byles JE, Inder KJ, “Equity of Access to Cardiac Rehabilitation: the Role of System Factors” International Journal for Equity in Health, 2010:9, pp.2 Zuvekas SH, Tallaferro GS, Pathways to Access: Health Insurance, the Health Care Delivery System, and Racial/Ethinic Disparities, 1996-1999, Health Affairs 2003; 22(2) pp 139-153.

Hargraves JH and Hadley J, The Contribution of Insurance Coverage and Community Resources to Reducing Racial/ Ethnic Disparities in Access to Care, Health Services Research 2003; 38(3) pp809-829.

Friedman, E. (2005). “Health insurance, the uninsured, and hospitals: collision course. [See comment].” Frontiers of Health Services Management 21(4): 3-15.

Cunningham, P. J., J. Hadley, et al. (2007). “Identifying affordable sources of medical care among uninsured persons.” Health Services Research 42(1 Pt 1): 265-85.

Bazzoli, G. J., R. C. Lindrooth, et al. (2006). “The influence of health policy and market factors on the hospital safety net.” Health Services Research 41(4 Pt 1): 1159-80.

Weinick RM, Zuvekas SH and Cohen JW, Racial and Ethnic Differences in Access to and Use of Health Care Services, 1977 to 1996, Medical Care Research and Review, 2000; 57 Suppl.1 pp 36-54

Week 7 Medical Practice Variation

Required Readings:

* Bach PB. A map to bad policy: hospital efficiency measures in the Dartmouth Atlas. N Engl J Med. 2010; 362(7):569–573, pmid: 20164483.

* Sutherland, Jason M., Fisher, Elliott S., Skinner, Jonathan S., (2009) Getting Past Denial — The High Cost of Health Care in the United States. New England Journal of Medicine 361:13, 1227-1230

* Song Y, Skinner J, Bynum J, Sutherland J, Wennberg JE, Fisher ES. Regional variations in diagnostic practices. N Engl J Med 2010; 363:45-53

* Zuckerman, Stephen, Waidmann, Timothy, Berenson, Robert, Hadley, Jack, (2010) Clarifying Sources of Geographic Differences in Medicare Spending. New England Journal of Medicine 363:1, 54-62

Optional Readings:

Gawande A. The cost conundrum: what a Texas town can teach us about health care. New Yorker. 2009 Jun 1.

The Medicare Payment Advisory Commission (MedPAC). Report to the Congress: Measuring Regional Variation in Service Use. Washington, DC. 2011

Skinner JS. A New Series of Medicare Expenditure Measures by Hospital Referral Region: 2003-2008. A Report of the Dartmouth Atlas Project (2011). The Dartmouth Institute for Health Policy and Clinical Practice.

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Skinner J, Staiger D, Fisher ES. Looking back, moving forward. N Engl J Med. 2010; 362(7):569–574, pmid: 20164482.

Fisher ES, Bynum JP, Skinner JS. Slowing the growth of health care costs – lessons from regional variation. N Engl J Med 2009; 360:849-852

Week 8 Comparative Effectiveness Research

Required Readings:

* Luce, B., Drummond, M., Jo¨nsson, B., Neumann, P., Schwartz, S., Siebert, U., Sullivan, S. (2010). EBM, HTA, and CER: Clearing the Confusion. The Milbank Quarterly, Vol. 88, No. 2, 256–276.

* McClellan, M., Leonard D. Schaeffer, L., Benner, J. (2009). Comparative Effectiveness Research: Will It Bend the Health Care Cost Curve and Improve Quality? Implementing Comparative Effectiveness Research: Priorities, Methods and Impact. Brookings, pp. 7-14.

* Garber, M., Meltzer, D. (2009) Setting Priorities for Comparative Effectiveness Research, Implementing Comparative Effectiveness Research: Priorities, Methods and Impact. Brookings, pp. 15-34. * Wu, A., Snyder C., Clancy C., Steinwachs, D. (2010). Adding the patient perspective to comparative effectiveness research, Health Affairs, (10):1863-71; * Teutsch SM, Fielding JE. (2011). Applying comparative effectiveness research to public and population health initiatives, Health Affairs, 30(2):349-55.

Optional Readings:

Tunis, S., Strategies to Improve Comparative Effectiveness Research Methods and Data Infrastructure, (2009). Comparative Effectiveness Research: Priorities, Methods and Impact. Brookings, pp. 35-55.

Sox, H., Greenfield, S. Comparative Effectiveness Research: A Report from the Institute of Medicine. Annals of Internal Medicine, Vol. 151, 2009, pp. 203-205.

Pearson, S., From Better Evidence to Better Care: Using Comparative Effectiveness Research to Guide Practice and Policy, Implementing Comparative Effectiveness Research: Priorities, Methods and Impact. (2009) Brookings, pp. 35-54.

Congressional budget Office (2007) Research on the Comparative Effectiveness of Medical Treatments.

Chokshi D., Avorn, J, Kesselheim, A. (2010). Designing comparative effectiveness research on prescription drugs: lessons from the clinical trial literature, (10):1842-8.

Institute of Medicine (2011). 100 Initial Priorities for Comparative Effectiveness Research, pp.1-7.

Basu A. (2011) Economics of individualization in comparative effectiveness research and a basis for a patient-centered health care. Journal of Health Economics, (3): 549-59. Epub 2011 Apr 23.

Lavis, J., Oxman, A., Simon Lewin, S., Fretheim, A. (2009). SUPPORT Tools for evidence-informed health policymaking. Health Research Policy and Systems, 7 (Suppl 1): doi: 10.1186/1478-4505-7-S1-I1.

Béland, .S, Tournier, M., Galbaud du Fort, G., Crott, R., Ducruet, T., Pariente, A., Moride, Y. (2011). Economic impact of nonpersistence with antidepressant treatment in the adult population of Quebec: A comparative cost-effectiveness approach, 14(4):492-8. Epub 2011 Apr 22.

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American College of Physicians. Improved Availability of Comparative Effectiveness Information: An Essential Feature for a High-Quality and Efficient United States Health Care System. Philadelphia: American College of Physicians; 2008: Position Paper.

Agency for Healthcare Research and Quality. Particle Beam Radiation Therapies for Cancer Executive Summary. September 2009

Etheredge, Lynn. “Medicare’s Future: Cancer Care”. Health Affairs Vol. 28, No. 1, 2009, pp. 148-159.

Skinner, J, Staiger, D., Fisher, E. “Is Technological Change In Medicine Always Worth It? The Case of Acute Myocardial Infarction”. Health Affairs, Web Exclusive 7 February 2006, w34-w47.

Pearson, Steven. From better evidence to better care: Using comparative effectiveness research to guide practice and policy. Implementing Comparative Effectiveness Research: Priorities, Methods and Impact. Brookings, Washington D.C. June 2009, pp. 55-81.

Congressional Budget Office. Technological change and the growth of health care spending. Available at: http://www.cbo.gov/ftpdocs/89xx/doc8947/01-31-TechHealth.pdf. (Focus review of role of technological change)

Kalipso Chalkidou and Gerald Anderson. Comparative Effectiveness Research: International Experiences and Implications for the United States. Academy Health July 2009

Naik, Aanand D., Petersen, Laura A. The Neglected Purpose of Comparative-Effectiveness Research. N Engl J Med 2009 360: 1929-1931

ECRI Institute. Comparative Effectiveness Resource Centerhttps://www.ecri.org/comparativeeffectiveness/Pages/default.aspx

Week 9 Spring Break

Week 10 Value Based Healthcare and Pay-for-Performance

Required Readings:

* Mullen KJ, Frank RG, Rosenthal MB. Can you get what you pay for? Pay-for-performance and the quality of healthcare providers RAND April 2009

* Profit J et al. Implementing pay-for-performance in the neonatal intensive care unit, Pediatrics 2007 119; 5:975-82

* Petersen LA et al. Does pay for performance improves the quality of health care. Ann Intern Med. 2006 Aug 15; 145(4):265-72.

* Armour, B.S., M.M. Pitts, et al. 2001. “The effect of explicit financial incentives on physician behavior.” Archives of Internal Medicine. 161:1261-6. Optional Readings:

Newhouse, J. 2002. “Why is there a quality chasm?” Health Affairs. 21:13-25. and letters to the editor from September/October 2002 Health Affairs.

Chapter 8 “Aligning payment policies with quality improvement” in the Institute of Medicine Crossing the Quality Chasm: A New Health System for the 21st Century National Academy Press, 2001.

Dudley RA, Miller RH, Korenbrot TY, Luft HS. The Impact of Financial Incentives on Quality of Health Care. Milbank Quarterly 1998. 76(4): 649-686.

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Casalino L, et al, "External incentives, Information Technology, and Organized Processes to Improve Health Care Quality for Patients with Chronic Diseases" JAMA, 2003; 289(4): 434-441. (Jan. 22/29, 2003)

Conrad D, et al, "The impact of financial incentives on physician productivity in medical groups" Health Services Research 34:4 (August 2002) 885-906.

Labelle R et al, "A re-examination of the meaning and importance of supplier-induced demand" Journal of Health Economics 13(1994): 347-368.

Culyer A and Evans R. "Mark Pauly on welfare economics: normative rabbits from positive hats." J Health Econ. 1996 Apr; 15(2):243-51; discussion 253-4.

Rosenthal, M.B. and J.P. Newhouse. 2002. “Managed Care and efficient rationing.” Journal of Health Care Finance.” 28:1-10.

Fernandopulle, R., T. Ferris, et al. 2003. “A research agenda for bridging the ‘quality chasm’.” Health Affairs. 212:13-25.

Week 11 Healthcare Reform; Concepts and Models

Required Readings:

* Enthoven, A. Chapter 4. Curing Fragmentation with Integrated Delivery Systems: What They Do, What Has Blocked Them, Why We Need Them, and How to Get There From Here. In Elhauge, E. "The Fragmentation of U.S. Health Care: Causes and Solutions". Oxford University Press. (2010).

*Enthoven, A. “A Few Cautions about Exchanges”. Kaiser Institute for Health Policy. Pp. 1-3. January 11, 2011

* Fisher ES, McClellan MB, Bertko J, et al. Fostering Accountable Health Care: Moving Forward In Medicare. Health Affairs. March/April 2009 2009; 28(2):w219-w231.

* McClellan M, McKethan AN, Lewis JL, Roski J, Fisher ES. A National Strategy to Put Accountable Care into Practice. Health Affairs. May 1, 2010 2010; 29(5):982-990.

* Roland and Rosen. “English NHS Embarks on Controversial and Risky Market-Style Reforms in Health Care. NEJM 364:14, 2011 pp. 1360-66.

Optional Readings:

Shen, Y. and G. Melnick, “Is Managed Care Still an Effective Cost Containment Device?” Forum for Health Economics and Policy, Vol. 9 (1) 2006, 1-22. http://www.bepress.com/fhep/9/1/3/ (free registration) Chernew, M., Gautam, G., McLaughlin, C., Gibson, T. “Quality and employers’ choice of health plans”. Journal of Health Economics, Vol 23, 2004, pp 471-492.

Deb P, Li C, Trivedi PK., D Zimmer. “The effect of managed care on healthcare services: Results from two contemporaneous healthcare surveys.” Health Economics, Vol. 15 (7), 2006, 743-60.

Maxwell, J, Temin, P. “Managed competition versus industrial purchasing of health care among the fortune 500,” Journal of Health Politics, Policy & Law, Feb 2002, Vol. 27 Issue 1, p5-31.

Schut, Frederik T.; Hassink, Wolter H.J. Managed Competition and Consumer Price Sensitivity in Social Health Insurance” Journal of Health Economics, November 2002, v. 21, iss. 6, pp. 1009-29

Aaron, Henry J. “A Funny Thing Happened on the Way to Managed Competition”. Journal of Health Politics, Policy & Law, Feb2002, Vol. 27 Issue 1, p31-36.

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Enthoven, A., "The History and Principles of Managed Competition." Health Affairs: Supplement 1993, pp. 24-48.

Rice, T. “The Desirability of Market Based Health Reforms: A Reconsideration of Economic Theory” in Health, Health Care and Health Economics ed. M. L. Barer, T.E. Getzen, and G. L. Stoddart, New York: John Wiley & Sons, 1998, pp. 415-463. ON

Fisher ES, Staiger DO, Bynum JPW, Gottlieb DJ. Creating Accountable Care Organizations: The Extended Hospital Medical Staff. Health Affairs. January 1, 2007 2007; 26(1):w44-w57.

J Lewis, A McKethan, “The Vermont Accountable Care Organization Pilot: A Community Health System to Control Total Medical Costs and Improve Population Health” The Commonwealth Fund- 2010 - genesys.org

Berenson RA, Ginsburg PB, Kemper N. Unchecked Provider Clout in California Foreshadows Challenges to Health Reform. Health Affairs. April 1, 2010 2010; 29(4):699-705.

Fisher ES, Shortell SM. Accountable Care Organizations. JAMA: The Journal of the American Medical Association. October 20, 2010 2010; 304(15):1715-1716.

Berenson RA, Ginsburg PB, May JH. Hospital-Physicians Relations: Cooperation, Competition, Or Separation? Health Affairs. January 1, 2007 2007; 26(1):w31-w43

Shortell SM, Casalino LP, Fisher ES. How The Center For Medicare And Medicaid Innovation Should Test Accountable Care Organizations. Health Affairs. July 1, 2010 2010; 29(7):1293-1298.

Week 12 Healthcare Reform the Patient Protection and Affordable Care Act

Required Readings:

* Gruber, J., and Perry, I. (2011). Realizing Health Reform’s Potential: Will the Affordable Care Act Make Health Insurance Affordable? Commonwealth Fund Pub. 1493, Vol. 2, 1-14.

* Cutler, D., Davis, K., Stremenikis, K. (2010) the Impact of Health Reform on Health System Spending, The Commonwealth Fund Pub. 1405, vol. 88, 1-13.

* Pauly, M. (2011). Patient protection and affordable care act cost-containment choices: the case for incentive-based approaches. J. Health Politics, Policy and Law, 36(3):591-6.

* Miller EA. (2011). Affordability of health insurance to small business: implications of the patient protection and affordable care act. J. Health Politics, Policy and Law, 36(3):

Optional Readings:

Pande, A., Ross-Degnan, D., Zaslavsky A., Salomon J. (2011). Effects of healthcare reforms on coverage, access, and disparities quasi-experimental analysis of evidence from Massachusetts, American Journal of Preventive Medicine, 41(1):1-8.

Cutler, D., Davis, K., Stremenikis, K. (2009) Why Health Reform Will Bend the Cost Curve, The Commonwealth Fund.

Fuchs, V. The proposed government health insurance company—no substitute for real reform. Posted by the NEJM, May 28, 2009.

Hacker, J. Healthy competition—the why and how of public-plan choice. Posted by the NEJM, May 8, 2009.

Antos, J., et al., Bending the Curve, Brookings Institution, 2009.

Wynand, P.P.M. van de Ven, Frederik Schut, “Universal Health Insurance in the Netherlands: A Model for the U.S.? Health Affairs, May/June 2008, 27(3) 771-781.

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Anderson, G. and Frogner, B., Health spending in OECD countries: Obtaining value per dollar. Health Affairs, Nov. /Dec. 2008, pp. 1718-1727.

White, C. Health Care Spending Growth: How different is the U.S. from the rest of the OECD? Health Affairs, Jan. /Feb. 2007, pp. 154-161.

Leu, R., Rutten, F., Brouwer, W. et. Al. The Swiss and Dutch health insurance systems: universal coverage and regulated competitive insurance market. The Commonwealth Fund, January 2009, pp. 1-29.

Arrow, K, et. Al., Toward a 21st-century health care system : recommendations for health care reform, Annals of Internal Medicine, vol 150: issue 7, April 2009.

Aaron, H. Why paying for health care reform is difficult and essential—numbers and rules. NEJM, August 5, 2009. Posted by the NEJM, July 22, 2009.

Davis, K. Slowing the growth of health care costs—learning from international experience. NEJM, Oct. 23, 2008, pp.1751-1755.

Enthoven AC “A Living Example of Managed Competition: A Conversation with the Dutch Minister of Health, Ab Klink,” Health Affairs Web Exclusive W 196, April 8, 2008. Cost Sharing for Health Care: France, Germany and Switzerland. Kaiser Family Foundation, Jan. 2009, pp. 1-23.

Consumers’ experience in Massachusetts: lessons for national health reform, Kaiser Family Foundation, September 2009, pp. 1-22.

In pursuit of affordable healthcare: on the ground lessons from families in Massachusetts, Kaiser Family Foundation, September 2009, pp. 1-9.

Week 13 Economic Development and Population Health in Low Income Countries

Required Readings:

* Strauss and Thomas—Health, Nutrition and Economic Development, Journal of Economic Literature, vol. XXXVI, June, 1998.

* Jamison, D. Investing in Health, in, Disease Control Priorities in Developing Countries, Jamison, D., et al., eds., The World Bank, 2006, pp. 3-34.

* Bloom and Canning, Booms, Busts and Echoes, Finance and Development, September 2006, pp. 6-13.

Optional Readings:

Schultz, Paul. Population and Health Policies. Working paper no. 66, Yale Univ. Dept. of Economics, July 2009.

Swint, J.M., Franzini, L., Honda, C., Murakami, Y., Rasu, R. (2008). Relationships between economic growth and population health in low and middle income countries. Osaka Economic Papers, vol. 58 (2), 73-106.

Preker, A., et al. Debt Financing of Health Care for the Poor, in Health Financing for Poor People. Preker, A. and Carrin, G., eds., The World Bank, 2004.

Bloom, D., Canning, D. and Sevilla J., The Effect of Growth on Economic Growth: A Production Function Approach. World Development. Nov. 2004.

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Franzini, L., Swint, J., Murakami, Y., and Rasu, R. Economic Development, in Reinventing Public Health, Jossey-Bass Pub., L. Aday, ed., 2005.

Tough Choices: Investing in Health For Development, WHO, Executive Summary, 2006.Health Financing Revisited, World Bank 2006 (Sequel volume), Chapter 5.Health Financing for Poor People, IBRD, The World Bank, Chapter 11, Debt Financing of Healthcare for the poor, 2004.

Week 14 Term Papers

Week 15 Term Papers

Week 16 Final Project Due

For technical support for this class, please contact the UF Help Desk at:● Learning-support@ufl.edu ● (352) 392-HELP - select option 2● https://lss.at.ufl.edu/help.shtml

ACADEMIC REQUIREMENTS AND GRADING

Assignments

1. One Page Summary per Article (70%)

Each week, every student should write one pager essay per article under Required Readings. The essay should include three sections: 1) a brief summary of the research questions presented in the article, 2) the “take home” message(s) from the article, and 3) a good question for discussion on each article. The essay is due on Sunday each week. Your paper should be typed, single-spaced on standard-sized paper (8.5" x 11") with 1" margins on all sides. You should use 12 pt. black Times New Roman font.

2. Final Project (30%)

Each student will need to submit a 10-page long paper using the knowledge they acquire in this class to write the term paper. It can be a research proposal or review paper. Students are expected to write an in depth, critical evaluation of one health economics issue in U.S. health care system. Research proposals will include the specific objectives, background and significance, theoretical framework, research design, and methods for data collection and analysis. Review papers will summarize the major conceptual and empirical research relating to a specific issue, critically evaluate this research and identify what is needed for improvement, and describe the methods used for selecting and evaluating the research. Your paper should be typed, double-spaced on standard-sized paper (8.5" x 11") with 1" margins on all sides. You should use 12 pt. black Times New Roman font.

Grading

Assignments Due date % of final grade Submission method

One Page Summary Every Sunday of course week, 9:00PM 70% Email

Final Project Apr 22, 9:00PM 30% Email

This class uses a Pass/Fail grading. A final score of 85 is required to get a Pass.

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Policy Related to Make up Exams or Other Work

Please note: Students are expected to complete all assignments by the due date. 10% penalty for late submission, additional 10% penalty for every 24 hours.

Example:

Score calculated based on the four components under ‘Grading’

Final Project Due date

Submission date

Final Score

95 Apr 22, 5:00PM

Apr 22, 5:00PM

95

95 Apr 22, 5:00PM

Apr 22, 6:00PM

95*(1-10%) = 85.5

95 Apr 22, 5:00PM

Apr 23, 6:00PM

95*(1-10%)*(1-10%) = 76.95

95 Apr 22, 5:00PM

Apr 24, 6:00PM

95*(1-10%)*(1-10%) *(1-10%) = 69.25

Any requests for make-ups due to technical issues MUST be accompanied by the ticket number received from LSS when the problem was reported to them. The ticket number will document the time and date of the problem. You MUST e-mail me within 24 hours of the technical difficulty if you wish to request a make-up.

Policy Related to Required Class Attendance

Please note all faculty are bound by the UF policy for excused absences. For information regarding the UF Attendance Policy see the Registrar website for additional details: https://catalog.ufl.edu/ugrad/current/regulations/info/attendance.aspx

The course instructor must be given notice before the start time of class via email or Canvas message. The time stamp of the email will be used to determine if the notification was before the start of the class.

Excused absences must be consistent with university policies in the Graduate Catalog (http://gradcatalog.ufl.edu/content.php?catoid=10&navoid=2020#attendance) and require appropriate documentation. Additional information can be found here: https://catalog.ufl.edu/ugrad/current/regulations/info/attendance.aspx

Policy Related to Guests Attending Class:

Only registered students are permitted to attend class. However, we recognize that students who are caretakers may face occasional unexpected challenges creating attendance barriers. Therefore, by exception, a department chair or his or her designee (e.g., instructors) may grant a student permission to bring a guest(s) for a total of two class sessions per semester. This is two sessions total across all courses. No further extensions will be granted. Please note that guests are not permitted to attend either cadaver or wet labs. Students are responsible for course material regardless of attendance. For additional information, please review the Classroom Guests of Students policy in its entirety. Link to full policy: http://facstaff.phhp.ufl.edu/services/resourceguide/getstarted.htm

STUDENT EXPECTATIONS, ROLES, AND OPPORTUNITIES FOR INPUT

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Expectations Regarding Course Behavior

Students are expected to: Attend all classes Complete reading assignments before class Participate in class discussions Be an active member of your group Exhibit professional behavior Laptops may be used in class only for taking notes, viewing slides, or accessing course assigned

materials Cell phones not allowed to use during class time.

Communication Guidelines

Students will be expected to communicate via the Canvas messaging system.

Academic Integrity

Students are expected to act in accordance with the University of Florida policy on academic integrity. As a student at the University of Florida, you have committed yourself to uphold the Honor Code, which includes the following pledge:

“We, the members of the University of Florida community, pledge to hold ourselves and our peers to the highest standards of honesty and integrity.”

You are expected to exhibit behavior consistent with this commitment to the UF academic community, and on all work submitted for credit at the University of Florida, the following pledge is either required or implied:

“On my honor, I have neither given nor received unauthorized aid in doing this assignment.”

It is your individual responsibility to know and comply with all university policies and procedures regarding academic integrity and the Student Honor Code. Violations of the Honor Code at the University of Florida will not be tolerated. Violations will be reported to the Dean of Students Office for consideration of disciplinary action. For additional information regarding Academic Integrity, please see Student Conduct and Honor Code or the Graduate Student Website for additional details:https://www.dso.ufl.edu/sccr/process/student-conduct-honor-code/http://gradschool.ufl.edu/students/introduction.html

Please remember cheating, lying, misrepresentation, or plagiarism in any form is unacceptable and inexcusable behavior.

Online Faculty Course Evaluation Process Students are expected to provide feedback on the quality of instruction in this course by completing online evaluations at https://evaluations.ufl.edu. Evaluations are typically open during the last two or three weeks of the semester, but students will be given specific times when they are open. Summary results of these assessments are available to students at https://evaluations.ufl.edu/results/.

 SUPPORT SERVICES

Accommodations for Students with DisabilitiesIf you require classroom accommodation because of a disability, you must register with the Dean of Students Office http://www.dso.ufl.edu within the first week of class. The Dean of Students Office will provide documentation of accommodations to you, which you then give to me as the instructor of the course to receive accommodations. Please make sure you provide this letter to me by the end of the second week of the course. The College is committed to providing reasonable accommodations to assist students in their coursework.

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Counseling and Student HealthStudents sometimes experience stress from academic expectations and/or personal and interpersonal issues that may interfere with their academic performance. If you find yourself facing issues that have the potential to or are already negatively affecting your coursework, you are encouraged to talk with an instructor and/or seek help through University resources available to you.

The Counseling and Wellness Center 352-392-1575 offers a variety of support services such as psychological assessment and intervention and assistance for math and test anxiety. Visit their web site for more information: http://www.counseling.ufl.edu. On line and in person assistance is available.

You Matter We Care website: http://www.umatter.ufl.edu/. If you are feeling overwhelmed or stressed, you can reach out for help through the You Matter We Care website, which is staffed by Dean of Students and Counseling Center personnel.

The Student Health Care Center at Shands is a satellite clinic of the main Student Health Care Center located on Fletcher Drive on campus. Student Health at Shands offers a variety of clinical services. The clinic is located on the second floor of the Dental Tower in the Health Science Center. For more information, contact the clinic at 392-0627 or check out the web site at: https://shcc.ufl.edu/

Crisis intervention is always available 24/7 from:Alachua County Crisis Center(352) 264-6789http://www.alachuacounty.us/DEPTS/CSS/CRISISCENTER/Pages/CrisisCenter.aspx

Do not wait until you reach a crisis to come in and talk with us. We have helped many students through stressful situations impacting their academic performance. You are not alone so do not be afraid to ask for assistance.

Inclusive Learning EnvironmentPublic health and health professions are based on the belief in human dignity and on respect for the individual. As we share our personal beliefs inside or outside of the classroom, it is always with the understanding that we value and respect the diversity of background, experience, and opinion, where every individual feels valued. We believe in, and promote, openness and tolerance of differences in ethnicity and culture, and we respect differing personal, spiritual, religious and political values. We further believe that celebrating such diversity enriches the quality of the educational experiences we provide our students and enhances our own personal and professional relationships. We embrace The University of Florida’s Non-Discrimination Policy, which reads, “The University shall actively promote equal opportunity policies and practices conforming to laws against discrimination. The University is committed to non-discrimination with respect to race, creed, color, religion, age, disability, sex, sexual orientation, gender identity and expression, marital status, national origin, political opinions or affiliations, genetic information and veteran status as protected under the Vietnam Era Veterans’ Readjustment Assistance Act.” If you have questions or concerns about your rights and responsibilities for inclusive learning environment, please see your instructor or refer to the Office of Multicultural & Diversity Affairs website: www.multicultural.ufl.edu

Note: This syllabus is subject to revision in the event of extenuating circumstances.(END)