Syllabus 1 Jean-Germain Gros, Ph.D. Spring 1997 Poli. Sci. 446 UMSL Graduate Seminar in Comparative Health Policy The aim of this seminar is to examine the making of health policy in four industrial democracies: the United States, Canada, Britain and Germany. These countries exhibit a remarkable degree of variations in their health care systems, while they also share a good deal in common at the macro level. What social, political and historical factors account for differences in the health systems of nations? Do structural variations have an impact on how well (or badly) issues of universal concern like rising health care costs, treatment outcomes and medical technology absorption are dealt with? In addition to these questions, one major theme of the course is health care reform in the four countries. In this vein, the failure of recent efforts to reform the American health care system will be examined in depth. Mechanics/Requirements: This seminar will essentially be run by the participants, with the instructor of record acting as a facilitator. The seminar sessions will be organized as follows. Each week the instructor of record will use the first 30 minutes of the class to introduce the dominant issues of the week's readings. Thereafter, class discussions will be turned over to one or two (depending on class size) "volunteers" who will walk the class through (a) an explication de texte and (b) a critique of the readings. Each student is expected to lead at least two sessions during the course of the semester, and to write 2 short papers (3-5 pages in length)based on those sessions' readings. Final grades will be determined by: the short papers (15% each), overall preparedness for and contribution to class discussions (20%), and a major research paper of 30-35 pages (50%). Students may use one of the short papers as a foundation for the long one. Required texts: Graig, Laurene A., Health of Nations: An International Pespective on U.S. Health Care Reform, Second Edition, (Washington D.C.: Congressional Quarterly Inc., 1993). Aaron, Henry (ed.), The Problem that Won't Go Away, Washington, D.C.: The Brookings Institution, 1996 White, Joseph, Competing Solutions: American Health Care Proposals and International Experience, (Washington, D.c.: The Brookings Institution, 1995). Warnings: Because of copyright restrictions, this course will have no reader. Reading materials other than the required texts will be available at the reserve library. They will be marked by an asterisk * throughout this course outline. The seminar is not for the faint-hearted, as there is a substantial amount of readings to be done. Students are expected to come to class fully prepared and to participate in the discussions. Office Hours: Tuesdays and Thursdays 1:00 - 2:00 PM (undergraduates and graduate students). I will also be available on MWF on an appointment basis. Students are encouraged to meet with me during the office hour on the day they are scheduled to lead the discussion sessions. Office: T803; tel. 5848; e-mail: sjgros@umslvma.umsl.edu. Seminar's Weekly Topics Week I Course Introduction Health: Comparative and Conceptual Perspectives Readings: Victor Fuchs, The Future of Health Policy (Cambridge: Harvard University Press, pp. 19-64.* Laurene A. Graig, Health of Nations (Washington D.C.: Congressional Quarterly), 1-34. White, Joseph, Competing Solutions: American Health Care Proposals and International Experience,(Washington, D.c.: The Brookings Institution, 1995). pp. 15-35. Charles Lockhart, "Values and Policy Conceptions of Health Policy Elites in the United States, the United Kingdom and the Federal Republic of Germany, " Journal of Health Politics, Policy and Law 6, no. 1 (1981). pp. 98-119* Week II Government's Role in Health: The U.S. Case Readings: Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), pp. 3-9, 235-289, 352-378.* Theodore R. Marmor, The Politics of Medicare (Chicago: Aldine, 1970), pp. 5-28, 74-124.* White, Joseph, Competing Solutions: American Health Care Proposals and International Experience, (Washington, D.c.: The Brookings Institution, 1995, pp. 36-60. Week III Paying for Health Care Readings: Suzanne W. Letsch, "National Health Care Spending in 1991," Health Affairs (Spring 1993), pp. 94-110.* Deborah A. Stone, "The Struggle for the Soul of Health Insurance," Journal of Health Politics, Policy and Law (Summer 1993) pp. 286-317.* Uwe E. Reinhardt, "The United States: Breakthroughs and Waste," Journal of Health Politics, Policy and Law (Summer (1993), pp. 637-666.* Joseph P. Newhouse, "An Iconoclastic View of Health Care Cost Containment," Health Affairs (Supplement 1993, pp. 152-171.* Week IV The Canadian Health Care System Readings Laurene A. Graig, Health of Nations (Washington D.C.: Congressional Quarterly), pp. 35-74. White, Joseph, Competing Solutions: American Health Care Proposals and International Experience, (Washington, D.c.: The Brookings Institution, 1995, pp. 61-72. Theodore Marmor, "Lessons from the Frozen North," Journal of Health Politics, Policy and Law (1993), pp. 763-770.* Robert G. Evans, "Canada: The Real Issues," Journal of Health Politics, Policy and Law (Winter 1992), pp. 739-762.* Week V The German Health Care System Readings Laurene A. Graig, Health of Nations (Washington D.C.: Congressional Quarterly), pp. 80-113. White, Joseph, Competing Solutions: American Health Care Proposals and International Experience, (Washington, D.C.: The Brookings Institution, 1995, pp. 72-90. Deborah Stone, The Limits of Professional Power (Chicago:University of Chicago Press), pp. 2-32, 67-122.* J. Mathias Graf v.d. Schulenberg, "Germany: Solidarity at a Price," Journal of Health Policy, Politics and Law (Winter 1992), pp. 711-738.* Special Guest: Professor Joyce Mushaben Week VI The British Health Care System Readings Laurene A. Graig, Health of Nations (Washington D.C.: Congressional Quarterly), pp. 147-165. White, Joseph, Competing Solutions: American Health Care Proposals and International Experience, (Washington, D.C.: The Brookings Institution, 1995) pp. 121-127. Rudolf Klein, "The Politics of Ideology vs. The Reality of Politics: The Case of Britain's National Health Service in the 1980's," Milbank Memorial Quarterly (Winter 1994), pp. 82-109.* Christopher Potter and Janet Porter, "American Perceptions of the British National Health Service: Five Myths," Journal of Health Politics, Policy and Law 14, no. 2, 1989.* Week VII Comparing Health Care Systems: Costs, Access, Quality, etc. Readings White, Joseph, Competing Solutions: American Health Care Proposals and International Experience, (Washington, D.C.: The Brookings Institution, 1995) pp. 128-162. Robert Evans, "Split Vision: Interpreting Cross-Border Differences in Health Spending," Health Affairs 7, no. 4 (1988).* Samuel Mitchell, "Defending the U.S. Appoach to Health Spending," Health Affairs 7, no. 4 (1988).* Week VIII Health Reform in the United States versus Western Europe (Part I) Readings White, Joseph, Competing Solutions: American Health Care Proposals and International Experience, (Washington, D.C.: The Brookings Institution, 1995) pp. 165-198 Paul Starr, "Healthy Compromise: Universal Coverage and Managed competition Under a Cap," The American Prospect (Winter 1993).* Deborah Stone, "When Patients Go to Market: The Workings of Managed Competition," and Starr reply, the American Prospect (Spring 1993) pp. 109-126.* Brian Abel-Smith, "Who is the Odd Man Out? The Experience of Western Europe in Containing the Costs of Health Care," Milbank Memorial Quarterly/Health and Society, 63, (1985), pp. 1-17.* Week IX Health Reform in the United States versus Western Europe and Canada: Is There Room for Mutual Learning? Readings White, Joseph, Competing Solutions: American Health Care Proposals and International Experience, (Washington, D.C.: The Brookings Institution, 1995) pp. 251-291. James Morone, " American Political Culture and the Search for Lessons from Abroad," Journal of Health Politics, Policy and Law 15, no.1 (1990).* Alain Enthoven, "What Can Europeans Learn from Americans?" in Health Care Systems in Transition, (Paris: OECD), 1990.* Johnsson Bengt, "What Can Americans Learn from Europeans?" in Health Care Systems in Transition, (Paris: OECD), 1990.* John Iglehart, "American Business Looks Abroad," Health Affairs 8, no. 4, 1990.* Week X Why the Clinton Health Reform Plan Failed, and Where Do We Go from Here? Readings Henry Aaron (ed.), The Problem that Won't Go Away, Washington, D.C.: Brookings Institution, 1996. Read entire book. Week XI Health Reform at the State Level in the United States Readings Henry Aaron and William Schwartz, "Managed Competition: Little Cost Containment Without Budget Limits," Health Affairs (Supplement 1993), pp. 204-215.* Marilyn Moon and John Holohan, "Can States Take the Lead in Health Care Reform?" Journal of the American Medical Association (9, 1992), pp. 1588-1594.* Daniel M. Fox and Howard Leichter, "The Ups and Downs of Oregon's Rationing Plan," Health Affairs (Summer 1993), pp. 66-70.* Harvey Sapolsky, James Aisenberg and James Morone, " The Call to Rome and Other Obstacles to State-Level Innovation," Public Administration Review (March/April 1987), pp. 135-142.* Week XII Managed Care and Health Maintenance Organizations in the United States Readings Lawrence D. Brown, Politics and Health Care Organization: HMOs as Federal Policy (Washington, D.C.: Brookings Institution) pp.129-194. Lisa Belkin, " But What About Quality?," New York Times Magazine, Dec. 8, 1996.* Joan Buchanan, Phoebe Lindsey, Arleen Leibowitz and Allyson Ross Davies, "HMOs for Medicaid: The Road to Financial independence is Often Poorly Paved," Journal of Health Politics, Policy and Law, vol. 17, no. 1 (1992) pp. 71-94.* Haya R. Rubin, Barbara Gandek, William Rogers, Mark Kosinki, Colleen McHorney and John Ware, "Patients' Ratings of Outpatient Visits in Different Practice Settings: Results from the Medical Outcomes Study," Journal of the American Medical Association, vol 270, no. 7 (1993) pp. 835-840.* Week XIII The Ethics of Health Care Rationing in Comparative Perspective Reading Henry Aaron and William Schwartz, The Painful Prescription (Washington, D.C.: Brookings Institution,1984).* Bruce Vladeck, "Unhealthy Rations," The American Prospect, no. 6 (Summer 1991), pp. 101-103* John Egerton, "Here's How Rationing of Care Really Works," Medical Economics (November 1990).* Jeffrey Merrill and Alan Cohen, "The Emperor's New Clothes: Unraveling the Myths about Rationing," Inquiry 24, 1987.* Week IXV Health Risks, Medical Technology and the 'Good Life' Readings Dale Rublee, "Medical Technology in Canada, Germany and the United States," Health Affairs 8, no. 3 (1987). J. Michael McGinnis and William Foege, "Actual Causes of Death in the United States," Journal of the American Medical Association (November 10, 1993) pp. 2207-2212. Harvey Sapolsky, "The Politics of Risk," Daedalus (Fall 1990) pp. 83-96. Centers for Disease Control, U.S. Public Health Service, "Homicide Surveillance 1979-1988," Morbidity and Mortality Weekly Report (May 29, 1992), pp. 1-33. Week XV Concluding remarks. Major research paper due.