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NEW YORK UNIVERSITY
Robert F. Wagner School of Public Service |
| P11.2852: Comparative Analysis of Health Systems: International Perspectives |
Spring 2003
Mondays 4:30PM-06:10PM
Shimkin Hall, Rm. 333
Prof. Victor Rodwin
4 WSN, Rm. 51
(212) 998-7459
Assistant: Zuzanna Kobrzynski: 212-998-7435, zk3@nyu.edu
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| COURSE DESCRIPTION |
We tend to be ethnocentric in our views of health
care organization and policy. A look abroad, however, can provide insights about problems
at home. In spite of differences in the organization and financing of their health care
systems, most countries share a number of common problems with the United States.
First, is the question of deciding -- or not explicitly deciding -- what proportion of
GNP should be devoted to health and welfare. Second, is the problem of agreeing on
appropriate criteria to allocate health and social service expenditures. Third, is
the problem of how to implement established policies: through regulation, promotion
of competition, budgeting, or reimbursement incentives directed at health care
providers.
In this course, students will be asked to
become "experts" about a health system of their choice outside the United States. One
theme concerns the organization and financing of health care systems in large,
wealthy "G7" nations, e.g. Britain, Canada, France, Germany and Japan, all of which
belong to the Organization of Economic Cooperation and Development (OECD). Another
theme concerns the organization and financing of health care in developing nations and
the transitional economies of Central and Eastern Europe. We will examine a range of
health systems with respect to the data collected, the analyses conducted, and the
policies pursued by international organizations, e.g. the World Health Organization
(WHO), OECD, the World Bank, and UNICEF.
The readings, lectures and class discussions
will focus on the common problems and themes noted above as they affect the organization
and financing of health systems in different nations. We begin with a discussion of the
impact of globalization on health system development and an overview of health system
models around the world. Second, we examine international organizations as they relate
to health systems. Third, we focus on the evaluation of health systems and discuss case
studies of health systems in selected nations. Throughout the seminar, we will consider
issues of medicine, culture and public health infrastructure; and the strengths and
weaknesses of alternative methods of comparative analysis in cross-national research.
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LEARNING OBJECTIVE
- Analyze conceptual and methodological issues in the study of health systems
- Identify common problems and differences among diverse health systems
- Highlight key features of health systems in OECD nations and other countries.
- Assess the impact of globalization on health system development
- Analyze the U.S. health system in comparative perspective
- Examine the uses of comparative analysis in learning from abroad
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| COURSE REQUIREMENTS |
| A comparative analyis of two or more
health care systems. A 3-4 page proposal and initial outline for this paper will be
due on March 3d. An altogether separate mid-term exercise will be due on April 7th.
The final paper will be due on May 5th.
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| PREREQUISITES |
| Consent of the Instructor. |
| GRADING |
| The research paper will count for 50% of
the final grade. The mid-term exercise will count for 30 percent of the grade. The paper
proposal will count for 10% of the grade and class participation, based on understanding of assigned readings, will count for the remaining 10% of the grade. |
REQUIRED BOOKS (Available at 530 LaGuardia Place, b/w Bleecker and W. Third St.)
- H.J. Aaron and W. Schwartz, The Painful Prescription: Rationing Hospital Care (Washington, D.C.: The Brookings Institution, 1991).
- L. Graig, Health of Nations: An International Perspective on U.S Health Care Reform (Washington D.C.: CQ Press, l993).
- L. Payer, Medicine and Culture: Varieties of Treatment in the United States, England, West Germany and France (New York: Henry Holt and Co., Inc., 2nd edition, 1996).
- M. Raffel, ed., Healh Care and Reform in Industrialized Countries. (Pennsylvania: The Pennsylvania State University, 1997).
- M. Lassey, W. Lassey, and M. Jinks, Health Care Systems Around the World: Characteristics, Issues, Reforms. (New Jersey: Prentice Hall, 1997).
- M. Koivusalo and E. Ollila, Making a Healthy World: Agencies, Actors & Policies in International Health. (New York: Zed Books, 1997).
- Special Issue of American Journal of Public Health (AJPH), January 2003.
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| OUTLINE OF COURSE TOPICS AND READINGS |
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| I. INTRODUCTION: AN INTERNATIONAL PERSPECTIVE ON HEATLH SYSTEMS |
- Globalization, Health System Development and Course Themes
(Jan. 27)
Required Reading:
- L. Graig, ch. 1
- M. Lassey, et. al., ch. 1
- I. Kaul, I. Grunberg, and M. Stern, eds. Global Public Goods International Cooperation in the 21st Century. Chapter 1, "Health As A Global Public Good." Chapter 2, "Global Epidemiological Surveillance International Cooperation to Monitor Infections Diseases." (Class Handout)
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- Health System Models in World Perspective
(Feb. 3)
Required Reading:
- M. Raffel, "Dominant Issues: Convergence, Decentralization, Competition, Health Services," 291-303
- D. Dror and A. Preker, eds. Social Reinsurance. Chapter 1, "Rich-Poor Differences in Health Care Financing." Chapter 2, "The Role of Communities in Combating Social Exclusion." Chapter 3, "Introduction to Insurance and Reinsurance Coverage." (Class Handout)
- M. Lassey, et. al. ch. 2 and 17
- K. Lee, "Globalization a new agenda for health," in M. McKee, et. al, eds. International Cooperation in Health. (Class Handout)
- International Organizations and Health Systems
(Feb. 10)
Required Reading:
- M. Koivusalo and E. Ollila. Making a Healthy World: Agencies, Actors & Policies in International Health, Chapters 1, 2, 3 and 12.
- J. Boufford, "Setting the Global Agenda for Health." in M. Osterwies, et al., eds. Global Dimensions of Domestic Health Issues. (Class Handout)
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| February 17- No Class due to President's Day |
| II. OVERVIEW OF SELECTED HEALTH SYSTEMS |
- The German NHI System
(Feb. 24)
Required Reading:
- L. Graig, ch. 3
- L. Payer, ch. 4, pp 74-101
- W. Greiner and J. Schulenburg, "The Health System of Germany," in M. Raffel, pp. 77-104
- M. Lassey et. al., ch. 6
- C. Altenstetter, "Insights From Health Care in Germany," AJPH (January, 2003) (Available on Blackboard)
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- The Canadian (NHI) System
(March 3)
Required Reading:
- L. Graig, ch. 6
- P. Leatt and A.P. Williams, "The Health Care System of Canada," in M. Raffel, pp. 1-28
- Lassey, ch. 4
- R.B Deber, "Health Care Reform: Lessons from Canada," AJPH (January, 2003) (Available on Blackboard)
- See Romanov Commission Website: www.healthcarecommission.ca
Assignment:
Research paper proposal due on health system(s) of your choice
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- France: A National Health Insurance System
(March 10)
Required Reading:
- L. Payer, Ch. 1: pp. 35-73
- V. Rodwin and S. Sandier, "Health Care Under French NHI," Health Affairs (Fall, 1993) (Available on Blackboard)
- V. Rodwin, "The Health Care System Under French National Health Insurance: Lessons for Health Rreform in the United States," AJPH (January, 2003) (Available on Blackboard)
- M.P. Pomey and J.P. Poullier, "France's Health Policy Conundrum," in M. Raffel, pp. 49-76
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- Rationing Health Care: A Case Study of the NHS
(March 17)
Required Reading:
- L. Payer, pp.101-123.
- Aaron, H. and Schultz, H., The Painful Prescription
- L. Graig, ch. 5, pp. 101-124
- Lassey, ch. 10
- The British National Health Service (NHS)
(March 24)
Required Reading:
- P. Hatcher, "The Health System of the United Kingdom," in m. Raffel, pp. 227-262
- D.W. Light, "Universal Health Care: Lessons from the British Experience," AJPH (January 2003) (Available on Blackboard)
- D.W. Light, "From Managed Competition to Managed Cooperation: Theory and Lessons from the British Experience," Milbank Quaterly (1997; 75)
- R. Klein, "What's Happening to Britain's National Health Service," NEJM (vol. 345 no. 4)
- D.W. Light, "NHS Waiting Lists: the Hidden Agenda," Consumer Policy Review (2000;10(4))
(Light's articles are available on Blackboard)
Optional Reading:
Light, D.W. "Managed Competition, Govermentality and Institutional Response in the United Kingdom," (2001; 52(8))
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| SPRING BREAK |
- Japan's NHI
(April 7)
Required Reading:
- L. Graig, ch. 5
- N. Ikegami and J. Campbell, "Medical Care in Japan", NEJM (333)19, Nov. 9, 1995. (Available on Blackboard).
- M. Lassey et. al. ch. 5
- T. Nakahara, "The Healty System of Japan," in M. Raffel, pp. 105-134
Assignment:
Mid-Term due: Using OECD Data, compare two health systems
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| III. EVALUATION OF HEALTH SYSTEMS |
- OECD'S APPROACH
(April 14)
Required Reading:
- OECD, "The Growth and Performance of Seven Health Systems,"; (Class Handout)
- Anderson, G., Sotir, P. and Hussey, "Comparing Health system Performance in OECD countries," Health Affairs, (20)3, 2001 (Article available on blackboard).
- OECD Website: www.oecd.org
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- WHO's Evaluation of Health System Performance
(April 21)
Required Reading:
- J. Coyne and P. Hilsenrath. "The World Health Report 2000: Can Health Care Systems Be Compared Using a Single Measure of Performance?" American Journal of Public Health (92)1, 2002. (Article available on blackboard).
- V. Navarro. "The World Health Report 2000: Can Health Care Systems Be Compared Using a Single Measure of Performance?" American Journal of Public Health (92)1, 2002. (Article available on blackboard).
- The World Health Organization, The World Health Report 2000.
http://www.who.int/whr/2000/en/report.htm
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- Student Presentations
(May 5)
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- Student Presentations
(May 12)
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Short Bibliography
- C. Altenstetter and J. Bjorkman, eds., Health Policy Reform, National Variations and Globalization. New York: St. Martin;s Press, 1997.
- O. Anderson, The Health Services Continuum in Democratic States. Ann Arbor, MI: Health Administration Press, 1989.
- P. Basch, Textbook of International Health. Oxford: Oxford University Press, 1999.
- A. Bennett, and O. Adams, Looking North: What Can We Learn from CanadaÕs Health Care System? San Francisco: Jossey-Bass, 1993.
- J. Campbell and N. Ikegami, The Art of Balance in Health Policy: Maintaining JapanÕs Low-Cost Egalitarian System. New York: Cambridge University Press, 1998.
- J. De Kervasdoue, J. Kimberly, and V. Rodwin, eds., The End of an Illusion: The Future of Health Policy in Western Industrialized Nations. Berkeley: University of California Press, 1984.
- A. Ellenweig, Analyzing Health Systems: A Modular Approach. New York: Oxford University Press, 1992.
- M. Field, ed., Success and Crisis in National Health Systems. New York: Routledge, 1989.
- D. Fox, Health Policies, Health Politics. Princeton, NJ: Princeton University Press, 1986.
- R. Freeman, The Politics of Health in Europe. Manchester and New York: Manchester University Press, 2000.
- W. Glaser, Health Insurance in Practice: International Variations in Financing, Benefits, and Problems. San Francisco: Jossey-Bass, 1991.
- L. Graig, Health of Nations: An International Perspective on U.S. Health Care Reform. Washington, DC: CQ Press, 1999.
- Health Affairs, Pursuit of Health Systems Reform (Special Issue), 10, Fall 1991.
- J. Hurst, The Reform of Health Care: A Comparative Analysis of Seven OECD Countries. Paris: OECD, 1992.
- E. Immergut, Health Politics: Interests and Institutions in Western Europe. New York: Cambridge University Press, 1992.
- Investing in Health: World Bank Development Report. Washington, DC: World Bank, 1993.
- M. Jerome-Forget, J. White, and J. Weiner, eds., Health Care Reform through Internal Markets: Experience and Proposals. Washington, DC: Brookings Institute for Research on Public Policy, 1995.
- Journal of Health Policy, Politics and Law, "Comparative Health Policy" Special Issue, 17, Winter, 1992.
- R. Klein, The New Politics of NHS, third edition. London: Longman, 1995.
- M. Lassey, W. Lassey, and M. Jinks, Health Care Systems Around the World. Upper Saddle River, NJ: Prentice Hall, 1997.
- H.M. Leichter, A Comparative Approach to Policy Analysis: Health Care Policy in Four Nations. Cambridge: Cambridge University Press, 1979.
- J. Lemco, ed. National Health Care: Lessons for the United States and Canada. Ann Arbor: University of Michigan Press, 1994.
- T. Marmor, Understanding Health Care Reform. New Haven: Yale University Press, 1994.
- J. Merrill, The Road to Health Care Reform. New York: Plenum, 1994.
- OECD, The Reform of Health Care: A Comparative Analysis of Seven OECD Countries (Paris: OECD, 1992).
- OECD, Health: Quality and Choice. Paris, 1994.
- OECD, New Directions in Health Policy. Paris, 1995.
- OECD, Health Care Reform: The Will to Change. Paris, 1996.
- OECD, Internal Markets in the Making: Health Systems in Canada, Iceland and the United Kingdom. Paris, 1995.
- L. Payer, Medicine and Culture: Varieties of Treatment in the United States, England, West Germany and France. New York: Henry Holt, Owl Book Edition, 1996.
- M. Raffel, ed., Health Care Reform in Industrial Countries. University Park, PA: Pennsylvania State University Press, 1997.
- V. Rodwin, The Health Planning Predicament: France, Quebec, England and the United States. Berkeley: University of California Press, 1984.
- M. Roemer, National Health Systems of the World (Vols. 1 and 2). New York: Oxford, 1991.
- R. Saltman, and C. Van Otter, Planned Markets and Public Competition: Strategic Reform in Northern Europe Health Systems. Philadelphia: Open University Press, 1992.
- R. Saltman, and C. Van Otter, Implementing Health Care Reform. Bristol. PA: Open University Press, 1995.
- R. Saltman and J. Figueras, European Health Care Reform. Cophenhagen: World Health Organization, 1997.
- A. Wall, ed., Health Care Systems in Liberal Democracies. London. Routledge, 1996.
- J. White, Competing Solutions: American Health Care Proposals and International Experience. Washington, DC: Brookings, Institution, 1995.
Websites
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