California State University, Chico




HCSV 431

Fall 2011



SECTION 1: Monday, 2:00 to 4:50

Butte 229

SECTION 2: Wednesday, 2:00 to 4:50

Butte 229



Richard A. Narad, D.P.A., J.D.

Phone:  (530) 898-5309

Butte 627

FAX: (530) 898-5107



Office Hours:  Monday/Tuesday 11:00-1:30, or by appointment


Scope of Course:  This course will provide an overview of the healthcare delivery system in the United States as it responds to the range and extent of healthcare needs.  We will discuss: 1) the major components of the system and the roles and responsibilities of system participants, 2) the differences among health financing mechanisms and issues relating to healthcare cost containment, including market failures in healthcare, and 3) current issues in the healthcare delivery system.

Learning objectives:  This course helps to meet the following objectives of the B.S., Health Science, Option in Health Services Administration:

The graduate in Health Services Administration will have knowledge, skills, and beliefs related to the health care delivery system and will identify participants in the system and describe their roles, responsibilities, and trends and issues related to them.

  • Identify various system participants.

  • Analyze a career within a specific type of health services organization or health subsystem.

  • Describe some aspect of the healthcare delivery system.

  • Compare some aspect of the U.S. healthcare delivery system to that in another country..

The graduate in Health Services Administration will have competent communication skills, including written and spoken communication, use of electronic media, and formal presentations/business reports

  • Develop a variety of communication skills

  • Search websites

The complete objectives of the B.S. Health Science with an option in Health Services Administration are available at


Reading Materials:


  • Leiyu Shi & Douglas A. Singh.  Delivering Health Care in America:  A Systems Approach, 5th Ed. (Jones and Bartlett, 2012).

Health administration core library:

  • Vergil Slee, Debora Slee, & HJ Schmidt (eds.). Slee's Health Care Terms, 5th Edition (St. Paul, MN: Tringa Press, 2008)—earlier editions are acceptable.

  • Diana Hacker. A Pocket Style Manual, 5th ed. (Boston: Bedford Books of St. Martin’s Press, 2008)—earlier editions are acceptable.

Articles on WebCt Vista:

  • Richard NARAD. "EMS System Design" Emergency Clinics of North America (1990)

  • Dan Beckham. “Integration versus Independence”  Health and Hospitals Network Weekly xxx

  • Atul Gawande. “The Cost Conundrum: What a Texas town can teach us about health care” The New Yorker (June 1, 2009 )

  •  Texas Medical Association. “Border Health Caucus Response to The New Yorker Article The Cost Conundrum”

  • Ian Morrison “Chasing Unicorns: The Future of ACOs” H&HN Magazine (2/10/2011)

Other (free subscription required)

  • Kaiser Daily Health Policy Report

  • California Healthline

Course Format:  Classes will combine lectures, discussions, and guest speakers.



  • Midterm.............................................................................................................. 200
  • Final.................................................................................................................... 200


  • Healthcare personnel paper/presentation...................................................... 200
  • Hospital profile paper....................................................................................... 200
  • Comparative systems paper/presentation..................................................... 200


  • Attendance:  50 points lost for every session missed.  One excused absence will be allowed.
  • Reading quizzes:  Up to four reading quizzes will be given during the semester.  Failure to pass the quiz will result in 25 points being deducted from your total grade, but no additional points will be added.


  • You will present on either your personnel paper OR you comparative health paper.
  • The subject description and identification of sources for the comparative systems paper will be graded as acceptable or unacceptable.  Any unacceptable material must be redone or the final paper will not be accepted. 



A            930 - 1000

C+       770 – 799

A-           900 - 929

C         730 – 769

B+          870 - 899

C-        700 – 729

B            830 - 869

D+       660 – 699

B-           800 - 829

D         600 – 659

Projects and Activities:

  • Healthcare personnel: Paper/presentation on a category of healthcare personnel.

  • Hospital profile:  Paper describing and analyzing a hospital based on public records.

  • Comparative systems: Paper/presentation comparing an aspect of the United States’ healthcare delivery system with that of another country.

  • Readings: Students are expected to have read the assigned readings by the date indicated on the course schedule.

  • Class participation: Attendance is expected.  Participation means more than being present in class.  Students are expected to actively participate in class activities and discussions.

  • Standard:  This syllabus includes descriptions of each of the written assignments.  General standards are described below.  Students should ensure that papers include all of the required items and meet these standards.

If you have difficulty writing, the Writing Center (898-5042, Student Services Building 310) on campus provides free tutoring and help with specific papers. USE THEIR SERVICES.

Confidentiality:  During this course, the instructor, guest speakers, or students may share information regarding specific organizations or individuals.  Such information should be treated as confidential and not discussed outside of the classroom.  If you are in doubt regarding the confidentiality of any information, consult the instructor.

Academic honesty: Students must ensure that appropriate credit is given for all materials.  Ideas taken from other persons must be properly cited.  Any direct quote must be enclosed in quotation marks and must be cited.

            All papers will be checked for plagiarism at "".  Any student who engages in academic dishonestly (e.g., plagiarism, cheating, etc.) will receive a failing grade in this course and Student Judicial Affairs will be notified.

Assignments should be of the same quality that is expected of an employee in a professional position in the healthcare field.  That means that grammar and spelling will be considered in grading assignments.  It means that due dates and project specifications are taken seriously.  It means that attendance is expected.

Written papers:  All papers turned in for this course must comply with the following:

  • You must turn in a hardcopy (printed) version of your term paper (which I will grade and return to you).  You must also submit an electronic version to "" using the link available on the class WebCT Vista page.

  • Use 81/2" x 11" paper, with one-inch margins on all sides.

  • Papers should be typed, with all text, double-spaced.

  • Do not use covers or cover pages.

  • Use Courier or Courier New 12 font

  • Do not exceed the maximum length for the assignment.

  • Papers should be free of typographical and spelling errors and should be grammatically correct

Papers not meeting these standards may be returned for rewriting before they are graded.  Any rewrite will result in a reduction of one grade.



On-line resources:  This class requires the use of WebCT Vista.  I will place class handouts on the site prior to each week's class.  Other materials (including old exams) and relevant linkages can be found there.

  S&S = Shi & Singh 








Health system overview





Development of the healthcare delivery system

S&S 1 (except pp. 21-28), Ch. 3

Paper signups



Monday: No Class—Labor Day




Wednesday: To be announced




Acute care hospitals

S&S Ch. 8



Health personnel


S&S Ch. 7, pp. 119-137; Beckham

Hospital profiles




Allied health professions

Non-MD independent practitioners

S&S pp. 137-151

Personnel papers








Healthcare subsystems:

·  Long-term care

·  Mental health

S&S Ch. 10, 11




Healthcare subsystems (cont):

·  Emergency medical services

·  Pharmaceuticals

S&S Ch. 5;  Narad



Utilization of health services

Gawande; Texas Medical Association

Comparative paper subject



Health economics

Health insurance




Payers and managed care organizations

Accountable care organizations

S&S Ch. 6, 9

Morrison; xxx



Healthcare issues and reform

S&S Ch. 2, 12, 13



Thanksgiving Break




Comparative health systems

S&S pp. 21-28, Ch. 14

Comparative papers




Comparative health systems

Future of h/c delivery





FINAL EXAM (Time to be announced)




Assignment: Select a category of health care personnel.  Sign up from a list provided in class.

Content:  The paper should include:

1.    General description and role

2.    Services provided

3.    Work setting(s)

4.   Salaries

5.   Career ladder

6.   Training/education

7.    Licensure/certification

Papers will be a maximum of three pages (plus endnotes).  Your sources should include an interview with someone in this profession.




Assignment:  Select a California hospital.  Sign up from a list provided in class.  Using the data sources provided on WebCT Vista, create a profile of the hospital


1.  Complete the hospital profile form (available on WebCT Vista).

2.  Summarize the data.

3.  For each data point, show the source of the information (list as “A”, “B”, etc.).

In addition to the form, the summary should be one page.




Assignment:. Select an area of interest from anywhere in the healthcare delivery system.  Compare it between the U.S. and one other country’s health care system.  You may focus on a:

Subject/Outline:  A brief description of your subject is due earlier in the semester.  This should include

Content:  The paper should include:

For healthcare delivery subsystems:

1.    Overview of the other country’s healthcare system;

2.    General description and role of the subsystem, including relation with other parts of the health system (as appropriate), types of organizations and personnel found in this sector (as appropriate), funding sources, and trends and issues;

3.    Comparisons and contrast with the equivalent subsystem in the U.S;

4.    Pros/cons of each countries’ approach;

5.    Lessons for the U.S. and your recommendations.

For health policy issues:

1.    Overview of the other country’s healthcare system;

2.    Summary of the issue, including current status, trends and issues, and potential policy options;

3.    Comparisons and contrast with the equivalent issue in the U.S;

4.    Pros/cons of each countries’ approach;

5.    Lessons for the U.S and your recommendations.

Do not take the whole paper to describe the systems/issues.  Instead, at least one-third of the paper should be used to analyze, including your view of the pros/cons of each countries’ approach, lessons for the U.S., and your recommendations. 

Papers will be a maximum of three pages (plus endnotes).