California State University, Chico

DEPARTMENT OF HEALTH AND COMMUNITY SERVICES

HCSV 435/POLS 405                                                                           Spring 2008

HEALTHCARE POLICY AND POLITICS

Monday, 6:00 to 8:50 p.m.                                                                       Butte 229

Richard A. Narad, D.P.A. , J.D.                                           Phone:  (530)898-5309

Butte 627                                                                               FAX:  (530) 898-5107

E-mail:  mailto:RNARAD@CSUCHICO.EDU                                                   

Office Hours:, Tuesday 2 to 5, Wednesday 10-12, or by appointment

1.    Scope of Course:  This course will analyze the political forces, both private and public, which impact upon the health industry in the United States.  It focuses on the political process as it relates to the health care delivery system and on major political/policy issues related to the delivery of health care.

2.    Reading Materials

Texts:

·       Bodenheimer, Thomas and Kevin Grumbach Understanding Health Policy: A Clinical Approach, 4th ed.

·       Cutler, David M. Your Money or Your Life : Strong Medicine for America's Health Care System

Health administration core library:

·       Vergil Slee, Debora Slee, & HJ Schmidt (eds.) Slee's Health Care Terms, 4th or 5^th Edition

·       Diana Hacker A Pocket Style Manual, 4th ed.

WebCT

·       Paul J. Feldstein "Health Associations and the Legislative Process" From TJ Litman and LS Robins, eds. Health Politics and Policy

·       Jon R. Gabel, Anthony T. Lo Sasso, and Thomas Rice “Consumer-Driven Plans” Health Affairs

·       Tom Baker “The Medical Malpractice Myth”

·       Rexford E. Santerre, Health Misery Index

·       National Quality Forum “Serious Reportable Events in Healthcare”

For students who have not completed HCSV 431 (and/or who do not feel comfortable with their knowledge of the health care delivery system) Kovner and Knickman’s Health Care Delivery in the United States is recommended.

3.    Course Format:  Classes will combine lectures, discussions, guest speakers, class exercises, and student presentations.

4.   Grading

Grades:

5.    Projects and Activities

·       Interest group profile: Paper and presentation on a special interest group which is involved in health care politics.

·       Friends and foes exercise: Identification of groups with whom your interest group might cooperate or compete.

·       Exercise summary:  Summary of an in-class simulation

·       Bill analysis:  Analysis of a bill, based on its impact on the above group, in the form of a memo to the organization’s legislative staff.

·       Position paper: Based on the above analysis, a legislative position paper in the form of a letter legislative committee.

·       Health issue: Paper and presentation on a current health policy issue.

·       System attributes:  Paper on the attributes of the ideal healthcare system.

This syllabus includes descriptions of each of the assignments.  Students should ensure that submitted papers include all of the required items and comply with the specifications listed in Section 9, below.

·       Readings:  Students are expected to have studied 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.

6.    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.

7.    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 "turnitin.com".  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. 

8.    You should be aware that this class will be harder than most classes that you have taken. This is a 400 level class--you are expected to analyze topics in your papers, presentations, and class discussions; and not to merely describe them. 

Assignments should be of the same quality that is expected of an employee in a professional position in the health care 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.

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

·         You must turn in both a hardcopy (printed) version of your term paper (which I will grade and return to you) and an electronic version.  The electronic version must be PC compatible and formatted as a Text (*.txt), MS-Word (*.doc), or Rich-Text-Format (*.rtf) file.  The electronic version must be submitted through WebCT.  Papers will be checked for plagiarism at "turnitin.com".

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

·         Papers should be typed, with all text, including quotes, 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.

10.  Presentations:  The presentations that you make in this class must comply with the following:

·         Presentations should cover the same area as the paper, but should not be just a reading of the written paper.  DON’T READ YOUR PAPER!

·         Be prepared to respond to questions from the instructor and the class

·         Do not exceed the maximum time for the presentation.

·         Use PowerPoint.

·         Dress professionally.  This means the same way that you would dress for a job interview or a professional presentation.

11.  On-line resources:  I have established a WebCT site (through the CSU, Chico Portal for class related materials.  Class handouts and other materials will be distributed only through this site.

Week

Topic(s)

Assignments

1 (1/28)

Introduction

Overview of health politics

2 (2/4)

Role of government in healthcare

On-line library tour

B&G 1,6,7

3 (2/11)

Policy analysis

Health financing

B&G 2,4,5

4 (2/18)

Interest groups

B&G 16

Feldstein

5 (2/25)

Interest groups profiles

Profile paper

6 (3/3)

Interest groups profiles (cont)

Friends and foes exercise

7 (3/10)

Legislative  analysis

Bill drafting exercise

Friends and foes paper

8 (3/24)

Health system design alternatives

Exercise summary

B&G 14

Gabel, et al.

9 (3/31)

No class—Cesar Chavez Day

10 (4/7)

Health policy issues:

·      Cost of care-5

·      Quality of care-9

Health issue paper

B&G 8, 9, 11,12,13

Santerre

National Quality Forum

11 (4/14)

Health policy issues:

·      Access to care-9

Bill analysis

B&G 3,10

12 (4/21)

Health policy issues:

·      Managed care issues-5

·      State reform issues-3

·      Presidential positions-2

13 (4/28)

Current health policy issues

·      Malpractice reform

·      Other?

Baker

14 (5/5)

In search of the ideal healthcare system

System attributes paper

Cutler (all)

15 (5/12)

Developing a political philosophy

B&G 18

Course review

16 (5/19)

FINAL EXAM

INTEREST GROUP PROFILE

Assignment:  Identify a special interest group which is involved in health care politics in California.  Sign up at the second class session.

Content:  The paper and presentation should include:

1.    General description of the group

·           Who are the members?

·            What is the general purpose of the organization?

2.    General goals/policies regarding the health care delivery system

·           What do they want the health system to be like?

·           Generally, what do they want to accomplish in legislation?

3.    Positions on specific health issues

·           What positions have they taken?

·           Using Feldstein’s model (from the article on WebCT), why have they taken these positions?

4.    The group's power

·           How successful/influential are they?

Your primary source of information will be the group itself.  You should contact them early because sending you information may not be their highest priority.  In addition to written information that they provide, you will probably need to interview them, either in person or on the telephone.  Some information is available from their web pages.  Where possible, these are linked to our class page.

Do not depend only on the information that they provide.  You should also look at the bills that they support and oppose and consider the reasons that they take the positions that they do.

Papers should be a maximum of three pages (plus endnotes).  Presentations should be five minutes.

FRIENDS AND FOES ANALYSIS

Assignment:  Based on the class presentations, identify three groups that you would expect to cooperate with your group on legislation and three groups that you would expect your group to compete with (that is, they would oppose your legislation and visa versa).

Content: 

1. Identify your group and give a brief summary of its general goals for the health system.

2. Identify three groups that would be friends and three groups that would be foes.  For each, explain why you believe this about them. 

Papers should be a maximum of two pages.

EXERCISE SUMMARY

Assignment:  Summarize your participation in the bill drafting exercise.

Content:  The analysis should include:

1.      Name of your group

2.      What was your initial position on the bill and why?

3.      What changes did you want on the bill and why?

4.      What groups did you ally with?  What did you have to give up to get their support?  What did they give you?

5.      Did you change your position at the end?  Why or why not?

Papers should be a maximum of one page.

HEALTH ISSUE PAPER/PRESENTATION

Assignment:  Select a current health policy issue (sign up at the second class session).  Prepare a written summary of the issue and a presentation. 

Content:  The paper and presentation should include:

1.    A summary of the issue—identify the issue and what problems are perceived to exist

2.    Potential policy options for solving these problems, including your analysis of their strengths and weakness

3.    Any current California or federal legislation (if any) on this topic

4.    A summary of recent actions (if any) on the issue.

5.    Your prediction regarding the likely position regarding major interest groups (not necessarily the group that you have used for other assignments).

Papers should be a maximum of three pages (plus endnotes).  Presentations should be ten minutes.

BILL ANALYSIS

Assignment:  A piece of current health legislation will be provided.  Analyze the bill to determine its impact on the group which you profiled.

Content:  The analysis should include:

1.    General goal/purpose of bill

2.    Specific contents

3.    Pros and cons of the initiative, from the viewpoint of your organization.

4.    Specific impacts on "your" organization and its members.

5.    A recommended position and rationale.   You must take a support or oppose position.  The bill is not one that your organization would sit back and watch!

The analysis should be in the form of a memo from you (role playing as a member of the legislative advocacy staff) to your organization's legislative advocate.  It should be a maximum of two pages.  (Of course, a memo would normally be single spaced, but for the purpose of this assignment, follow the specifications in this syllabus).

SYSTEM ATTRIBUTES PAPER

Assignment:  Identify attributes of the ideal healthcare system, evaluate our current system, and suggest a solution.

Content:  The paper should:

1.      Identify three attributes (one each addressing cost, quality, and access) that you believe are important for an ideal health system.  Briefly explain why you think this attribute is important.

2.      Evaluate the current status of that attribute in the US healthcare system

3.      Identify what you believe is the best way to achieve this attribute.  Briefly explain why you think this approach is desirable.

An attribute is defined as “a quality or characteristic inherent in or ascribed to someone or something.”  You should use the format “An ideal healthcare system would . . .  because . . . “ in stating your attributes.

NOTE:  “universal coverage” is used as an example below, so don’t use this one.

Example:

·      Attribute:  An ideal healthcare system would ensure universal coverage because it will maximize access to the healthcare system and will ensure appropriate reimbursement to healthcare providers.

·      Current status:  Currently, no state ensures universal coverage.  An estimated 17% of Americans do not have health insurance.  In addition, an estimated 22% have inadequate insurance (e.g., doesn’t cover prior existing conditions or reimbursement is so low that no providers are willing to take it).

·      Solution:  The best mechanism to ensure universal coverage is an individual mandate.  It would require each person to have insurance without impacting employers although employers could provide it if they desired. 

Papers should be a maximum of two pages (plus endnotes)