PubH-6556 - School of Public Health

Transcription

PubH 6556
Health and Health Systems
Fall 2014
Credits:
3
Meeting Days:
Tuesdays, September 2 – December 9
Meeting Time:
9:05 – 11:45 am
Meeting Place:
WDH 2-110
Instructor:
Jon B. Christianson
Office Address:
15-225 Phillips Wangensteen Building
Office Phone:
612-625-3849
Fax:
612-624-2196
E-mail:
[email protected]
Office Hours:
By Appointment
I.
Course Description
The course provides an overview of the U.S. health care system and current health policy issues. Topics are addressed from a
health care management perspective.
II.
Course Prerequisites
Students must be admitted to the University of Minnesota’s Master in Healthcare Administration Program or have consent of the
instructor.
III. Course Goals and Objectives
Specific goals and learning objectives are listed below for each class session.
IV. Methods of Instruction and Work Expectations
Each topic will be introduced during the assigned class period through a didactic presentation on the part of the instructor. For
each class session, PowerPoint slides and related material will be posted on the Moodle website for downloading and viewing. (To
learn more about Moodle, watch Moodle: Online Orientation for Students and/or visit the Moodle support website at
http://www1.umn.edu/moodle/, which has a link for “Student support” with user guides, help and FAQs.) Significant health care
organization and policy issues will be identified and discussed, referencing the readings for the class period. From time to time,
the class will be asked to read and discuss a short article distributed during class. In most classes, student teams will present
policy “briefs” to the class on pre-assigned topics. Students will be expected to prepare for each class by completing the readings
and assignments prior to class and participating in the discussion of those readings during class.
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V.
Course Text and Readings
1. All suggested readings have links to the article following the cite. Please make sure you are logged in to the University using
your x500 ID and password particularly when using the link for journal articles. Click on the link to access the reading. If you
have any problems accessing assigned readings online, contact Jane Raasch at [email protected]. If you do not have a
University of Minnesota Internet ID and password, call 301-HELP and support staff will help you set up an account (or set up
your own account at www.umn.edu/initiate and follow the directions.)
2. The readings for each class session are divided into two parts: “Suggested” readings and “Further” readings. The suggested
readings are organized by subtopic. For some sessions, the list of suggested readings is long, but many individual readings
are quite brief. “Starred” readings should receive first priority. There are no “Required” readings. The more of the suggested
readings that you are able to complete, the better prepared you will be for your quizzes, assignments, and class discussion;
and, the better prepared you will be for your career. In sessions where there are a large number of suggested readings, you
may want to divide responsibility among study group members, with each member summarizing a subset of readings. The
“Further” readings provide additional information on the topics covered in each session. They are intended to be useful in
clarifying areas that you feel are not covered adequately in the suggested readings, or in providing additional information on
topics of particular interest to you. The following sources of information are useful in keeping up-to-date on current
developments in the health care system and in health policy.
Newspapers:
New York Times (liberal perspective)
Wall Street Journal (conservative perspective)
Washington Post (political issues)
Daily Feeds (all free): Kaiser Daily Health Policy Report/Kaiser Health News
AHIP Solutions Smart Brief
Ramlett, Morning Consult
The Hill
Websites with short “Research Briefs” on Various Health Care Topics:
Urban Institute
MPR (Mathematica Policy Research)
AcademyHealth
The Robert Wood Johnson Foundation
The Commonwealth Fund
VI. Course Outline/Weekly Schedule
Session/Week
1
Sept. 2
2
Sept. 9
3
Sept. 16
4
Sept. 23*
5
6
7, 8
Sept. 30
Oct. 7
Oct. 14, 21
9
Oct. 28
10
11
Nov. 4
Nov. 11
12
Nov. 18
13
Nov. 25
Topics
The U.S. Health Care System and Prospects for Reform
Health System Performance: From Iron Triangle to Three-Legged Stool to the Triple Aim – Cost and
Population Health
Health System Performance: From Iron Triangle to Three-Legged Stool to the Triple Aim – Patient
Experience
The Health Policy Process and the Accountable Care Act: Crabs in a Bucket?
Care Delivery
A Macro View of Physician Supply: Do We Have Enough Physicians Now? Will We Need More in the
Future?
[Assignment 1 due, 5 pts.]
Rethinking Primary Care: From Marcus Welby to Team-based Care?
The Nurse Workforce: “Is There a Nurse in the House?”
The Hospital: Doctors’ Workshop or “Big Med”?
[Assignment 2 due October 14, 10 pts.]
Long-Term Care: Can This Rubik’s Cube be Solved?
[Quiz 1: Material from Sessions 1-8, 30 pts.]
Medical Technology and Devices: At the Cutting Edge?
Pharmaceuticals: What Price Progress?
Financing
Health Insurance, Uninsurance, and the Private Health Insurance Market: What Works, What Doesn’t
and How Might Health Reform Change It?
Medicaid: How Can This “Vast Public Enterprise” Be Sustained?
2
Topics
Paying for Care for Seniors: Is This Any Way to Run an Insurance Program?
[Assignment 3 due, 10 pts.]
15
Dec. 9
Medicare: A Program at the Brink?
[Quiz 2: Material from Sessions 9-15, 30 pts.]
*For this class, you will listen to an audio lecture synchronized to PowerPoints. You will have a short assignment to submit to the
instructor prior to class.
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Session/Week
Dec. 2
The U.S. Health Care System and Prospects for Reform
Session 1 – September 2, 2014
Health System Performance: From Iron Triangle to Three-Legged Stool to the Triple Aim – Cost and
Population Health
The U.S. health care system is incredibly complex (some would call it a “non-system”), characterized by a variety of different financing
mechanisms and delivery systems. Before exploring that system in greater detail, the first two sessions of the course provide an
overview of how the U.S. health care system performs relative to components of the Triple Aim: per capita costs, patient experience,
and population health. We also compare the performance of the U.S. health care system to systems in other countries.
Learning Objectives – Session 1
Students should be able to:
1. Discuss the different components of the Triple Aim and the performance of the U.S. health care system relative to:
 Cost per capita: components of costs, drivers of cost growth, variation in costs
 Population health
2. Compare and contrast different views regarding whether, or under what circumstances, health care expenditures that grow at
a faster rate than the rest of the economy should be regarded with concern.
3. Discuss evidence on geographic variation in health care costs in the United States.
4. Discuss and explain differences between the U.S. and other countries in health care costs and population health
Suggested Readings
The Triple Aim
1*. Berwick, D.M., Nolan, T.W., Whittington, J. “The triple aim: Care, health and cost.” Health Affairs 27(3):759-769, 2008.
http://content.healthaffairs.org/content/27/3/759.full.pdf+html
2*. Moses, III, H., Matheson, D.H.M., Dorsey, E.R., George, B.P., Sadoff, D., Yoshimura, Y. “The anatomy of health care in the
United States.” Journal of the American Medical Association 310(18):1947-1963, 2013. Available at:
http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=928805&direction=P
Spending on Health Care
Trends
1*. The Henry J. Kaiser Family Foundation. “Health care costs. A primer.” May 2012. Available at:
http://www.kff.org/insurance/upload/7670-03.pdf
2*. Thompson, D. “What if healthcare spending doesn’t destroy America?” The Atlantic, July 18, 2014. Available at:
http://www.theatlantic.com/business/archive/2014/07/health-care-spending-the-future-predictions/374608/
3*. Sanger-Katz, M. “The Global Slowdown in Medical Costs.” The New York Times, July 16, 2014. Available at:
http://search.proquest.com/docview/1545380953/fulltext/812618369A234A20PQ/1?accountid=14586
4 McArdle, M. “Obamacare isn’t what’s slowing costs.” BloombergView, July 17, 2014. Available at:
http://www.bloombergview.com/articles/2014-07-17/obamacare-isn-t-what-s-slowing-costs
5 Mauldin, J. “The new normal of healthcare spending.” Forbes, June 29, 2014. Available at:
http://www.forbes.com/sites/johnmauldin/2014/06/29/the-new-normal-of-healthcare-spending/
6 McIntyre, A. “Orszag: It’s time for some optimism about health care spending.” Vox, June 15-2014. Available at:
http://www.vox.com/2014/6/15/5807046/orszag-its-time-for-some-optimism-about-health-care-spending
7 Kliff, S. “The $2.8 trillion question: Are health costs growing fast again?” Vox, April 15, 2014. Available at:
http://www.vox.com/2014/4/15/5612900/health-spending-growth-fast
8 Kennedy, K. “New data signal smaller jump in health care costs.” USA Today, April 16, 2014. Available at:
http://www.usatoday.com/story/news/nation/2014/04/16/lower-rise-in-health-care-costs/7515185/
9 Altman, D. “Health cost growth is down, or not, in depends who you ask.” Kaiser Family Foundation, March 5, 2014. Available
at: http://kff.org/health-costs/perspective/health-cost-growth-is-down-or-not-it-depends-who-you-ask/
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10 Kliff, S. “For the first time in 50 years, health prices are barely growing.” Vox, May 27, 2014. Available at:
http://www.vox.com/2014/5/27/5755416/for-the-first-time-in-50-years-health-prices-are-barely-growing
11 Murphy, T. “Study: Care costs continue slower growth in 2014.” The Big Story, May 21, 2014. Available at:
http://bigstory.ap.org/article/study-care-costs-continue-slower-growth-2014
12 Orszag, P.R. “Stopping the spike in health-care costs.” Bloomberg View, May 5, 2014. Available at:
http://www.bloombergview.com/articles/2014-05-05/stopping-the-spike-in-health-care-costs
Geographic Variation in Health Spending
1*. Rau, J. “Medicare spending variations mostly due to health differences, study concludes.” Kaiser Health News, May 28, 2013.
Available at: http://www.kaiserhealthnews.org/Stories/2013/May/28/medicare-state-geographic-variation-costs.aspx
Views Regarding Health Spending
1*. Pauly, M.V. “The trade-off among quality, quantity, and cost: How to make it—if we must.” Health Affairs 30(4):574-580, 2011.
2*. Altman, D., Levitt, L. “We still have a health-care spending problem.” Washington Post, April 21, 2012. Available at:
http://articles.washingtonpost.com/2013-04-21/opinions/38717666_1_health-spending-health-costs-health-care-spending
3. RWJF. “Consumer attitudes on health care costs: Insights from focus groups in four U.S. cities.” January 2013. Available at:
http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf403428
4. Douthat, R. “Conservatives and health care costs.” New York Times, May 15, 2013. Available at:
http://douthat.blogs.nytimes.com/2013/05/15/conservatives-and-health-care-costs/?_r=0
Drivers of Growth in Spending
1*. Rao, A. “IOM report focuses on $750 billion in inefficient health care spending.” Kaiser Health News Blog, September 6, 2012.
Available at: http://capsules.kaiserhealthnews.org/index.php/2012/09/iom-report-focuses-on-750-billion-in-inefficient-healthcare-spending/
2*. Appleby, J. “Higher prices charged by hospitals, other providers, drove health spending during downturn.” Kaiser Health
News, May 21, 2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/May/21/higher-health-care-priceshospitals.aspx
3*. Kliff, S. “Over next two decades, obesity could cost us $550 billion.” The Washington Post, September 18, 2012. Available at:
http://www.washingtonpost.com/blogs/wonkblog/wp/2012/09/18/over-next-two-decades-obesity-could-cost-us-550-billion/
4*. Rosenberg, Y. “Do you really need that test? Doctors warn on 90 treatments.” The Fiscal Times, February 21, 2013. Available
at: http://www.thefiscaltimes.com/Articles/2013/02/21/Doctors-Warn-on-90-Overused-Medical-Treatments.aspx#page1
5. Acaramenico. “Poll of emergency physicians shows more than half order tests as protection against being sued.” May 26,
2011 Available at: http://californiaprevailingwage.wordpress.com/2011/05/26/poll-of-emergency-physicians-shows-more-thanhalf-order-tests-as-protection-against-being-sued/
6. Porter, E. “Health care’s overlooked cost factor.” New York Times, June 11, 2013. Available at:
http://www.nytimes.com/2013/06/12/business/examinations-of-health-costs-overlook-mergers.html?pagewanted=all
7. Fuchs, V.R. “The gross domestic product and health care spending.” New England Journal of Medicine May 22, 2013.
Available at: http://www.nejm.org/doi/full/10.1056/NEJMp1305298
8. Garber, S., Gates, S.M., Keeler, E.B., et al. “Redirecting innovation in U.S. health care. Options to decrease spending and
increase value.” RAND Corporation, 2014. Available at: http://www.rand.org/pubs/research_reports/RR308.html
Population Health
Trends
1*. Winslow, R. “Americans are living longer, but not necessarily healthier, study shows.” The Wall Street Journal, July 10, 2013.
Available at: http://online.wsj.com/article/SB10001424127887324694904578597444105321914.html
2. US Burden of Disease Collaborators. “The state of US health, 1990-2010. Burden of diseases, injuries, and risk factors.”
Journal of the American Medical Association, Published online July 10, 2013. Available at:
http://jama.jamanetwork.com/onlineFirst.aspx
3. Pitman, D. “Gains made, but U.S. still lags in life expectancy.” MedPage Today, July 10, 2013. Available at:
http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/40381
4. Diamond, D. “Four charts on how health care has changed since ‘Mad Men’.” Forbes, April 13, 2014. Available at:
http://www.forbes.com/sites/dandiamond/2014/04/13/four-charts-on-how-health-care-has-changed-since-mad-men/
Illness-specific Measures
1*. Reuters. “U.S. cholesterol levels decline: Study.” October 16, 2012. Available at:
http://www.reuters.com/article/2012/10/16/health-cholesterol-idUSL3E8LG7C120121016
2*. Reinberg, S. “Nearly 30 percent of Americans have high blood pressure: CDC.” WebMD News from HealthDay, April 4, 2013.
Available at: http://www.webmd.com/hypertension-high-blood-pressure/news/20130404/nearly-30-percent-of-americans-havehigh-blood-pressure-cdc
3. HealthDay. “Asthma cases continue to rise in U.S., affecting millions.” May 15, 2012. Available at:
http://consumer.healthday.com/Article.asp?AID=664789
4. USA Today. “Percentage of severely obese adults skyrockets.” October 1, 2012. Available at:
http://www.usatoday.com/story/news/nation/2012/10/01/severely-obese-americans-increasing/1606469/
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Disparities
1*. HealthDay News. “Health disparities persist in U.S., report shows.” January 13, 2011. Available at:
http://health.usnews.com/health-news/family-health/heart/articles/2011/01/13/health-disparities-persist-in-us-report-shows
2. Kaiser Health News. “Race plays role in diagnosis and treatment.” July 24, 2009. Available at:
http://www.kaiserhealthnews.org/daily-reports/2009/july/24/racial-disparities.aspx?referrer=search
3. Tavernise, S. “The health toll of immigration.” New York Times, May 18, 2013. Available at:
http://www.nytimes.com/2013/05/19/health/the-health-toll-of-immigration.html?pagewanted=all
International Comparisons
Costs
1*. Fuchs, V.R. “How and why US health care differs from that in other OECD countries.” New England Journal of Medicine
309(1):33-34, 2013. Available at: http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=926163&direction=P
2*. Lorenzoni, L., Belloni, A., Sassi, F. “Health-care expenditure and health policy in the USA versus other high-spending OECD
countries.” The Lancet 384(9937):83-92, 2014. Available at: http://www.sciencedirect.com/science/journal/01406736/384/9937
3. Fox, M. “Survey shows Americans pay a lot more for health care." NationalJournal, March 25, 2012. Available at:
http://www.nationaljournal.com/healthcare/survey-shows-americans-pay-a-lot-more-for-health-care-20120304
4. Heavey, S. “Obesity, lack of insurance cited in U.S. health gap.” Reuters, January 9, 2013. Available at:
http://www.reuters.com/article/2013/01/09/us-usa-health-ranking-idUSBRE9080ZN20130109
5. Laugesen, M.J., Glied, S.A. “Higher fees paid to U.S. physicians drive higher spending for physician services compared to
other countries.” Health Affairs 30(9):1647-1656, 2011. http://content.healthaffairs.org/content/30/9/1647.full.pdf+html
6. Goldhill, D. “Other nations don’t compare to U.S. health care.” Bloomberg, June 20, 2013. Available at:
http://www.bloomberg.com/news/2013-06-20/what-the-world-can-t-tell-us-about-health-care.html
Population Health
1. Goodwin, J. “Americans have worse health than English peers, study finds.” US News, March 9, 2011. Available at:
http://health.usnews.com/health-news/family-health/boomer-health/articles/2011/03/09/americans-have-worse-health-thanenglish-peers-study-finds
Further Readings
1.
Wayne, A. “Health cost growth slows further even as economy rebounds.” Bloomberg, June 18, 2013. Available at:
http://www.bloomberg.com/news/2013-06-18/health-cost-growth-slows-further-even-as-economy-rebounds.html
2. Goldhill, D. “Focus on health-care costs causes more spending.” Bloomberg, January 1, 2013. Available at:
http://www.bloomberg.com/news/2013-01-01/focus-on-health-care-costs-causes-more-spending.html
3. Kaiser Family Foundation. “Assessing the effects of the economy on the recent slowdown in health spending.” April 2013.
Available at: http://kff.org/health-costs/issue-brief/assessing-the-effects-of-the-economy-on-the-recent-slowdown-in-healthspending-2/
4. Steuerle, G. “A slower rate of health cost growth? What happens when an irresistible force meets an increasingly immovable
object?” Altarum Institute Health Policy Forum, May 10, 2013. Available at: http://www.altarum.org/forum/post/slower-ratehealth-cost-growth-what-happens-when-irresistible-force-meets-increasingly
5. Samuelson, R.J. “Is the health-care spending slowdown for real?” The Washington Post, May 19, 2013. Available at:
http://articles.washingtonpost.com/2013-05-19/opinions/39376698_1_affordable-care-act-affordable-health-coverage-healthaffairs
6. Bipartisan Policy Center. “What is driving U.S. health care spending?” September 2012, Available at:
http://bipartisanpolicy.org/sites/default/files/BPC%20Health%20Care%20Cost%20Drivers%20Brief%20Sept%202012.pdf
7. Detsky, A.S. “How to control health care costs.” Journal of General Internal Medicine 27(9):1095-1096, 2012. Available at:
http://link.springer.com/content/pdf/10.1007%2Fs11606-012-2119-0.pdf
8. Reinhardt, U.E., “Is U.S. health spending finally under control.” New York Times online, January 20, 2012. Available at:
http://economix.blogs.nytimes.com/2012/01/20/is-u-s-health-spending-finally-under-control/
9. Roehrig, C., Turner, A., Hughes-Cromwick, P., Miller, G. “When the cost curve bent – Pre-recession moderation in health
care.” New England Journal of Medicine 367(7):590-593, 2012. Available at:
http://www.nejm.org/doi/pdf/10.1056/NEJMp1205958
10. Roehrig, C.S., Rousseau, D.M. “The growth in cost per case explains far more of U.S. health spending increases than rising
disease prevalence.” Health Affairs 30(9):1657-1663, 2011. Available at:
11. Gawande, A. “The cost conundrum: What a Texas town can teach us about health care.” The New Yorker, June 1, 2009.
Available at: http://go.galegroup.com/ps/retrieve.do?sgHitCountType=None&sort=DASORT&inPS=true&prodId=PROF&userGroupName=mnaumntwin&tabID=T003&searchId=R1&resultListType=RESULT_LIST
&contentSegment=&searchType=AdvancedSearchForm&currentPosition=1&contentSet=GALE%7CA201451685&&docId=GA
LE|A201451685&docType=GALE&role=&docLevel=FULLTEXT
12. Klein, E. “One way Obamacare may already be working.” Bloomberg, May 29, 2013. Available at:
http://www.bloomberg.com/news/2013-05-29/one-way-obamacare-may-already-be-working.html
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13. Philipson, T., Eber, M., Lakdawalla, D.N., Corral, M., Conti, R., Goldman, D.P. “An analysis of whether higher health care
spending in the United States versus Europe is ‘worth it’ in the case of cancer.” Health Affairs 31(4):667-675, 2012. Available
at: http://content.healthaffairs.org/content/31/4/667.full.pdf+html
14. Reinberg, S. “Aging population could send cancer costs soaring.” January 12, 2011. Available at:
http://news.health.com/2011/01/12/aging-population-could-send-cancer-costs-soaring/
15. Carroll, A. “The ‘iron triangle’ on health care: Access, cost, and quality.” JAMA Forum, October 3, 2012. Available at:
http://newsatjama.jama.com/2012/10/03/jama-forum-the-iron-triangle-of-health-care-access-cost-and-quality/
16. Healy, M. “Obesity in U.S. projected to grow, though pace slows: CDC study.” LA Times online, May 7, 2012. Available at:
http://articles.latimes.com/2012/may/07/news/la-heb-obesity-projection-20120507
17. Mahoney, D. “Uncontrolled hypertension deemed pervasive in U.S. adults.” Internal Medicine News, September 4, 2012.
Available at: http://www.internalmedicinenews.com/single-view/uncontrolled-hypertension-deemed-pervasive-in-usadults/e84cc5f65b0596965e8e9b606b653355.html
18. Banks, J., Marmot, M., Oldfield, Z., Smith J.P. “Disease and disadvantage in the United States and in England.” JAMA
2006;295(17):2037-2045. http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=5022&direction=P
19. Goodell, S., Escarce, J.J. “Racial and ethnic disparities in access to and quality of health care.” Policy Brief 12, The Synthesis
Project, Robert Wood Johnson Foundation, September 2007. Available at: http://www.rwjf.org/en/research-publications/findrwjf-research/2007/09/racial-and-ethnic-disparities-in-access-to-and-quality-of-health.html
20. Baker, S. “Study: US leads in healthcare spending, but ranks last in health.” The Hill’s Healthcare Blog, May 12, 2011.
Available at: http://thehill.com/policy/healthcare/160845-study-us-leads-in-healthcare-spending-but-ranks-last-in-health21. Cauchon, D. “Health care spending is transferred out of ICU.” USA Today, March 4, 2013. Available at:
http://www.usatoday.com/story/news/health/2013/03/04/health-care-spending-growth-slows/1963165/
22. Barnes, K. “Behind the health spending numbers.” Health Affairs Blog, June 18, 2013. Available at:
http://healthaffairs.org/blog/2013/06/18/behind-the-health-spending-numbers/
23. Roehrig, C. “U.S. health spending as a share of GDP – Where are we headed?” Altarum Institute, July 16, 2013. Available at:
http://altarum.org/health-policy-blog/u-s-health-spending-as-a-share-of-gdp-where-are-we-headed
24. Pal, S. “U.S. healthcare: Still pricey, but getting better.” MedPageToday, July 1, 2013. Available at:
http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/46574
25. Porter, E. “Acceleration is forecast for spending on health.” The New York Times, April 22, 2014. Available at:
http://search.proquest.com/docview/1518237501/fulltext/EDC3C52A256E4194PQ/1?accountid=14586
26. Furman, J., Fiedler, M. “Alongside expanded coverage, underlying slow growth in health costs is continuing.” The White
House, May 27, 2014. Available at: http://www.whitehouse.gov/blog/2014/05/27/alongside-expanded-coverage-underlyingslow-growth-health-costs-continuing
27. Adamopoulos, H. “Healthcare spending grew 7.1% in March.” Becker’s Hospital Review, May 9, 2014. Available at:
http://www.beckershospitalreview.com/finance/healthcare-spending-grew-7-1-in-march.html
28. “Health care spending sees biggest jump since 1980.” MSN Money, April 30, 2014. Available at:
http://money.msn.com/saving-money-tips/post--biggest-explosion-in-health-care-spending-in-over-30-years
29. Joynt, K.E., Jha, A.K. “The relationship between cost and quality. No free lunch.” Journal of the American Medical Association
30. Nichols, L. “Seven challenges for continued health care cost control: Will Congress step up to the plate?” Altarum Institute,
August 20, 2013. Available at: http://altarum.org/health-policy-blog/seven-challenges-for-continued-health-care-cost-controlwill-congress-step-up-to-the-plate
31. Rosenthal, E. “The $2.7 trillion medical bill.” New York Times, June 1, 2013. Available at:
http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-healthexpenditures.html?pagewanted=all
32. Gordon, J. “The medical arms race.” Minnesota Medicine, February 2007. Available at:
http://www.minnesotamedicine.com/PastIssues/PastIssues2007/February2007/FeatureFebruary2007.aspx
33. Pittman, G. “Unnecessary repeat cholesterol tests common: study.” Reuters, July 1, 2013. Available at:
http://www.reuters.com/article/2013/07/01/us-unnecessary-repeat-cholesterol-idUSBRE96015420130701
34. Centers for Disease Control and Prevention. “Chronic diseases and health promotion.” Available at:
http://www.cdc.gov/chronicdisease/overview/
Health System Performance: From Iron Triangle to Three-Legged Stool to the Triple Aim – Patient
Experience
There is widespread concern across political boundaries that patients’ experiences in the health care system leave much to be desired.
Critics cite under use, over use, and inappropriate use of health services. Access to services is a major issue for population subgroups,
and medical care costs continue to be a contributing factor to personal bankruptcies. And, for the last 12 years, the public spotlight has
focused on “preventable” medical errors. Historically, medical errors were attributed to the failures of individuals, but the literature on
patient safety also focuses on creating medical care delivery systems that limit the potential for human error. Nevertheless, estimates
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are that well over 100,000 people die each year from avoidable errors. There is also a growing body of evidence that poor
communication between providers and patients, along with inadequate coordination of care, contribute to poor quality care, medical
errors, and patient frustrations with the health care system.
Learning Objectives
1. Discuss issues and evidence relating to access to care and deficiencies in the quality of health care in the United States
2. Discuss the evidence regarding prevalence of medical errors in the U.S. health care system and their sources.
3. Use terminology related to “medical errors” appropriately.
4. Discuss basic approaches being used in hospitals and other providers to reduce medical errors.
5. Discuss how poor communication and care coordination can affect medical errors and patient outcomes.
Suggested Readings
Patient Safety and Medical Errors: Concepts, Terminology, and Impact
Overview
1*. Leape, L. “Error in medicine.” Journal of the American Medical Association 272(23):1851-1857, 1994 (Posted on Moodle)
2*. Boodman, S.G. “Doctors’ diagnostic errors are often not mentioned but can take a serious toll.” Kaiser Health News, May 6,
2013. Available at: http://www.kaiserhealthnews.org/stories/2013/may/07/doctor-errors-misdiagnosis-more-common-thanknown-serious-impact.aspx
3*. Allen,, M. “We’re still not tracking patient harm.” Propublica, July 17, 2014. Available at: http://www.propublica.org/article/werestill-not-tracking-patient-harm
4. Van Den Bos, J., Rustagi, K., Gray, T., Halford, M., Ziemkiewicz, E., Shreve, J. “The $17.1 billion problem: The annual cost of
measurable medical errors.” Health Affairs 30(4):596-603, 2011. Available at:
5. Young, J. “Hospital errors occur 10 times more than reported, study finds.” Bloomberg.com, April 6, 2011. Available at:
http://www.bloomberg.com/news/2011-04-07/hospital-errors-occur-10-times-more-than-reported-study-finds.html
6. Weber, T., Ornstein, C., Allen, M. “Why can’t medicine seem to fix simple mistakes? ProPublica, July 20, 2012. Available at:
http://www.propublica.org/article/why-cant-medicine-seem-to-fix-simple-mistakes
7. Southwick, F.S. “Losing my leg to a medical error.” The New York Times, February 19, 2013. Available at:
http://www.nytimes.com/2013/02/20/opinion/losing-my-leg-to-a-medical-error.html?smid=pl-share&_r=0
8. Zimlichman, E., Henderson, D., Tamir, O., et al. “Health care-associated infections. A meta-analysis of costs and financial
impact on the US health care system.” JAMA Internal Medicine, September 2, 2013. Available at:
http://archinte.jamanetwork.com/article.aspx?articleID=1733452
9. Brown, E. “Senator: Hospitals reducing treatment errors, but problems remain.” The Los Angeles Times, April 25, 2014.
Available at: http://www.latimes.com/local/lanow/la-me-ln-boxer-hospital-errors-20140425-story.html
10. Millman, J. “Hospitals are cutting down on their deadly mistakes, HHS says.” The Washington Post, May 7, 2014. Available at:
http://search.proquest.com/docview/1521893302/fulltext/E15539BC35254636PQ/1?accountid=14586
11. Tavernise, S. “Infections at hospitals are falling, C.D.C. says.” The New York Times, March 26, 2014. Available at:
http://search.proquest.com/docview/1510343620/fulltext/B9D98808BC034F5APQ/2?accountid=14586
12. Begley, S. “Hospital ratings show sharp differences in safety, chance of dying.” Reuters, March 27, 2014. Available at:
http://www.reuters.com/article/2014/03/27/us-hospitals-ratings-idUSBREA2Q0NC20140327
13. Reinberg, S. “1 in 5 U.S. patients injured by medical care.” HealthDay, May 27, 2014. Available at:
http://consumer.healthday.com/general-health-information-16/injury-health-news-413/1-in-5-medicare-patients-injuredbecause-of-their-medical-care-688223.html
Causes of Medical Errors
1*. Volpp, K.G.M., Grande, D. “Residents’ suggestions for reducing errors in teaching hospitals.” New England Journal of
Medicine 348(9):851-855, 2003. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMsb021667
2*. Couse-Baker, R. “Even a doctor can’t keep his father safe in the hospital.” Cognoscenti, April 5, 2013. Available at:
http://cognoscenti.wbur.org/2013/04/05/medical-errors-ashish-jha
3. Sun, L.H. “’Alarm fatigue’ leads hospital caregivers to ignore beeps, posing risks for patients.” Bangor Daily News, July 23,
2013. Available at: http://bangordailynews.com/2013/07/08/health/alarm-fatigue-leads-hospital-caregivers-to-ignore-beepsposing-risks-for-patients/
4. Richtel, M. “As doctors use more devices, potential for distraction grows.” New York Times, December 15, 2011, p. A.1.
Available at: http://www.nytimes.com/2011/12/15/health/as-doctors-use-more-devices-potential-for-distractiongrows.html?pagewanted=all&_r=0
5. Robertson, J. “Digital health records’ risks emerge as deaths blamed on systems.” Bloomberg, June 25, 2013. Available at:
http://www.bloomberg.com/news/2013-06-25/digital-health-records-risks-emerge-as-deaths-blamed-on-systems.html
6. Smith, K. “For doctors, too much information.” Politico, March 5, 2013. Available at:
http://www.politico.com/story/2013/03/electronic-alert-glut-overloads-doctors-88394.html
7
7.
Welch, J.R. “As she lay dying: How I fought to stop medical errors from killing my mom.” Health Affairs 31(12):2817-2820,
2012. Available at: http://content.healthaffairs.org/content/31/12/2817.full.pdf+html
8. Sun, L.H. “Hospital antibiotic use can put patients at risk, study says.” The Washington Post, March 4, 2014. Available at:
http://search.proquest.com/docview/1504030034/fulltext/BF4E6C58E6474034PQ/1?accountid=14586
Proposals and Interventions Aimed at Reducing Reduce Medical Errors
1*. Gawande, T. “The Checklist.” New Yorker, 83(39):86-95, December 10, 2007. Available at:
http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande
2*. Shaw, G. “Researchers: CPOE averted 17.4 million medication errors in one year.” FierceHealthIT, February 22, 2013.
Available at: http://www.fiercehealthit.com/story/researchers-cpoe-averted-174-million-medication-errors-one-year/2013-02-22
3*. Shekelle, P.G., Pronovost, P.J., Wachter, R.M., et al. “The top patient safety strategies that can be encouraged for adoption
now.” Annals of Internal Medicine 158(5-Part 2):365-368, 2013. Available at:
http://annals.org/issue.aspx?journalid=90&issueID=926462&direction=P
4. Millenson, M.L. “Analysis: Is a new federal patient safety effort doing enough to curb medical errors?” Kaiser Health News,
February 22, 2012. Available at: http://www.kaiserhealthnews.org/stories/2012/february/23/millenson-hens.aspx
5. Hartocollis, A. “With money at risk, hospitals push staff to wash hands.” The New York Times, May 28, 2013. Available at:
http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?_r=0
6. Ofri, D. “Ashamed to admit it: Owning up to medical error.” Health Affairs 29(8):1549-1551, 2010. Available at:
7. Clark, C. “It’s impossible to know what $1B in federal quality spending buys.” HealthLeaders Media, February 20, 2014.
Available at: http://www.healthleadersmedia.com/page-1/QUA-301234/Its-Impossible-to-Know-What-1B-in-Federal-QualitySpending-Buys##
Care Coordination and Communication Issues
1*. Schoen, C., Osborn, R., Squires, D., Doty, M., Pierson, R., Applebaum, S. “New 2011 survey of patients with complex care
needs in eleven countries finds that care is often poorly coordinated.” Health Affairs 30(12):2437-2448, 2011. Available at:
2. Pham, H.H., Grossman, J.M., Cohen, G., Bodenheimer, T. “Hospitalists and care transitions: The divorce of inpatient and
outpatient care.” Health Affairs 27(5):1315-1327, 2008. Available at:
3. Levinson, W., Pizzo, P.A. “Patient-physician communication. It’s about time.” Journal of the American Medical Association
How Patients Experience the Health Care System
1*. Jauhar, S. “Referral system turns patients into commodities.” The New York Times, May 26, 2009, p.D.5. Available at:
http://www.nytimes.com/2009/05/26/health/26essa.html?scp=12&sq=health%20care&st=cse
2. Blendon, R.J., Buhr, T., Cassidy, E.F., Perez, D.J., Sussman, T., Benson, J.M., et al. “Disparities in physician care:
Experiences and perceptions of a multi-ethnic America. Health Affairs 27(2):507-517, 2008. Available at:
3. Dimick, J., Ruhter, J., Sarrazin, M.V., Birkmeyer, J.D. “Black patients more likely than Whites to undergo surgery at low-quality
hospitals in segregated regions.” Health Affairs 32(6):1046-1053, 2013. Available at:
4. Colwill, J.M. “A case of ‘medical homelessness’.” Health Affairs 29(5):1067-1070, 2010. Available at:
5. Mayer, M.L. “On being a ‘difficult’ patient.” Health Affairs 27(5):1416-1421, 2008. Available at:
6. Hiltzik, M. “The U.S. healthcare system: Worst in the developed world.” The Los Angeles Times, June 17, 2014. Available at:
http://www.latimes.com/business/hiltzik/la-fi-mh-the-us-healthcare-system-20140617-column.html
Access to Care
1*. Galewitz, P. “Health care increasingly out of reach for millions of Americans.” Kaiser Health News, May 7, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/may/07/health-affairs-care-increasingly-out-of-reach-for-millions.aspx
2. Pecquet, J. “Report: Americans still struggling with medical debt.” The Hill, March 7, 2012. Available at:
http://thehill.com/blogs/healthwatch/health-insurance/214759-report-americans-still-struggling-with-medical-debt
3. Kenney, G.M., McMorrow, S., Zuckerman, S., Goin, D.E. “A decade of health care access declines for adults hold implications
for changes in the Affordable Care Act.” Health Affairs 31(5):899-908, 2012. Available at:
4. Rosenthal, E. “The health care waiting game.” The New York Times, July 5, 2014. Available at:
http://search.proquest.com/docview/1543264717/fulltext/FADD4A64271D46B6PQ/1?accountid=14586
8
Quality of Care
Not Enough?
1. Maugh, T.H. “Nearly 70,000 Americans die needlessly each year because they are not given optimal heart failure therapy.”
June 6, 2011. Available at: http://www.latimes.com/health/boostershots/la-heb-heart-failure06062011,0,4047246.story?track=rss
2. Reuters. “Cardiac arrest survival improving in U.S. hospitals: Study.” July 16, 2012. Available at:
http://www.reuters.com/article/2012/07/17/us-heart-idUSBRE86G01F20120717
3. HealthDay. “Many lacked preventive care before health reform law: U.S. report.” June 14, 2012. Available at:
http://consumer.healthday.com/Article.asp?AID=665762
4. Mohammed, K.A., Bullard, K.M., Saaddine, J.B., Cowie, C.C., Imperatore, G., Gregg, E.W. “Achievement of goals in U.S.
diabetes care, 1999-2010.” The New England Journal of Medicine, 2013;368(17):1613-1624. Available at:
http://www.nejm.org/doi/pdf/10.1056/NEJMsa1213829
5. Weintraub, K. “1 and 20 adult outpatients misdiagnosed, study reports.” The Boston Globe, April 16, 2014. Available at :
http://search.proquest.com/docview/1517862010/fulltext/C2F1E953A7794EAAPQ/1?accountid=14586
Too Much Care?
1*. PR Newswire. “U.S. physician groups identify commonly used tests or procedures they say are often not necessary.” April 4,
2012. Available at: http://www.prnewswire.com/news-releases/us-physician-groups-identify-commonly-used-tests-orprocedures-they-say-are-often-not-necessary-146046345.html
2. Abelson, R., Creswell, J. “Hospital chain inquiry cited unnecessary cardiac work.” New York Times online, August 6, 2012.
Available at: http://www.nytimes.com/2012/08/07/business/hospital-chain-internal-reports-found-dubious-cardiacwork.html?pagewanted=all
3. Brownlee, S., Saini, V., Cassel, C. “When less is more: Issues of overview in health care.” Health Affairs, April 25, 2014.
Available at: http://healthaffairs.org/blog/2014/04/25/when-less-is-more-issues-of-overuse-in-health-care/
4. Chassin, M.R. “Improving the quality of health care: What’s taking so long?” Health Affairs 32(10):1761-1765, 2013. Available
Further Readings
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Commins, J. “Diagnostic errors common, costly, and harmful.” HealthLeaders Media, April 23, 2013. Available at:
http://www.healthleadersmedia.com/page-1/QUA-291407/Diagnostic-Errors-Common-Costly-and-Harmful##
Kennedy, K. “HHS: Hospitals ignoring requirements to report errors.” USA Today online, July 20, 2012. Available at:
http://www.usatoday.com/news/health/story/2012-07-19/hospitals-preventable-errors-report/56343348/1
Lerner, M. “In new safety test, not all Minnesota hospitals earn A: National report card rates 38 state hospitals for patient
safety.” Star Tribune, June 7, 2012, p. B3. Available at: http://www.startribune.com/lifestyle/health/157309745.html
O’Connell, K. “Two arms, two choices: If only I’d known then what I know now.” Health Affairs 31(8):1895-1899, 2012.
Available at: http://content.healthaffairs.org/content/31/8/1895.full.pdf+html
Welch, H.G. “Testing what we think we know.” New York Times online, August 19, 2012. Available at:
http://www.nytimes.com/2012/08/20/opinion/testing-standard-medical-practices.html
Pryor, D., Hendrich, A., Henkel, R.J., Beckmann, J.K., Tersigni, A.R. “The quality ‘journey’ at Ascension Health: How we’ve
prevented at least 1,500 avoidable deaths a year — and aim to do even better.” Health Affairs 30(4):604-611, 2011. Available
Crosby, J. “Getting it right (or left); Wrong-site surgeries continue to plague hospitals, but a new campaign hopes to ensure
everyone takes a “timeout” before surgery.” Star Tribune, June 20, 2011, p. D.1. Available at:
http://www.highbeam.com/doc/1G1-259321876.html
McCoy, J. “7 medical error disclosure deterrents.” HealthLeaders Media, February 9, 2011. Available at:
http://www.healthleadersmedia.com/content/PHY-260817/7-Medical-Error-Disclosure-Deterrents.html
Moisse, K. “HHS announces partnership for patients to save lives, money.” abc News, April 12, 2011. Available at:
http://abcnews.go.com/Health/Wellness/hospital-safety-government-industry-team-reduce-errors/story?id=13355460
Terry, T. “Electronic prescriptions have as many errors as written prescriptions.” FierceHealthIT, June 30, 2011. Available at:
http://www.fiercehealthit.com/story/prescription-errors-equal-whether-written-or-electronic/2011-06-30
Metzger, J., Welebob, E., Bates, D.W., Lipsitz, S., Classen, D.C. “Mixed results in the safety performance of computerized
physician order entry.” Health Affairs 29(4):655-663, 2010. Available at:
Szabo, L. “Studies: Surgeons could save lives, $20B by using checklist.” USA Today, January 14, 2009. Available at:
http://www.usatoday.com/news/health/2009-01-14-surgery-checklist_N.htm
Garbutt, J., Waterman, A.D., Kapp, J.M., Dunagan, W.C., Levinson, W., Fraser, V., Gallagher, T.H. “Lost opportunities: How
physicians communicate about medical errors.” Health Affairs 27(1):246-255, 2008. Available at:
9
14. Koppel, R., Wetterneck, T., Telles, J.L., Karsh, B-T. “Workarounds to barcode medication administration systems: Their
occurrences, causes, and threats to patient safety.” Journal of the American Medical Informatics Association 15(4):408-423,
2008. Available at: http://www.sciencedirect.com/science/journal/10675027/15/4
15. Buerhaus, P.I. “Is hospital patient care becoming safer? A conversation with Lucian Leape.” Health Affairs – Web Exclusive
26(6):w687-w696, published online October 9, 2007. Available at:
http://content.healthaffairs.org/content/26/6/w687.full.pdf+html
16. Leape, L. “Reporting of adverse events.” New England Journal of Medicine 347(20):1633-1638, 2002. Available at:
http://www.nejm.org/doi/pdf/10.1056/NEJMNEJMhpr011493
17. Kaiser Health News. “Race Plays Role in Diagnosis and Treatment.” July 24, 2009. Available at:
http://www.kaiserhealthnews.org/daily-reports/2009/july/24/racial-disparities.aspx?referrer=search
18. Ofri, D. “My near miss.” The New York Times, May 28, 2013. Available at:
http://www.nytimes.com/2013/05/29/opinion/addressing-medical-errors.html
19. Johnson, C.K. “Poor infection control at many surgery centers.” MSNBC, June 8, 2010. Available at:
http://www.msnbc.msn.com/id/37577363
20. Sittig, D.F., Singh, H. “Defining health information technology—related errors.” Archives of Internal Medicine 171(14):12811284, 2011. Available at: http://archinte.jamanetwork.com/Issue.aspx?journalid=71&issueID=22519&direction=P
21. Harris, G. “U.S. inaction lets look-alike tubes kill patients.” The New York Times, August 20, 2010. Available at:
http://www.nytimes.com/2010/08/21/health/policy/21tubes.html?pagewanted=all
22. Schiff, G.D. “Medical error. A 60-year-old man with delayed care for a renal mass.” Journal of the American Medical
Association 305(18):1890-1898, 2011. Available at:
http://jama.jamanetwork.com/Issue.aspx?journalid=67&issueID=20328&direction=P
23. Ledger, K. “Safety first. How anesthesiologists launched the patient-safety movement.” Minnesota Medicine, March 2011.
Available at: http://www.minnesotamedicine.com/PastIssues/PastIssues2011/March2011/SafetyFirst.aspxes
24. Drolet, B.C., Khokhar, M.T., Fischer, S.A. “The 2011 duty-hour requirement — a survey of residence program directors.” The
New England Journal of Medicine 368(8):694-697, 2013. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1214483
25. HealthDay. “Fewer U.S. patients getting weight counseling from doctors.” U.S. News, January 10, 2013. Available at:
http://health.usnews.com/health-news/news/articles/2013/01/10/fewer-us-patients-getting-weight-counseling-from-doctors
26. Roy, A. “The Commonwealth Fund rags on U.S. health care.” National Review, June 27, 2010. Available at:
http://www.nationalreview.com/agenda/230340/commonwealth-fund-rags-u-s-health-care/avik-roy#!
27. Hiatt, K. “9 warning signs of bad care.” US News, February 26, 2013. Available at: http://health.usnews.com/health-news/bestnursing-homes/articles/2013/02/26/9-warning-signs-of-bad-care
The Health Policy Process and the Accountable Care Act: Crabs in a Bucket?
The government plays a major role in shaping the U.S. health care system and its performance. About half of all health care spending in
the United States flows through government programs, and every aspect of health care is subject to relatively extensive, if not always
effective, government oversight. In each subsequent session of the course, key health policy issues will be identified and described.
This session provides a foundation for subsequent sessions. First, a general overview of the public policy process and its key
participants is presented. Then, the politics of health care reform is discussed in the context of the recently passed, and continually
challenged, federal health Accountable Care Act (ACA).
Learning Objectives
1. Demonstrate an understanding of the political process as it relates to health care.
2. Describe the key components in the recently passed ACA.
3. Discuss the role that various health care interest groups played in the passage of the ACA and its implementation to date.
4. Discuss the implications of changes in the ACA (subsequent to passage) for its ability to accomplish its objectives.
Suggested Readings
Overview of the Policy Process
1*. Marmor, T.R., Christianson, J.B. “The political market for government health policies.” Chapter 3 in Health Care Policy. A
Political Economy Approach. Beverly Hills, CA: Sage Publications, 1982 (Posted on Moodle)
2*. Kaiser Family Foundation. “KaiserEDU.org Tutorial: U.S. Congress and health policy.” June 29, 2011. Available at:
http://kff.org/interactive/the-u-s-congress-and-health-policy-tutorial/
4. Vaida, B., Weaver, C. “Scorecard: How health industry PACs placed their election bets. Spending reflected view on health
law.” Kaiser Health News, November 23, 2010. Available at:
http://www.kaiserhealthnews.org/Stories/2010/November/17/health-industry-pacs-election-bets.aspx
10
5.
ACA
Israel, J. “Top health information technology firms prefer ‘revolving door’ lobbyists.” iWatchNews, August 22, 2011. Available
at: http://www.iwatchnews.org/2011/08/22/5859/top-health-information-technology-firms-prefer-revolving-door-lobbyists
6. Reinhardt, U.E. “Is there hope for the uninsured?” Health Affairs – Web Exclusive, pp.w3-376-w3-390, published online August
27, 2003. Available at: http://content.healthaffairs.org/content/early/2003/08/27/hlthaff.w3.376.full.pdf+html
7. Millman, J. “Doctors are donating less often to Republican candidates.” The Washington Post, June 2, 2014. Available at:
http://www.washingtonpost.com/blogs/wonkblog/wp/2014/06/02/doctors-are-donating-less-often-to-republican-candidates/
8. Rovner, J. “The politics of health in 2014 aren’t what you think.” Kaiser Health News, May 22, 2014. Available at:
http://www.kaiserhealthnews.org/stories/2014/may/22/the-politics-of-health-in-2014-arent-what-you-think.aspx
9. Easley, J. “Health lobbying headed for fifth year of declines.” Morning Consult, May 18, 2014. Available at:
http://themorningconsult.com/2014/05/healthcare-lobbying-on-pace-for-fifth-consecutive-year-of-declines/
10. Despres, S. “How Congress brought the measles back.” Politico Magazine, June 22, 2014. Available at:
http://www.politico.com/magazine/story/2014/06/congress-the-measles-108161.html
11. Associated Press. “Groups spend heavily lobbying on Medicaid.” The Washington Post, July 14, 2014. Available at:
http://www.washingtonpost.com/local/va-hospital-group-spends-400000-on-lobbying/2014/07/14/544ba222-0b7d-11e4-bd2c919fc31dc2e6_story.html
Overview
1*. Kaiser Family Foundation. “KaiserEDU.org Tutorial – Health reform: An overview.” October 1, 2010. Available at:
http://kff.org/interactive/health-reform-an-overview-tutorial/
2*. Klein, E. “As health-care reform law turns 1, some clarity on what it does and how it does it.” Washington Post, March 22,
2011, p. A.12. Available at: http://articles.washingtonpost.com/2011-03-21/business/35260878_1_health-care-reform-lawaffordable-care-act-insurance
3. Samuelson, R.J. “Why Obamacare is oversold.” Washington Post, May 9, 2013. Available at:
http://articles.washingtonpost.com/2013-05-09/opinions/39133432_1_affordable-care-act-health-care-uninsured-andmedicaid-recipients
4. Keller, B. “Five Obamacare myths.” The New York Times, July 15, 2012. Available at:
http://www.nytimes.com/2012/07/16/opinion/keller-five-obamacare-myths.html?pagewanted=all&_r=0
5. Carroll, A.E., Frakt, A.B., “New evidence supports, challenges, and informs the ambitions of health reform.” Journal of the
American Medical Society 309(24):2600-2601, 2013. Available at:
http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=927181&direction=P
6. Chait, J. “Republicans finally admit why they really hate Obamacare.” New York Magazine, 2014. Available at:
http://nymag.com/daily/intelligencer/2014/06/republicans-finally-admit-why-they-hate-the-aca.html
7. Levitt, L. “How well is the affordable care act working?” JAMA Forum, July 9, 2014. Available at:
http://newsatjama.jama.com/2014/07/09/jama-forum-how-well-is-the-affordable-care-act-working/
8. Goldstein, A. “Federal insurance exchange subsidies cut premiums by average of 76%, HHS reports.” The Washington Post,
June 18, 2014. Available at:
http://search.proquest.com/docview/1537139368/fulltext/3FFEFC81D7A54431PQ/1?accountid=14586
9. Emanuel, E.J. “Inside the making of Obamacare.” The Wall Street Journal, March 7, 2014. Available at:
http://online.wsj.com/news/articles/SB10001424052702303824204579421553914382752
10. Manzi, J. “Cautions about interpreting the Massachusetts mortality study.” National Review Online, May 14, 2014. Available at:
http://www.nationalreview.com/corner/377938/cautions-about-interpreting-massachusetts-mortality-study-jim-manzi
11. Sargent, G. “Morning plum: Conventional wisdom on Obamacare is changing. Really.” The Washington Post, May 28, 2014.
Available at: http://search.proquest.com/docview/1398880770/fulltext/C4B45FD5238E4F60PQ/1?accountid=14586
12. Beutler, B. “The GOP’s outrageous health care hypocrisy: Vets aren’t the only people who die awaiting care.” New Republic,
May 27, 2014. Available at: http://www.newrepublic.com/article/117911/gop-veterans-health-care-outrage-doesnt-applyuninsured-people
13. Hiltzik, M. “Healthcare debate lacks factual arguments against Obamacare.” The Los Angeles Times, June 27, 2014. Available
at: http://www.latimes.com/business/hiltzik/la-fi-hiltzik-20140629-column.html#page=1
14. Krugman, P. “Inventing a failure.” The New York Times, May 4, 2014. Available at:
http://search.proquest.com/docview/1520722174/fulltext/2A4498AF218B4E5FPQ/1?accountid=14586
The Supreme Court Decision
1*. Rau, J., Appleby, J. “Justices uphold individual mandate, set limits on Medicaid expansion.” Kaiser Health News, June 28,
2012. Available at: http://www.kaiserhealthnews.org/stories/2012/june/28/supreme-court-upholds-individual-mandate.aspx
2. Jost, T.S. “The affordable care act largely survives the Supreme Court’s scrutiny – but barely.” Health Affairs 31(8):16591662, 2012. Available at: http://content.healthaffairs.org/content/31/8/1659.full
3. Diamond, D. “Two years ago, the Supreme Court changed Obamacare. Here’s what’s happened since.” Forbes, June 27,
2014. Available at: http://www.forbes.com/sites/dandiamond/2014/06/27/on-a-big-anniversary-four-ways-obamacare-haschanged/
11
Implementation of ACA
1*. Schouten, F. “Health care law opponents dominate advertising wars.” USA Today, July 10, 2013. Available at:
http://www.usatoday.com/story/news/politics/2013/07/10/affordable-care-act-ads-nfl-president-obama-republicansattacks/2506633/
2*. Bolton, A. “Government shutdown looms over ObamaCare.” The Hill, July 23, 2013. Available at:
http://thehill.com/homenews/administration/312727-shutdown-looms-over-obamacare
3*. Cheney, K. “House GOP unveils death by 1,000 cuts.” Politico, July 17, 2012. Available at:
http://www.politico.com/news/stories/0712/78627.html
4*. Editorial Board. “Obamacare’s tricky next phase.” The Washington Post, May 19, 2013. Available at:
http://articles.washingtonpost.com/2013-05-19/opinions/39376708_1_health-insurance-health-coverage-obamacare-s
5*. Klein, E., Soltas, E. “Wonkbook: House Republicans hate Obamacare. But they also kind of need it.” The Washington Post,
May 17, 2013. Available at: http://www.washingtonpost.com/blogs/fact-checker/post/is-long-beach-really-limiting-the-hours-of1600-workers-because-of-obamacare/2013/05/05/81e9a5b6-b4fe-11e2-9a98-4be1688d7d84_blog.html
6*. Baker, S. “Court challenges could tear down major pieces of Obamacare.” The Hill, June 2, 2013. Available at:
http://thehill.com/blogs/healthwatch/health-reform-implementation/302895-court-challenges-could-tear-down-major-pieces-ofobamacare
7. Cohn, J. “This is what it looks like when an Obamacare attack backfires.” New Republic, June 18, 2014. Available at:
http://www.newrepublic.com/article/118241/obamacare-insurance-bailout-republican-attack-backfires
8. Pear, R. “Racing to spread word about new health plans.” The New York Times, April 23, 2013. Available at:
http://www.nytimes.com/2013/04/24/health/racing-to-inform-millions-unaware-of-new-healthcoverage.html?pagewanted=all&_r=0
9. Brooks, D. “Health chaos ahead.” The New York Times, April 25, 2013. Available at:
http://www.nytimes.com/2013/04/26/opinion/brooks-health-chaos-ahead.html
10. Kessler, D.P. “The coming Obamacare shock.” The Wall Street Journal, April 29, 2013. Available at:
http://online.wsj.com/article/SB10001424127887324874204578441032081716170.html
11. Kessler, G. “Is Long Beach really limiting the hours of 1,600 workers because of ‘Obamacare’?” The Washington Post, May 6,
2013. Available at: http://www.washingtonpost.com/blogs/fact-checker/post/is-long-beach-really-limiting-the-hours-of-1600workers-because-of-obamacare/2013/05/05/81e9a5b6-b4fe-11e2-9a98-4be1688d7d84_blog.html
12. Carey, M.A. “GOP fears about IRS’ access to medical records disputed.” Kaiser Health News Blog, May 20, 2013. Available
at: http://capsules.kaiserhealthnews.org/?p=19604
13. Bogardus, K. “Labor unions break ranks with White House on Obamacare.” The Hill, May 21, 2013. Available at:
http://thehill.com/business-a-lobbying/300881-labor-unions-break-ranks-on-health-law
14. Weisman, J., Pear R. “Partisan gridlock thwarts effort to alter health law.” The New York Times, May 26, 2013. Available at:
http://www.nytimes.com/2013/05/27/us/politics/polarized-congress-thwarts-changes-to-health-care-law.html?pagewanted=all
15. Esenstadt, A. “Democrats’ 2014 strategy: Own Obamacare.” Politico, June 4, 2013. Available at:
http://www.politico.com/story/2013/06/dems-2014-strategy-own-obamacare-92172.html
16. Baker, S. “What a GOP Senate would mean for Obamacare.” National Journal, June 23, 2014. Available at:
http://www.nationaljournal.com/health-care/what-a-gop-senate-would-mean-for-obamacare-20140623
17. Krugman, P. “The incompetence dogma.” The New York Times, June 26, 2014. Available at:
http://search.proquest.com/docview/1540644973/fulltext/85C8ED14D83442EAPQ/1?accountid=14586
18. Chait, J. “Here is the most shameless anti-Obamacare argument yet.” New York Magazine, June 26, 2014. Available at:
http://nymag.com/daily/intelligencer/2014/06/most-shameless-anti-obamacare-argument-yet.html
19. Jacobs, L.R., Skocpol, T. “Where pragmatism about health reform lives.” The Hill, July 8, 2014. Available at:
http://thehill.com/blogs/pundits-blog/healthcare/211503-where-pragmatism-about-health-reform-lives
20. Parente, S.T. “The short unhappy life of ObamaCare.” The Wall Street Journal, June 10, 2014. Available at:
http://search.proquest.com/docview/1534437669/fulltext/4A3B41EBEC9445C8PQ/1?accountid=14586
21. Editorial Board. “The vanishing cry of ‘repeal it’.” The New York Times, June 1, 2014. Available at:
http://search.proquest.com/docview/1530914521/fulltext/EAF4F2CA746B4F6APQ/1?accountid=14586
22. Conover, C. “Five alternative futures for Obamacare.” Forbes, May 31, 2014. Available at:
http://www.forbes.com/sites/theapothecary/2014/05/31/five-alternative-futures-for-obamacare/
23. Cheney, K., Haberkorn, J. “GOP’s Obamacare fears come true.” Politico, June 1, 2014. Available at:
http://www.politico.com/story/2014/06/republicans-obamacare-states-healthcare-gov-107290.html
24. Meckler, L. “How GOP’s health-law attacks are evolving.” The Wall Street Journal, May 28, 2014. Available at:
http://blogs.wsj.com/washwire/2014/05/28/how-gops-health-law-attacks-are-evolving/
25. Beutler, B. “The GOP’s latest, embarrassing retreat from the Obamacare wars.” New Republic, June 17, 2014. Available at:
http://www.newrepublic.com/article/118208/vitters-medicaid-expansion-ploy-bad-news-purple-state-gopers
Current Status of ACA
1. Levey, N.N. “Young adults healthier after passage of Obamacare, study finds.” The Los Angeles Times, June 17, 2014.
Available at: http://www.latimes.com/nation/nationnow/la-na-obamacare-young-adults-20140617-story.html
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2.
Millman, J. “Obamacare ‘sticker shock’ not so shocking, conservative economist suggests.” The Washington Post, June 18,
2014. Available at: http://www.washingtonpost.com/blogs/wonkblog/wp/2014/06/18/obamacare-sticker-shock-not-so-shockingconservative-economist-suggests/
3. Drum, K. “It’s time to acknowledge reality: Obamacare is working pretty well.” Mother Jones, June 18, 2014. Available at:
http://www.motherjones.com/kevin-drum/2014/06/its-time-acknowledge-reality-obamacare-working-pretty-well
4. Klein, E. “How conservatives won with Obamacare.” Vox, July 15, 2014. Available at:
http://www.vox.com/2014/7/15/5900187/conservatives-won-with-obamacare-they-just-dont-know-it
5. Carroll, A.E. “Why improving access to health care does not save money.” The New York Times, July 14, 2014. Available at:
http://www.nytimes.com/2014/07/15/upshot/why-improving-access-to-health-care-does-not-save-money.html?_r=0
6. Biebeck, E. “Analysis: Lawmakers barely mentioning O-Care.” The Hill, July 11, 2014. Available at:
http://thehill.com/policy/healthcare/211957-analysis-lawmakers-barely-mentioning-o-care
7. Krugman, P. “Obamacare fails to fail.” The New York Times, July 13, 2014. Available at:
http://search.proquest.com/docview/1544719114/fulltext/C12D25B6FAA04D38PQ/1?accountid=14586
Other Efforts to Expand Coverage for the Uninsured
1*. Goldman, D. Leive, A. “Why ‘Medicare-for-all” is not the answer.” Health Affairs Blog, May 14, 2013. Available at:
http://healthaffairs.org/blog/2013/05/14/why-medicare-for-all-is-not-the-answer/
2. Henry J. Kaiser Family Foundation. “Massachusetts health care reform: Six years later.” Issue Brief, May 2012. Available at:
http://www.kff.org/healthreform/upload/8311.pdf
3. Hsiao, W.C. “State-based, single-payer health care — A solution for the United States?” New England Journal of Medicine
364(13):1188-1190, 2011. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1100972
Further Readings
1.
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15.
Goodnough, A. “Critics of health care law outspending its supporters on ads.” The New York Times, June 4, 2013. Available
at: http://www.nytimes.com/2013/06/05/us/politics/critics-of-health-care-law-outspending-its-supporters-onads.html?gwh=36412B4E76FE81E688FB25886FB8FE9F
Baker, S. “HHS delays Obamacare option for small businesses, saying it’s too complicated.” The Hill, May 31, 2013. Available
at: http://thehill.com/blogs/healthwatch/health-reform-implementation/302769-hhs-finalizes-delay-in-obamacare-option-forsmall-businesses
Viebeck, E. “Botched Obamacare rollout tops Democratic fears for 2014 election.” The Hill, May 1, 2013. Available at:
http://thehill.com/blogs/healthwatch/health-reform-implementation/297103-botched-obamacare-tops-dem-fears-for-14
Klein, E. “Republicans will clobber Obamacare until they hug it.” Bloomberg, April 24, 2013. Available at:
http://www.bloomberg.com/news/2013-04-24/republicans-will-clobber-obamacare-until-they-hug-it.html
Vestal, S. “Lack of competition might hamper health exchanges.” Kaiser Health News, April 23, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/april/23/stateline-lack-of-competition-hamper-health-exchanges.aspx
Chen, L. “How Obamacare will distort the health-care market.” Bloomberg, April 7, 2013. Available at:
http://www.bloomberg.com/news/2013-04-07/how-obamacare-will-distort-the-health-care-market.html
Dionne Jr., E.J. “A victory for Obama – and for Roberts.” Washington Post online Opinions, June 28, 2012. Available at:
http://www.washingtonpost.com/opinions/ej-dionne-jr-a-win-for-obama--and-roberts/2012/06/28/gJQAlWta9V_story.html
Horwitz, J., Levy, H. “Health care economics 101 and the Supreme Court.” Health Affairs Blog, May 23, 2012. Available at:
http://healthaffairs.org/blog/2012/05/23/health-care-economics-101-and-the-supreme-court/
Kessler, G. “Fact checker: Does Romney’s assessment of the economic impact of Obama’s health-care law hold up?”
Washington Post online Politics, June 16, 2012. Available at: http://www.washingtonpost.com/politics/fact-checker-doesromneys-assessment-of-the-economic-impact-of-obamas-health-care-law-hold-up/2012/06/16/gJQAJjsqhV_story.html
Daschle, T. “Obama’s 4 major ACA hurdles to go.” Politico, July 8, 2012. Available at:
Gerstein, J., Haberkorn, J. “Supreme Court health care ruling: 6 takeaways.” Politico, June 28, 2012. Available at:
Pear, R. “Short of repeal, G.O.P. will chip at health law.” New York Times, September 21, 2010, p. A.1. Available at:
http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=nor
mal&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroup
s=&sortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA237499337
Cafarella, N., Carrk, T. “Myth vs. fact: Health care reform in Massachusetts. The state model for the affordable care act is
working and broadly popular.” Washington, DC: Center for American Progress. April 2011. Available at:
http://www.americanprogress.org/issues/2011/04/mvf_healthcare_mass.html
Murray, T.H. “American values and health care reform.” New England Journal of Medicine 362(4):285-287, 2010. Available at:
Berwick D.M. “Putting health care on the right track.” Washington Post online Opinions, June 21, 2012. Available at:
http://www.washingtonpost.com/opinions/putting-health-care-on-the-right-track/2012/06/21/gJQAtBGltV_story.html
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16. Deparle, N.A. “The successes of Obamacare.” Washington Post, May 9, 2013. Available at:
http://articles.washingtonpost.com/2013-05-09/opinions/39133432_1_affordable-care-act-health-care-uninsured-andmedicaid-recipients
17. Calmes, J. “New worries for Democrats on health law.” The New York Times, May 6, 2013. Available at:
http://www.nytimes.com/2013/05/07/us/politics/gop-is-readying-a-new-offensive-over-health-law.html?pagewanted=all
18. Krugman, P. “Insurance and freedom.” The New York Times, April 7, 2013. Available at:
http://www.nytimes.com/2013/04/08/opinion/krugman-insurance-and-freedom.html
19. Radnofsky, L. “Some states see in the health law a chance to pursue unique solutions.” The Wall Street Journal Online, June
8, 2014. Available at: http://search.proquest.com/docview/1534003712/fulltext/D8454CC8DAFA4E7CPQ/1?accountid=14586
20. Editorial Board. “How to run on health reform.” The New York Times, April 28, 2014. Available at:
http://search.proquest.com/docview/1517525958/fulltext/3A310FE91B5B4DC0PQ/1?accountid=14586
21. Sargent, G. “Morning plum: GOP’s ‘new’ Obamacare repeal message will fizzle, too.” The Washington Post, June 19, 2014.
Available at: http://search.proquest.com/docview/1537654913/fulltext/84A270FF16054ACEPQ/1?accountid=14586
Care Delivery
A Macro View of Physician Supply: Do We Have Enough Physicians Now? Will We Need More in the
Future?
Assignment 1 Due
People are the critical element in any health care delivery system. In this session, we will focus on physicians, particularly on physician
education, challenges to ways in which physicians have historically organized and practiced medicine, and concerns about aggregate
level physician supply. There is now a major disagreement about whether there will be a future physician shortage and, if so, how to
address it. There is also concern that health reform will make matters worse. This session presents opposing perspectives on these
issues and discusses the likelihood of a public policy response. Subsequent courses in the MHA program will cover material relating to
physician payment and management of physician practices.
Learning Objectives
1. Explain the limitations of the present medical education system in expanding physician supply.
2. Discuss ongoing changes in the way that physicians organize and practice medicine.
3. Discuss the points of controversy regarding the prediction of future shortages or surpluses in physician supply in America.
4. Discuss the public policy issues regarding expanding physician supply.
Suggested Readings
Physician Education
1*. Saxton, J. “The medical education of physicians.” Background Paper No. 73, National Health Policy Forum. February 17, 2010.
Available at: http://www.nhpf.org/library/background-papers/BP73_MedicalEducation_02-17-10.pdf
2.* Iglehart, J.K. “The residency mismatch.” The New England Journal of Medicine 369(4):297-299, 2013. Available at:
http://www.nejm.org/doi/full/10.1056/NEJMp1306445
3*. Dower, C. “Graduate medical education. A debate continues over the size and scope of federal subsidies to support
residency training of the nation’s physicians.” Health Affairs Policy Brief, August 16, 2012. Available at:
http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_73.pdf
4*. Ofri, D. “The third year of medical school turns students from altruistic to bitter.” Slate, June 4, 2013. Available at:
http://www.slate.com/articles/health_and_science/medical_examiner/2013/06/medical_school_dark_side_the_third_year_mak
es_students_less_empathetic.html
5. Iglehart, J.K. “Financing graduate medical education – mounting pressure for reform.” New England Journal of Medicine
366(17):1562-1563, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1114236
6. Cohen, J. “New med school aims to train primary care docs.” Kaiser Health News, April 2, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/april/02/quinnipiac-medical-school-primary-care.aspx
7. Sack, K. “Summer of work exposes medical students to system’s ills.” The New York Times, September 9, 2009. Available at:
http://www.nytimes.com/2009/09/09/health/policy/09medschool.html?_r=0
8. Crosson, F.J., Leu, J., Roemer, B.M., Ross, M.N. “Gaps in residency training should be addressed to better prepare doctors
for a twenty-first century delivery system.” Health Affairs 30(11):2142-2148, 2011. Available at:
9. Hartman, B. “The 3 year medical school: Is shorter good enough?” MedPage Today, September 16, 2013. Available at:
http://www.medpagetoday.com/PublicHealthPolicy/MedicalEducation/41651
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10. Hoekzema, G. “Graduate education for primary care physicians.” Health Affairs 33(6):1102, 2014. Available at:
http://content.healthaffairs.org/content/33/6/1102.1.full.pdf+html
11. Shannon, S.C., Buser, B.R., Hahn, M.B. “Graduate medical education: The authors reply.” Health Affairs 33(6):1102, 2014,
Available at: http://content.healthaffairs.org/content/33/6/1102.2.full.pdf+html
12. Chandra, A., Khullar, D., Wilensky, G.R. “The economics of graduate medical education.” The New England Journal of
Medicine 370:2357-2360, 2014. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1402468
13. Chen, P.W. “Are med school grads prepared to practice medicine?” The New York Times, April 24, 2014. Available at:
http://www.lexisnexis.com/lnacui2api/api/version1/getDocCui?lni=5C26-84H1-DY2MW3KW&csi=379740&hl=t&hv=t&hnsd=f&hns=t&hgn=t&oc=00240&perma=true
14. Wickline, S. “Biggest match day yet.” MedPage Today, March 21, 2014. Available at:
http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/44866
Physician Concerns
1. Goodnough, A. “New law’s demands on doctors have many seeking a network.” The New York Times, March 2, 2014.
Available at: http://search.proquest.com/docview/1503511347/fulltext/FF55492CC4D94464PQ/1?accountid=14586
2. Cortez, M.F. “Pay gap for women doctors increases to $50,000 a year.” Bloomberg, September 2, 2013. Available at:
http://www.bloomberg.com/news/2013-09-02/pay-gap-for-women-doctors-increases-to-50-000-a-year.html
3. Bornstein, D. “Medicine’s search for meaning.” The New York Times, September 18, 2013. Available at:
http://opinionator.blogs.nytimes.com/2013/09/18/medicines-search-for-meaning/
4. Pearl, R. “Medicine is an art, not a science: Medical myth or reality.” Forbes, June 12, 2014. Available at:
http://www.forbes.com/sites/robertpearl/2014/06/12/medicine-is-an-art-not-a-science-medical-myth-or-reality/
5. Pho, K. “Doctors are not overpaid: Column.” USA Today, July 2, 2014. Available at:
http://www.usatoday.com/story/opinion/2014/07/02/doctors-salaries-health-care-costs-physician-column/12113999/
6. Rosenthal, E. “Medicine’s top earners are not the M.D.s.” The New York Times, May 17, 2014. Available at:
http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html?_r=0
7. Pollack, A. “Cost of treatment may influence doctors.” The New York Times, April 17, 2014. Available at:
http://www.nytimes.com/2014/04/18/business/treatment-cost-could-influence-doctors-advice.html
8. Tobey, P. “Doctors still make good money.” The Washington Post, April 18, 2014. Available at:
http://www.washingtonpost.com/news/morning-mix/wp/2014/04/18/doctors-still-make-good-money/
Challenges to Traditional Physician Practice
1*. Ringel, S.P. “Practicing medicine versus pushing paper. A neurologist reflects on the realities of his workday after a patient
asks why doctors complain about payers’ bureaucratic oversight.” Health Affairs 30(6):1200-1202, 2011.
2*. Gamble, M. “68% of graduating physicians want sign-on bonus, 29% want hospital practice.” Becker’s Hospital Review,
August 16, 2012. Available at: http://www.beckershospitalreview.com/hospital-physician-relationships/68-of-graduatingphysicians-want-sign-on-bonus-29-want-hospital-practice.html
3. Morra, D., Nicholson, S., Levinson, W., Gans, D.N., Hammons, T., Casalino, L.P. “US Physician practices versus Canadians:
Spending nearly four times as much money interacting with payers.” Health Affairs 30(8):1443-1450, 2011.
4. Yeh, C. “’Nothing is broken’: For an injured doctor, quality-focused care misses the mark.” Health Affairs 33(6):1094-1097,
2014. Available at: http://content.healthaffairs.org/content/33/6.toc
5. Bernstein, L. “How many patients should your doctor see each day?” The Washington Post May 22, 2014. Available at:
http://search.proquest.com/docview/1527270597/fulltext/FC95ED13FDFF42E4PQ/1?accountid=14586
6. Reschovsky, J. “Does location determine medical practice patterns?” Virtual Mentor 16(2):138-141, 2014. Available at:
http://virtualmentor.ama-assn.org/2014/02/pdf/oped1-1402.pdf
7. Hethcock, B. “Physician turnover rises as hospitals employ more docs.” Dallas Business Journal, March 17, 2014. Available
at: http://www.bizjournals.com/dallas/news/2014/03/17/physician-turnover-rises-as-hospitals-employ-more.html?page=all
8. Bastian, L.A. “Evolution of hospital medicine and the impact of residents’ career choices.” Journal of General Internal Medicine
29(7):971-972, 2014. Available at: http://link.springer.com/journal/11606/29/7/page/1
Physician Supply Projections
1*. KaiserEDU.org. “Primary care shortage; Background brief.” Available at:
http://www.wcl.american.edu/secle/materials/Fall_2012/Next_Steps_in_Health_Reform/TAB%2012.Background-Brief.pdf
2*. Robert Wood Johnson Foundation. “Will the United States have a shortage of physicians in 10 years?” November 2009.
Available at: http://www.academyhealth.org/files/publications/HCFOReportDec09.pdf
3. Iglehart, J.K. “Grassroots activism and the pursuit of an expanded physician supply.” New England Journal of Medicine
358(16):1741-1749, 2008. http://www.nejm.org/doi/pdf/10.1056/NEJMhpr0800058
4. Dunn, L. “What will the physician workforce look like in 2030?” Becker’s Hospital Review, May 13, 2013. Available at:
http://www.beckershospitalreview.com/hospital-physician-relationships/what-will-the-physician-workforce-look-like-in-2030.html
5. Preidt, R. “Primary care doctors still in short supply in U.S.” MedlinePlus, June 14, 2013. Available at:
http://www.nlm.nih.gov/medlineplus/news/fullstory_137836.html
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6.
Sadick, B. “In search of more primary-care doctors.” The Wall Street Journal, November 17, 2013. Available at:
http://online.wsj.com/news/articles/SB10001424052702303902404579151510997182566
7. Gordon, E. “Primary care shortage? Not for the insured, study shows.” Kaiser Health News, April 8, 2014. Available at:
http://capsules.kaiserhealthnews.org/index.php/2014/04/primary-care-shortage-not-for-the-insured-study-shows/
8. Krasselt, K., O’Donnell, J. “Supply won’t meet growing demand for primary care.” USA Today, June 30, 2014. Available at:
http://www.usatoday.com/story/news/politics/2014/06/29/primary-care-shortage-health/11101265/
9. Punke, H. “5 things to know about provider dispersion in the US.” Becker’s Hospital Review, May 22, 2014. Available at:
http://www.beckershospitalreview.com/hospital-physician-relationships/5-things-to-know-about-provider-dispersion-in-theus.html
Options for Increasing Physician Supply
1*. Pardes, H., Miller, E.D. “We can’t afford to train fewer doctors.” New York Times, July 12, 2011, p. A.13.
2*. Caramenico, A. “Med school enrollment growth won’t ease doc shortage.” FierceHealthcare, May 3, 2013. Available at:
http://www.fiercehealthcare.com/story/med-school-enrollment-growth-wont-ease-doc-shortage/2013-05-03
3. Editorial. “An Rx for the doctor shortage.” Los Angeles Times, April 21, 2013. Available at:
http://articles.latimes.com/2013/apr/21/opinion/la-ed-medical-professionals-20130421
4. Sanders, B. “Primary physician shortage calls for intervention.” Politico, May 7, 2013. Available at:
http://www.politico.com/story/2013/05/doctors-physician-shortage-calls-for-intervention-91024.html
5. Gold, J. “Immigrant docs help ease California’s primary care shortage.” Kaiser Health News, April 4, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/april/04/california-doctors-primary-care-latin-america.aspx
6. Torrey, E.F., Torrey, B.B. “The US distribution of physicians from lower income countries.” PLoS One 7(3):1-4, 2012. Available
at: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0033076
7. McAllester, M. “America is stealing the world’s doctors.” New York Times online, March 7, 2012. Available at:
http://www.nytimes.com/2012/03/11/magazine/america-is-stealing-foreign-doctors.html?pagewanted=all
8. Association of American Medical Colleges. “Medical school enrollment continues to climb with new diversity gains.” October
24, 2012. Available at: https://www.aamc.org/newsroom/newsreleases/310002/121023.html
9. Rampell, C. “Path to United States practice is long slog to foreign doctors.” The New York Times, August 11, 2013. Available
at: http://www.nytimes.com/2013/08/12/business/economy/long-slog-for-foreign-doctors-to-practice-in-us.html
Public Policy Issues and Concerns About Physician Supply
1*. Goozner, M. “More doctors on the way, higher costs to follow.” The Fiscal Times, May 4, 2012. Available at:
http://www.thefiscaltimes.com/Articles/2012/05/04/More-Doctors-on-the-Way-Higher-Costs-to-Follow.aspx#page1
2*. Reinhardt, U.E. “Health-care reform and the ‘doctor shortage’.” New York Times online, August 17, 2012. Available at:
http://economix.blogs.nytimes.com/2012/08/17/health-care-reform-and-the-doctor-shortage/
3. Reinhardt, U.E. “From physician glut to physician shortage.” The New York Times, August 31, 2012. Available at:
http://economix.blogs.nytimes.com/2012/08/31/from-physician-glut-to-physician-shortage/
4. Lowrey, A., Pear, R. “Doctor shortage likely to worsen with health law.” New York Times, July 29, 2012, p. A.1.
http://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.html
5. Davis, K.L. “Demand for doctors soaring as cuts loom.” Politico, March 5, 2013. Available at:
http://www.politico.com/story/2013/03/demand-for-doctors-soaring-as-cuts-loom-88390.html
6. Ubel, P. “How much money should a cardiologist make?” Forbes, December 7, 2012. Available at:
http://www.forbes.com/sites/peterubel/2012/12/07/how-much-money-should-a-cardiologist-make/
7. Robertson, K. “Legislation would speed up education for doctors.” Sacramento Business Journal, March 12, 2014. Available
at: http://www.bizjournals.com/sacramento/news/2014/03/12/calif-legis-education-doctors-accelerate.html
8. Kennedy, K. “Obama budget will seek record funding for new doctors.” USA Today, February 27, 2014. Available at:
http://www.usatoday.com/story/news/nation/2014/02/27/new-budget-proposes-record-funding-for-new-doctors/5836317/
Further Readings
1.
2.
3.
4.
5.
6.
Conover, C. “Are U.S. doctors paid too much?” Forbes, May 28, 2013. Available at:
http://www.forbes.com/sites/theapothecary/2013/05/28/are-u-s-doctors-paid-too-much/
ConsumerReports. “What bugs you most about your doctor.” June 2013. Available at:
http://www.consumerreports.org/cro/magazine/2013/06/what-bugs-you-most-about-your-doctor/index.htm
Hixon, T. “Rebutting the premise that doctors help drive high health care costs.” Forbes, March 24, 2012. Available at:
http://www.forbes.com/sites/toddhixon/2012/03/24/rebutting-the-premise-that-doctors-help-drive-high-health-care-costs/
Novak, S. “Luring students into family medicine.” The New York Times, September 9, 2012. Available at:
http://www.nytimes.com/2012/09/10/us/10iht-educlede10.html?pagewanted=all
Tulenko, K. “America’s health worker mismatch.” The New York Times, September 13, 2012. Available at:
http://www.nytimes.com/2012/09/14/opinion/americas-health-worker-mismatch.html
Schwartz, M.D. “Health care reform and the primary care workforce bottleneck.” Journal of General Internal Medicine
27(4):469-472, 2012. http://link.springer.com/content/pdf/10.1007%2Fs11606-011-1921-4
16
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Gold, J. “The next frontier for elite med schools: Primary care.” Kaiser Health News, September 23, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/september/24/mt-sinai-primary-care.aspx
Goldstein, A. “Primary-care health panel caught in partisan dispute.” The Washington Post, May 16, 2011, p. A.3. Available at:
http://www.highbeam.com/doc/1P2-28704120.html
Cassel, C. K., Reuben, D.B. “Specialization, subspecialization, and subsubspecialization in internal medicine.” New England
Journal of Medicine 364(12):1169-1173, 2011. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMsb1012647
Grady, D. “Foreign-born doctors give equal care in U.S.” New York Times, August 3, 2010, p. D.7.
http://www.nytimes.com/2010/08/03/health/03doctors.html
Kaiser Health News. “Medical school costs, loan rates rise sharply.” March 20, 2010. Available at:
http://www.kaiserhealthnews.org/Daily-Reports/2010/March/10/medical-school-cost.aspx
LA Times online. “Medical school enrollment on the rise.” October 24, 2011. Available at:
http://latimesblogs.latimes.com/money_co/2011/10/medical-school-enrollment.html
Liao, J.M., Wachter, R.M. “Grading residents’ clinical performance: Unique opportunities and challenges.” Journal of General
Internal Medicine 29(7):983-985, 2014. Available at: http://link.springer.com/journal/11606/29/7/page/1
Lee, D. “Physician-hospital links grow. Overhead, reimbursement fuel trend of doctors forgoing autonomy.” Indy.com, March 4,
2010. Available at: http://www.indystar.com/article/20100304/BUSINESS/3040377/Physician-hospital-links-grow
Burling, S. “Why heart doctors are leaving practice to work for hospitals.” philly.com, January 27, 2012. Available at:
http://mobile.philly.com/health/?wss=/philly/health&id=138095/623
Barr, S. “Few doctors consider themselves rich, survey says.” Kaiser Health News, April 25, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/04/few-doctors-consider-themselves-rich-survey-says/
Punke, H. “11 specialties with most satisfied physicians.” Becker’s Hospital Review, April 30, 2013. Available at:
http://www.beckershospitalreview.com/hospital-physician-relationships/11-specialties-with-most-satisfied-physicians.html
Johnson, C. “Survey shows growing approval and acceptance of integrated, employed physicians.” Physician Executive
40(2):8-12, 2014. Available at: http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=3&sid=25083265-ad74-4eac-84659fd33b527661%40sessionmgr110&hid=122
Wayne, A. “Doctor shortage may swell to 130,000 with cap.” Bloomberg, August 28, 2012. Available at:
http://www.bloomberg.com/news/2012-08-29/doctor-shortage-may-swell-to-130-000-with-u-s-cap.html
Sanner, A. “Newly insured to deepen primary care doctor gap.” TwinCities.com, June 22, 2013. Available at:
http://www.loganbanner.com/view/full_story/22993974/article-Newly-insured-to-deepen-primary-care-doctor-gap
HealthDay News. “Shortage of doctors who treat diabetes looming.” June 20, 2014. Available at:
http://consumer.healthday.com/diabetes-information-10/misc-diabetes-news-181/shortage-of-doctors-who-treat-diabeteslooming-689004.html
Hart, L.G. et al. “International medical graduate physicians in the United States: Changes since 1981.” Health Affairs
26(4):1159-1169, 2007. http://content.healthaffairs.org/content/26/4/1159.full.pdf+html
Rethinking Primary Care: From Marcus Welby to Team-based Care?
Improving the delivery of primary care is a growing challenge for policymakers, clinicians, and health care managers. The flaws in the
present system are painfully evident, with various alternatives now being adopted in hopes of correcting, or at least mitigating, them. In
this session, we describe the challenges currently facing primary care, with particular focus on new models for organizing the delivery of
care, and the potential expanded role for advanced practice nurses in rethinking primary care.
Learning Objectives
1. Explain the reasons for the current focus on changing primary care delivery in the U.S.
2. Discuss changes in the workplace and work arrangements for primary care physicians.
3. Compare and contrast new models for reforming primary care.
4. Discuss how public policy, and health care reform in particular, is likely to affect primary care.
Suggested Readings
Overview of Primary Care
1*. Bodenheimer, T. and Pham H.H. “Primary care: Current problems and proposed solutions.” Health Affairs 29(5):799-805,
2010. http://content.healthaffairs.org/content/29/5/799.full.pdf+html
2. Dower, C., O’Neil, E. “Primary care health workforce in the United States.” Robert Wood Johnson Foundation Research
Synthesis Report No. 22, July 2011. Available at: http://www.rwjf.org/files/research/070811.policysynthesis.workforce.rpt.pdf
3. Kavilanz, P. “Med students rush to primary care programs.” CNN Money, March 23, 2011. Available at:
http://money.cnn.com/2011/03/23/news/economy/more_medical_students_pick_family_medicine/index.htm
17
4.
The Commonwealth Fund. “Primary care: Our first line of defense.” June 12, 2013. Available at:
http://www.commonwealthfund.org/Publications/Health-Reform-and-You/Primary-Care-Our-First-Line-ofDefense.aspx?page=all
5. Johnson, W. “Family care doctors are in high demand.” CBSnews, February 18, 2012. Available at:
http://www.cbsnews.com/8301-18563_162-57380915/family-care-doctors-are-in-high-demand/
Challenges to Traditional Models of Primary Care Delivery
1*. Iglehart, J.K. “Primary care update – light at the end of the tunnel?” New England Journal of Medicine 366(23):2144-2146,
2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1205537
2. Vaughn, B.T., DeVrieze, S.R., Reed, S.D., Schulman, K.A. “Can we close the income and wealth gap between specialists and
primary care physicians?” Health Affairs 29(5):933-940, 2010. http://content.healthaffairs.org/content/29/5/933.full.pdf+html
3. Rabin, R.C. “15-minute visits take a toll on the doctor-patient relationship.” Kaiser Health News, April 21, 2014. Available at:
http://www.kaiserhealthnews.org/stories/2014/april/21/15-minute-doctor-visits.aspx
4. Iglehart, J.K. “Doctor-workers of the world, unite!” Health Affairs 30(4):556-558, 2011.
5. Delude, C. “What happened to the family doctor?” Los Angeles Times, June 27, 2011. Available at:
http://articles.latimes.com/print/2011/jun/27/health/la-he-primary-care-doctors-20110627
6. Peterson, S.M., Phillips Jr., R.L., Bazemore, A.W., Koinis, G.T. “Unequal Distribution of the U.S. primary care workforce.”
American Family Physician 87(11):1. Available at:
https://www.clinicalkey.com/#!/BrowserCtrl/doBrowseTo/journalIssue/{"facet":["1-s2.0S0002838X13X60101"],"issn":"0002838X","contentType":"Journals"}
Changes in the Workplace for Primary Care Physicians
1*. Sun, L.H. “Hospitals courting primary-care doctors.” Washington Post, June 20, 2011, p. A.1.
http://articles.washingtonpost.com/2011-06-19/national/35265390_1_primary-care-care-at-lower-costs-medicine
2. Cresswell, J. “Race is on to profit from rise of urgent care.” The New York Times, July 9, 2014. Available at:
http://search.proquest.com/docview/1543865034/fulltext/17B1AFE046614757PQ/1?accountid=14586
3. Landon, B.E. “Use of quality indicators in patient care. A senior primary care physician trying to take good care of his patients.”
Journal of the American Medical Association 307(9):956-964, 2012. Available at:
4. Becker, A.E. “More physicians turning to hospital-based practice.” Ctmirror, August 15, 2011. Available at:
http://ctmirror.org/story/13550/hospitalists
5. Harris, G. “Family physician can’t give away solo practice.” New York Times, April 23, 2011, p. A.1.
http://www.nytimes.com/2011/04/23/health/23doctor.html?pagewanted=all
6. Rabin, R.C. “Burnt out primary care docs are voting with their feet.” Kaiser Health News, April 1, 2014. Available at:
http://www.kaiserhealthnews.org/stories/2014/april/01/doctor-burnout.aspx
New Models for Primary Care
Patient Centered Medical Homes (PCMHs) and Team Care
1*. Hoff, T. “The shaky foundation of the patient-centered medical home.” American Journal of Managed Care 16(6):e134-e136,
2010. http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=b1ae00b1-d01d-4f57-a3a7c3fa2b2aa56c%40sessionmgr14&vid=4&hid=16
2*. Casalino, L.P. “Analysis & commentary. A Martian’s prescription for primary care: Overhaul the physician’s workday.” Health
Affairs 29(5):785-790, 2010. http://content.healthaffairs.org/content/29/5/785.full.pdf+html
3*. Margolius, D., Bodenheimer, T. “Transforming primary care: From past practice to the practice of the future.” Health Affairs
29(5):779-784, 2010. http://content.healthaffairs.org/content/29/5/779.full.pdf+html
4*. Ghorob, A., Bodenheimer, T. “Sharing the care to improve access to primary care.” New England Journal of Medicine
366(21):1955-1957, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1202775
5. Landro, L. “The doctor’s team will see you know.” Wall Street Journal, February 17, 2014. Available at:
http://search.proquest.com/docview/1498563221/fulltext/1F01977C615641F1PQ/1?accountid=14586
6. Altschuler, J., Margolius, D., Bodenheimer, T., et al. “Estimating a reasonable patient panel size for primary care physicians
with team-based task delegation.” Annals of Family Medicine 10(5):396-400, 2012. Available at:
http://www.annfammed.org/content/10/5/396.full.pdf+html
7. Berenson, R.A., Devers, K.J., Burton, R.A. “Will the patient-centered medical home transform the delivery of health care?”
Washington, DC: Urban Institute, August 2011. Available at: http://www.urban.org/UploadedPDF/412373-will-patient-centeredmedical-home-transform-delivery-health-care.pdf
8. Adair, R., Christianson, J., Wholey, D., et al. “Care guides: Employing nonclinical laypersons to help primary care teams
manage chronic disease.” Journal of Ambulatory Care Management 35(1):27-37, 2012. Available at:
http://ovidsp.tx.ovid.com/sp3.12.0b/ovidweb.cgi?WebLinkFrameset=1&S=CFOHFPMDFJDDFEOCNCMKNGJCIHLMAA00&returnUrl=ovidweb.cgi%3f%2
6TOC%3dS.sh.18.19.23.27%257c4%257c50%26FORMAT%3dtoc%26FIELDS%3dTOC%26S%3dCFOHFPMDFJDDFEOCN
CMKNGJCIHLMAA00&directlink=http%3a%2f%2fgraphics.tx.ovid.com%2fovftpdfs%2fFPDDNCJCNGOCFJ00%2ffs047%2fov
18
ft%2flive%2fgv031%2f00004479%2f00004479-20120100000004.pdf&filename=Care+Guides%3a+Employing+Nonclinical+Laypersons+to+Help+Primary+Care+Teams+Manage+Chron
ic+Disease.&PDFIdLinkField=%2ffs047%2fovft%2flive%2fgv031%2f00004479%2f00004479-20120100000004&link_from=S.sh.18.19.23.27%7c4&pdf_key=B&pdf_index=S.sh.18.19.23.27&D=ovft
9. Green, L.V., Savin, S., Lu, Y. “Primary care physician shortages could be eliminated through use of teams, nonphysicians, and
electronic communications.” Health Affairs 32(1):11-19, 2013. Available at:
10. Rao, A. “Doctors transform how they practice medicine.” Kaiser Health News, May 15, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/may/15/doctors-transform-practices-over-financial-lifestylepressures.aspx?referrer=search
11. Elliott, V.S. “Study quantifies practice boost from physicians delegating tasks.” amednews.com, November 19, 2012. Available
at: http://www.amednews.com/article/20121119/business/311199967/6/
12. NCQA. “NCQA medical homes pass 6,000 mark.” NCQA, September 24, 2013. Available at:
http://www.ncqa.org/Newsroom/NewsArchive/2013NewsArchive/NewsReleaseSeptember242013.aspx
Increased Reliance on Advanced Practice Nurses
1*. Kliff, S. “Nurse practitioners look to fill gap with expected spike in demand for health services.” Washington Post online, May
12, 2012. Available at: http://www.washingtonpost.com/national/health-science/nurse-practitioners-look-to-raise-profile-fillgap-from-doctor-shortage/2012/05/12/gIQAHmHYLU_story.html
2*. Beck, M. “Battles erupt over filling doctors’ shoes.” The Wall Street Journal, February 4, 2013. Available at:
3*. Tran, A. “Docs, nurses disagree over expanded nurse roles.” Kaiser Health News Blog, May 15, 2013. Available at:
http://capsules.kaiserhealthnews.org/?p=19536
4. Galewitz, P. “Urgent care centers are booming, which worries some doctors.” The Washington Post, September 17, 2012.
Available at: http://www.washingtonpost.com/national/health-science/urgent-care-centers-are-booming-which-worries-somedoctors/2012/09/17/e87f1a0c-e0cb-11e1-a19c-fcfa365396c8_story.html
5. Elliott, V.S. “Sharp increase expected in number of nurse practitioners.” amednews.com, July 2, 2012. Available at:
http://www.ama-assn.org/amednews/2012/07/02/bisb0702.htm
6. Aizenman, N.C. “Nurses can practice without physician supervision in many states.” The Washington Post, March 24, 2013.
Available at: http://www.washingtonpost.com/national/health-science/nurses-can-practice-without-physician-supervision-inmany-states/2013/03/24/98b241cc-8745-11e2-999e-5f8e0410cb9d_story.html
7. SullivanCotter and Associates, Inc. “Advanced practice clinician pay – what’s happening and what’s coming.” 2012. Available
at:
http://www.sullivancotter.com/sites/default/files/SullivanCotter_2012_APC%20Pay_What's%20Happening%20and%20What's
%20Coming_0.pdf
8. Dill, M.J., Pankow, S., Erikson, C., Shipman, S. “Survey shows consumers open to a greater role for physician assistants and
nurse practitioners.” Health Affairs 32(6):1135-1142, 2013. Available at:
9. Pohl, J., Barksdale, D., Werner, K. “The latest data on primary care nurse practitioners and physicians: Can we afford to waste
our workforce? Health Affairs Blog, June 18, 2013. Available at: http://healthaffairs.org/blog/2013/06/18/the-latest-data-onprimary-care-nurse-practitioners-and-physicians-can-we-afford-to-waste-our-workforce/
The Influence of Public Policy and Health Reform on Primary Care
1. Wang, S.S. “Pilot plan on health an option for states.” Wall Street Journal, June 8, 2010. Available at:
http://online.wsj.com/article/NA_WSJ_PUB:SB10001424052748704749904575293044222043802.html.
2. DoBias, M. “Adapt or else. Whether it wants to or not, the health care system is being forced to reinvent itself.”
NationalJournal.com, March 10, 2011. Available at: http://www.nationaljournal.com/member/magazine/health-reform-forcesindustry-to-reinvent-itself-20110310?mrefid=site_search&page=1
3. LeBlanc, S. “50 Million New Patients? More Primary Docs a Must.” Fox News, September 13, 2009. Available at:
http://www.foxnews.com/story/0,2933,549762,00.html
Further Readings
1.
2.
3.
4.
Elliott, V.S. “Study quantifies practice boost from physicians delegating tasks.” Amednews.com, November 19, 2012.
Available at: http://www.ama-assn.org/amednews/2012/11/19/bisb1119.htm
Fiegl, C., O’Reilly, K.B. “AMA meeting: Guidance on health care teams approved.” Amednews.com, November 26, 2012.
Available at: http://www.ama-assn.org/amednews/2012/11/26/prsc1126.htm
Bohmer, R.M.J. “Managing the new primary care: The new skills that will be needed.” Health Affairs 29(5):1010-1014, 2010.
Bodenheimer, T., Berenson, R.A., and Rudolf, P. “The primary care—Specialty income gap: Why it matters.” Annals of Internal
Medicine 146(4):301-306, 2007. Available at: http://annals.org/issue.aspx?journalid=90&issueID=20131&direction=P
19
5.
6.
7.
8.
9.
10.
11.
12.
13.
Chen, P. “Delivering Better Primary Care.” New York Times, May 13, 2010. Available at:
http://www.nytimes.com/2010/05/13/health/13chen.html
Frolkis, J.P. “The Columbo phenomenon.” Journal of the American Medical Association 309(22):2333-2334, 2013. Available
at: http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=927088&direction=P
Landon, B.E. “Moving ahead with the PCMH: Some progress, but more testing needed.” Journal of General Internal Medicine
28(6):753-755, 2013. Available at: http://link.springer.com/content/pdf/10.1007%2Fs11606-013-2434-0.pdf
Johnsen, M. “California expands scope of pharmacy practice.” Drug Store News, October 2, 2013. Available at:
http://drugstorenews.com/article/california-expands-scope-pharmacy-practice
Rosenthal, M.B., Friedberg, M.W., Singer, S.J., Eastman, D., Li, Z., Schneider, E.C. “Effect of a multipayer patient-centered
medical home on health care utilization and quality: The Rhode Island chronic care sustainability initiative pilot program.”
JAMA Internal Medicine 173(20):1907-1913, 2013. Available at:
http://archinte.jamanetwork.com/issue.aspx?journalid=71&issueid=928839&direction=P
Pohl, J.M., Hanson, C., Newland, J.A., Cronenwett, L. “Analysis & commentary. Unleashing nurse practitioners’ potential to
delivery primary care and lead teams.” Health Affairs 29(5):900-905, 2010.
Punke, H. “Hiring of non-physician providers on the rise.” Becker’s Hospital Review, November 2, 2012. Available at:
http://www.beckershospitalreview.com/hospital-physician-relationships/hiring-of-non-physician-providers-on-the-rise.html
State of Iowa, Iowa Board of Medicine. “Board reminds physicians of responsibilities when supervising up to 5 physician
assistants.” March 11, 2013. Available at:
http://medicalboard.iowa.gov/Board%20News/2013/Board%20offers%20guidance%20on%20supervision%20of%20physician
%20assistants%20-%2003112013.pdf
Bartolone, P. “California weighs expanded role for nurse practitioners.” Kaiser Health News, May 9, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/may/09/california-expanded-role-nurse-practitioners.aspx?referrer=search
Session 6 – October 7, 2014
The Nurse Workforce: “Is There a Nurse in the House?”
Nurses have been called the backbone of the U.S. health care system. They work in all health care settings, including hospitals, clinics,
long-term care facilities and insurance plans. Historically, at the aggregate level, maintaining an adequate supply of nurses has been a
perplexing issue. At the micro-level, scope-of-practice and work environment have been particularly important questions for the nursing
profession. This session provides an overview of the nurse workforce, addressing specifically the topics of nurse supply, scope of
practice, and work environment, and public policies towards nursing.
Learning Objectives
1.
2.
3.
Compare and contrast the various explanations for historical and more recent periods of nursing shortage.
Discuss nurse scope of practice and work force issues from the points of view of nurses and health care managers.
Discuss recent state and federal policy initiatives directed at nursing.
Suggested Readings
The Supply of Nurses
1*. kaiserEDU.org. “Nursing workforce.” Available at: http://www.kaiseredu.org/Issue-Modules/Addressing-the-NursingShortage/Background-Brief.aspx?referrer=search
2*. Dugger, C.W. “U.S. plan to lure nurses may hurt poor nations.” New York Times, May 24, 2006. p. A.1.
http://www.nytimes.com/2006/05/24/world/americas/24nurses.html?pagewanted=all&gwh=406ABEDB7F6145991210844C7D
302A93
3*. Auerbach, D.I., Buerhaus, P.I., Staiger, D.O. “Registered nurse supply grows faster than projected amid surge in new
entrants ages 23-26.” Health Affairs 30(12):2286-2292, 2011. http://content.healthaffairs.org/content/30/12/2286.full.pdf+html
4*. Luthra, S. “Registered nurses increasingly delay retirement, study finds.” Kaiser Health News Blog, July 16, 2014. Available at:
http://capsules.kaiserhealthnews.org/index.php/2014/07/registered-nurses-increasingly-delay-retirement-study-finds/
5. Brown, T. “Is there a nurse in the house?” [Op-Ed], New York Times, June 19, 2010. p. A.21.
http://www.nytimes.com/2010/06/19/opinion/19brown.html?gwh=0A5962B0824676E3F9353359C2462BA9
6. Aiken, L.H. “Nurses for the future.” The New England Journal of Medicine 364:196-198, 2011.
7. Ostrom, C.M. “Hospital cuts add to oversupply of health-care workers.” The Seattle Times, November 18, 2012. Available at:
http://seattletimes.com/html/localnews/2019711613_nurses19m.html
8. Nurse.com. “Study: More BSN nurses means lower mortality rates.” March 7, 2013. Available at:
http://news.nurse.com/article/20130307/NATIONAL02/103180008
20
9.
CareFirst. “CareFirst invests another $1 million in nursing shortage.” May 29, 2013. Available at:
https://member.carefirst.com/wps/portal/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hLbzN_Q09LYwN_Fw9DA09fi1BHj6
AgQwNHM_2CbEdFANmphzQ!/?WCM_GLOBAL_CONTEXT=/wcmwps/wcm/connect/contentmember/carefirst/memberportal/medianews/popup/medianews20130528
Workplace Issues for Nursing
1*. McHugh, M.D., Kutney-Lee, A., Cimiotti, J.P., Sloane, D.M., Aiken, L.H. “Nurses’ widespread job dissatisfaction, burnout, and
frustration with health benefits signal problems for patient care.” Health Affairs 30(2):202-210, 2011.
2. Cheung, K. “One-fourth of nurses seek new jobs after dissatisfaction.” FierceHealthcare.com, June 29, 2011. Available at:
http://www.fiercehealthcare.com/story/one-fourth-nurses-seek-new-jobs-after-dissatisfaction/2011-06-29
3. Cheung, K.M. “Hospital labor study reveals hidden costs of nurses.” FierceHealthcare.com, June 9, 2011. Available at:
http://www.fiercehealthcare.com/story/hospital-labor-study-reveals-hidden-costs-nurses/2011-06-09
4. Schuster, J.L. “With nurses at risk of compassion fatigue, hospitals try to ease their stress.” The Washington Post, June 10,
2013. Available at: http://articles.washingtonpost.com/2013-06-10/national/39865768_1_burnout-intensive-care-unit-nurses
5. Lupkin, S. “Nurses prone to injuries with heavier patients.” abc News, September 26, 2013. Available at:
http://abcnews.go.com/Health/nurses-prone-injury-heavier-patients/story?id=20373428
6. Stahl, B. “In Minnesota, nurses in trouble get 2nd chances.” Star Tribune, October 6, 2013. Available at:
http://www.startribune.com/lifestyle/health/226301371.html
7. McHugh, M.D., Berez, J., Small, D.S. “Hospitals with higher nurse staffing had lower odds of readmissions penalties than
hospitals with lower staffing.” Health Affairs 32(10):1740-1747, 2013. Available at:
http://content.healthaffairs.org/content/32/10.toc
Rethinking the Role of Nurses
1. Martin, T.W. “Nurses seek expanded role.” The Wall Street Journal, October 2, 2012. Available at:
2. Shekelle, P.G. “Nurse—patient ratios as a patient safety strategy: A systematic review.” Annals of Internal Medicine 158(5Part 2):404-409, 2013. Available at: http://annals.org/issue.aspx?journalid=90&issueID=926462&direction=P
Public Policy Towards Nurses
1*. Schultz, D. “Nurses fighting state by state for minimum staffing laws.” Kaiser Health News, April 23, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/april/24/nurse-staffing-laws.aspx
2*. Fairman, J.A., Rowe, J.W., Hassmiller, S., Shalala, D.E. “Broadening the scope of nursing practice.” New England Journal of
Medicine 364:193-196, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1012121
3. Jauhar, S. “Nurses are not doctors.” The New York Times, April 29, 2014. Available at:
http://www.nytimes.com/2014/04/30/opinion/nurses-are-not-doctors.html?_r=0
4. Shenoy, R. “Nurses set aside goal on hospital staffing.” MPR News, March 16, 2013. Available at:
http://minnesota.publicradio.org/display/web/2013/03/16/politics/nurses-compromise-on-hospital-staffing
5. Kasperowicz, P. “Dem proposes federal regulation of nurse-to-patient ratios in hospitals.” The Hill, April 17, 2013. Available at:
http://thehill.com/blogs/floor-action/senate/294477-dem-proposes-federal-regulation-of-nurse-to-patient-ratios-in-hospitals
6. Editorial. “Nurse ratios are for hospitals, not legislators, to decide.” TwinCities.com Pioneer Press, February 16, 2013.
Available at: http://www.twincities.com/opinion/ci_22600798/editorial-nurse-ratios-are-hospitals-not-legislators-decide
7. Editorial. “Minnesota responds sensibly on nurse staffing ratios.” Star Tribune, March 28, 2013. Available at:
http://www.startribune.com/opinion/editorials/200523861.html
Further Readings
1.
2.
3.
4.
5.
HealthDay News. “Good news for those worried about U.S. nursing shortage.” USNews, December 5, 2011. Available at:
http://health.usnews.com/health-news/managing-your-healthcare/economics/articles/2011/12/05/good-news-for-those-worriedabout-us-nursing-shortage
Wood, D., “Retirees and new graduate nurses: The wild cards impacting the nursing shortage.” NurseZone.com, February 18,
2011. Available at: http://www.nursezone.com/nursing-news-events/more-features/Retirees-and-New-Graduate-Nurses-TheWild-Cards-Impacting-the-Nursing-Shortage_36300.aspx
Krischke, M.M. “Decreased interruptions lead to more time at the bedside.” NurseZone.com, March 18, 2011. Available at:
http://www.nursezone.com/Nursing-News-Events/more-news/Decreased-Interruptions-Lead-to-More-Time-at-theBedside_36554.aspx
Weber, T. and Omstein, C. “Nurses cited elsewhere kept licenses; many punished in other states will now face disciplinary
action in California.” Los Angeles Times, June 28, 2010. p. A.1. Available at: http://articles.latimes.com/2010/jun/28/local/lame-adv-nurses-20100628
Bovbjerg, R.R., Ormond, B.A., and Pindus, N. The Nursing Workforce Challenge. Public Policy for a Dynamic and Complex
Market. Washington, DC: Urban Institute, August 2009. Available at:
http://www.urban.org/uploadedpdf/411933_professionalnurse.pdf
21
6.
Buerhaus, P.I., Auerbach, D.I., and Staiger, D.O. “The recent surge in nurse employment: causes and implications.” Health
Affairs – Web Exclusive 28(4):w-657-w668 (published online June 12, 2009). Available at:
http://content.healthaffairs.org/content/28/4/w657.full.pdf+html
7. Linden, C. and Suran, M. “Nurses, once in high demand, face job shortages.” Kaiser Health News, August 28, 2009. Available
at: http://www.kaiserhealthnews.org/Stories/2009/August/28/medill-nurses.aspx
8. Smith, A. “Nursing crisis looms as baby boomers age.” CNNMoney.com, December 23, 2009. Available at:
http://money.cnn.com/2009/12/17/news/economy/nursing_shortage/index.htm
9. Georgia Health News. “Nurses without jobs: A sign of the times.” March 11, 2013. Available at:
http://www.georgiahealthnews.com/2013/05/nurses-jobs-sign-times/
10. Horstmann, S. “When nurses bond with their patients.” The New York Times, September 13, 2013, Available at:
http://well.blogs.nytimes.com/2013/09/13/when-nurses-bond-with-their-patients/?_r=0
11. Punke, H. “3 biggest causes of nurse turnover.” Becker’s Hospital Review, July 12, 2013. Available at:
http://www.beckershospitalreview.com/workforce-labor-management/3-biggest-causes-of-nurse-turnover.html
Sessions 7 and 8 – October 14, 21, 2014
The Hospital: Doctors’ Workshop or “Big Med”?
Assignment 2 Due October 14
Health care can be delivered in a variety of settings, but care delivered in hospitals (“inpatient care”) has long been the focus of special
attention from policy makers and health care payers. More recently, hospitals have expanded the “outpatient care” they provide. We
discuss trends in hospital use and in the configuration of the hospital industry. We also address financial, care delivery, competitive and
health policy challenges facing hospitals in the present environment. Material relating to the structure, management, and economics of
hospitals will be covered in other courses in the MHA Program, as will issues relating to hospital finance.
Learning Objectives
1. Describe recent changes in the configuration of the U.S. hospital industry and the public policy concerns they raise.
2. Understand the critical role emergency departments play for hospitals, and the ways in which that role is changing.
3. Discuss current changes and challenges in hospital/physician relations.
4. Describe the various financial challenges facing some U.S. hospitals.
Suggested Readings
Overview
1*. Gawande, A. “Big med.” The New Yorker, August 13, 2012. Available at:
http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande
2* Cutler, D.M., Morton, F.S. “Hospitals, market share, and consolidation.” Journal of the American Medical Association
3*. The Economist. “American hospital companies. Bigger and better. America’s big hospital groups will continue to gobble up
competitors.” April 28, 2011. Available at: http://www.economist.com/node/18621132
4. Vogt, W.B. “Hospital market consolidation: Trends and consequences.” Expert Voices. Washington, DC: NIHCM Foundation.
November 2009. Available at: http://nihcm.org/pdf/EV-Vogt_FINAL.pdf
5. Tsai, T.C., Jha, A.K. “Hospital consolidation, competition, and quality. Is bigger necessarily better?” JAMA, 312(1):29-30,
2014. Available at: http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=930449&direction=P
6. Grube, M., Kaufman, K., York, R. “Decline in utilization rates signals a change in the inpatient business model.” Health Affairs
blog, March 8, 2013. Available at: http://healthaffairs.org/blog/2013/03/08/decline-in-utilization-rates-signals-a-change-in-theinpatient-business-model/
7. Creswell J., Abelson, R. “New laws and rising costs create a surge of supersizing hospitals.” The New York Times, August 12,
2013. Available at: http://search.proquest.com/results/4E7E8483169E4DF8PQ/1?accountid=14586
8. Kolata, G. “At acute care hospitals, recovery is rare, but comfort is not.” The New York Times, June 23, 2014. Available at:
http://www.nytimes.com/2014/06/24/health/life-goes-on-at-long-term-acute-care-hospitals.html?_r=0
9. DesRoches, C.M., Charles, D., Furukawa, M.F., et al. “Adoption of electronic health records grows rapidly, but fewer than half
of US hospitals had at least a basic system in 2012.” Health Affairs 32(8):1478-1485, 2013. Available at:
10. Joynt, K.E., Le, S.T., Orav, J., Jha, A.K. “Compensation of chief executive officers at nonprofit US hospitals.” JAMA Internal
Medicine 174(1):61-67, 2014. Available at:
http://archinte.jamanetwork.com/Issue.aspx?journalid=71&issueID=929622&direction=P
11. MacDonald, I. “Hospital construction booming across the country.” FierceHealthcare, February 18, 2014. Available at:
http://www.fiercehealthcare.com/story/hospital-construction-booming-across-country/2014-02-18
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Role of the Emergency Department
1*. Goodell, S., DeLia, D., Cantor, J.C. “Emergency department utilization and capacity.” Policy Brief No. 17, RWJ Synthesis
Project, July 2009. Available at: http://www.rwjf.org/en/research-publications/find-rwjf-research/2009/07/emergencydepartment-utilization-and-capacity0.html
2*. Schuur, J.D., Venkatesh, A.K. “The growing role of emergency departments in hospital admissions.” New England Journal of
Medicine 367(5):391-393, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1204899
3*. Rabin, R.C. “Statistics: Who visits the emergency room? 20 percent of Americans, insured or not.” New York Times, August
2010, Available at: http://www.nytimes.com/2010/08/10/health/research/10stats.html?_r=0
4*. Abelson, R. “E.R.’s account for half of hospital admissions, study says.” The New York Times, May 20, 2013. Available at:
http://www.nytimes.com/2013/05/21/business/half-of-hospital-admissions-from-emergency-rooms.html?_r=0
5*. Feibel, C. “Patients can pay a high price for ER convenience.” npr, August 13, 2013. Available at:
http://www.npr.org/blogs/health/2013/08/15/211411828/patients-can-pay-a-high-price-for-er-convenience
6. Jacob, S. “The hospital emergency department is now the admissions department.” Dallas/Fort Worth Healthcare Daily, March
12, 2014. Available at: http://healthcare.dmagazine.com/2014/03/12/the-hospital-emergency-department-is-now-theadmissions-department/
7. Rabin, E., Kocher, K., McClelland, M., Pines, J., Hwang, U., Rathlev, N., et al. “Solutions to emergency department ‘boarding’
and crowding are underused and may need to be legislated.” Health Affairs 31(8):1757-1766, 2012. Available at:
8. Galewitz, P. “ER use of CT scans rises sharply, raising questions about costs and benefits.” Kaiser Health News, August 10,
2011. Available at: http://capsules.kaiserhealthnews.org/index.php/2011/08/getting-a-ct-scan-at-the-er-becoming-routine/
9. Galewitz, P. “Study: Most seniors’ ER visits could be avoided.” Kaiser Health News Blog, October 5, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/10/study-most-seniors-er-visits-could-be-avoided/
10. Grens, K. “ER crowding tied to higher in-hospital death rates.” Reuters, December 13, 2012. Available at:
http://www.reuters.com/article/2012/12/13/us-er-hospital-deaths-idUSBRE8BC0Z420121213
11. Morganti, K.G., Bauhoff, S., Blanchard, J.C., et al. “The evolving roles of emergency departments.” RAND Corporation, 2013.
Available at: http://www.rand.org/pubs/research_briefs/RB9715.html
12. HealthDay. “1 in 5 Americans goes to the ER each year.” WCAX.com, May 30, 2013. Available at:
http://www.wcax.com/story/22459623/1-in-5-americans-goes-to-the-er-each-year-cdc
13. Wilson, M., Cutler, D. “Emergency department profits are likely to continue as the affordable care act expands coverage.”
Health Affairs 33(5):792-799, 2014. Available at: http://content.healthaffairs.org/content/33/5.toc
Changing Hospital/Physician Relations
1*. Casalino, L.P., November, A.E., Berenson, R.A., Pham, H.H. “Hospital-physician relations: Two tracks and the decline of the
voluntary medical staff model.” Health Affairs 27(5):1305-1314, 2008. Available at:
2*. O’Malley, A.S., Bond, A.M., Berenson, R.A. “Rising hospital employment of physicians: Better quality, higher costs?” Issue
Brief No. 136, August 2011. Washington, DC: Center for Studying Health System Change. Available at:
http://www.hschange.com/CONTENT/1230/1230.pdf
3. Iglehart, J. “The emergence of physician-owned specialty hospitals.” New England Journal of Medicine 352(1):78-84, 2005.
http://www.nejm.org/doi/pdf/10.1056/NEJMhpr043631
4. Mathews, A.W. “Doctor, hospital deals probed.” The Wall Street Journal, September 13, 2012. Available at:
5. Caramenico, A. “Hospitals woo more heart docs with employment.” FierceHealthcare, September 11, 2012. Available at:
http://www.fiercehealthcare.com/story/hospitals-woo-more-heart-docs-employment/2012-09-11
6. O’Neill, L., Hartz, A.J. “Lower mortality rates at cardiac specialty hospitals traceable to healthier patients and to doctors’
performing more procedures.” Health Affairs 31(4):806-815, 2012.
7. Baker, L.C., Bundorf, M.K., Kessler, D.P. “Vertical integration: Hospital ownership of physician practices is associated with
higher prices and spending.” Health Affairs 33(5):756-763, 2014. Available at: http://content.healthaffairs.org/content/33/5.toc
8. Galewitz, P. “As medical providers consolidate, questions about effects on costs, quality of care.” The Washington Post, April
19, 2014. Available at: http://search.proquest.com/docview/1517742682/fulltext/E6EFFD9DB054439BPQ/1?accountid=14586
9. Betbeze, P. “An independent community health system carves its own niche.” HealthLeaders Media, February 21, 2014.
Available at: http://www.healthleadersmedia.com/page-1/LED-301260/An-Independent-Community-Health-System-Carves-ItsOwn-Niche##
10. Letourneau, R. “NFP hospitals’ revenue growth outpaced by expense growth rate.” HealthLeaders Media, April 24, 2014.
Available at: http://www.healthleadersmedia.com/page-1/FIN-303771/NFP-Hospitals-Revenue-Growth-Outpaced-by-ExpenseGrowth-Rate##
11. Cantlupe, J. “Patient volumes, patterns shifting.” HealthLeaders Media, April 2, 2014. Available at:
http://www.healthleadersmedia.com/content/QUA-302909/Patient-Volumes-Patterns-Shifting.html
23
Financial Challenges Facing Some U.S. Hospitals
Controversy Over Hospital Pricing
1*. Reinhardt, U.E. “Shocked, shocked, over hospital bills.” The New York Times, March 1, 2013. Available at:
http://economix.blogs.nytimes.com/2013/03/01/shocked-shocked-over-hospital-bills/
3. Rau, J. “Behind the fiscal cliff deal, a prolonged hospital finance fight.” Kaiser Health News, January 3, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/january/04/fiscal-cliff-deal-hospital-finance-fight.aspx
4. Meier, B., McGinty, J.C., Creswell, J. “Hospital billing varies wildly, government data shows.” The New York Times, May 8,
2013. Available at: http://www.nytimes.com/2013/05/08/business/hospital-billing-varies-wildly-us-data-shows.html?smid=plshare
5. Reinhardt, U.E. “American health care as a source of humor.” The New York Times, May 10, 2013. Available at:
http://economix.blogs.nytimes.com/2013/05/10/american-health-care-as-a-source-of-humor/
6. Gokhale, K. “Heart surgery in India for $1,583 costs $106,385 in U.S.” Bloomberg, July 28, 2013. Available at:
http://www.bloomberg.com/news/2013-07-28/heart-surgery-in-india-for-1-583-costs-106-385-in-u-s-.html
7. Creswell, J., Fink, S., Cohen, S. “Hospital charges surge for common ailments, data shows.” The New York Times, June 2,
2014. Available at: http://search.proquest.com/docview/1531391041/fulltext/7B8250C66A924B8EPQ/1?accountid=14586
8. Williams, G. “5 hidden costs of hospital visits.” U.S.News, April 8, 2014. Available at:
http://money.usnews.com/money/personal-finance/articles/2014/04/08/5-hidden-costs-of-hospital-visits
9. Armstrong, D., Waldman, P., Putka, G. “In New York, a heart surgery factory with ‘obscene levels’ of pay.” Bloomberg, March
6, 2014. Available at: http://www.bloomberg.com/news/2014-03-06/mount-sinai-cath-lab-takes-nyc-heart-emergencies-byappointment.html
Changes in Hospital Reimbursement and Their Implications
1*. Gold, J. “Of ACOs and proton beams: why hospitals ‘live in two worlds.’” Kaiser Health News Blog, June 6, 2013. Available at:
2. Goldsmith, J. “Analyzing shifts in economic risks to providers in proposed payment and delivery system reforms.” Health
Affairs 29(7):1299-1304, 2010. Available at: http://content.healthaffairs.org/content/29/7/1299.full.pdf+html
3. Zuger, A. “Revolving doors at hospitals.” The New York Times, June 9, 2014. Available at:
http://www.lexisnexis.com/lnacui2api/api/version1/getDocCui?lni=5CD1-RGV1-JBKK51T0&csi=379740&hl=t&hv=t&hnsd=f&hns=t&hgn=t&oc=00240&perma=true
Hospitals Strategies to Improve Finances
1*. Carrier, E.R., Dowling, M., Berenson, R.A. “Hospitals’ geographic expansion in quest for well-insured patients: Will the
outcome be better care, more cost, or both?” Health Affairs (31)4):827-835, 2012. Available at:
2*. “Cleveland Clinic to provide heart care in Chicago; Johns Hopkins increases primary care in D.C. area.” Kaiser Health News,
July 17, 2010. Available at: http://www.kaiserhealthnews.org/Daily-Reports/2010/July/16/Hospitals-and-health-systems.aspx
3. Graham, J. “Mayo clinic seeks to extend its reach with series of affiliations around the country.” Kaiser Health News, August
24, 2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/August/24/Mayo-Clinic-Extends-Reach.aspx
4. Mathews, A.W. “Cleveland Clinic, hospital operator forge alliance; community health deal reflects how top medical centers are
leveraging brands.” The Wall Street Journal, March 11, 2013. Available at:
5. Rabin, R.C. “Hospitals look to become insurers, as well as providers of care.” Kaiser Health News, August 26, 2012. Available
at: http://www.kaiserhealthnews.org/stories/2012/august/26/hospital-insurers.aspx
6. Gregg, H. “Study: Healthcare reviews, ratings increasingly impact hospitals’ bottom lines.” Becker’s Healthcare Hospital
Review, April 9, 2013. Available at: http://www.beckershospitalreview.com/quality/study-healthcare-reviews-ratingsincreasingly-impact-hospitals-bottom-lines.html
Patient Safety Issues – See Session 2 Readings
Potential Impact of Health Reform Legislation on Hospitals
1*. Bernstein, N. “Hospitals aren’t waiting for verdict on health care law.” New York Times online, June 10, 2012. Available at:
http://www.nytimes.com/2012/06/11/nyregion/maimonides-medical-center-grapples-with-health-careuncertainty.html?pagewanted=all
2. Aizenman, N.C. “Health law’s rules help hospitals cut patient readmission rate.” The Washington Post, February 27, 2013.
Available at: http://articles.washingtonpost.com/2013-02-27/national/37332837_1_readmissions-providers-medicare-andmedicaid-services
3. Rau, J. “Doctor-owned hospitals prosper under healthcare law.” The Washington Post, April 13, 2013. Available at:
http://articles.washingtonpost.com/2013-04-13/national/38509331_1_hospitals-health-law-kaiser-health-news
4. Fiore, K. “Hospitals already feeling ACA pinch.” MedPage Today, June 28, 2013. Available at:
http://www.medpagetoday.com/Washington-Watch/Reform/40160
5. Goodnough, A. “Hospitals look to health law, cutting charity.” The New York Times, May 25, 2014. Available at:
http://search.proquest.com/docview/1528455868/fulltext/F7B1D1EB776C42B4PQ/1?accountid=14586
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Further Readings
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Galewitz, P. “An Obamacare winner: Safety-net hospitals.” USA Today, May 24, 2014. Available at:
http://www.usatoday.com/story/news/nation/2014/05/24/obamacare-safety-net-hospitals-uninsured/9456671/
Robinson, J.C. “Hospital market concentration, pricing, and profitability in orthopedic surgery and interventional cardiology.”
American Journal of Managed Care 17(6):e241-e248, 2011. Available at:
http://www.ajmc.com/articles/AJMC_11jun_Robinson_e241_248/#sthash.FBsYgiBz.dpuf
Galewitz, P. “Hospitals promoting bargain CT scans for smokers.” Kaiser Health News, August 16, 2011. Available at:
http://www.kaiserhealthnews.org/Stories/2011/August/16/Hospitals-Promoting-Bargain-CT-Scans-For-Smokers.aspx
Rabin, R.C. “Study finds fewer emergency rooms as need rises.” New York Times, May 18, 2011, p. A.13. Available at:
http://www.nytimes.com/2011/05/18/health/18hospital.html?gwh=8BE0A11C4D3D1AD5267D93AE06A90C58
DeLia, D., Cantor, J. “Emergency department utilization and capacity.” Robert Wood Johnson Foundation, The Synthesis
Project Policy Brief No. 17, July 2009. Available at: http://www.rwjf.org/en/research-publications/find-rwjfresearch/2009/07/emergency-department-utilization-and-capacity0.html
Galewitz, P. “U.S. emergency rooms find ways to fix what ails them; mindful of complaints, innovative hospitals aim to cut
crowding, delays.” USA Today, December 15, 2008. p. D.9. Available at: http://usatoday30.usatoday.com/news/health/200812-14-emergency-rooms_N.htm?csp=34
Goodell, S. and Casalino, L.P. “Physician self-referral and physician-owned specialty facilities.” Robert Wood Johnson
Foundation, The Synthesis Project Policy Brief No. 15, June 2008. Available at:
http://www.rwjf.org/files/research/062408.policysynthesis.physreferral.brief.pdf
Weintraub, A. “In an age of consolidation, some community hospitals struggle to remain independent.” Kaiser Health News,
September 9, 2010. Available at: http://www.kaiserhealthnews.org/Stories/2010/September/09/community-hospitals.aspx
Mathews, A.W. “Hospitals put on sick list.” Wall Street Journal, August 10, 2011, p. B.3.
Caramenico, A. “National hospital chains see better M&A value creation.” FierceHealthcare, June 3, 2013, Available at:
http://www.fiercehealthcare.com/story/national-hospital-chains-see-better-ma-value-creation/2013-06-03
DealBook. “Tenent to acquire Vanguard health systems for $1.8 billion.” The New York Times, June 24, 2013. Available at:
http://dealbook.nytimes.com/2013/06/24/tenet-to-acquire-vanguard-health-systems-for-1-8-billion/?_r=0
Frakt, A. “Bigger health companies: Good for Medicare, maybe not for others.” The New York Times, June 23, 2014. Available
at: http://www.nytimes.com/2014/06/24/upshot/bigger-health-companies-good-for-medicare-maybe-not-for-others.html
Brownlee, S., Saini, V. “Bigger hospitals mean higher prices, not better care.” Bloomberg, February 18, 2014. Available at:
http://www.bloombergview.com/articles/2014-02-18/bigger-hospitals-mean-higher-prices-not-better-care
Mullins, P.M., Goyal, M., Pines, J.M. “National growth in intensive care unit admissions from emergency departments in the
United States from 2002 to 2009.” Academic Emergency Medicine 20(5):479-486, 2013. Available at:
http://onlinelibrary.wiley.com/doi/10.1111/acem.12134/pdf
Nurse.com. “Report showcases EDs’ central role in U.S. healthcare.” June 13, 2013. Available at:
http://news.nurse.com/article/20130613/NATIONAL02/106240005/0/NATIONAL01
Kaiser Health News. “Study says lower-cost hospitals don’t have lower quality care for certain illnesses.” February 23, 2010.
Available at: http://www.kaiserhealthnews.org/daily-reports/2010/february/23/hospital-study.aspx?referrer=search
Thomas, L. “Hospitals, doctors moving out of poor city neighborhoods to more affluent areas.” Journal Sentinel, June 14,
2014. Available at: http://www.jsonline.com/news/health/hospitals-doctors-moving-out-of-poor-city-neighborhoods-to-moreaffluent-areas-b99284882z1-262899701.html
McCann, E. “Setback for Sutter after $1B EHR crashes.” Healthcare IT News, August 28, 2013. Available at:
http://www.healthcareitnews.com/news/setback-sutter-after-1b-ehr-system%20crashes
Bresnick, J. “EHR defaults cause medication, patient safety errors.” EHR Intelligence, September 5, 2013. Available at:
http://ehrintelligence.com/2013/09/05/ehr-defaults-cause-medication-patient-safety-errors/
Appleby, J. “Hospitals and insurers face growing antitrust scrutiny.” Kaiser Health News, April 5, 2011. Available at:
http://www.kaiserhealthnews.org/Stories/2011/April/05/Hospitals-And-Insurers-Face-Growing-Antitrust-Scrutiny.aspx
Lipton, E. “Ex-lawmaker still a friend of hospitals.” New York Times, August 5, 2011. Available at:
http://www.nytimes.com/2011/08/06/us/politics/06pomeroy.html?_r=1
Session 9 – October 28, 2014
Long-Term Care: Can This Rubik’s Cube be Solved?
Quiz 1: Material from Sessions 1-8
Demands on our present system for delivering long-term care are expected to intensify as the “baby boom” generation ages. Traditional
financing models are being challenged, as are existing models for delivering long-term care. At the same time, improving quality and
reducing fraud and abuse continue to be thorny issues, and provisions included in the federal health reform legislation relating to longterm care have been abandoned.
25
Learning Objectives
1. Describe the different types of long-term care and the characteristics of the people who receive this care.
2. Discuss the different mechanisms, public and private, that finance long-term care.
3. Compare and contrast delivery models for long-term care.
4. Discuss factors that affect the quality of long-term care, including the potential for patient abuse in long-term care settings.
5. Understand and compare different approaches to long-term care reform.
Suggested Readings
Overview of Long-Term Care and the Nursing Home Industry
1*. The Kaiser Commission on Medicaid and the Uninsured. “Overview of nursing facility capacity, financing, and ownership in the
United States in 2011.” The Henry J. Kaiser Family Foundation, June 2013. Available at: http://kff.org/medicaid/factsheet/overview-of-nursing-facility-capacity-financing-and-ownership-in-the-united-states-in-2011/
2*. Greene, K. “Long-term-care insurance gap hits seniors.” The Wall Street Journal, July 1, 2013. Available at:
3*. El Nasser, H. “Fewer seniors live in nursing homes; improved health, more options for care cited.” USA Today, September 27,
2007. p. A.1. http://usatoday30.usatoday.com/printedition/news/20070927/1a_bottomstrip27_dom.art.htm
4. Greene, K. The cost of living longer. The Wall Street Journal, October 26, 2012. Available at:
5. Higgs, R. “Nursing-home, assisted-living costs rise.” Cleveland.com, April 30, 2009. Available at:
http://www.cleveland.com/medical/index.ssf/2009/04/nursinghome_assistedliving_cos.html
6. Seewer, J. “Aging baby boomers face home health care challenge.” YAHOO News, August 12, 2012. Available at:
http://news.yahoo.com/aging-baby-boomers-face-home-health-care-challenge-162044207--finance.html
7. Pruitt, A.D. “Health-care owners shun nursing homes.” The Wall Street Journal, April 30, 2013. Available at:
http://dailyhealthguide.net/health-care-owners-shun-nursing-homes-wall-street-journal/
8. National Health Policy Forum. “The basics. National spending for long-term services and supports (LTSS), 2012.” Washington,
DC, The George Washington University, March 27, 2014. Available at: http://www.nhpf.org/library/details.cfm/2783
9. Erb, R. “Nursing home care now costs more than twice seniors’ average income.” Detroit Free Press, June 19, 2014.
Available at: http://www.freep.com/article/20140619/NEWS06/306190034/nursing-homes-long-term-care-Michigan
10. Jaffe, I. “How your state rates in terms of long-term care.” NPR, June 19, 2014. Available at:
http://www.npr.org/blogs/health/2014/06/19/323356217/how-your-state-rates-in-terms-of-long-term-care
Long-Term Caregivers
1*. Hagerty, J.R. “As America ages, shortage of help hits nursing homes.” The Wall Street Journal, April 14, 2013. Available at:
2*. Bahrampour, T. “Huge shortage of caregivers looms for baby boomers, report says.” The Washington Post, August 26, 2013.
Available at: http://search.proquest.com/docview/1427961343/fulltext/D7DCB914337940CEPQ/1?accountid=14586
3. Tran, A. “Obama administration mulls rule to give home health aides better wages.” Kaiser Health News, April 29, 2013.
Available at: http://www.kaiserhealthnews.org/stories/2013/april/29/home-health-aides-better-wages-rules.aspx
4. Fox, S., Duggan, M., Purcell, L. “Family caregivers are wired for health.” Washington, DC: Pew Research Center, June 20,
2013. Available at: http://www.pewinternet.org/Reports/2013/Family-Caregivers.aspx
5. Bebinger, M. “Moving people home after nursing home stay is complicated.” Kaiser Health News, August 16, 2013. Available
at: http://www.kaiserhealthnews.org/stories/2013/august/15/nursing-home-money-follows-the-person-massachusetts.aspx
6. Lagnado, L. “Nursing homes’ drug use falls.” The Wall Street Journal, August 26, 2013. Available at:
http://search.proquest.com/docview/1427997421/fulltext/12B392E135764827PQ/1?accountid=14586
7. Saslow, E. “Opportunity’s knocks.” The Washington Post, May 31, 2014. Available at:
http://www.washingtonpost.com/sf/national/2014/05/31/opportunitys-knocks/
Issues Relating to Fraud, Abuse and Poor Quality
1*. Pear, R. “Oversight of nursing homes is criticized.” New York Times, April 22, 2007. p. 1.20.
http://www.nytimes.com/2007/04/22/health/22nursing.html?_r=0
2*. The Washington Post, APNewsBreak: Fed watchdog report says Medicare paid $5.1B to nursing homes offering poor care.”
February 27, 2013. Available at: http://news.yahoo.com/medicare-paid-5-1b-poor-130312778.html
3*. Hoffman, J. “Watchful eye in nursing homes.” The New York Times, November 18, 2013. Available at:
http://www.lexisnexis.com/hottopics/lnacademic/?verb=sr&csi=379740
4. Allen, M. “One third of skilled nursing patients harmed in treatment.” Propublica, March 3, 2014. Available at:
http://www.propublica.org/article/one-third-of-skilled-nursing-patients-harmed-in-treatment
5. Kaiser Health News. “One third of nursing home patients harmed by caregivers.” March 4, 2014. Available at:
http://www.kaiserhealthnews.org/daily-reports/2014/march/04/quality.aspx
6. Duhigg, C. “At many homes, more profit and less nursing.” New York Times, September 23, 2007. p. 1.1.
http://www.nytimes.com/2007/09/23/business/23nursing.html?pagewanted=all
26
7.
The New York Times. “State rewards home care firms once rebuked.” June 24, 2013. Available at:
http://www.nytimes.com/2013/06/24/nyregion/reinventing-long-term-care-and-endorsing-firms-accused-offraud.html?pagewanted=all
8. Bergal, J. Feds say nursing homes overbilled Medicare by $1.5 billion. Kaiser Health News, November 15, 2012. Available at:
http://www.kaiserhealthnews.org/Stories/2012/November/15/nursing-homes-inspector-general-medicare.aspx
9. Gorman, A. “Waiting – and – waiting on the nursing home inspector.” Kaiser Health News, April 14, 2014. Available at:
http://www.kaiserhealthnews.org/stories/2014/april/11/waiting-on-the-nursing-home-inspector.aspx?referrer=search
Approaches to Long-Term Care Reform
1*. Koren, M.J. “Person-centered care for nursing home residents: The culture-change movement.” Health Affairs 29(2):312-317,
2*. Konetzka, R.T., Werner, R.M. “Applying market-based reforms to long-term care.” Health Affairs 29(1):74-80, 2010.
3*. Jaffe, S. “Long-term care panel releases recommendations but fails to offer plan to help pay for services.” Kaiser Health News,
September 13, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/september/13/long-term-care-commissionrecommendations.aspx
4. Meier, D.E., Lim, B., Carlson, D.A. “Raising the standard: Palliative care in nursing homes.” Health Affairs 29(1):136-140,
5. Graham, J. “Ohio Medicaid program raises stakes for nursing homes.” Kaiser Health News, August 14, 2012. Available at:
http://www.kaiserhealthnews.org/Stories/2012/August/15/ohio-medicaid-nursing-homes.aspx
6. Mayer, C.E. “Calculating a long-term care policy: Will it cover your needs, can you pay for it and can you afford not to have
it?” Kaiser Health News, January 23, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/january/24/calculating-a-long-term-care-policy.aspx
7. Arling, G., Cooke, V., Lewis, T., et al. “Minnesota’s provider-initiated approach yields care quality gains at participating nursing
homes.” Health Affairs 32(9):1631-1638, 2013. Available at: http://content.healthaffairs.org/content/32/9/1631.full.pdf+html
8. Evans, M. “Putting the home in a nursing home.” Kaiser Health News, July 10, 2014. Available at:
http://www.kaiserhealthnews.org/Stories/2014/July/10/nursing-home-neighborhood-Q-and-A.aspx
9. Harris, R. “Heading toward the caregiving cliff.” The Washington Post, March 4, 2014. Available at:
http://www.washingtonpost.com/national/health-science/heading-toward-the-caregiving-cliff/2014/03/04/eb1661ec-9846-11e3afce-3e7c922ef31e_story.html
10. Thomas, K.S., Mor, V. “Providing more home-delivered meals is one way to keep older adults with low care needs out of
nursing homes.” Health Affairs 32(10):1796-1802, 2013. Available at: http://content.healthaffairs.org/content/32/10.toc
11. Bernstein, N. “Pitfalls seen in a turn to privately run long-term care.” The New York Times, March 6, 2014. Available at:
http://search.proquest.com/docview/1504720829/fulltext/EC65FF3924F34525PQ/1?accountid=14586
12. Ollove, M. “How states are fixing the long-term care part of Obamacare.” Governing, July 7, 2014. Available at:
http://www.governing.com/news/headlines/how-states-are-fixing-the-long-term-care-part-of-obamacare.html
13. O’Shaughnessy, C.V. “Money follows the person (MFP) rebalancing demonstration: A work in progress.” Washington, DC: The
George Washington University National Health Policy Forum, February 2014. Available at:
http://www.nhpf.org/uploads/announcements/BP85_MFP_05-10-13.pdf
Further Readings
1.
2.
3.
4.
5.
6.
7.
8.
Comarow, A. “U.S. news’ best nursing homes – 2013.” msn.com, 2013. Available at:
http://healthyliving.msn.com/diseases/caregiving/us-news-best-nursing-homes-2013
Available at: Graham, J. “Medicare studying plans to pay nursing homes based on quality.” Kaiser Health News, August 14,
2012. Available at: http://www.kaiserhealthnews.org/Stories/2012/August/15/medicare-nursing-homes-quality.aspx
Stevenson, D.G. and Grabowski, D.C. “Private equity investment and nursing home care: Is it a big deal?” Health Affairs
27(5):1399-1408, 2008. Available at: http://content.healthaffairs.org/content/27/5/1399.full.pdf+html
Jaffe, S. “IG report findings could strengthen nursing home inspections.” Kaiser Health News, March 7, 2014. Available at:
http://www.kaiserhealthnews.org/stories/2014/march/07/inspector-general-report-findings-could-strengthen-nursing-homeinspections.aspx?referrer=search
Gorman, A. “L.A. county officials told inspectors to cut short nursing home probes.” Kaiser Health News, March 3, 2014.
Available at: http://www.kaiserhealthnews.org/stories/2014/march/03/la-nursing-homes.aspx?referrer=search
Gugliotta, G. “Tennessee cuts Medicaid benefit funding for some long-term care patients.” Kaiser Health News, July 29,
2012. Available at: http://www.kaiserhealthnews.org/stories/2012/july/29/tennessee-medicaid-long-termcare.aspx?referrer=search
Castle, N.G. “The nursing home compare report card: Consumers’ use and understanding.” Journal of Aging & Social Policy
21(2):187-208, 2009. Available at: http://www.tandfonline.com/doi/pdf/10.1080/08959420902733272
Feder, J., Berenson, R. “Good palliative care requires good long-term care: A Medicare strategy to strengthen both.” Health
Affairs Blog, March 10, 2014. Available at: http://healthaffairs.org/blog/2014/03/10/good-palliative-care-requires-good-longterm-care-a-medicare-strategy-to-strengthen-both/
27
Session 10 – November 4, 2014
Medical Technology and Devices: At the Cutting Edge?
As health care spending continues to grow in this country, more and more attention is being paid to the use of new technologies as both
a driver of cost and value. Some policy analysts emphasize the contribution of medical technology to cost increases, while others argue
that, from a long run perspective, new technologies can save costs and/or improve quality of care and patient quality of life. This is often
a “front page” debate, stimulated by rapid advances in surgical and diagnostic techniques, but also by questions about conflicts of
interest between physicians and medical device companies as well as questionable marketing practices and conflicts between medical
device companies and the FDA. Issues relating to medical technology are of critical importance to Minnesota because this state long
has been an incubator for new technologies and medical device companies are major employers in the state. In this class session we
discuss how medical technology “fits” in the current health care system and describe regulatory and market issues relating to medical
devices.
Learning Objectives
1. Describe the process of new medical technology development in the U.S. from discovery to commercial product.
2. Discuss patient, provider and regulatory issues relating to the introduction of new medical devices and their integration into
medical care treatment.
3. Discuss provisions of health care reform that may affect the medical device industry directly and indirectly.
Suggested Readings
Overview of the Medical Device Industry
1*. Kaiser Family Foundation. “How changes in medical technology affect health care costs.” March 2007. Available at:
http://www.kff.org/insurance/snapshot/chcm030807oth.cfm
2*. Robinson, J.C. “Value-based purchasing for medical devices.” Health Affairs 27(6):1523-1531, 2008.
3. Curfman, G.D., Redberg R.F. “Medical devices – balancing regulation and innovation,” New England Journal of Medicine
(Online), August 10, 2011. Available at: http://www.nejm.org/doi/full/10.1056/NEJMp1109094
4. Sorenson, C., Drummond, M., Burns, L.R. “Evolving reimbursement and pricing policies for devices in Europe and the United
States should encourage greater value.” Health Affairs 32(4):788-796, 2013. Available at:
5. Walsh, J., Spencer, J. “Boomers’ embrace of devices gives rise to new med-tech age.” Star Tribune, September 15, 2013.
Available at: http://www.startribune.com/business/223770251.html
6. Cortez, M.F. “Medical device’s slow growth forces search for new areas.” Bloomberg, September 24, 2013. Available at:
http://www.bloomberg.com/news/2013-09-24/medical-device-s-slow-growth-forces-search-for-new-areas.html
7. Rosenthal, E. “Even small medical advances can mean big jumps in bills.” The New York Times, April 5, 2014. Available at:
http://search.proquest.com/docview/1516475731/fulltext/C1B4DE0CDE4E4570PQ/1?accountid=14586
Concerns About Conflicts of Interest Involving Medical Device Manufacturers and Physicians
1*. Meier, B. “Doctors who don’t speak out.” The New York Times, February 15, 2013. Available at:
http://www.nytimes.com/2013/02/17/sunday-review/the-hip-replacement-case-shows-why-doctors-often-remain-silent.html
2*. Whoriskey, P. “Rise in spinal fusion surgeries may be driven partly by financial incentives, study says.” The Washington Post,
November 13, 2013. Available at:
http://search.proquest.com/docview/1459084935/fulltext/E465ECC5E454228PQ/1?accountid=14586
3. Wang, S.S. “Corporate news: Doctors, device makers: Close ties.” The Wall Street Journal, March 14, 2014. Available at:
http://search.proquest.com/docview/1507139270/fulltext/CE942D0C30734E5BPQ/1?accountid=14586
4. Carreyrou, J. “Warning over doctor-run groups.” The Wall Street Journal, March 26, 2013. Available at:
5. Reinberg, S. “Many may get unneeded implantable defibrillators.” Health.com, January 4, 2011. Available at:
http://news.health.com/2011/01/04/many-may-get-unneeded-implantable-defibrillators/
6. Egbuonu-Davis, L. “System transformation intensifies demand for evidence: The trust conundrum.” Health Affairs Blog,
September 10, 2013. Available at: http://healthaffairs.org/blog/2013/09/10/system-transformation-intensifies-demand-forevidence-the-trust-conundrum/
7. Carreyrou, J. “Surgeons eyed over deals with medical-device makers.” The Wall Street Journal, July 25, 2013. Available at:
http://search.proquest.com/docview/1412547816/fulltext/9563C5D80D4A4570PQ/1?accountid=14586
8. Eisler, B. “Device makers pay high-volume spine surgeons consulting, design fees.” CBS News, May 12, 2014. Available at:
http://www.cbsnews.com/news/device-makers-pay-high-volume-spine-surgeons-consulting-design-fees/
9. Stynes, T. “Medtronic to pay $9.9M over improper doctor payments. Pioneer Press, May 23, 2014. Available at:
http://www.twincities.com/ci_25852088/medtronic-pay-9-9-million-over-improper-payments
28
Other Controversial Practices in the Medical Device Industry
1*. Meier, B., Thomas K. “Troubling flaws in heart device shake industry.” New York Times, April 7, 2012, p. A.1.
http://www.nytimes.com/2012/04/07/health/flaws-in-st-jude-heart-defibrillator-shake-the-industry.html?pagewanted=all
2*. Meier, B. “Johnson & Johnson to offer $2.5 billion hip device settlement.” The New York Times, November 19, 2013. Available
at: http://www.nytimes.com/2013/11/20/business/johnson-johnson-to-offer-2-5-billion-hip-device-settlement.html
3. Boden, W.E. and Diamond, G.A. “DTCA for PTCA – Crossing the line in consumer health education?” New England Journal of
4. Reinberg, S. “Many may get unneeded implantable defibrillators.” Health.com, January 4, 2011. Available at:
http://news.health.com/2011/01/04/many-may-get-unneeded-implantable-defibrillators/
5. Weaver, C. St. Jude riata heart-device flaws known for years. The Wall Street Journal, October 10, 2012. Available at:
6. Meier, B. “Outside review of clinical data finds a spinal treatment’s benefit overstated.” The New York Times, June 17, 2013.
Available at: http://www.nytimes.com/2013/06/18/business/infuse-a-spinal-treatment-found-no-better-than-olderremedy.html?pagewanted=all
7. Andrews, M. “Questions arise about robotic surgery’s cost, effectiveness.” Kaiser Health News, April 23, 2013. Available at:
http://www.kaiserhealthnews.org/features/insuring-your-health/2013/042313-michelle-andrews-robotic-surgery.aspx
8. Rockoff, J.D. “In wake of Medtronic’s Covidien deal, Bernstein asks: Who’s next.” The Wall Street Journal, June 18, 2014.
Available at: http://blogs.wsj.com/moneybeat/2014/06/18/in-wake-of-medtronics-covidien-deal-bernstein-asks-whos-next/
9. The Economist. “Heart to heart.” June 21, 2014. Available at: http://www.economist.com/news/business/21604554-taxbenefits-aside-medtronics-deal-covidien-makes-sense-heart-heart
The Medical Device Industry and the FDA
1*. Economist, The. “Left to their own devices.” 400(8750):71-73, 2011.
http://go.galegroup.com/ps/retrieve.do?sgHitCountType=None&sort=DASORT&inPS=true&prodId=PROF&userGroupName=mnaumntwin&tabID=T003&searchId=R2&resultListType=RESULT_LIST
&contentSegment=&searchType=AdvancedSearchForm&currentPosition=5&contentSet=GALE%7CA266486808&&docId=GA
LE|A266486808&docType=GALE&role=
2*. Kaiser Health News. “Study: Expedited Medical Device Reviews Account for Majority of Recalls.” February 15, 2011.
Available at: http://www.kaiserhealthnews.org/Daily-Reports/2011/February/15/medical-devices.aspx
3*. Meier, B. Remedy is elusive as metallic hips fail at a fast rate.” New York Times online, September 30, 2011. Available at:
http://www.nytimes.com/2011/10/01/health/01hip.html?pagewanted=all
4. Harris, G. and Halbfinder, D.M. “F.D.A. reveals it fell to a push by lawmakers.” New York Times, September 25, 2009. p. A.1
http://www.nytimes.com/2009/09/25/health/policy/25knee.html?pagewanted=all&_r=0 .
5. Burton, T.M. “Corporate news: Recalls doubled of medical devices.” The Wall Street Journal, March 21, 2014. Available at:
http://search.proquest.com/docview/1508925347/fulltext/B98D4D7F96FA4BC2PQ/1?accountid=14586
6. Zuckerman, D.B., Brown, P., Nissen, S.E. “Medical device recalls and the FDA approval process.” Archives of Internal
Medicine 171(11):1006-1011, 2011. http://archinte.jamanetwork.com/Issue.aspx?journalid=71&issueID=5819&direction=P
7. Gottlieb, S. “How the FDA could cost you your life.” Wall Street Journal, October 3, 2011, p. A.17.
8. Carroll, L. “Shocking ending: Implanted defibrillators can bring misery to final hours.” Vitals on NBCNEWS.com, October 10,
2011. Available at: http://vitals.nbcnews.com/_news/2011/10/10/8212715-shocking-ending-implanted-defibrillators-can-bringmisery-to-final-hours?lite
9. Resnic, F.S., Normand, S-L.T. “Postmarketing surveillance of medical devices – filling in the gaps.” New England Journal of
10. Hollmer, M. “Budget battles hold new FDA user fees hostage.” FierceMedicalDevices, March 4, 2013. Available at:
http://www.fiercemedicaldevices.com/story/budget-battles-hold-new-fda-user-fees-hostage/2013-03-04
11. Editorial. “Move forward on medical device tracking.” Star Tribune, June 21, 2013. Available at:
http://www.startribune.com/opinion/editorials/212405031.html
12. Burton, T. “Medical device recalls nearly doubled in a decade.” The Wall Street Journal, March 21, 2014. Available at:
http://search.proquest.com/docview/1508871210/fulltext/4DCED7EA1A8240C2PQ/1?accountid=14586
Health Care Reform and the Medical Device Industry
1*. Spencer, J. “Med-tech firms fight tax on devices.” Star Tribune, September 8, 2011, p. D.1. Available at:
http://www.startribune.com/business/129425158.html
2. Barr, S. “Dream of a medical ‘price list’ dies in Florida legislature.” Kaiser Health News Blog, January 20, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/01/dream-of-a-medical-price-list-dies-in-florida-legislature/
3. Bayh, E. Evan Bayh: ObamaCare’s tax raid on medical devices. The Wall Street Journal, September 27, 2012. Available at:
4. Rao, A. “New website will disclose health industry payments to doctors.” Kaiser Health News Blog, April 23, 2013. Available at:
29
5.
6.
Carey, M.A. “What’s at stake if Congress repeals the medical device tax.” Kaiser Health News, October 11, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/october/11/faq-medical-device-tax.aspx
Spiro, T. “The myth of the medical-device tax.” The New York Times, October 16, 2013. Available at:
http://search.proquest.com/docview/1442325424/fulltext/D1BA8278F072470EPQ/1?accountid=14586
Further Readings
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Donnelly, L. et al. “Experts call for transparency over medical devices.” The Telegraph, May 7, 2013. Available at:
http://www.telegraph.co.uk/health/healthnews/10042607/Experts-call-for-transparency-over-medical-devices.html
Thomas, K. Unpredictable danger looms close to the heart. The New York Times, September 7, 2012. Available at:
http://www.nytimes.com/2012/09/08/business/patients-with-st-jude-medicals-defibrillator-wires-face-adilemma.html?pagewanted=all
Walsh, J. “A flawed device brings a tough choice for Riata patients.” Star Tribune online, March 10, 2012. Available at:
http://www.startribune.com/business/142118413.html?refer=y
Silverman, E. “Commercial support for CME dives, again.” Pharmalot.com, July 30, 2012. Available at:
http://www.pharmalot.com/2012/07/commercial-support-for-cme-dives-again/
Cortez, M.F. St. Jude faces boon-or-bust verdict on heart-plus studies. Bloomberg, October 24, 2012. Available at:
http://www.bloomberg.com/news/2012-10-24/st-jude-faces-boon-or-bust-verdict-on-heart-plug-studies.html
Gormley, B., Maltby, E. Medical start-ups challenged by health-care reform. The Wall Street Journal, October 31, 2012.
Institute of Medicine of the National Academies. “Medical Devices and the Public’s Health. The FDA 510(k) clearance process
at 35 years.” Report Brief, July 2011. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2011/Medical-Devicesand-the-Publics-Health-The-FDA-510k-Clearance-Process-at-35Years/510k%20Clearance%20Process%202011%20Report%20Brief.pdf
Snowbeck, C. “U.S. charges Guidant over device woes – Firm allegedly gave FDA a false report on defibrillators.” St. Paul
Pioneer Press, February 26, 2010. Available at: http://infoweb.newsbank.com/iwsearch/we/InfoWeb?p_product=NewsBank&p_theme=aggregated5&p_action=doc&p_docid=12E236032D50A5A0&p_docnum
=93&p_queryname=1
Mundy, A. and Favole, J.A. “FDA memo hints at curbs to approval process for medical devices.” Wall Street Journal, February
18, 2010. Available at: http://online.wsj.com/article/SB10001424052748704398804575071791464778482.html
Meier, B. “Hip device phaseout followed FDA data request.” New York Times, March 23, 2012, p. B.1. Available at:
http://www.nytimes.com/2012/03/23/business/fda-asked-depuy-for-safety-data-just-before-hip-implants-phaseout.html
Meier, B. Panel says Medtronic edited product studies. The New York Times, October 25, 2012. Available at:
http://www.nytimes.com/2012/10/25/business/senate-panel-says-medtronic-edited-studies.html?_r=0
Meier, B. “Tipping the odds for an implant maker.” New York Times, April 3, 2011, p. A.1. Available at:
http://query.nytimes.com/gst/fullpage.html?res=9502E2DF1E30F930A35757C0A9679D8B63
Meier, B. “When heart devices fail, who should be blamed?” New York Times, April 21, 2010. p, B.1. Available at:
http://www.nytimes.com/2010/04/21/business/21device.html?hpw
Meier, B. “Growing debate as doctors train on new devices.” New York Times, August 1, 2006, p. A.1. Available at:
http://www.nytimes.com/2006/08/01/business/01train.html?pagewanted=all
Hollmer, M. “Medtronic, Boston Scientific battle in declining cardiac device market.” FierceMedical Devices, May 7, 2013.
Available at: http://www.fiercemedicaldevices.com/story/medtronic-boston-scientific-battle-declining-cardiac-devicemarket/2013-05-07
Garde, D. “Devicemakers plot paths out of CRM funk.” FierceMedical Devices, March 4, 2013. Available at:
http://www.fiercemedicaldevices.com/special-reports/2012s-top-5-cardiac-rhythm-management-companies
Hollmer, M. “Medtronic debuts health services arm.” FierceMedicalDevices, September 3, 2013. Available at:
http://www.fiercemedicaldevices.com/story/medtronic-debuts-health-services-arm/2013-09-03
Cortez, M.F. “Medtronic’s sales miss estimates on defibrillator demand.” Bloomberg, August 20, 2013. Available at:
http://www.bloomberg.com/news/2013-08-20/medtronic-s-quarterly-profit-rises-on-demand-for-heart-devices.html
Carreyrou, J. “Senators request probe of surgeons,” Wall Street Journal (Online), June 9, 2011.
Carreyrou, J., McGinty, T. “Taking double cut, surgeons implant their own devices.” Wall Street Journal online, October 8,
2011. Available at: http://online.wsj.com/article/SB10001424053111904106704576582621677354508.html
BusinessWire. “Three large health systems and UnitedHealthcare launch SharedClarity, a new venture to study long-term
effectiveness of medical devices.” April 9, 2013. Available at:
http://www.businesswire.com/news/home/20130409005531/en/Large-Health-Systems-UnitedHealthcare-LaunchSharedClarity-Venture
Kolata, G. “Stroke therapy device fails in study.” Star Tribune online, September 7, 2011. Available at:
http://www.startribune.com/lifestyle/129423093.html?refer=y
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23. Challoner, D.R., Vodra, W.W. “Medical devices and health – creating a new regulatory framework for moderate-risk devices.”
New England Journal of Medicine (Online), August 10, 2011. Available at:
http://www.nejm.org/doi/full/10.1056/NEJMp1109150
24. Norman, B. “FDA user fee bill appears safe from GOP poison pills.” Politico, May 6, 2012. Available at:
25. Tavernise, S. “F.D.A. to regulate some health apps.” The New York Times, September 23, 2013. Available at:
http://www.nytimes.com/2013/09/24/health/fda-to-regulate-only-some-health-apps.html
Pharmaceuticals: What Price Progress?
Pharmaceuticals and medical devices are similar in the way they are developed, brought to market, and regulated. However, there are
important differences as well. In monetary terms, the pharmaceutical market is much larger than the medical device market, and
pharmaceutical firms pursue different marketing approaches. Managing pharmaceutical costs poses significant issues for health care
payers, as does the regulation of pharmaceuticals by the Food and Drug Administration (FDA).
Learning Objectives
1. Describe the pharmaceutical “supply chain” and public policy issues relating to the marketing of pharmaceuticals.
2. Discuss contrasting views pertaining to the proliferation of prescription drugs and the growth in spending on pharmaceuticals.
3. Explain what a pharmacy benefit management company is and describe the services it provides.
4. Compare and contrast the nature and significance of different regulatory issues relating to pharmaceuticals.
5. Discuss how the pharmaceutical industry may be affected by health reform.
Suggested Readings
Overview of the Pharmaceutical Industry and the Role of Prescription Drugs in the Health Care System
1*. Kleinke, J. “The price of progress: prescription drugs in the health care market,” Health Affairs 20(5):43-60, 2001.
2*. Mann, D. “Half of heart patients make mistakes with their meds: Study.” USNews, July 3, 2012. Available at:
http://health.usnews.com/health-news/news/articles/2012/07/03/half-of-heart-patients-make-mistakes-with-their-meds-study
3. Hobson, K. “Spending more on drugs doesn’t mean spending less on other care.” Wall Street Journal, June 10, 2010.
Available at: http://blogs.wsj.com/health/2010/06/10/spending-more-on-drugs-doesnt-mean-spending-less-on-other-care/
4. Mogul, F. “Big-name drugs are falling off the ‘patient cliff’.” Kaiser Health News, October 24, 2011. Available at:
http://www.kaiserhealthnews.org/stories/2011/october/24/big-name-drugs-are-falling-off-the-patent-cliff.aspx?referrer=search
5. Japsen, B. “Walgreen and Express Scripts reach deal.” New York Times, July 20, 2012, p. B.2.
http://www.nytimes.com/2012/07/20/business/walgreen-and-express-scripts-settle-their-dispute.html
6. Thomas, K. “U.S. drug costs dropped in 2012, but rises loom.” The New York Times, March 18, 2013. Available at:
http://www.nytimes.com/2013/03/19/business/use-of-generics-produces-an-unusual-drop-in-drugspending.html?pagewanted=all&_r=0
7. Huh, J., DeLorme, D.E., Reid, L.N., An, S. “Direct-to-consumer prescription drug advertising: History, regulation and issues.”
Minnesota Medicine, March 2010. Available at:
http://www.minnesotamedicine.com/PastIssues/PastIssues2010/March2010/ClinicalJisuMarch2010.aspx
8. Thomas, K. “Pills tracked from doctor to patient to aid drug marketing.” The New York Times, May 16, 2013. Available at:
http://www.nytimes.com/2013/05/17/business/a-data-trove-now-guides-drug-company-pitches.html?pagewanted=all
9. Johnson, L.A. “Study: Wiser medication use could cut health costs.” Fox News, June 20, 2013. Available at:
http://www.foxnews.com/health/2013/06/20/wiser-medication-use-could-cut-health-costs/
10. Torsoli, A. “Lilly bets quality will pay off in U.S. diabetes battle.” Bloomberg, September 24, 2013. Available at:
http://www.bloomberg.com/news/2013-09-24/lilly-bets-quality-will-pay-off-in-u-s-diabetes-battle.html
11. McArdle, M. “Can Lipitor save big pharma?” Bloomberg, March 3, 2014. Available at:
http://www.bloombergview.com/articles/2014-03-03/can-lipitor-save-big-pharma
12. Taylor, L. “US drug spending ‘to rise 3%-5% this year.” PharmaTimes online, March 9, 2014. Available at:
http://www.pharmatimes.com/article/14-03-09/US_drug_spending_to_rise_3_-5_this_year.aspx
13. O’Donnell, J. “Do drug benefit managers reduce health costs?” USA Today, March 3, 2014. Available at:
http://www.usatoday.com/story/money/personalfinance/2014/03/03/pharmacy-benefit-managers-healthcare-costssavings/5495317/
14. Tozzi, J. “The crazy way the government buys billions of dollars of drugs.” Bloomberg, July 1, 2014. Available at:
http://www.businessweek.com/articles/2014-07-01/the-crazy-way-the-government-buys-billions-of-dollars-of-drugs
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15. De La Merced, M.J., Gelles, D., Abrams, R. “Seeking the right chemistry, drug makers hunt for mergers.” The New York
Times, April 22, 2014. Available at: http://www.lexisnexis.com/lnacui2api/api/version1/getDocCui?lni=5C4J-DXS1-DY2MW3TB&csi=379740&hl=t&hv=t&hnsd=f&hns=t&hgn=t&oc=00240&perma=true
Pharmaceutical Pricing
1*. Reuters. “Analysis: Drugmakers face more scrutiny of discordant U.S. prices.” May 10, 2013. Available at:
http://www.reuters.com/article/2013/05/10/us-usa-health-drugs-analysis-idUSBRE9490MH20130510
2*. Kliff, S. “Each of these hepatitis C pills cost $1,000. That’s actually a great deal.” Vox, July 16, 2014. Available at:
http://www.vox.com/2014/7/16/5902271/hepatitis-c-drug-sovaldi-price
3. Beasley, D. “U.S. branded drug prices soar as generic pressure rises.” Reuters, March 23, 2011. Available at:
http://www.reuters.com/article/2011/03/23/us-branded-drug-prices-idUSTRE72M57X20110323
4. Thomas, K. Brand-name drug prices rise sharply, report says. The New York Times, November 28, 2012. Available at:
http://www.nytimes.com/2012/11/29/business/cost-of-brand-name-prescription-medicines-soaring.html
5. Martin, T.W. “Drugstores press for pricing data.” The Wall Street Journal, March 27, 2013. Available at:
6. Viebeck, E. “Liberal groups push for lower Medicare drug prices.” The Hill, February 14, 2013. Available at:
http://thehill.com/blogs/healthwatch/medicare/283077-liberal-groups-push-for-lower-medicare-drug-prices
7. Pollack, A. “Doctors denounce cancer drug prices of $100,000 a year.” The New York Times, April 25, 2013. Available at:
http://www.nytimes.com/2013/04/26/business/cancer-physicians-attack-high-drug-costs.html?partner=rss&emc=rss
The Specialty Drug Challenge
1. Andrews, M. “Patients share of expensive specialty drugs is rising.” Kaiser Health News, May 7, 2012. Available at:
http://www.npr.org/blogs/health/2012/05/08/152245452/why-your-drug-copay-could-change
2. Gottlieb, S. “Why we should be spending more on pricey cancer drugs.” Forbes, June 10, 2013. Available at:
http://www.forbes.com/sites/scottgottlieb/2013/06/10/why-we-should-spend-more-on-pricey-cancer-drugs/
3. Howard, P. “Sure, we’ll (eventually) beat cancer. But can we afford to?” Forbes, May 16, 2014. Available at:
http://www.forbes.com/sites/theapothecary/2014/05/16/sure-well-eventually-beat-cancer-but-can-we-afford-to/
4. Thomas, K. “Prices soaring for specialty drugs, researchers find.” The New York Times, April 15, 2014. Available at:
http://search.proquest.com/docview/1515883212/fulltext/9FE8D9F8DB634F20PQ/1?accountid=14586
5. Express Scripts. “Express Scripts study reveals keys to controlling specialty drug costs.” PRNewswire, March 7, 2013.
Available at: http://www.prnewswire.com/news-releases/express-scripts-study-reveals-keys-to-controlling-specialty-drug-costs195839241.html
6. Langreth, R. “Cancer doctors join insurers in U.S. drug-cost revolt.” Bloomberg, May 7, 2014. Available at:
http://www.bloomberg.com/news/2014-05-07/cancer-doctors-join-insurers-in-revolt-against-drug-costs.html
Drug Shortages
1*. Wilson, D. “Deepening drug shortages.” Health Affairs 31(2):263-266, 2012.
2*. Thomas, K. Drug shortages persist in U.S., harming care. The New York Times, November 16, 2012. Available at:
http://www.nytimes.com/2012/11/17/business/drug-shortages-are-becoming-persistent-in-us.html?pagewanted=all
3*. Thomas, K. Lapses at big drug factories add to shortages and danger. The New York Times, October 17, 2012. Available at:
http://www.nytimes.com/2012/10/18/business/drug-makers-stalled-in-a-cycle-of-quality-lapses-andshortages.html?pagewanted=all
4. Anand, G., Shah, S., McKay, B. “Shortage of drugs threaten TB fight.” The Wall Street Journal, June 6, 2013. Available at:
5. Dembosky, A. “Shortage of saline solution has hospitals on edge.” Kaiser Health News, June 25, 2014. Available at:
http://www.kaiserhealthnews.org/stories/2014/june/25/dembosky-saline-shortage-has-hospitals-worried.aspx
6. Thomas K., Tavernise, S. “Nitroglycerin, a staple of emergency rooms, is in short supply.” The New York Times, March 25,
2014. Available at: http://search.proquest.com/docview/1509959775/fulltext/C9E116F795CA4062PQ/1?accountid=14586
7. Premier, Inc. “Drug shortages 2014: A Premier healthcare alliance update.” February 2014. Available at:
https://www.premierinc.com/wps/wcm/connect/bd794cb2-6f31-4ffb-ac85-30af42be7ef0/DrugShortage-SurveyWhite+Paper.pdf?MOD=AJPERES
8. Johnson, L.A. “Hospitals coping better as drug shortages persist.” Associated Press, February 27, 2014. Available at:
http://bigstory.ap.org/article/hospitals-coping-better-drug-shortages-persist
Controversial Practices in the Pharmaceutical Industry
1*. “When a drug fails.” New York Times, July 26, 2010, P. A.22.
http://search.proquest.com/docview/1461211022/fulltextPDF/D05894CF1E60439APQ/1?accountid=14586
2*. Wilson, D. “Pfizer gives details on payments to doctors.” New York Times, April 1, 2010. p. B.2
http://www.nytimes.com/2010/04/01/business/01payments.html
3*. Los Angeles Times. CVS Caremark has become a frequent subject of government probes. October 24, 2012. Available at:
http://articles.latimes.com/2012/oct/24/business/la-fi-cvs-caremark-20121024
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4*. Kesselheim, A.S., Murtagh, L., Mello, M.M. “’Pay for delay’ settlements of disputes over pharmaceutical patents.” New
England Journal of Medicine 365(15):1439-1445, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMhle1102235
5. Millman, J. “What are drug companies paying your doctor? You can find out soon.” The Washington Post, July 7, 2014.
Available at: http://search.proquest.com/docview/1543435502/fulltext/7702FC4B298F4A5APQ/1?accountid=14586
6. Rubin, R. “Pfizer fined record $2.3b for illegal marketing in off-label drug case.” USA Today, September 3, 2009. Available at:
http://www.usatoday.com/money/industries/health/2009-09-02-pfizer-fine_N.htm
7. Harris, G. “Drug maker hid test data, files indicate.” New York Times, July 13, 2010, p. A.1
http://www.nytimes.com/2010/07/13/health/policy/13avandia.html?_r=3&hp
8. Wolston, M. “An MS patient loses trust when she finds out her doctor is paid by drug companies.” Health Affairs 30(12):24492452, 2011. http://content.healthaffairs.org/content/30/12/2449.full.pdf+html
9. Meier, B., Thomas, K. “Insurers pay big markups as doctors dispense drugs.” New York Times online, July 11, 2012.
Available at: http://www.nytimes.com/2012/07/12/business/some-physicians-making-millions-sellingdrugs.html?pagewanted=all
10. Clapp, M., Rie, M.A., Zweig, P. “How a cabal keeps generics scarce.” The New York Times, September 2, 2013. Available at:
http://search.proquest.com/docview/1429361796/fulltext/ACE2BF5154E24BC5PQ/1?accountid=14586
11. Carlson, J. “Supreme court slates generic drug ‘pay-for-delay’ case.” ModernHealthcare, December 8, 2012. Available at:
http://www.modernhealthcare.com/article/20121208/NEWS/312089949
12. Rowley, J. “Tighter compounding pharmacy oversight advances in Senate.” Bloomberg, November 13, 2013. Available at:
http://www.bloomberg.com/news/2013-11-13/tighter-compounding-pharmacy-oversight-advances-in-senate.html
13. Rosenthal, E. “Rapid price increases for some generic drugs catch users by surprise.” The New York Times, July 8, 2014.
Available at: http://search.proquest.com/docview/1543582675/fulltext/A86F40037E8A40B2PQ/1?accountid=14586
14. Rosenthal, E. “For drugs that save lives, a steep cost.” The New York Times, April 26, 2014. Available at:
http://search.proquest.com/docview/1519112585/fulltext/D7C6542263804C58PQ/2?accountid=14586
15. Pollack, A. “Gilead revenue soars on hepatitis C drugs.” The New York Times, April 22, 2014. Available at:
http://search.proquest.com/docview/1518237662/fulltext/3764545630A94390PQ/1?accountid=14586
16. Editorial Board. “Refusals to pay high drug prices.” The New York Times, June 24, 2014. Available at:
http://search.proquest.com/docview/1539634504/fulltext/7A2837E717F64438PQ/1?accountid=14586
17. Rich, S., Whoriskey, P. “These maps tell you everything that’s wrong with our drug pricing system.” The Washington Post,
April 11, 2014. Available at:
http://search.proquest.com/docview/1515195925/fulltext/94EC3F9A329E46E1PQ/2?accountid=14586
18. Langreth, R. “Gilead CEO becomes billionaire on $84,000 hepatitis drug.” Bloomberg, March 3, 2014. Available at:
http://www.bloomberg.com/news/2014-03-03/gilead-ceo-becomes-billionaire-on-84-000-hepatitis-drug.html
19. Burger, L., Severin, T. “Germany’s stance on pricing threatens drug firm profits.” Reuters, February 18, 2014. Available at:
http://www.reuters.com/article/2014/02/18/us-germany-drugs-analysis-idUSBREA1H09E20140218
20. Rosenthal, E. “The price of prevention: Vaccine costs are soaring.” The New York Times, July 2, 2014. Available at:
http://search.proquest.com/docview/1542266235/fulltext/27794E45DDF74307PQ/2?accountid=14586
21. Ornstein, C., Jones R.G. “Double dip: Doctors paid to advise, promote drug companies that fund their research.” Propublica,
March 25, 2014. Available at: http://www.propublica.org/article/double-dip-doctors-paid-to-advise-promote-drug-companiesthat-fund-research
22. Clarke, T., Berkrot, B. “Unease grows among U.S. doctors over Indian drug quality.” Reuters, March 18, 2014. Available at:
http://www.reuters.com/article/2014/03/18/us-usa-india-genericdrugs-insight-idUSBREA2H06Y20140318
23. Japsen, B. “Senators say Walgreen domicile move like ‘giving up on America.’” Forbes, June 25, 2014. Available at:
http://www.forbes.com/sites/brucejapsen/2014/06/25/senators-say-walgreen-domicile-move-like-giving-up-on-america/
Relationship between Pharmaceutical Industry and the FDA
1*. Boldrin, M., Swanidass, S.J. “A new bargain for drug approvals.” Wall Street Journal, July 27, 2011, p. A.15
2. Pecquet, J. “Dems: FDA should be able to recall drugs.” The Hill, May 27, 2010. Available at: http://thehill.com/business-alobbying/100375-dems-fda-should-be-able-to-recall-drugs
3. Alexander, G.C., O’Connor, A.B., Stafford, R.S. “Enhancing prescription drug innovation and adoption.” Annals of Internal
Medicine 154:833-837, 2011. http://annals.org/issue.aspx?journalid=90&issueID=20233&direction=P
4. Ponnuru, R. “Too much FDA meddling means not enough drugs.” Bloomberg View, June 21, 2011. Available at:
http://www.bloomberg.com/news/2011-06-21/too-much-fda-intervention-equals-too-few-drugs-ramesh-ponnuru.html
5. Gever, J. “Clinical notes: FDA turns up heat on compounders.” MedPage Today, April 14, 2013. Available at:
http://www.medpagetoday.com/InfectiousDisease/PublicHealth/38438
6. Caroll, J. “Bristol-Myers gains FDA’s ‘breakthrough’ track in race for hep C drug approval.” Fierce Biotech, April 25, 2013.
Available at: http://www.fiercebiotech.com/story/bristol-myers-gains-fdas-breakthrough-track-race-hep-c-drug-approval/201304-25
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7.
Dimond, P.F. “FDA speeds things up. What’s happened so far with breakthrough therapy designation?” Genetic Engineering &
Biotechnology News, September 4, 2013. Available at: http://www.genengnews.com/insight-and-intelligence/fda-speedsthings-up/77899888/
8. Dennis, B. “FDA has free-speech, safety issues to weigh in review of ‘off-label’ drug marketing rules.” Washington Post, July 9,
2014. Available at: http://search.proquest.com/docview/1544562564/fulltext/4CD9BB185FFB4419PQ/1?accountid=14586
9. Editorial Board. “Updated warnings for generic drugs.” The New York Times, March 26, 2014. Available at:
http://search.proquest.com/docview/1510343325/fulltext/93B8D2700A3E4B94PQ/1?accountid=14586
10. Lazarus, D. “Generic drug industry needs to stand up for patient safety.” Los Angeles Times, February 27, 2014. Available at:
http://search.proquest.com/docview/1502935803/fulltext/83C5CB9921734F3FPQ/1?accountid=14586
11. Edney, A. “FDA failed to track substandard generics, Congress told.” Bloomberg, February 27, 2014. Available at:
http://www.bloomberg.com/news/2014-02-26/fda-failed-to-track-substandard-generics-congress-told.html
12. Pollack, A. “U.S. and European regulators call popular diabetes drugs safe.” The New York Times, February 26, 2014.
Available at: http://search.proquest.com/docview/1502185209/fulltext/1579E106D1B7412APQ/1?accountid=14586
Health Reform and the Pharmaceutical Industry
1. “Pharmaceutical companies offer $80 billion toward health care reform.” PBS NewsHour, June 22, 2009. Available at:
http://www.pbs.org/newshour/updates/health/jan-june09/pharma_06-22.html
2. Frates, C. “PhRMA quietly spends big in 2010.” POLITICO.com, November 10, 2010. Available at:
3. Kendall, B. “White House seeks to speed up generic drugs’ path to market.” Wall Street Journal, February 15, 2011, p. D.2.
4. Lipton, E., Sack K. “Fiscal footnote: Big senate gift to drug maker.” The New York Times, January 19, 2013. Available at:
http://www.nytimes.com/2013/01/20/us/medicare-pricing-delay-is-political-win-for-amgen-drug-maker.html
5. Morgan, D. “Chronically ill facing high drugs costs under U.S. health law.” Reuters, February 28, 2014. Available at:
http://www.reuters.com/article/2014/02/28/us-usa-healthcare-costs-idUSBREA1R08420140228
Further Readings
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Langreth, R. “Drugmakers open new front against cancer with next generation of experimental drugs.” The Washington Post,
May 12, 2013. Available at: http://www.bloomberg.com/news/2013-05-13/human-immune-boosting-cancer-drugs-seenextending-lives.html
Newcomer, L.N. “Changing physician incentives for cancer care to reward better patient outcomes instead of use of more
costly drugs.” Health Affairs 31(4):780-785, 2012. Available at: http://content.healthaffairs.org/content/31/4/780.full.pdf+html
Stynes, T. Express Scripts earnings rise 21%. The Wall Street Journal, November 5, 2012. Available at:
Andrews, M. “Why your drug copay could change.” NPR health blog, May 8, 2012. Available at:
http://www.npr.org/blogs/health/2012/05/08/152245452/why-your-drug-copay-could-change
Reuters, Drug shortage led to spike in kids’ infections. October 11, 2012. Available at: http://news.yahoo.com/drug-shortageled-spike-kids-infections-204333255.html
Reuters. Bayer CEO decries pressure to lower drug prices. September 19, 2012. Available at:
http://www.reuters.com/article/2012/09/19/us-bayer-dekkers-idUSBRE88I1HR20120919
Reuters. Drop in hospital visits seen with lower drug copay. October 3, 2012. Available at:
http://www.reuters.com/article/2012/10/03/us-drop-drug-idUSBRE8921AP20121003
Pollack, A. New drugs for Lipids set off race. The New York Times, November 5, 2012. Available at:
http://www.nytimes.com/2012/11/06/business/new-drugs-for-lipids-set-offrace.html?gwh=EA0CDFB609598B0CE03A72AA05D1D5E8&_r=0
Bach, P.B., Salta, L.B., Wittes, R.E. In cancer care, cost matters. The New York Times, October 14, 2012. Available at:
http://www.nytimes.com/2012/10/15/opinion/a-hospital-says-no-to-an-11000-a-month-cancer-drug.html
Pittman, D. Fewer drugs in short supply. MedPage Today, September 24, 2012. Available at:
http://www.medpagetoday.com/Washington-Watch/FDAGeneral/34935
Bloomberg, Arizona sues McKesson over allegations of inflated drug prices. September 20, 2012. Available at:
http://www.bloomberg.com/news/2012-09-19/arizona-sues-mckesson-alleging-it-inflated-drug-prices.html
Drug Channels. Pharmacy ownership: Getting less profitable. October 23, 2012. Available at:
http://www.drugchannels.net/2012/10/pharmacy-ownership-getting-less.html
Editorial. “Some legal clarity on generic drugs.” New York Times, July 18, 2012, p. A.26. Available at:
http://www.nytimes.com/2012/07/18/opinion/some-legal-clarity-on-generic-drugs.html?_r=0
Editorial. “Why do drug shortages persist?” USA Today, May 16, 2012. Available at:
http://www.usatoday.com/news/opinion/editorials/story/2012-05-16/drug-shortages-FDA/55028206/1
Kolata, G. Cancer study points to tighter pairing of drugs and patients. The New York Times, September 9, 2012. Available at:
http://www.nytimes.com/2012/09/10/health/research/for-a-lung-cancer-drug-treatment-may-be-within-reach.html
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16. Kresge, N. Roche $5.7 billion tumor drug sales hinge on rival tests. Bloomberg, September 23, 2012. Available at:
http://www.bloomberg.com/news/2012-09-23/roche-5-7-billion-tumor-drug-sales-hinge-on-rival-tests.html
17. Whalen, J. Gene-therapy approval marks major milestone. The Wall Street Journal, November 2, 2012. Available at:
18. Wilson, D. “Drug firms face billions in losses in ’11 as patents end.” New York Times, March 6, 2011. Available at:
http://www.nytimes.com/2011/03/07/business/07drug.html?pagewanted=all
19. Pecquet, J. “Kohl urges trade officials to be wary of drug industry consolidation.” The Hill’s Healthcare Blog, May 19, 2011.
Available at: http://thehill.com/blogs/healthwatch/medical-devices-and-prescription-drug-policy-/162153-kohl-urges-tradeofficials-to-be-wary-of-drug-industry-consolidation
20. Pollack, A. “New drugs fight prostate cancer, but at high cost.” New York Times, June 28, 2011, p. A.1. Available at:
http://www.nytimes.com/2011/06/28/health/28prostate.html
21. Mishori, R. “Some doctors insist on brand-name drugs even when cheaper generics are available.” Washington Post online,
July 11, 2011. Available at: http://www.washingtonpost.com/national/some-doctors-insist-on-brand-name-drugs-even-whencheaper-generics-are-available/2011/06/13/gIQAmC0L9H_story.html
22. Editorial. “The shortage of vital drugs.” New York Times, August 26, 2011, p. A.26. Available at:
http://www.nytimes.com/2011/08/26/opinion/the-shortage-of-vital-drugs.html
23. Gatesman, M.L., Smith, T.J. “The shortage of essential chemotherapy drugs in the United States.” New England Journal of
Medicine 365(18):1653-1655, 2011. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1109772
24. Chabner, B.A., “Drug shortages – a critical challenge for the generic-drug market.” New England Journal of Medicine
365(23):2147-2148, 2011. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1112633
25. Baker, S. “FTC: ‘pay-for-delay’ settlements up 60 percent.” The Hill’s Healthcare Blog, May 3, 2011. Available at:
http://thehill.com/blogs/healthwatch/medical-devices-and-prescription-drug-policy-/159085-ftc-pay-for-delay-settlements-up-60
26. Bate, R. “Beware of risks of generic drugs: Copies aren’t always as good as the original—especially when ingredients are
sourced in China.” Wall Street Journal (Online), July 6, 2011. Available at:
27. Ross, J.S., Kravitz, R.L. “Direct-to-consumer television advertising: Time to turn off the tube?” Journal of General Internal
Medicine 28(7):862-864, 2013. Available at: http://link.springer.com/content/pdf/10.1007%2Fs11606-013-2424-2.pdf
28. Ahlawat, H., Chierchia, G., van Arkel, P. “The secret of successful drug launches.” McKinsey & Company, March 2014.
Available at: http://www.mckinsey.com/insights/health_systems_and_services/the_secret_of_successful_drug_launches
29. Viebeck, E. “Drugs cheapest at Costco, priciest at CVS, study finds.” The Hill, March 29, 2013. Available at:
http://thehill.com/blogs/healthwatch/medical-devices-and-prescription-drug-policy-/290945-drugs-cheapest-at-costco-priciestat-cvs-study-finds
30. Smolinski, I. “The fight grows around specialty drug pricing.” The Morning Consult, June 25, 2014. Available at:
http://themorningconsult.com/2014/06/fight-grows-around-specialty-drug-pricing/
31. Bartz, D. “US sees jump in “pay-for-delay” drug settlements.” Reuters, July 27, 2010. Available at:
http://www.reuters.com/article/idUSN2712034820100727
32. Reuters. “U.S. Files 2nd lawsuit accusing Novartis of kickbacks.” April 26, 2013. Available at:
33. Elliott, C. “Useless studies, real harm.” The New York Times, July 28, 2011. Available at:
http://www.nytimes.com/2011/07/29/opinion/useless-pharmaceutical-studies-real-harm.html?_r=2
34. Samouni, S., Langreth, R. “Cancer doctors plan to compare value of expensive drugs.” Bloomberg, April 17, 2014. Available
at: http://www.bloomberg.com/news/2014-04-16/cancer-doctors-plan-to-compare-value-of-expensive-drugs.html
Financing
Health Insurance, Uninsurance, and the Private Health Insurance Market: What Works, What Doesn’t and
How Might Health Reform Change It?
The private market for health insurance is under enormous stress. Premiums typically increase each year at a faster rate than employee
income or overall GDP. Employers, who are major actors in this market, appear to be re-examining their traditional roles. One result is
that an increasing number of people who previously purchased insurance through their employers are no longer able to do so. In this
session we describe the nature of health insurance, how the health insurance market has evolved over time, the design of different
health insurance products and the strengths and weaknesses of the current private health insurance system. The efforts of health plans
to control costs and improve quality, as well as the theoretical aspects of health insurance, are addressed in subsequent MHA courses.
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Learning Objectives
1. Discuss the logical foundations for health insurance.
2. Describe how the private health insurance market is structured and functions.
3. Contrast the characteristics of different types of health insurance benefit designs.
4. Describe the strengths and weaknesses of the current private health insurance system.
Suggested Readings
History and Current State of Private Health Insurance
1*. Blumenthal, D. “Employer-sponsored health insurance in the United States – Origins and implications,” New England Journal
of Medicine 355(1):82-88, 2006. http://www.nejm.org/doi/pdf/10.1056/NEJMhpr060703
2*. Blumenthal, D. “Employer-sponsored insurance – riding the health care tiger.” New England Journal of Medicine 355(2):195202, 2006. http://www.nejm.org/doi/pdf/10.1056/NEJMhpr060704
3*. Henry J. Kaiser Family Foundation. “How private health coverage works: A primer, 2008 update. Available at:
http://www.kff.org/insurance/7766.cfm
4*. Hancock, J. “How employer-sponsored health insurance is changing.” Kaiser Health News, September 17, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/september/17/employer-sponsored-health-insurance-trends.aspx
5. Archer, D. “Private insurance is bankrupting Americans: Is Congress paying attention?” Health Affairs Blog, June 26, 2012.
Available at: http://healthaffairs.org/blog/2012/06/26/private-insurance-is-bankrupting-americans-is-congress-paying-attention/
6. Collins, S.R., Robertson, R., Garber, T., Doty, M.M. “Insuring the future. Current trends in health coverage and the effects of
implementing the Affordable Care Act.” Commonwealth Fund, April 2013. Available at:
http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2013/Apr/1681_Collins_insuring_future_bienni
al_survey_2012_FINAL.pdf
7. National Institute for Health Care Management. “Spending for private health insurance in the United States.” January 2013.
Available at: http://nihcm.org/images/stories/Spending_for_Private_Health_Insurance_Rev.pdf
8. Andrews, M. “Large companies are increasingly offering workers only high deductible health plans.” Kaiser Health News,
March 26, 2013. Available at: http://www.kaiserhealthnews.org/features/insuring-your-health/2013/032613-michelle-andrewson-high-deductible-plans-and-large-employers.aspx
9. Carrk, T. “Putting 2015 health care premium rates into context.” Center for American Progress, May 19, 2014. Available at:
http://www.americanprogress.org/issues/healthcare/report/2014/05/19/90053/putting-2015-health-care-premium-rates-intocontext/
10. Herrera, C-N, Gaynor, M., Newman, D., Town, R.J., Parente, S.T. “Trends underlying employer-sponsored health insurance
growth for Americans younger than age sixty-five.” Health Affairs 32(10):1715-1722, 2013. Available at:
Characteristics of Organizations Providing Private Health Insurance or Administrative Services to Employers, and the
Products They Offer
1*. Nussbaum, A. “WellPoint’s Kleinman sees health insurer ‘oligopoly’ fed by U.S. overhaul.” Bloomberg.com, June 24, 2010.
Available at: http://www.bloomberg.com/news/2010-06-24/wellpoint-s-kleinman-sees-health-insurer-oligopoly-fed-by-u-soverhaul.html
2*. Kulkarni, S.S. “Quick facts about high-deductible health plans.” Kaiser Health News, April 27, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/april/27/high-deductible-health-plans.aspx?referrer=search
3. The Washington Post. “Stocks surge on health-insurer gains.” February 24, 2014. Available at:
http://search.proquest.com/docview/1501854899/fulltext/B748D20C86024E99PQ/1?accountid=14586
4. Tocknell, M.D. “’Dismal’ understanding of health plans among consumers.” HealthLeaders Media, August 21, 2013. Available
at: http://www.healthleadersmedia.com/page-1/HEP-295480/Dismal-Understanding-of-Health-Plans-Among-Consumers##
Strengths and Weaknesses of the Current Private Health Insurance Market
1*. Abelson, R. “Health insurers profit as many postpone care.” New York Times, May 14, 2011, p. A.1
http://search.proquest.com/docview/866382905/fulltext/E44BBC90BD244204PQ/1?accountid=14586
2*. Kaiser Commission on Medicaid and the Uninsured. “Five facts about the uninsured.” September, 2011. Available at:
http://www.kff.org/uninsured/upload/7806-04.pdf
3. Baker, S. “Insurers: Hospital prices rising steeply.” The Hill, March 18, 2013. Available at:
http://thehill.com/blogs/healthwatch/health-insurance/288705-insurers-hospital-prices-rising-steeply
4. Kaiser Health Reform Source. How small business owners get health insurance. September 28, 2012. Available at:
http://policyinsights.kff.org/2012/september/how-small-business-owners-get-health-insurance.aspx
5. Silver-Greenberg, J. “Patients mired in costly credit from doctors.” The New York Times, October 13, 2013. Available at:
http://search.proquest.com/docview/1441629838/fulltext/26FE2FA437B24531PQ/1?accountid=14586
6. Maldonado, M. “In the safety net: A tale of ticking clocks and tricky diagnoses.” Health Affairs 32(8):1501-1504, 2013.
Available at: http://content.healthaffairs.org/content/32/8.toc
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7.
Reinhardt, U.E. “The real health care ‘war’ on the young.” The New York Times, January 17, 2014. Available at:
http://www.lexisnexis.com/hottopics/lnacademic/?verb=sr&csi=379740
Health Reform and the Health Insurance Market
1*. Darling, H. “Health care reform: perspectives from large employers.” Health Affairs 29(6):1220-1224, 2010. Available at:
2*. Klein, E. “The six ways Obamacare changes insurance premiums.” The Washington Post, June 3, 2013. Available at:
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/03/the-six-ways-obamacare-changes-insurance-premiums/
3. Brennan, T.A., Studdert, D.M. “How will health insurers respond to new rules under health reform.” Health Affairs 29(6):11471151, 2010. Available at: http://content.healthaffairs.org/content/29/6/1147.full.pdf+html
4. Pear, R. “Health insurers to be required to justify rate increases over 10 percent.” New York Times, December 22, 2010, p.
A.21. Available at: http://www.nytimes.com/2010/12/22/health/policy/22insure.html?_r=0
5. Johnson, A. “Reforms prod insurers to diversify.” Wall Street Journal, May 12, 2011, p. B.1. Available at:
6. Pecquet, J. “Employers unlikely to drop coverage because of health law, survey finds.” The Hill, August 2, 2011. Available at:
http://thehill.com/blogs/healthwatch/health-insurance/174961-employers-unlikely-to-drop-coverage-because-of-health-lawsurvey-finds
7. Galewitz, P. “Health insurers see big opportunities in health law’s Medicaid expansion.” Kaiser Health News, March 8, 2013.
Available at: http://www.kaiserhealthnews.org/stories/2013/march/08/molina-health-care-florida-medicaid-managed-care.aspx
8. Fisher, N. “Employers dropping health care coverage could benefit health care quality and cost.” Forbes, February 20, 2013.
Available at: http://www.forbes.com/sites/aroy/2013/02/20/employers-dropping-health-care-coverage-could-benefit-healthcare-quality-and-cost/
9. Bernasek, A. “Why a health insurance penalty may look tempting.” The New York Times, June 22, 2013. Available at:
http://www.nytimes.com/2013/06/23/business/why-a-health-insurance-penalty-may-look-tempting.html
10. Carroll, A. “Time to reconsider the ACA’s employer mandate?” JAMA Forum, May 14, 2014. Available at:
http://newsatjama.jama.com/2014/05/14/jama-forum-time-to-reconsider-the-acas-employer-mandate/
11. Hancock, J. “Study: Limited competition raised Obamacare prices.” Kaiser Health News Blog, May 19, 2014. Available at:
http://capsules.kaiserhealthnews.org/index.php/2014/05/study-limited-competition-raised-obamacare-prices
Further Readings
1.
Bridgeforth, S. “Employers and employees agree on the value of voluntary benefits.” Preduential, March 5, 2013. Available at:
http://news.prudential.com/article_display.cfm?article_id=6526
2. Sonier, J., Bried, B., Au-Yeung, C., Auringer, B. “State-level trends in employer-sponsored health insurance. A state-by-state
analysis. Robert Wood Johnson Foundation, April 2013. Available at:
http://www.rwjf.org/content/dam/farm/reports/reports/2013/rwjf405434
3. Abelson, R. “Health insurance companies get in shape for 2014.” The New York Times, February 5, 2013. Available at:
http://www.nytimes.com/2013/02/06/business/florida-blue-and-other-health-insurers-prepare-for-newregulations.html?pagewanted=all&gwh=833B26A78906F2CC635B132B5FF568C6
4. Abelson, R., Greenhouse, S. Small employers weigh impact of providing health insurance. The New York Times, November
30, 2012. Available at: http://www.nytimes.com/2012/12/01/business/small-employers-weigh-impact-of-providing-healthinsurance.html?pagewanted=all
5. Hancock, J. “The new normal in health insurance: High deductibles.” Kaiser Health News, June 3, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/june/04/high-deductible-health-insurance.aspx?referrer=search
6. Robertson, R., Stremikis, K., Collins, S.R., Doty, M.N., Davis, K. Realizing health reform’s potential: Jobs without benefits: The
health insurance crisis faced by small businesses and their workers. November 2012. Available at:
http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Oct/1640_Robertson_jobs_without_benefit
s_small_businesses.pdf
7. Cheung, K.M. “Three-quarters of Fortune 50 firms in booming health industry.” FierceHealthcare, June 9, 2011. Available at:
http://www.fiercehealthcare.com/story/three-quarters-fortune-50-firms-booming-health-industry/2011-06-09
8. Mendes, E. “U.S. employer-based health coverage continues to decline.” Gallup, March 4, 2011. Available at:
http://www.gallup.com/poll/146492/employer-based-health-coverage-continues-decline.aspx
9. Henry J. Kaiser Family Foundation. “Tax subsidies for health insurance. An issue brief. July 2008. Available at:
http://www.kff.org/insurance/7779.cfm
10. Fronstin, P. “Employment-based health benefits: Trends in access and coverage, 1997-2010.” EBRI Issue Brief #370, April
2012. Available at: http://www.ebri.org/pdf/briefspdf/EBRI_IB_04-2012_No370_HI-Trends.pdf
11. Muligan, C.B. Employer-provided health insurance and the market. The New York Times, November 21, 2012. Available at:
http://economix.blogs.nytimes.com/2012/11/21/the-future-of-employer-provided-health-insurance/
12. “Employers plan aggressive response to shifting health care landscape, Towers Watson/National Business Group on health
survey finds.” Towers Watson, March 7, 2013. Available at: http://www.towerswatson.com/en/Press/2013/03/Employers-PlanAggressive-Response-to-Shifting-Health-Care-Landscape-TW-NBGH-Survey-Finds
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13. Hancock, J. “Health savings account membership up 18 percent.” Kaiser Health News blog, May 30, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/05/health-savings-account-membership-up-18-percent/
14. Pear, R. “Health care premiums soar as coverage shrinks.” New York Times, March 5, 2011, p. A.13.
http://www.nytimes.com/2011/03/05/health/policy/05cost.html?_r=1&hp
15. Andrews, M. “With high deductible health plans, it pays to shop around for care.” Kaiser Health News, May 20, 2013. Available
at: http://www.kaiserhealthnews.org/stories/2013/may/19/with-high-deductible-plans-it-pays-to-shop-around-for-care.aspx
16. “Ezra Klein’s Wonkbook.” The Washington Post, July 24, 2013. Available at:
http://view.ed4.net/v/VP6EHT/BMA0WF/WT6XV0Z/HFNG26/
17. Terhune, C. “California insurance commissioner chides Blue Shield over rates.” Los Angeles Times, March 7, 2013. Available
at: http://articles.latimes.com/2013/mar/07/business/la-fi-mo-blue-shield-rates-20130307
18. Appleby, J. “Insurers’ efforts to delay health law compliance could affect premiums, benefits for millions.” Kaiser Health News,
April 5, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/april/05/health-law-insurance-deadlines.aspx
Medicaid: How Can This “Vast Public Enterprise” Be Sustained?
The Medicaid program has been characterized as an “after thought” in the passage of legislation creating Medicare. It has grown
steadily over the years to become the largest state-federal collaborative program and one of the top two expenditure categories in most
state budgets. When the economy weakens and state tax revenues decline, the number of individuals eligible for Medicaid typically
increases, creating financial challenges for states. The passage of health reform promises to place substantial new strains on state
Medicaid programs while the Supreme Court decision offers states options. In this class session we discuss the status of Medicaid and
related programs designed to serve the poor and uninsured, as well as their likely futures under health reform and federal budgetbalancing efforts.
Learning Objectives
1. Discuss the distribution of funding and administrative responsibilities between the states and the federal government under
Medicaid.
2. Describe the relative importance of different categories of expenditures under Medicaid.
3. Describe the experience of Medicaid programs in contracting with managed care organizations.
4. Discuss how economic downturns and state efforts to respond to budget crises have affected Medicaid programs.
5. Discuss how health reform affects Medicaid programs.
Suggested Readings
How Medicaid Is Structured and Financed
1*. Iglehart, J. “Medicaid revisited – skirmishes over a vast public enterprise,” New England Journal of Medicine 356(7):734-740,
2007. http://www.nejm.org/doi/pdf/10.1056/NEJMhpr066650
2*. National Health Policy Forum. “Medicaid financing,” The Basics, The George Washington University, Washington, DC,
January 15, 2009, pp 1-4. Available at: http://www.nhpf.org/library/details.cfm/2528
3. Iglehart, J.K. “Medicaid at a crossroads.” New England Journal of Medicine 364:1585-1587, 2011.
4. Tran, A. “Expanding Medicaid didn’t lead to big health gains in Oregon, study finds.” Kaiser Health News, May 1, 2013.
Available at: http://capsules.kaiserhealthnews.org/?p=19086
5. Klein, E., Soltas, E. “Wonkbook: Everything you need to know about the Oregon health study.” The Washington Post, May 2,
2013. Available at: http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/02/wonkbook-everything-you-need-to-knowabout-the-oregon-health-study/
6. Pugh, T. “Most doctors still reject Medicaid as program expansion nears.” McClatchy Washington Bureau, May 13, 2013.
Available at: http://www.mcclatchydc.com/2013/05/13/191105/most-doctors-still-reject-medicaid.html
7. Galwitz, P. “Nearly half of U.S. births are covered by Medicaid, study finds.” The Washington Post, September 3, 2013.
Available at: http://articles.washingtonpost.com/2013-09-03/national/41716418_1_medicaid-coverage-health-law-state-federalhealth-insurance-program
8. Humer, C. “Insurers, Medicaid fear multibillion-dollar hepatitis C drug tab.” Reuters, March 4, 2014. Available at:
http://www.reuters.com/article/2014/03/04/us-health-hepatitis-idUSBREA2328H20140304
9. Long, S.K. “Physicians may need more than higher reimbursements to expand Medicaid participation: Findings from
Washington State.” Health Affairs 32(9):1560-1567, 2013. Available at: http://content.healthaffairs.org/content/32/9.toc
10. The Kaiser Commission on Medicaid and the Uninsured. “Medicaid moving forward.” June 17, 2014. Available at:
http://kff.org/medicaid/fact-sheet/the-medicaid-program-at-a-glance-update/
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11. Bruen, B., Young, K. “Paying for prescribed drugs in Medicaid: Current policy and upcoming changes.” The Kaiser
Commission on Medicaid and the Uninsured, May 23, 2014. Available at: http://kff.org/medicaid/issue-brief/paying-forprescribed-drugs-in-medicaid-current-policy-and-upcoming-changes/
12. Kliff, S. “One in five Americans is now on Medicaid.” Vox, June 4, 2014. Available at:
http://www.vox.com/2014/6/4/5780024/one-in-five-americans-are-now-on-medicaid
Expenditures Under Medicaid and the Impact of Recessions on Medicaid Programs
1*. Galewitz, P., Fleming, M. “13 states cut Medicaid to balance budgets.” Kaiser Health News, July 24, 2012. Available at:
http://www.kaiserhealthnews.org/Stories/2012/July/25/medicaid-cuts.aspx
2*. Reuters. “Fewer jobs means more spending on U.S. Medicaid.” May 4, 2012. Available at:
http://www.reuters.com/article/2012/05/04/us-usa-states-medicaid-idUSBRE8431IQ20120504
3. Rowland, D. “Health care and Medicaid – Weathering the recession.” New England Journal of Medicine, 360(13):1273-1276,
2009. http://www.nejm.org/doi/pdf/10.1056/NEJMp0901072
4. Shinkman, R. “Providers may face Medicaid payment cuts in 33 states.” Fierce HealthFinance.com, June 6, 2011. Available
at: http://www.fiercehealthfinance.com/story/providers-may-face-medicaid-payment-cuts-33-states/2011-06-06
5. Kaiser Commission on Medicaid and the Uninsured. “Medicaid in a historic time of transformation: Results from a 50-state
Medicaid budget survey for state fiscal years 2013 and 2014.” The Henry J. Kaiser Family Foundation, October 2013.
Available at: http://kff.org/medicaid/report/medicaid-in-a-historic-time-of-transformation-results-from-a-50-state-medicaidbudget-survey-for-state-fiscal-years-2013-and-2014/
6. Young, K., Glemans-Cope, L., Lawton, E., Holahan, J. “Medicaid spending growth in the great recession and its aftermath, FY
2007-2012.” The Kaiser Commission on Medicaid and the Uninsured, July 3, 2014. Available at: http://kff.org/medicaid/issuebrief/medicaid-spending-growth-in-the-great-recession-and-its-aftermath-fy-2007-2012/
Medicaid Contracting with Managed Care Plans
1*. Frakt, A., Carroll, A.E., Pollack, H.A., Reinhardt, U. “Our flawed but beneficial Medicaid program.” New England Journal of
Medicine 364:e31, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1103168
2*. Iglehart, J.K. “Desperately seeking savings: States shift more Medicaid enrollees to managed care.” Health Affairs
30(9):1627-1629, 2011. http://content.healthaffairs.org/content/30/9/1627.full.pdf
3*. Forbes. Benefits and challenges of Medicaid managed care. October 18, 2012. Available at:
http://www.forbes.com/sites/aroy/2012/10/18/benefits-and-challenges-of-medicaid-managed-care/
4. Galewitz, P. “Health law expected to boost Medicaid enrollees in managed care.” Kaiser Health News, November 12, 2010.
Available at: http://www.kaiserhealthnews.org/Stories/2010/November/12/health-law-medicaid-managed-care.aspx
5. Thompson, B., McLean, J. “Kansas’ great hope: Managed care will tame Medicaid costs.” Kaiser Health News, February 6,
2013. Available at: http://www.kaiserhealthnews.org/stories/2013/february/06/kansas-medicaid-managed-care.aspx
6. Tozzi, J. “The Medicaid black hole that costs taxpayers billions.” Bloomberg Businessweek, June 23, 2014. Available at:
http://www.businessweek.com/articles/2014-06-23/the-medicaid-black-hole-that-costs-taxpayers-billions
Policy Proposals for Reforming Medicaid
1*. Sommers, B.D., Epstein, A.E. “Why states are so miffed about Medicaid — Economics, politics, and the “woodwork effect.””
New England Journal of Medicine 365:100-102, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1104948
2*. New York Times Editorial. “The Ryan plan for Medicaid. A good deal for the federal government would be a very bad deal for
the states.” May 1, 2011, p. WK.9.
http://search.proquest.com/docview/864137750/fulltext/FA2430BA64764FD8PQ/1?accountid=14586
3. Holahan, J. “Restructuring Medicaid through a swap: An alternative to a block grant.” Urban Institute Health Policy Center,
April, 2011. Available at: http://www.urban.org/uploadedpdf/412327-restructuring-medicaid-through-swap.pdf
4. Howard, P., Sykes, R. Medicaid is broken—let the states fix it. The Wall Street Journal, October 10, 2012. Available at:
5. Kaiser Commission on Medicaid and the Uninsured. “Emerging Medicaid accountable care organizations: The role of
managed care.” May 2012. Available at: http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8319.pdf
6. Hancock, J. “The Arkansas Medicaid model: What you need to know about the ‘private option’.” Kaiser Health News, May 1,
2013. Available at: http://www.kaiserhealthnews.org/stories/2013/may/02/arkansas-medicaid-private-option-faq.aspx’
7. Baker, S. “Republicans propose Medicaid caps.” The Hill, May 1, 2013. Available at:
http://thehill.com/blogs/healthwatch/medicaid/297301-republicans-propose-medicaid-caps
8. Takach, M., Buxbaum, J. “Care management for Medicaid enrollees through community health teams.” The Commonwealth
Fund, May 21, 2013. Available at: http://www.commonwealthfund.org/Publications/Fund-Reports/2013/May/CareManagement.aspx
ACA and Medicaid
1*. Somashekhar, S. “GOP governors’ endorsements of Medicaid expansion deepen rifts within party.” The Washington Post,
June 2, 2013. Available at: http://articles.washingtonpost.com/2013-06-02/national/39697956_1_medicaid-expansionmedicaid-plan-gop-governors
2*. Aizenman, N.C. “Health-care law could backfire for thousands on Medicaid.” The Washington Post, April 6, 2013. Available at:
http://articles.washingtonpost.com/2013-04-06/national/38327847_1_medicaid-program-childless-adults-poverty
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3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Jost, T.S., Rosenbaum, S. “The Supreme Court and the future of Medicaid.” New England Journal of Medicine online, July
25, 2012. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1208219
Samuelson, R. “The Medicaid albatross.” Real Clear Politics, July 23, 2012. Available at:
http://www.realclearpolitics.com/articles/2012/07/23/the_medicaid_albatross_114865.html
Somashekhar, S. “Medicaid shapes up as major battleground.” Washington Post online, August 14, 2012. Available at:
http://www.washingtonpost.com/politics/medicaid-shapes-up-as-major-battleground/2012/08/14/c9b8d164-e592-11e1-8f6258260e3940a0_story.html
Kaiser Commission on Medicaid and the Uninsured. Faces of the Medicaid expansion: Profiles of uninsured adults who could
gain coverage. November 2012. Available at: http://www.kff.org/medicaid/8385.cfm
Pear, R. “States’ policies on health care exclude some of the poorest.” The New York Times, May 24, 2013. Available at:
http://www.nytimes.com/2013/05/25/us/states-policies-on-health-care-exclude-poorest.html?pagewanted=all
Henneberry, J., Gifford, K.D. “Medicaid expansion: What’s at stake for 2014 and beyond?” National Institute for Health Care
Management, April 2013. Available at: http://www.nihcm.org/images/stories/Medicaid_Expansion__Whats_at_Stake_for_2014_and_Beyond.pdf
Klein, E. Soltas, E. “Wonkbook: The terrible deal for states rejecting Medicaid.” The Washington Post, June 4, 2013. Available
at: http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/04/wonkbook-the-terrible-deal-for-states-rejecting-medicaid/
Wayne, A., Mildenberg, D. “Working poor losing Obamacare as states resist Medicaid.” Bloomberg, June 25, 2013. Available
at: http://www.bloomberg.com/news/2013-06-25/working-poor-losing-obamacare-as-states-resist-medicaid.html
Kaiser Commission on Medicaid and the Uninsured. “Faces of the Medicaid expansion: Profiles of uninsured adults who could
gain coverage.” The Henry J. Kaiser Family Foundation, November 2012. Available at: http://kff.org/health-reform/issuebrief/faces-of-the-medicaid-expansion-experiences-and/
Alonso-Zaldivar, R. “Medicaid surge triggers cost concerns for states.” Fox News, May 26, 2014. Available at:
http://www.foxnews.com/politics/2014/05/26/medicaid-surge-triggers-cost-concerns-for-states-101039544/
Kardish, C. “Uncompensated care dropping fast in Medicaid expansion states.” Governing, June 17, 2014. Available at:
http://www.governing.com/topics/health-human-services/gov-uncompensated-care-dropping-fast.html
Vestal, C. “’Private option’ for Medicaid expansion would cut some benefits.” The PEW Charitable Trusts. Available at:
http://www.pewtrusts.org/en/imported-delta/stateline/2014/03/27/private-option-for-medicaid-expansion-would-cut-somebenefits
Further Readings
1.
Kellermann, A.L., Weinick, R.M. “Emergency departments, Medicaid costs, and access to primary care – understanding the
link.” New England Journal of Medicine 366(23): 2141-2143, 2012. http://www.nejm.org/doi/pdf/10.1056/NEJMp1203247
2. Alfred, R. Medicaid provider to terminate contract with state. October 17, 2012. Available at:
http://www.vcstar.com/news/2012/oct/17/medicaid-provider-to-terminate-contract-with/
3. Angeles, J. “How health reform’s Medicaid expansion will impact state budgets.” Center on Budget and Policy Priorities, July
25, 2012. Available at: http://www.cbpp.org/cms/index.cfm?fa=view&id=3801
4. Bernstein, N. With Medicaid, long-term care of elderly looms as a rising cost. The New York Times, September 6, 2012.
Available at: http://www.nytimes.com/2012/09/07/health/policy/long-term-care-looms-as-rising-medicaidcost.html?pagewanted=all&gwh=B1F9D581D1BEFF5095F1E3383662CD14
5. Carey, M.A. “FAQ: Ryan’s plan would make key changes in Medicaid, too.” Kaiser Health News, August 14, 2012. Available
at: http://www.kaiserhealthnews.org/Stories/2012/August/15/medicaid-ryan-faq.aspx
6. Cowen, T. The new tug of war over Medicaid. The New York Times July 14, 2012. Available at:
http://www.nytimes.com/2012/07/15/business/medicaids-new-tug-of-war-economicview.html?gwh=E558BF2424118B33B125C6CF5BFBFB79
7. Decker, S.L. “In 2011 nearly one-third of physicians said they would not accept new Medicaid patients, but rising fees may
help.” Health Affairs 31(8):1673-1679, 2012. Available at: http://content.healthaffairs.org/content/31/8/1673.full.pdf+html
8. Galewitz, P. GOP plan would cut Medicaid by $1.7 trillion, study says, KHN Blog, October 23, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/10/gop-plan-would-cut-medicaid-by-1-7-trillion-study-says/
9. Goodnough, A. “Lines are drawn over opting out of Medicaid plan.” New York Times, July 13, 2012, p. A.1. Available at:
http://www.nytimes.com/2012/07/13/health/policy/in-florida-a-fight-brews-over-governors-vow-to-opt-out-of-medicaidexpansion.html?pagewanted=all&_r=0&gwh=773D13624922754D8D4F1BF241A9E670
10. Smith, M.D. “The Supreme Court’s Medicaid surprise.” JAMA Forum, July 6, 2012. Available at:
http://newsatjama.jama.com/2012/07/06/jama-forum-the-supreme-courts-medicaid-surprise/
11. The New York Times. New York’s Medicaid reforms. September 17, 2012. Available at:
http://www.nytimes.com/2012/09/18/opinion/new-yorks-medicaidreforms.html?gwh=1E20B72A1A0A842EEF8A2F4CE72499F5
12. The Henry J. Kaiser Family Foundation. “Explaining health care reform: questions about Medicaid’s role.” Issue Brief, April
2010. Available at: http://www.kff.org/healthreform/upload/7920-02.pdf
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13. Holahan, J., McGrath, M. “As the economy improves, the number of uninsured is falling but not because of a rebound in
employer sponsored insurance.” The Kaiser Commission on Medicaid and the Uninsured, March 2014. Available at:
http://kff.org/uninsured/issue-brief/as-the-economy-improves-the-number-of-uninsured-is-falling-but-not-because-of-a-reboundin-employer-sponsored-insurance/
14. Nussbaum, A., Wayne, A. “WellPoint deal shows Medicaid prospects trump court view.” Bloomberg, July 10, 2012. Available
at: http://www.bloomberg.com/news/2012-07-10/wellpoint-deal-shows-medicaid-prospects-trump-court-view.html
15. American Health Insurance Plans. “Innovations in Medicaid managed care: Highlights of health plans’ programs to improve the
health and well-being of Medicaid beneficiaries.” March 2013. Available at: http://www.ahip.org/MedicaidInnovationsBook/
16. Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured. “Characteristics of uninsured low-income
adults.” August 2012. Available at: http://kff.org/health-reform/fact-sheet/characteristics-of-uninsured-low-income-adults/
Session 14 – December 2, 2014
Paying for Care for Seniors: Is This Any Way to Run an Insurance Program?
Assignment 3 Due
Medicare is one of the largest single items in the federal budget. Changes in Medicare expenditures have ripple effects on other
government programs and major impacts on the health care delivery system. The alleged cost-shifting to private payers that occurs due
to Medicare “underpayments” is only one of many ongoing policy issues. In this session we describe the structure of the Medicare
program, some of the challenges it has faced since its inception, and how Medicare has affected, and been affected by, changes in the
greater health care system.
Learning Objectives
1. Compare the Medicare Trust Funds A and B with respect to the way they are funded and the coverage they provide.
2. Describe the benefit coverage under Medicare and compare it to typical private insurance benefit coverage.
3. Discuss the structure and evolution of Medicaid Part C.
4. Describe how the Medicaid Part D prescription drug benefit is structured.
5. Compare and contrast how hospitals and physicians are paid under Medicare.
Suggested Readings
The Structure of the Medicare Program
1*. Henry J. Kaiser Foundation. “Medicare. A primer. 2010. Available at: http://www.kff.org/medicare/upload/7615-03.pdf
2*. Henry J. Kaiser Family Foundation. “Health care on a budget. The financial burden of health spending by Medicare
households.” June 2011. Available at: http://www.kff.org/medicare/8171.cfm
3. Hendrickson, M. “Did you really pay for your Medicare benefits?” Forbes, March 7, 2013. Available at:
http://www.forbes.com/sites/markhendrickson/2013/03/07/did-you-really-pay-for-your-medicare-benefits/
4. Kaiser Family Foundation. “Medicare advantage 2013 spotlight: Enrollment market update.” June 2013. Available at:
http://kaiserfamilyfoundation.files.wordpress.com/2013/06/8448.pdf
5. ConsumerReports. “Managing Medicare.” February 2014. Available at:
http://www.consumerreports.org/cro/2012/09/managing-medicare/index.htm
6. Cubanski, J., Swoope, C., Damico, A., Neuman, T. “Health care on a budget: The financial burden of health spending by
Medicare households.” Kaiser Family Foundation, January 2014. Available at: http://kff.org/medicare/issue-brief/health-careon-a-budget-the-financial-burden-of-health-spending-by-medicare-households/
7. Reinhardt, U.E. “How the medical establishment got the treasury’s keys.” The New York Times, February 28, 2014. Available
at: http://economix.blogs.nytimes.com/2014/02/28/how-the-medical-establishment-got-the-treasuryskeys/?_php=true&_type=blogs&_r=0
8. National Health Policy Forum. “The Basics. Medicare.” February 12, 2014. Available at:
http://www.nhpf.org/library/details.cfm/2545
9. The Economist. “The $272 billion swindle.” May 31, 2014. Available at: http://www.economist.com/printedition/2014-05-31
10. The Wall Street Journal. “House panel is subpoenaed as trading probe heats up.” The Wall Street Journal, June 19, 2014.
Available at: http://online.wsj.com/news/articles/SB20001424052702304034804579632153881894142
Issues Facing Medicare
Hospitals
1*. Rau, J. “Medicare to add hospital efficiency, patient safety to payment formula.” KHN Blog, April 24, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/04/medicare-to-add-hospital-efficiency-patient-safety-to-paymentformula/
2*. Abelson, R., Creswell, J., Palmer, G.J. Medicare bills rise as records turn electronic. The New York Times, September 21,
2012. Available at: http://www.nytimes.com/2012/09/22/business/medicare-billing-rises-at-hospitals-with-electronicrecords.html?pagewanted=all
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3*. Pear, R., Abelson, R. “Hospitals fear they’ll bear brunt of Medicare cuts.” The New York Times, December 18, 2012. Available
at: http://www.nytimes.com/2012/12/19/business/medicare-cuts-how-deep-and-where.html?ref=business&_r=1&
4. Rau, J. “Medicare spotlights hospitals with especially costly patients. Kaiser Health News, May 9, 2012. Available at:
http://www.kaiserhealthnews.org/Stories/2012/May/09/Medicare-Hospitals-Costly-Patients.aspx
5. Rau, J. “Medicare to penalize 2,211 hospitals for excess readmissions.” Kaiser Health News, August 13, 2012. Available at:
http://www.kaiserhealthnews.org/Stories/2012/August/13/medicare-hospitals-readmissions-penalties.aspx
6. Goldhill, D. “The high costs of Medicare’s low prices.” The Washington Post, March 10, 2013. Available at:
http://articles.washingtonpost.com/2013-03-10/opinions/37605696_1_medicare-beneficiaries-private-insurers-health-care
7. Jaffe, S. “Medicare may be overpaying hospitals for short-stay patients.” Kaiser Health News, May 20, 2014. Available at:
http://www.kaiserhealthnews.org/Stories/2014/May/20/medicare-observation-care-overpaying-hospitals-for-short-stays.aspx
8. Kaiser Health News. “Should Medicare pay the same no matter where the patient gets care?” May 21, 2014. Available at:
http://www.kaiserhealthnews.org/stories/2014/may/21/health-on-the-hill-medicare-site-of-service-paymentchanges.aspx?referrer=search
9. Quinn, K. “After the revolution: DRGs at age 30.” Annals of Internal Medicine 160(6):426-429, 2014. Available at:
http://annals.org/issue.aspx?journalid=90&issueid=929862&direction=P
10. Rau, J. “More than 750 hospitals face Medicare crackdown on patient injuries.” Kaiser Health News, June 22, 2014. Available
at: http://www.kaiserhealthnews.org/stories/2014/june/23/patient-injuries-hospitals-medicare-hospital-acquired-conditionreduction-program.aspx
11. Jaffe, S. “FAQ: Hospital observation care can be costly for Medicare patients.” Kaiser Health News, June 18, 2014. Available
at: http://www.kaiserhealthnews.org/stories/2013/september/04/observation-care-faq.aspx?referrer=search
Physicians
1*. Carey, M.A. “FAQ on Medicare doctor pay: Why is it so hard to fix?” Kaiser Health News, February 10, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2011/december/15/faq-doc-fix.aspx
2. Carey, M.A. “FAQ: The ‘doc fix’ dilemma.” Kaiser Health News, February 17, 2012. Available at:
http://www.kaiserhealthnews.org/daily-reports/2012/february/21/4khn-story.aspx?referrer=search
3. Schulte, F., Eaton, J., Donald, D. “Doctors, others billing Medicare at higher rates.” The Washington Post, September 15,
2012. Available at: http://articles.washingtonpost.com/2012-09-15/national/35496252_1_data-codes-medicare
4. Hensley, S. “Doctors fleeing Medicare? Not so fast, feds say.” npr, August 23, 2013. Available at:
http://www.npr.org/blogs/health/2013/08/23/214894592/doctors-fleeing-medicare-not-so-fast-feds-say
5. Kaiser Health News. “Permanent ‘doc fix’ may be on hold as House passes short-term patch.” March 27, 2014. Available at:
http://www.kaiserhealthnews.org/stories/2014/march/27/sgr-sustainable-growth-rate-doc-fix-patch-health-on-the-hill.aspx
6. Rau, J. “Harvard: Overused medical services cost Medicare billions.” Kaiser Health News Blog, May 12, 2014. Available at:
http://capsules.kaiserhealthnews.org/index.php/2014/05/harvard-overused-medical-services-cost-medicarebillions/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Capsules-TheKhnBlog+(Capsules++The+KHN+Blog)
7. Pfeifer, S. “IPC the hospitalist defrauded Medicare and Medicaid, U.S. lawsuit says.” The Los Angeles Times, June 17, 2014.
Available at: http://www.latimes.com/business/la-fi-ipc-medicare-overcharge-20140618-story.html
8. McClure, J. “Examining the cost of too much care.” Dallas News, May 24, 2014. Available at:
http://www.dallasnews.com/investigations/20140524-examining-the-cost-of-too-much-care.ece
9. Carey, M.A. “Hill plan would reward Medicare doctors for quality.” Kaiser Health News, February 7, 2014. Available at:
http://www.kaiserhealthnews.org/stories/2014/february/06/bipartisan-bill-medicare-sustainable-growth-rate-doc-fix.aspx
10. Kulash, T. “Patient coordination would get boost if Medicare changes how it pays docs.” Kaiser Health News, February 4,
2014. Available at: http://www.kaiserhealthnews.org/stories/2014/february/04/way-medicare-pays-doctors-maychange.aspx?referrer=search
11. Steinbrook, R. “Public disclosure of Medicare payments to individual physicians. JAMA 311(13):1285-1286, 2014. Available at:
12. Ginsburg, P.B. “Using science to shape Medicare physician payment.” JAMA Internal Medicine 173(18):1737-1738, 2013.
Available at: http://archinte.jamanetwork.com/Issue.aspx?journalid=71&issueID=928181&direction=P
13. Ehrenfreund, M. “Want to see how problematic Medicare pricing is? Look to ophthalmology.” The Washington Post, April 9,
2014. Available at: http://search.proquest.com/docview/1515695243/fulltext/CE61EA76530B4A85PQ/2?accountid=14586
14. Patel, K., Nadel, J. “Yet another short-term ‘doc fix’, but with glimmers of hope.” The Hill, March 29, 2014. Available at:
http://thehill.com/blogs/congress-blog/healthcare/202063-yet-another-short-term-doc-fix-but-with-glimmers-of-hope
15. Ornstein, C. “Medicare overpays billions for office visits, patient evaluations.” Propublica, May 29, 2014. Available at:
http://www.propublica.org/article/medicare-overpays-billions-for-office-visits-patient-evaluations
16. Frakt, A. “How Congress is actually holding down Medicare spending.” The New York Times, April 28, 2014. Available at:
http://www.nytimes.com/2014/04/29/upshot/how-congress-is-actually-holding-down-medicare-spending.html
17. Wilensky, G.R. “Medicare physician payment reform in 2014 is looking unlikely.” The Milbank Quarterly 92(2):182-185, 2014.
Available at: http://onlinelibrary.wiley.com/doi/10.1111/milq.2014.92.issue-2/issuetoc
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Pharmaceuticals and Devices
1*. Hoadley, J. “Medicare Part D spending trends: Understanding key drivers and the role of competition.” KFF Medicare Policy
Issue Brief, May, 2012. Available at: http://www.kff.org/medicare/upload/8308.pdf
2*. Jaffee, S. “Seniors cautioned to pay close attention to details as enrollment begins in Medicare plans.” Kaiser Health News,
October 15, 2013. Available at: http://www.kaiserhealthnews.org/stories/2013/october/15/medicare-open-enrollmentbegins.aspx
3*. Rosenblatt, B. Understanding Medicare. Figuring out the Part D. market. The Medicare NewsGroup, November 29, 2012.
Available at: http://www.medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicareblog/2012/11/29/figuring-out-the-part-d-market
4*. National Health Policy Forum. “The Medicare drug benefit (Part D).” Washington, DC: The George Washington University,
February 20, 2014. Available at: http://www.nhpf.org/library/details.cfm/2708
5. Editorial Board. “Let Medicare negotiate drug prices: our view.” USA Today, April 20, 2014. Available at:
http://www.usatoday.com/story/opinion/2014/04/20/medicare-part-d-prescription-drug-prices-negotiate-editorialsdebates/7943745/
6. Jaffe, S. “Strange pricing details can bedevil Medicare beneficiaries.” Kaiser Health News Blog, November 13, 2013. Available
at: http://capsules.kaiserhealthnews.org/index.php/2013/11/strange-pricing-details-can-bedevil-medicare-beneficiaries/
7. “Medical equipment prices highlight some of Medicare’s difficulties,” July 21, 2009. Available at:
http://www.medicalnewstoday.com/articles/158369.php
8. “Specialty drugs force high Medicare out-of-pocket costs.” March, 2010. Available at: http://www.advfn.com/news_SpecialtyDrugs-Force-High-Medicare-Out-Of-Pocket-Costs_41779029.html
9. Knox, R. “Medicare reverses denial of costly treatment for hepatitis C patient.” Kaiser Health News Blog, May 15, 2014.
Available at: http://capsules.kaiserhealthnews.org/index.php/2014/05/medicare-reverses-course-on-life-saving-treatment-forhepatitis-c-patient/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+CapsulesTheKhnBlog+(Capsules+-+The+KHN+Blog)
10. Carey, M.A. “Three key changes proposed for Medicare Part D.” Kaiser Health News, March 3, 2014. Available at:
http://www.kaiserhealthnews.org/stories/2014/march/03/three-key-changes-proposed-for-medicare-part-d.aspx
11. Neuman, T., Hoadley, J., Cubanski, J. “The cost of a cure: Medicare’s role in treating hepatitis C.” Health Affairs Blog, June 5,
2014. Available at: http://healthaffairs.org/blog/2014/06/05/the-cost-of-a-cure-medicares-role-in-treating-hepatitis-c/
12. Yen, H. “Lawmakers urge Medicare coverage for cancer test.” Associated Press, June 17, 2014. Available at:
http://bigstory.ap.org/article/lawmakers-urge-medicare-coverage-cancer-test
Health Plans
1*. Gold, M. “Medicare Advantage: Facts, fallacies, and the future.” Health Affairs Blog, March 14, 2011. Available at:
http://healthaffairs.org/blog/2011/03/14/medicare-advantage-facts-fallacies-and-the-future
2. Norman, B., Haberkorn, J. “CMS reverses course on cuts.” Politico, April 3, 2013. Available at:
http://www.politico.com/story/2013/04/insurance-medicare-advantage-cuts-health-care-89569.html
3. “The liberal Medicare advantage revolt.” The Wall Street Journal, March 29, 2013. Available at:
4. Garland, E. “Avalere analysis reveals first drop in Medicare Advantage offerings since 2011.” Avalere, September 23, 2013.
Available at: http://avalerehealth.net/news/avalere-analysis-reveals-first-drop-in-medicare-advantage-offerings-since-2
5. Al-Faruque, F. “Investigation: Feds overpaid $70B to Medicare Advantage.” The Hill, June 4, 2014. Available at:
http://thehill.com/policy/healthcare/208181-investigation-feds-overpaid-70b-to-medicare-advantage
6. Jacobson, G., Swoope, C., Perry, M., Slosar, M.C. “How are seniors choosing and changing health insurance plans?” Kaiser
Family Foundation, May 2014. Available at: http://kff.org/medicare/report/how-are-seniors-choosing-and-changing-healthinsurance-plans/
7. Wasik, J.F. “Medicare Advantage isn’t reducing health care costs.” The Fiscal Times, April 16, 2014. Available at:
http://www.thefiscaltimes.com/Columns/2014/04/16/Medicare-Advantage-Isn-t-Reducing-Health-Care-Costs
8. Frakt, A. “Gingrich’s correct prediction about Medicare’s future.” New York Times, July 7, 2014. Available at:
http://www.nytimes.com/2014/07/08/upshot/gingrichs-correct-prediction-about-medicares-future.html?_r=0
Further Readings
1.
2.
3.
4.
Congressional Budget Office. “CBO’s May 2013 Medicare baseline.” May 14, 2013. Available at:
http://www.cbo.gov/sites/default/files/cbofiles/attachments/44205_Medicare_0.pdf
Overland, D. “Medicare advantage poised for strong membership growth.” FierceHealthPayer, May 17, 2013. Available at:
http://www.fiercehealthpayer.com/story/medicare-advantage-plans-see-50-increase-membership/2013-05-17
Kaiser Family Foundation: “Medigap: Spotlight on enrollment, premiums, and recent trends.” April 2013. Available at:
http://kff.org/medicare/report/medigap-enrollment-premiums-and-recent-trends/
Government Accountability Office. Medicare physician payment: Private-sector initiatives can help inform CMS quality and
efficiency incentive efforts.” December 26, 2012. Available at: http://www.gao.gov/products/GAO-13-160
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5.
Lowes, R. “Bill would repeal SGR, phase out Medicare fee-for-service.” Medscape News, May 9, 2012. Available at:
http://www.medscape.com/viewarticle/763589?src=mpnews&spon=16
6. Marte, J. Medicare open-enrollment: Find the right drug plan. The Wall Street Journal, October 13, 2012. Available at:
http://articles.marketwatch.com/2012-11-08/finance/34421801_1_coverage-gap-medicare-plans-drug-plans
7. Porter, E. Rationing health care more fairly. The New York Times, August 21, 2012. Available at:
http://www.nytimes.com/2012/08/22/business/economy/rationing-health-care-more-fairly.html?pagewanted=all
8. Tran, A. Seniors satisfied with Medicare, anxious about future, survey finds. KHN Blog, October 18, 2012. Available at:
http://capsules.kaiserhealthnews.org/index.php/2012/10/seniors-satisfied-with-medicare-anxious-about-future-survey-finds/
9. Davis, K., Stremikis, K., Doty, M.M., Zezza, M.A. “Medicare beneficiaries less likely to experience cost- and access-related
problems than adults with private coverage.” Health Affairs 31(8):1866-1875, 2012. Available at:
10. Rau, J. “Hospitals’ readmission rates still too high, government says.” Washington Post online, July 19, 2012. Available at:
http://www.washingtonpost.com/politics/hospitals-readmission-rates-still-too-high-governmentsays/2012/07/19/gJQAZIqdwW_story.html
11. Klepper, B. “A legal challenge to CMS’ reliance on the RUC.” Health Affairs Blog, August 9, 2011. Available at:
http://healthaffairs.org/blog/2011/08/09/a-legal-challenge-to-cms-reliance-on-the-ruc/
12. Kowalczyk, L. “Hospital charges bring a backlash.” The Boston Globe, March 11, 2013. Available at:
http://www.bostonglobe.com/lifestyle/health-wellness/2013/03/10/patients-surprised-high-medical-bills-challenge-hospitaloverhead-charges/EY2x6jKTiPLiGXpSCyskKM/story.html
Session 15 – December 9, 2014
Medicare: A Program at the Brink?
Quiz 2: Material from Sessions 9-15
Health reform, the rising national debt, and changing population demographics have focused attention on slowing the growth of
Medicare expenditures. Both political parties have “plans” for the Medicare program; Medicare “reform” was an important topic in the
past presidential election and seems likely to remain a contentious issue in upcoming national elections as well.
Learning Objectives
1. Discuss the challenges that enrollment growth poses for Medicare.
2. Explain how health reform and the growing federal government debt could affect Medicare.
3. Describe proposals for Medicare reform and how recent moderation in Medicare expenditure growth could affect the
enactment of reforms.
Suggested Readings
The Medicare Solvency Issue
1*. Wasson, E., Baker S. “Medicare on track for insolvency in 2026; Social Security seven years later. The Hill, May 31, 2013.
Available at: http://thehill.com/blogs/on-the-money/budget/302719-social-security-insolvent-by-2033
2. Goodman, J.C., Kotlikoff, “Medicare by the scary numbers.” The Wall Street Journal, June 24, 2013. Available at:
3. Lawrence B.R. “The illusion of health-care ‘trust funds.’” The Washington Post, October 18, 2012. Available at:
http://articles.washingtonpost.com/2012-10-18/opinions/35502037_1_trust-fund-medicare-trustees-health-care
4. Stern, L., Heavey, S. “Insight: What if baby boomers don’t live forever?” Reuters, August 14, 2012. Available at:
http://www.reuters.com/article/2012/08/14/us-usa-babyboomers-life-expectancy-idUSBRE87D0ZT20120814
5. Social Security and Medicare Boards of Trustees. “Status of the Social Security and Medicare Programs. A summary of the
2013 annual reports.” 2013. Available at: http://www.ssa.gov/oact/trsum/
6. Kennedy, K. “Trustees: Medicare on sounder footing than last year.” USA Today, May 31, 2013. Available at:
http://www.usatoday.com/story/news/politics/2013/05/31/medicare-social-security-trustees-report/2375581/
The Impact of Health Reform on Medicare
1. Kliff, S. “Romney’s right: Obamacare cuts Medicare by $716 billion. Here’s how.” Washington Post online, August 14, 2012.
Available at: http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/08/14/romneys-right-obamacare-cuts-medicare-by-716billion-heres-how/
2. Pasternak, S. “End-of-life care constitutes third rail of U.S. health care policy debate.” Medicare Newgroup, June 3, 2013.
Available at: http://medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicareblog/2013/06/03/end-of-life-care-constitutes-third-rail-of-u.s.-health-care-policy-debate
3. Rau, J. “Medicare data show wide differences in ACOs’ patient care.” Kaiser Health News, February 21, 2014. Available at:
http://www.kaiserhealthnews.org/Stories/2014/February/21/Medicare-Data-Shows-Wide-Differences-In-ACOs-PatientCare.aspx
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4.
Carey, M.A. “FAQ: Decoding the $716 billion in Medicare reductions.” Kaiser Health News, August 17, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/august/17/faq-716-billion-medicare-reductions.aspx
Medicare and the Federal Budget
1*. Serafini, M.W. “FAQ: Obama v. Ryan on controlling federal Medicare spending.” Kaiser Health News, May 3, 2012.
Available at: http://www.kaiserhealthnews.org/stories/2012/may/04/obama-ryan-controlling-federal-medicare-spendingfaq.aspx
2*. Gale, W.G. “Six takeaways from CBO’s new long-term budget outlook.” Brookings, July 15, 2014. Available at:
http://www.brookings.edu/blogs/up-front/posts/2014/07/15-6-takeaways-cbo-budget-outlook-gale
3*. Kaiser Family Foundation. “Medicare and the federal budget: Comparison of Medicare provisions in recent federal debt and
deficit reduction proposals.” March 2013. Available at: http://kaiserfamilyfoundation.files.wordpress.com/2013/04/8124-022.pdf
4*. Neuman, T., Cubanski, J. “The mystery of the missing $1,000 per person: Can Medicare’s spending slowdown continue?”
Kaiser Family Foundation, July 8, 2014. Available at: http://kff.org/health-costs/perspective/the-mystery-of-the-missing-1000per-person-can-medicares-spending-slowdown-continue/
5. Cohn, J. “GOP budget: Time travel back to when seniors couldn’t afford health care — guest opinion.” Kaiser Health News,
April 26, 2011. Available at: http://www.kaiserhealthnews.org/Columns/2011/April/042611cohn.aspx
6. Klein, E. “Paul Ryan’s budget keeps Obama’s Medicare cuts. Full stop.” Washington Post online, August 14, 2012.
Available at: http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/08/14/ryans-budget-keeps-obamas-medicare-cuts-fullstop/
7. Reinhardt, U.E. “Medicare spending isn’t out of control.” The New York Times, December 21, 2012. Available at:
http://economix.blogs.nytimes.com/2012/12/21/medicare-spending-isnt-out-of-control/?_r=0
8. Tyson, L.D. “Evidence vs. ideology in the Medicare debate.” The New York Times, August 24, 2012. Available at:
http://economix.blogs.nytimes.com/2012/08/24/evidence-vs-ideology-in-the-medicare-debate/?_r=0
9. Altman, D. “The truth about those ‘greedy’ seniors. The Wall Street Journal, June 13, 2014. Available at:
http://blogs.wsj.com/washwire/2014/06/13/the-truth-about-those-greedy-seniors/
10. Cowan, J., Kessler, J. “The left needs to get real on Medicare, social security and the deficit.” The Washington Post, June 27,
2014. Available at: http://search.proquest.com/docview/1372279238/fulltext/1240486EC83C4527PQ/1?accountid=14586
Alternatives for Medicare Reform
1*. Rosenthal, M.B. “Hard choices — Alternatives for reining in Medicare and Medicaid spending.” New England Journal of
Medicine 364: 1887-1890, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1104428
2*. Serafini, M.W. “FAQ: How Paul Ryan proposes to change Medicare.” Kaiser Health News, August 11, 2012. Available at:
http://www.kaiserhealthnews.org/stories/2012/august/11/faq-paul-ryan-house-republican-medicare-plan.aspx?referrer=search
3. Appleby, J., Carey, M.A., McGinley, L. “CBO: Seniors would pay much more for Medicare under Ryan plan.” Kaiser Health
News, April 5, 2011. Available at: http://www.kaiserhealthnews.org/Stories/2011/April/06/CBO-Seniors-Pay-More-MedicareRyan-Plan.aspx
4. Cohn, J. “Analysis: Medicare, liberals and the lesser of two evils.” Kaiser Health News, August 15, 2011. Available at:
http://www.kaiserhealthnews.org/Stories/2011/August/15/medicare-super-committee-cohn-analysis.aspx
5. Miller, M. “Paul Ryan’s path to nowhere.” Washington Post online, March 21, 2012. Available at:
http://www.washingtonpost.com/opinions/paul-ryans-budget-to-nowhere/2012/03/21/gIQAe8qYRS_story.html
6. Antos, J. “The Ryan plan: The cliffs notes version of Republican health reform.” Health Affairs Blog, March 21, 2012.
Available at: http://healthaffairs.org/blog/2012/03/21/the-ryan-plan-the-cliffs-notes-version-of-republican-health-reform/
7. Orszag, P.R. “Paul Ryan is thoughtful, handsome and misguided.” Bloomberg.com, August 11, 2012. Available at:
http://www.bloomberg.com/news/2012-08-11/paul-ryan-is-thoughtful-handsome-and-misguided.html
8. Berenson, R., Holahan, J., Zuckerman, S. “Can Medicare be preserved while reducing the deficit? Timely analysis of
immediate health policy issues.” Urban Institute, March 2013. Available at: http://www.urban.org/UploadedPDF/412759-CanMedicare-Be-Preserved-While-Reducing-the-Deficit.pdf
9. Gregg, J. “Opinion: A way out of the Medicare maze.” The Hill, April 8, 2013. Available at:
http://thehill.com/opinion/columnists/judd-gregg/292237-opinion-a-way-out-of-the-medicare-maze
10. Viebeck, E. “Unified Medicare benefit would save billions, study says.” The Hill, May 6, 2013. Available at:
http://thehill.com/blogs/healthwatch/medicare/298019-unified-medicare-benefit-would-save-billions-study-says
11. McArdle, M. “Who should set Medicare prices?” Bloomberg, July 29, 2013. Available at:
http://www.bloomberg.com/news/2013-07-29/who-should-set-medicare-prices-.html
12. Eaton J. “How the other Washington may hold the key to the Medicare cost crisis.” Kaiser Health News, July 29, 2013.
Available at: http://www.kaiserhealthnews.org/stories/2013/july/29/lessons-from-washington-state-for-medicare.aspx
13. Viebeck, E. “House panel hints at Medicare reforms.” The Hill, June 18, 2014. Available at:
http://thehill.com/policy/healthcare/209778-house-panel-hints-at-medicare-reforms
14. Orszag, P. “Yes, we can trim Medicare spending.” Bloomberg, February 11, 2014. Available at:
http://www.bloombergview.com/articles/2014-02-11/yes-we-can-trim-medicare-spending
45
15. Carlson, J. “Seeking Medicare savings, OIG considers caps on hospital compensation.” Modern Healthcare, February 11,
2014. Available at: http://www.modernhealthcare.com/article/20140211/NEWS/302119958
16. Galewitz, P. “Impact of Medicare Advantage cuts on seniors sharply disputed.” Kaiser Health News, February 23, 2014.
Available at: http://www.kaiserhealthnews.org/stories/2014/february/24/medicare-advantage-react.aspx
17. Jacobson, G., Swoope, C. “Summary of Medicare provisions in the President’s budget for fiscal year 2015.” Kaiser Family
Foundation, March 2014. Available at: http://kff.org/medicare/issue-brief/summary-of-medicare-provisions-in-the-presidentsbudget-for-fiscal-year-2015/
18. Pannuru, R. “Good news for Paul Ryan’s Medicare plan.” Bloomberg View, April 17, 2014. Available at:
http://www.bloombergview.com/articles/2014-04-17/good-news-for-paul-ryan-s-medicare-plan
Prospects for Near Term Changes in Medicare
1*. Carey, M.A. “Five ways the President’s budget would change Medicare.” Kaiser Health News, April 15, 2013. Available at:
http://www.kaiserhealthnews.org/stories/2013/april/15/medicare-and-obama-budget.aspx
2*. Porter, E. “Medicare needs fixing, but not right now.” The New York Times, February 26, 2013. Available at:
http://www.nytimes.com/2013/02/27/business/medicare-needs-fixing-but-not-right-now.html?pagewanted=all
3. Joachim, D.S. “Budget office lowers its estimate on federal spending for health care.” The New York Times, July 15, 2014.
Available at: http://search.proquest.com/docview/1545134396/fulltext/BE4159A68AFD4FEAPQ/1?accountid=14586
4. Edsall, T.B. “The war on entitlements.” The New York Times, March 6, 2013. Available at:
http://opinionator.blogs.nytimes.com/2013/03/06/the-war-on-entitlements/
5. Harwood, J. “A complex role for Medicare in the standoff in Washington.” The New York Times, February 24, 2013. Available
at: http://www.nytimes.com/2013/02/25/us/politics/medicare-is-at-the-heart-of-the-fiscal-fight.html?pagewanted=all
6. Holzer, H.J., Sawhill, I. “Payments to elders are harming our future.” The Washington Post, March 8, 2013. Available at:
http://articles.washingtonpost.com/2013-03-08/opinions/37561450_1_federal-budget-entitlement-programs-debt-to-gdp-ratio
7. Hiltzik, M. “The five biggest lies about entitlement programs.” Los Angeles Times, March 8, 2013. Available at:
http://articles.latimes.com/2013/mar/08/business/la-fi-hiltzik-20130310
8. Samuelson, R.J. “We need to stop coddling the elderly.” The Washington Post, November 3, 2013. Available at:
http://search.proquest.com/docview/1458567092/fulltext/4BB9E41653464FCDPQ/1?accountid=14586
9. Easley, J. “Obama’s new healthcare dilemma.” The Hill, April 6, 2014. Available at: http://thehill.com/policy/healthcare/202702obamas-new-healthcare-dilemma
10. Hancock, J. “Decoding the high-stakes debate over Medicare Advantage cuts.” Kaiser Health News, April 7, 2014. Available
at: http://www.kaiserhealthnews.org/stories/2014/april/07/decoding-the-high-stakes-debate-over-medicare-advantagecuts.aspx
11. Ritger, C. “Congress braves first steps in Medicare reform.” NationalJournal, January 20, 2014. Available at:
http://www.nationaljournal.com/health-care/congress-braves-first-steps-in-medicare-reform-20140120
12. Whoriskey, P., Keating, D. “Medicare pricing drives high health-care costs.” The Washington Post, December 31, 2013.
Available at: http://search.proquest.com/docview/1473675552/fulltext/B1199F164B93453BPQ/1?accountid=14586
13. Wilensky, G.R. “Developing a viable alternative to Medicare’s physician payment strategy.” Health Affairs 33(1):153-160,
2014. Available at: http://content.healthaffairs.org/content/33/1.toc
14. America’s Health Insurance Plans. “Five members of Senate Finance Committee send letter urging CMS to protect seniors in
Medicare Advantage.” March 27, 2014. Available at: http://www.ahipcoverage.com/2014/03/27/five-members-of-senatefinance-committee-send-letter-urging-cms-to-protect-seniors-in-medicare-advantage/
15. America’s Health Insurance Plans. “Overwhelming evidence shows Medicare Advantage improves health outcomes.” March
28, 2014. Available at: http://www.ahipcoverage.com/2014/03/28/overwhelming-evidence-shows-medicare-advantageimproves-health-outcomes/
16. Demko, P. “Medicare sequestration cuts extended to 2024 as veteran benefits restored.” Modern Healthcare, February
12,2014. Available at: http://www.modernhealthcare.com/article/20140212/NEWS/302129952
Further Readings
1.
2.
3.
4.
Klein, E. “The GOP’s Medicare confusion.” The Washington Post, November 29, 2012. Available at:
http://www.washingtonpost.com/blogs/wonkblog/wp/2012/11/29/the-gops-medicare-confusion/
Krugman, P. “Republicans and Medicare.” New York Times, February 12, 2010. p. A.31. Available at:
http://ic.galegroup.com/ic/suic/NewsDetailsPage/NewsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=nor
mal&contentModules=&mode=view&displayGroupName=News&limiter=&currPage=&disableHighlighting=false&displayGroup
s=&sortBy=&source=&search_within_results=&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA218792481
Newhouse, J.P., Garber, A.M. “Geographic variation in Medicare services.” New England Journal of Medicine 368(16):14651468, 2013. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1302981
Huesch, M. “How ideas from private industry help combat Medicare fraud, waste, and abuse.” Health Affairs Blog, May 23,
2013. Available at: http://healthaffairs.org/blog/2013/05/23/how-ideas-from-private-industry-help-combat-medicare-fraudwaste-and-abuse/
46
VII. Evaluation and Grading
Grades will be determined based on aggregated responses to short essay questions on class material (2 quizzes, 30 pts. each),
three individual assignments (5, 10 and 10 pts.) and one group assignment (15 pts.). In the quizzes, students will be asked to
answer short essay questions based on the material assigned from the previous classes and discussed in those classes. Fortyfive minutes will be allocated for this purpose, with the student receiving a grade of 0-30 points. Each quiz must be taken during
the scheduled period, unless prior permission to postpone the quiz has been obtained from the instructor. The student will receive
a grade of zero for any quiz missed without prior arrangement or medical excuse. The student will receive a grade of zero on any
assignment not submitted as scheduled, unless prior arrangements have been made for late submission. The group project will
require preparation of a policy briefing for a health care administrator. The briefing will address the potential implications of a
specific public policy proposal or piece of legislation. Thirty minutes will be allocated for the group to present a PowerPoint
analysis to the class and respond to class questions. The group also will draft a brief memo to the CEO summarizing points made
in the presentation. The topics for the briefing will be assigned one week before the scheduled time of the briefing, to assure
timeliness.
Grading Scale
The University utilizes plus and minus grading on a 4.000 cumulative grade point scale in accordance with the following:
A
4.000 - Represents achievement that is outstanding relative to the level necessary to meet course requirements
A-
3.667
B+
3.333
B
3.000 - Represents achievement that is significantly above the level necessary to meet course requirements
B-
2.667
C+
2.333
C
2.000 - Represents achievement that meets the course requirements in every respect
C-
1.667
D+
1.333
D
1.000 - Represents achievement that is worthy of credit even though it fails to meet fully the course requirements
S
Represents achievement that is satisfactory, which is equivalent to a C- or better.
In this course, the percentage score on assignments will be converted to a letter grade as follows:
A=93-100%
Represents outstanding achievement relative to the level necessary to meet course requirements
A- = 90-92.99%
B+ = 87-89.99%
B = 83-86.99%
Represents achievement that is significantly above the level necessary to meet course requirements
B- = 80-82.99%
47
C+ = 77-79.99%
C = 73-76.99%
Represents achievement that meets the minimum course requirements
C- = 70-72.99%
D+ = 65-69.99%
D = 60-64.99%
F = < 59.99%
No credit. Signifies work was below level of achievement that represents minimum threshold to
obtain credit or work was not completed and there was no agreement between instructor and
student that the student would be awarded an I.
The instructor reserves the right to adjust final grades “upward” based on the overall distribution of points for the class. That is,
students may receive a higher grade than expected based on their overall point total, but not a lower grade.
Course Evaluation
The SPH will collect student course evaluations electronically using a software system called CoursEval:
www.sph.umn.edu/courseval. The system will send email notifications to students when they can access and complete their
course evaluations. Students who complete their course evaluations promptly will be able to access their final grades just as soon
as the faculty member renders the grade in SPHGrades: www.sph.umn.edu/grades. All students will have access to their final
grades through OneStop two weeks after the last day of the semester regardless of whether they completed their course
evaluation or not. Student feedback on course content and faculty teaching skills are an important means for improving our work.
Please take the time to complete a course evaluation for each of the courses for which you are registered.
Incomplete Contracts
A grade of incomplete “I” shall be assigned at the discretion of the instructor when, due to extraordinary circumstances (e.g.,
documented illness or hospitalization, death in family, etc.), the student was prevented from completing the work of the course on
time. The assignment of an “I” requires that a contract be initiated and completed by the student before the last official day of
class, and signed by both the student and instructor. If an incomplete is deemed appropriate by the instructor, the student in
consultation with the instructor, will specify the time and manner in which the student will complete course requirements. Extension
for completion of the work will not exceed one year (or earlier if designated by the student’s college). For more information and to
initiate an incomplete contract, students should go to SPHGrades at: www.sph.umn.edu/grades.
University of Minnesota Uniform Grading and Transcript Policy
A link to the policy can be found at onestop.umn.edu.
VIII. Other Course Information and Policies
Grade Option Change (if applicable)
For full-semester courses, students may change their grade option, if applicable, through the second week of the semester. Grade
option change deadlines for other terms (i.e. summer and half-semester courses) can be found at onestop.umn.edu.
Course Withdrawal
Students should refer to the Refund and Drop/Add Deadlines for the particular term at onestop.umn.edu for information and
deadlines for withdrawing from a course. As a courtesy, students should notify their instructor and, if applicable, advisor of their
intent to withdraw.
Students wishing to withdraw from a course after the noted final deadline for a particular term must contact the School of Public
Health Office of Admissions and Student Resources at [email protected] for further information.
Student Conduct Code:
The University seeks an environment that promotes academic achievement and integrity, that is protective of free inquiry, and that
serves the educational mission of the University. Similarly, the University seeks a community that is free from violence, threats,
and intimidation; that is respectful of the rights, opportunities, and welfare of students, faculty, staff, and guests of the University;
and that does not threaten the physical or mental health or safety of members of the University community.
As a student at the University you are expected adhere to Board of Regents Policy: Student Conduct Code. To review the Student
Conduct Code, please see: http://regents.umn.edu/sites/default/files/policies/Student_Conduct_Code.pdf.
48
Note that the conduct code specifically addresses disruptive classroom conduct, which means "engaging in behavior that
substantially or repeatedly interrupts either the instructor's ability to teach or student learning. The classroom extends to any
setting where a student is engaged in work toward academic credit or satisfaction of program-based requirements or related
activities."
Use of Personal Electronic Devices in the Classroom:
Using personal electronic devices in the classroom setting can hinder instruction and learning, not only for the student using the
device but also for other students in the class. To this end, the University establishes the right of each faculty member to
determine if and how personal electronic devices are allowed to be used in the classroom. For complete information, please
reference: http://policy.umn.edu/Policies/Education/Education/STUDENTRESP.html.
Scholastic Dishonesty
Students are responsible for knowing the University of Minnesota, Board of Regents' policy on Student Conduct and Sexual
Harassment found at www.umn.edu/regents/polindex.html.
Students are responsible for maintaining scholastic honesty in their work at all times. Students engaged in scholastic dishonesty
will be penalized, and offenses will be reported to the SPH Associate Dean for Academic Affairs who may file a report with the
University’s Academic Integrity Officer.
The University’s Student Conduct Code defines scholastic dishonesty as “plagiarizing; cheating on assignments or examinations;
engaging in unauthorized collaboration on academic work; taking, acquiring, or using test materials without faculty permission;
submitting false or incomplete records of academic achievement; acting alone or in cooperation with another to falsify records or to
obtain dishonestly grades, honors, awards, or professional endorsement; or altering, forging, or misusing a University academic
record; or fabricating or falsifying of data, research procedures, or data analysis.”
Reference: “a mention or citation of a source of information in a book or article” (Compact Oxford English Dictionary, 2012)
Citation: “a quotation from or reference to a book, paper, or author, especially in scholarly work” (Compact Oxford English
Dictionary, 2012)
Quotation: “a group of words taken from a text or speech and reported by someone other than the original author or speaker”
(Compact Oxford English Dictionary, 2012)
Plagiarism: “the process of taking another person’s work, ideas, or words, and using them as if they were your own” (Macmillan
Dictionary, 2012)
You will be asked to review a variety of sources of information when completing assignments for this course. It is important that
you acknowledge these sources of information appropriately in your written assignments and verbal presentations. If you are
quoting a source directly (using the words in the source, not your words) you must indicate this by using quotation marks, as in the
definitions above, and by including a citation to the reference from which the quote was extracted. There is nothing wrong with
including quotes in your assignments, but you are expected to put them in quotation marks and cite them appropriately. If you use
the words of someone else, but do not put them in quotation marks, this is called plagiarism (even if you include a citation), and it
violates the University’s academic code. Essentially, you are saying that you wrote these words, when that isn’t true, so you are
lying to your instructor and classmates. In addition to using citations for quotations, you should use citations in the text to indicate
instances where you have drawn on specific works of others in framing your answer or arguments. In using citations for this
purpose, you acknowledge that the thoughts are not entirely yours, even though you may have expressed them in your own
words. You should include a reference list at the end of your assignment. This list should include a complete description of all
citations included in the text.
References
1. Compact Oxford English Dictionary, Oxford University Press, 2012, http://oxforddictionary.com/definition/english (accessed on
August 21, 2012).
2. MacMillan Dictionary, 2012, http://www.macmillandictionary.com/dictionary/american (accessed on August 21, 2012).
Plagiarism is an important element of this policy. It is defined as the presentation of another's writing or ideas as your own.
Serious, intentional plagiarism will result in a grade of "F" or "N" for the entire course. For more information on this policy and for a
helpful discussion of preventing plagiarism, please consult University policies and procedures regarding academic integrity:
http://writing.umn.edu/tww/plagiarism/.
Students are urged to be careful that they properly attribute and cite others' work in their own writing. For guidelines for correctly
citing sources, go to http://tutorial.lib.umn.edu/ and click on “Citing Sources”.
49
In addition, original work is expected in this course. Unless the instructor has specified otherwise, all assignments, papers, reports,
etc. should be the work of the individual student. It is unacceptable to hand in assignments for this course for which you receive
credit in another course unless by prior agreement with the instructor. Building on a line of work begun in another course or
leading to a thesis, dissertation, or final project is acceptable.
Makeup Work for Legitimate Absences:
Students will not be penalized for absence during the semester due to unavoidable or legitimate circumstances. Such
circumstances include verified illness, participation in intercollegiate athletic events, subpoenas, jury duty, military service,
bereavement, and religious observances. Such circumstances do not include voting in local, state, or national elections. For
complete information, please see: http://policy.umn.edu/Policies/Education/Education/MAKEUPWORK.html.
Appropriate Student Use of Class Notes and Course Materials:
Taking notes is a means of recording information but more importantly of personally absorbing and integrating the educational
experience. However, broadly disseminating class notes beyond the classroom community or accepting compensation for taking
and distributing classroom notes undermines instructor interests in their intellectual work product while not substantially furthering
instructor and student interests in effective learning. Such actions violate shared norms and standards of the academic
community. For additional information, please see: http://policy.umn.edu/Policies/Education/Education/STUDENTRESP.html.
Sexual Harassment
"Sexual harassment" means unwelcome sexual advances, requests for sexual favors, and/or other verbal or physical conduct of a
sexual nature. Such conduct has the purpose or effect of unreasonably interfering with an individual's work or academic
performance or creating an intimidating, hostile, or offensive working or academic environment in any University activity or
program. Such behavior is not acceptable in the University setting. For additional information, please consult Board of Regents
Policy: http://regents.umn.edu/sites/default/files/policies/SexHarassment.pdf
Equity, Diversity, Equal Opportunity, and Affirmative Action:
The University will provide equal access to and opportunity in its programs and facilities, without regard to race, color, creed,
religion, national origin, gender, age, marital status, disability, public assistance status, veteran status, sexual orientation, gender
identity, or gender expression. For more information, please consult Board of Regents Policy:
http://regents.umn.edu/sites/default/files/policies/Equity_Diversity_EO_AA.pdf.
Disability Accommodations:
The University of Minnesota is committed to providing equitable access to learning opportunities for all students. The Disability
Resource Center Student Services is the campus office that collaborates with students who have disabilities to provide and/or
arrange reasonable accommodations.
If you have, or think you may have, a disability (e.g., mental health, attentional, learning, chronic health, sensory, or physical),
please contact DS at 612-626-1333 or [email protected] to arrange a confidential discussion regarding equitable access and
reasonable accommodations.
If you are registered with DS and have a current letter requesting reasonable accommodations, please contact your instructor as
early in the semester as possible to discuss how the accommodations will be applied in the course.
For more information, please see the DS website, https://diversity.umn.edu/disability/.
Mental Health and Stress Management:
As a student you may experience a range of issues that can cause barriers to learning, such as strained relationships, increased
anxiety, alcohol/drug problems, feeling down, difficulty concentrating and/or lack of motivation. These mental health concerns or
stressful events may lead to diminished academic performance and may reduce your ability to participate in daily activities.
University of Minnesota services are available to assist you. You can learn more about the broad range of confidential mental
health services available on campus via the Student Mental Health Website: http://www.mentalhealth.umn.edu.
The Office of Student Affairs at the University of Minnesota:
The Office for Student Affairs provides services, programs, and facilities that advance student success, inspire students to make
life-long positive contributions to society, promote an inclusive environment, and enrich the University of Minnesota community.
Units within the Office for Student Affairs include, the Aurora Center for Advocacy & Education, Boynton Health Service, Central
Career Initiatives (CCE, CDes, CFANS), Leadership Education and Development –Undergraduate Programs (LEAD-UP), the
Office for Fraternity and Sorority Life, the Office for Student Conduct and Academic Integrity, the Office for Student Engagement,
50
the Parent Program, Recreational Sports, Student and Community Relations, the Student Conflict Resolution Center, the Student
Parent HELP Center, Student Unions & Activities, University Counseling & Consulting Services, and University Student Legal
Service.
For more information, please see the Office of Student Affairs at http://www.osa.umn.edu/index.html.
Academic Freedom and Responsibility: for courses that do not involve students in research:
Academic freedom is a cornerstone of the University. Within the scope and content of the course as defined by the instructor, it
includes the freedom to discuss relevant matters in the classroom. Along with this freedom comes responsibility. Students are
encouraged to develop the capacity for critical judgment and to engage in a sustained and independent search for truth. Students
are free to take reasoned exception to the views offered in any course of study and to reserve judgment about matters of opinion,
but they are responsible for learning the content of any course of study for which they are enrolled.*
Reports of concerns about academic freedom are taken seriously, and there are individuals and offices available for help. Contact
the instructor, the Department Chair, your adviser, the associate dean of the college, or the Vice Provost for Faculty and Academic
Affairs in the Office of the Provost. [Customize with names and contact information as appropriate for the course/college/campus.]
OR:
Academic Freedom and Responsibility, for courses that involve students in research:
Academic freedom is a cornerstone of the University. Within the scope and content of the course as defined by the instructor, it
includes the freedom to discuss relevant matters in the classroom and conduct relevant research. Along with this freedom comes
responsibility. Students are encouraged to develop the capacity for critical judgment and to engage in a sustained and
independent search for truth. Students are free to take reasoned exception to the views offered in any course of study and to
reserve judgment about matters of opinion, but they are responsible for learning the content of any course of study for which they
are enrolled.* When conducting research, pertinent institutional approvals must be obtained and the research must be consistent
with University policies.
Reports of concerns about academic freedom are taken seriously, and there are individuals and offices available for help. Contact
the instructor, the Department Chair, your adviser, the associate dean of the college, or the Vice Provost for Faculty and Academic
Affairs in the Office of the Provost. [Customize with names and contact information as appropriate for the course/college/campus.]
* Language adapted from the American Association of University Professors "Joint Statement on Rights and Freedoms of Students".
Template update 6/2014
51

PubH-6556 - School of Public Health

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