public policy: health (Jan.22, 2007)

Political Science/Public Administration 6321; Spring, 2007; MWF 7:30-8:20; OSH 208

Bob Huefner   581-6043  OSH 210d   Office hours: Tue. 4-5:30 (usually) or by appointment

Email: robert.huefner@poli-sci.utah.edu      Web page: http://www.poli-sci.utah.edu/~rhuef/

Assisted by Cathy Chambless  585-0371 OSH 213 email: cathy.chambless@cppa.utah.edu    

Course Purposes: That participants further develop their:

• Understanding of the politics of health and the health of politics,

• Understanding of problems, purposes, and processes of (health) policy,

• Familiarity with current issues and terminology of health policy,

• Abilities to predict and influence future (health) policy,

• Professional tools to analyze health policy choices and administer health services: data analysis and presentation (e.g. tables, statistical tools, graphics, analytic tools, and narrative); acquisition and appraisal of research and financial analysis (e.g. locating sources and assessing their products); communications (e.g. written and oral communications, group efforts, marketing, and negotiation); and professional presentation (e.g. résumé and memos/summaries)


Texts:

There is no text. Study materials include:
 • Utah's Health, An Annual Review, Vol. XI, to be distributed.

        • Academy for Health Services Research and Health Policy, Glossary (http://www.academyhealth.org/publications/glossary.htm).

        • Various newspapers, web connections, and library materials

         Other materials may be assigned: on reserve, on the web, or distributed in class.

ASSIGNMENTS:
• Study team: Organize and submit names to Huefner (Wed., Jan. 10) of a two person study team.  Study team is to prepare a data page, prepare for class discussions, critique draft assignments, prepare a summary (paragraph) proposal for U S health policy (Mon., Mar. 12) and prepare for exams.

• Résumé: Update or prepare your résumé, for seeking a position upon graduation. Share the résumé with your study partner (Wed., Jan. 17). Return other team member's résumé with constructive critique (Fri., Jan. 19). Submit your revised résumé (Wed., Jan. 24). For assistance, see Office of Career Services, 581-6186,  room 350, Student Services Bldg., http://careers.utah.edu 

• Experience: Prepare paragraph descriptions, with assessments of what they say about the quality of health care, of two personal health care experiences (one positive and one problematic) that you are willing to share with the class. Discuss in your study team in class (Wed., Jan. 10) and revise and submit (Fri., Jan 12).

• Class participation is a primary means of learning, and the course seeks constructive (including challenging) discussion. If you have a special problem in arriving at class on time (e.g. child care), see Huefner in advance.

• Media Reviews (4) of items appearing during the previous week in a major news source listed in the course schedule. Select from the assigned source what you find to be the most important health policy issue related to the policy aspect addressed that week.  In about fifty words, address at least the first three of the following questions and be prepared to address all of them in class discussion:
   Why is this the key issue?
   What pertinent facts (about health and politics) are known?
   What are the uncertainties
   What are likely to be key policy steps and actors?
   What information, now known or unknown and  in whose hands, can improve policy?

Individuals will be called upon to initiate the discussion. (If you can not attend a session, please notify Huefner in advance.) All class members are invited to participate in the discussion. Reviews will be scored as satisfactory (75), comprehensive (85), or  especially insightful (95).

• Quizzes (5) unannounced, beginning of class.  No make ups. Scores from 0 to 5, with each class member's lowest score changed to 5.


• Data Page: As a study team, update and rework a data page of Utah's Health. Report to Huefner the page selected (Fri., Jan.12). Submit two copies (Mon., Jan.29) to be reviewed, but not graded, by two other class members and returned with comments (Mon., Feb. 5). Revise and submit (Mon., Feb.12). Update the data by (1) using the best sources available, (2) refining the narrative to be more helpful to the lay reader by doing research at the Eccles Library and on the web, and (3) improving the presentation by making changes in the page layout and emphasis.

• Research Results: (1) In class (Wed., Jan.24) choose a result from Research Activities published by AHRQ (from copies distributed in class). Report to the class (in 3 sentences) the result, the source of the finding, and a question related to the finding that deserves further investigation.  Raise a question deserving further investigation related to the finding reported by the class member immediately ahead of you in the alphabet. (2) Go to the web page of Research Activities and select the PDF version of a report (any year) for the month of your birth and from that select a finding of interest. Prepare a short paragraph citing the month, year, page, and title of the finding, summarizing the finding, identifying the source of the finding, and raising a question related to the finding that deserves further investigation. Give this (Wed., Feb.14) to the class member immediately after you in the alphabet to raise a second question related to the finding that deserves further investigation (Wed., Feb 21). Then do research on the web and at the Eccles Library to answer as best you can whether there has been further research on the two questions raised and if so how well it answers the questions. Write two short paragraphs summarizing your findings for the two questions, and submit the completed (three paragraph) report (Mon., Mar.5). Limit you web/library research of the two questions to three hours of your time. Include a footnote for your completed report saying what sources were most helpful and what problems were encountered in your research.


 • Book comparison: Read one of the following books: •Complications (Atul Gawande); •Ashes to Ashes (Richard Kluger); •A Civil Action (Jonathan Harr); •A Question of Intent (David Kesler); •A Midwife's Tale (Laurel Thatcher Ulrich); •Medicine & Culture (Lynn Payer); •Educated Guesses (Louise Russell); •To Err is Human (Inst. of Med.); •Crossing the Quality Chasm (Inst. of Med.); •Smoking and Politics (Fritchler & Hoefler); •The Spirit Catches You and You Fall Down (Anne Fadiman); •Pathologies of Power (Paul Farmer); •The 9/11 Commission Report; •The Great Influenza (John Barry); or •China Syndrome (Karl Taro Greenfeld).  Team with another course participant who is reading a different book to inform each other (by Wed., Apr. 4) of how the books relate to the questions listed above for the "Media Reviews" assignment. Then individually write and submit (Wed., Apr. 11) a comparison, in two readable pages, of the perspectives provided by these two books, considering the "review" questions that you find most significant. Inform Huefner (by Friday, January 19) of the book selected and the name of the other team member. Be prepared to discuss in class your book and comparison.

GRADES will be based upon the following (there are no extra-credit projects):

• 10% Class Participation: entire semester

• 10% Data Page


• 10% March 2 Research Results report

• 10% Media Reviews (4)

• 10% Quizzes (5)


• 10% Book Comparison

• 15% Midterm Exam

• 25% Final Exam

No examination study guides, beyond the "notes" on Huefner's web page, will be distributed.
If you would like your final exam returned, Leave a stamped, addressed envelope.

Persons with Disabilities:
The University of Utah seeks to provide equal access to its programs, services and activities for people with disabilities. If you will need accommodations in this class, reasonable prior notice needs to be given to Huefner and to the Center for Disability Services, 162 Union Building, 581-5020 to make arrangements for accommodations.
Course Schedule and assignments
Course sessions will introduce and consider facts and frameworks, and perspectives and principles, for approaching health policy and administration. These will be VERY briefly outlined in the course "notes" on Huefner's web page, notes not to replace but for checking the coverage of your notes of discussions, materials, and reflections.

i. Introductions: January 8 through 12

Health costs are lumpy (a few of us face health problems that account for most costs).
That's why we need insurance, and that's why today's insurance market does not work.
That's why states (e.g. Utah) can not assure care, and that's why states now must try.
Is this a problem to be solved as a business, or as a democracy?

Monday, January 8
Wednesday, January 10
° Inform Huefner of study team membership
° Share Health Experiences with study team member
Friday, January 12
° Inform Huefner of Data Page chosen
° Submit Health Experiences

I. Measures & Sources: January 15 through 26

How well do we: know the situation; measure achievement; establish accountability; assure accuracy; etc.

Monday, January 15:   Martin Luther King Jr. Day, No Class
° Begin reviewing New York Times  week day paper editions, January 15 - 19 re "Measures & Sources"
Wednesday, January 17
° Share Résumés  with study team partners
Friday, January 19
° Inform Huefner of Partner re Book Comparison and of Books Chosen
° Return Résumés
Monday, January 22: Robert Rolfs, MD, State Epidemiologist
Wednesday, January 24
° Submit Résumés;
° Submit Media Review re "Measures & Sources" from New York Times week day paper editions, January 15 - 19
° Choose and report on a research result from reports distributed this day

II. Issues: January: 29 through February 9
A. Costs of Health Care:
    Why does health care now consume a sixth of our (U.S.) gross domestic product?
    Why does business find it the most burdensome increase in costs of production?
    Why is Medicaid now larger than Medicare in enrollees and in expenditures?
    Why is government now paying half the costs of all health care?
    Why does it make a difference who pays the costs of health care?
    What does "public policy as a human endeavor" imply?
B. Access to Health Care:
    Is health care a right?
    What does "access" mean?
C. Quality of Health Care:
    In what sense does the U.S. have the best health care in the world?
    IOM estimated 44 to 98 thousand deaths a year from errors in hospitals; so what?

Monday, January 29
° Submit Two Copies Group Data Page for review by other members of the class
° Begin reviewing Wall Street Journal week day paper editions, January 29 - February 2,  re "Issues" 
Wednesday, January 31
Monday, February 5
° Return group data pages to authors, with comments
 Wednesday, February 7
° Submit Media Review re "Issues" from Wall Street Journal week day paper editions, January 29 - February 2

III. Hypotheses/Presumptions: February 12 through February 23

How are the health and health care situations determined by the environment (cultural, economic, political, technological, etc.)?
What values and ideologies shape "reforms"?

Monday, February 12
° Submit Data Page
° Begin monitoring the "News Hour" (PBS) TV (preferably) or on line, February 12-16, re "Hypotheses/Presumptions" 
Wednesday, February 14
° Give summary of Research Result to other class member
Monday, February 19:   Presidents' Day, No Class


Wednesday, February 21
° Give other class member a follow-up question for the Research Result
° Submit Media Review re "Hypotheses/Presumptions"  from "News Hour," February 12-16
Midterm Review

IV.  Designs: February 26 through March 9

What reforms have, or should have, public attention?
Technically, how effective might they be? What are their problems
Politically, how realistic are they? What hurdles do they face? What drives them?

Monday, February 26:    Midterm Exam
° Begin reviewing Salt Lake Tribune or  Morning News week day paper editions, February 26-March 2,  re "Designs"
Wednesday, February 28
(cc)
Monday, March 5
° Submit Report of Research Results
Wednesday, March 7: Kim Wirthlin, UofU VP (legislative relations)
° Submit Media Review re "Designs"  from Salt Lake Tribune or  Morning News, February 26-March 2

V. Politics: March 12 through March  30

How does the nature of politics in the United States shape the nature of  the evolution and reform of policy?
    In terms of the several levels of government?
    In terms of the three branches of government?
How are these politics (of fragmentation, incrementalism, interest groups, etc.) affecting the policy and effectiveness of public health?
Of health care?

Monday, March 12
° Bring Study Group's Proposed U S Health Policy
Wednesday, March 14
Monday, Wednesday, & Friday, March 19 -  23:   Spring Break, No Class
Monday, March26
Wednesday, March 28


VI.  Quantitative Tools: April 2 through April 6

What bag of tools might be brought to efforts to improve health policies?
What are the limits and dangers of such tools?
Why questions must be asked?

Monday, April 2
Wednesday, April 4
° Complete Meetings With Partner re Comparison of Books

VII. Interactive Tools: April 9 through April 13

How might organizational and communication skills be developed and applied to shape health policy?
What time horizon should guide the character of the communication?

Monday: April 9
Wednesday: April 11 David Sundwall, MD, Director, Utah Department of Health
° Submit Book Comparison

VIII.  Reviews and Discussions of Books: April 16 through April 25

Monday, April 16
Wednesday, April 18
Monday, April 23
Wednesday, April 25
Final review

Friday, April 27:    Final Exam: 8-10 a.m.