SYLLABUS. HMP 633: Health Insurance in America: How Did We Get into this Mess? How Do We Get Out?

Transcription

1 SYLLABUS HMP 633: Health Insurance in America: How Did We Get into this Mess? How Do We Get Out? University of Michigan School of Public Health Dept. of Health Management and Policy Fall, 2012 Lecturers:, Paul Austin, Meeting Time & Place: Wednesdays, 3:00-6:00 pm, Room Office Hours: By appointment, or or Course Materials: Readings are listed on the CTools site and in a printed handout. There are two categories of readings: required and recommended. All students are expected to have read all required readings prior to class. In general, lectures will not repeat the material covered in the readings but lecturers will be prepared to answer questions related to the readings. Recommended readings are offered for students who want greater depth in the particular topic. Those writing papers on the topic for that class session should find the recommended readings quite helpful. Review of recommended readings will also be useful for class exercises though they are not required. Course Description: This course will explore the history, structure and likely future trends of health insurance in the U.S. The course will include policy analyses of health insurance related issues with a focus on potential solution alternatives to political and practical problems. It will provide an in depth overview of the basic features of private health insurance: from rating and underwriting practices, to operational challenges and requirements, to cost and quality controls. The course will also review public insurance in the U. S., including discussion of the financial and political challenges to continued viability of Medicare and Medicaid. Some comparison will also be provided to international systems as a means for better understanding the unique aspects of the American system. Course Objectives/Competencies: Objectives: The major objective of the course is to provide the student with a comprehensive understanding of how the United States public/private health insurance system functions. It will provide future health services leaders with a working knowledge of the interrelationships between public programs and private insurance and approaches to cost control using risk management, provider reimbursement, benefit design and other approaches.

2 Overall Competencies: Students who complete this course will develop the following competencies: 1. Improvement in writing, presentation and analytic skills, focused on framing issues and developing logical approaches to the resolution of issues. 2. Practical understanding of how the private insurance market functions, including how the market is segmented and the competencies required for each segment. 3. Understanding of the impact of risk on private insurance and techniques that are utilized to manage and mitigate the influence of risk selection. 4. Identification of the different international models for health care financing and coverage and the unique aspects of the American system. 5. Appreciation of the distinction between lowering costs to improve competitive advantage and lowering overall health care costs and the tactics and strategies that could be developed for each approach. 6. Understanding of the challenges that confront the future viability of public health insurance programs, including assessment of the options that will be considered, and the strengths and weaknesses of centralized versus decentralized administrative models. 7. Improved skills in working with groups to evaluate and craft potential solutions to policy issues. 8. Recognize the challenges inherent in balancing affordability, access and quality in public and private health insurance programs and the tradeoffs that are required to achieve a mix that meets purchaser and political requirements. Course Requirements: 1. A demonstration of an understanding of the readings and lectures through class discussion and participation in structured activities; 2. 3 short papers (2-3 pages in length) are required. These papers should be in the form of policy memos/policy analyses. Some examples of good analyses and writing are included on the CTools site for reference purposes. For the short papers, written questions are included in the syllabus for each class lecture. Over the semester, students are expected to select as a topic for their short papers a question from 3 different class sessions distributed over three segments of the course. Papers on the associated question should be based on the readings and other research and must be turned in advance of or at the beginning of class, prior to the lecture on that topic. Papers may be turned in electronically via to any of the instructors, in printed form or via CTools longer paper (5-8 pages in length) with a class presentation. For the final paper, students should prepare an analysis of a major health care insurance issue, with a focus on potential solutions to existing or emerging problems. The longer paper should be in the form of a policy brief/proposal. Students will select a topic from a list of issues, including: viable options for Medicare reform; alternatives for improving access, quality and viability of Medicaid; issues in health care cost control and benefit design; and other topics to be determined by the lecturers and provided at the first class session. The topic and recommended change will be given lesser weight than the strength of the

3 rationale for the change based on the learnings from the readings and discussion in the course and the policy framework used throughout the course. Assignments and Grading: Grades on the short papers will be either a check plus, check or check minus. A check is a very good (and most commonly given) grade and indicates understanding of the topic, the readings and a well done and well supported policy memo. A check plus indicates evident extra research (as documented in the footnotes and framing of the policy argument) and a superbly constructed, well written policy paper. A check minus indicates a lack of understanding of the material and/or a poorly constructed policy memo. At the end of the term, the 3 short papers will be considered as a body of work in the final grade. Improvement in the short papers over the term will be taken into account. Grades on the long paper will be letter grades with an A+ possible for outstanding work. Clarity and carefulness of writing will be considered in all written work. Class participation will be judged based on the understanding of the readings and lectures, ability to work with colleagues and intellectual curiosity shown by the questions, comments and presentations made. Grade calculations: 20% class participation 40% short papers 40% final paper Academic Conduct: The Department of Health Management and Policy and the School of Public Health clearly state in their expectations that "Scrupulous honesty is the foundation of excellence." You are expected to hold the highest standards of academic integrity both in your participation and other responsibilities, including written assignments. If you are in doubt about anything you are writing, you should come ask us. You are strongly encouraged to discuss class material with your classmates. However, your written work should be your own. We reserve the right to question students whose work appears to duplicate others or published material. Those who cannot defend their written work will receive a substantial sanction, including a failing grade for assignments that evidently plagiarize from others work. For further information, please refer to the school s policies on academic conduct:

4 Classroom Expectations/Etiquette: The course combines lecture, discussion and presentations. The first half of each class session will be in lecture format, led by one or more of the lecturers. Students will be encouraged to ask questions of clarification during the lecture. The second half of each class will be a discussion format and students will be expected to respond to the lecture based on the assigned readings or other relevant research. The second half of each class will focus on a discussion of alternative solutions to the challenges and problems for the topic areas highlighted in each lecture. The final class sessions will be presentations by the students of their final paper. Additional Information: Copies of all handouts, assignments and power point slides can be found on the CTools site. Course Topics and Reading List: The Readings are listed on the CTools site and in a printed handout that can be found on CTools. Date Topics Lecturer September 5 Overview of Course & Introduction of Issue and ALL Context & History of Health Coverage - evolution of private insurance system; social and political context for health reform initiatives; development of public insurance September 12 September 19 September 26 Health Care Costs: introduction Products Delivery Systems: Hospitals Delivery System: Physician, Pharmacy, Other Provider Exercise Foundations of Private Insurance: market segmentation, adverse selection and regulation Adverse Selection Exercise Paul Austin

5 October 3 October 10 October 17 Private Insurance Company Operations: rating and underwriting, state variations, essential benefits Rating Exercise Exchanges and ACA alternatives Team Meetings with faculty *November 14/21 presenting teams Medicare - long term viability; future of private health plans (Medicare Advantage); financing/cost control options; impact of ACA Team Meetings with faculty *November 28 presenting teams Paul Austin Paul Austin Paul Austin,, Paul Austin,, October 24 Medicaid - evolution; state variations; influence of managed care; administrative challenges; financing issues; impact of ACA Provider Contracting Exercise: part 1 October 31 Health Care Cost Control - what works and what doesn t Continuation of Provider Contracting Exercise November 7 Health Reform Politics - factors influencing political decision making; unique aspect of health care politics November 14 BCN Exercise U.S. Compared to other Countries - finance and delivery models developed in other countries; comparisons to U. S. system CLASS PRESENTATIONS Student Teams November 21 CLASS PRESENTATIONS Student Teams

6 *2 hour class November 28 CLASS PRESENTATIONS Student Teams December 6 Wisdom for the Future: Potential Health Care Black Swans ALL