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Understanding Health Insurance: Public/Private Options
Fall Quarter 2002 Syllabus
4 Credit Hours
 
Faculty E-Mail Office Phone #
Joan Bantz, MPA, RHU bantzj@evergreen.edu LAB I, Room 3011 360-867-5095

Classroom: Lab I, Room 1040    Class Sessions: Wednesdays, 6pm to 9:30pm

I. Program Description:
    The goal of this class is to develop an active learning community in which to explore current health care issues. The subject will be explored through a variety of learning formats - lectures, seminars, video, interactive workshops, guest speakers, etc. By examining the historical and cultural context, stakeholders and political perspectives, comparative systems and the personal voices of health care we will be able to frame and focus health care reform discussions.
This MPA Health Policy Concentration or Elective will prepare students to understand the current three tiered health care delivery and payment model: public, private, uninsured (and underinsured).  Particular emphasis will be given to service delivery, managed care, uninsured, underinsured, types of insuring options and state/federally funded options for coverage.

This foundation course will examine the "patchwork" of health care access, cost and quality within the United States and comparative systems of other countries. Each nation's care system is a reflection of the society in which they have evolved. In the final analysis, like politics, all health care is local.  While the United State's historical and philosophical underpinnings place greater emphasis on individual rights and responsibility, freedom of choice, and a pluralistic state, federal, state and private system; while other industrial nations focus on preserving equitable access to health care for an entire population as a social good.

Students will examine current health care issues such as prevention, quality, access, aging of population,  innovations, genetics, alternative care, demographic trends, culture, HIPAA, eHealth, bio-terrorism, public health services, lifestyle and health behaviors.  Payment mechanisms, regulations, laws, consumer rights, contracts, quality and other issues will be explored to better understand the inter-woven complexities of insurance which is the main mechanism health care is delivered under in the US.  We will also examined citizens who fall through the cracks of such an accidental system.

In order to understand the current marketplace, insurance and future scenarios we will review how conflicting policy and regulations impact health care; e.g., the Clinton Administration nearly implement a national managed care plan in 1994 and then tried to regulate managed care out of existence in 1999. Policy has been focused on incremental reform or as a byproduct of unintended consequences. We will review attempted solutions to the health crisis, such as: vertical integrated systems as the wave of the future, disease management companies, hospital owned HMOs or a managed competition model of vertically integrating systems like Group Health to compete head to head for patients. Another wishful solution is for the consumer using the Internet, being "engaged" with their care working hand in hand to solve the health care crisis.  Even with all of these "solutions" health care premiums are rising by double digits, more patients are concerned about quality of care, wanting "caring versus cure", the number of uninsured is increasing, Medicaid increases are breaking states budgets, etc.

We are in a place where we have run out of workable ideas and the times are ripe for trying ill-conceived solutions in desperation. Policies at the state and federal levels are hung up on provider fraud and abuse and managed care regulation, both but a patch on a "non-system" at best.  This lack of a coherent direction is further adding to provider losses and reluctance to serve Medicaid or Medicare enrollees. And as we look around things appear to be getting worse for consumers, providers, insurers and government. In an era of unprecedented technological medical solutions we still suffer from the same old problems of cost, quality, access and security of health benefits that we have concerned ourselves with for the past forty years. To better understand our landscape we will explore historical US health care reform efforts, with special attention to the Clinton reform efforts. The Washington state reform process and current incremental reform strategies will be studied.  We will examine how special interest groups capture and frame health care rhetoric and reform efforts. We will explore alternative models of care to better appreciate the complexity and multi-faceted "system" of health care; craft multiple perspectives; explore policy making and implementation; integrate race, class and gender implication on health access and quality of care; and explore various competing models of change and reform to enhance our understanding of pathways for participatory action.

    By reviewing the historical and cultural context, stakeholder and political perspectives and the personal voices of health care through readings, seminar, reflective essays and team projects we will be able to frame and focus reform discussions.

Learning objectives for this program include:

    As co-learners we will: challenge the individually and socially derived constructs of privilege versus right; access to what level of care; health as a financial service and choice - while exploring mind/body/spirit integration.
 

 II. REQUIREMENTS AND ASSIGNMENTS:
    A successful learning community requires that students attend classes regularly, arrive prepared to discuss the readings in-depth and complete assignments in a timely manner. Please contact me in advance if you must be absent from class by e-mail or by phone - more than two absences may result in loss of credit. Written work submitted late will be read only under extraordinary circumstances.

A. Self Assessment
"How will you know you've arrived if you don't know where you're going?"

A self assessment tool will be utilized at the start of class, in Week 5 you will reappraise, and in
Week 10 will fill out again to note intellectual growth towards your goals . This mapping of your intellectual journey will complement your journal and drafting of your self-evaluation.

B. Individual Intellectual Journals
    Intellectual Journals will be due and exchanged with a peer. These personal intellectual journals or cognitive maps should summarize the major themes and concepts from the reading and personal exploration in a form that will useful be to yourself and members of the learning community. Journal entries will be exchanged with a co-learner at the end of class sessions. Peer critique is due the following week, and these comments will be incorporated into your journal.

Your journal should develop a form best suited to your own way of knowing. However, it is not a book report, but a representation of what is important in understanding the text and your journey. The intent of a journal is to capture your thoughts about several particular ideas, facts, or issues presented in the text or class that warrant seminar discussion or reflection, and to summarize these concepts and theories in a form that will be useful in your intellectual journey.

Fall Quarter Readings:
 
TEXT
AUTHOR
Health Care in the new Millennium: Vision, Values, and Leadership  Morrison, Ian
Health and Health Care 2010: The Forecast, the Challenge. March 2000 Institute for the Future: Bodenhorn, Karen; Cain, Mary; Cypress, Diana; Dempsey, Hank. 
ISBN: 0787953482
The Accidental System: Health Care Policy in America  Reagan, Michael D.
Governing Health: The Politics of Health Policy 2ND  Weissert, Carol & William

 

C. Individual Paper  - Due November 6

A formal research paper on a self selected, approved, topic of current health care of 3-5 pages in length.  The paper will incorporate an analysis and framing of the issues following the process outlined in class.
 

D. Major Team Health Care  Project - Due December 4 and 11

    Four or five person teams will be formed and participants will explore current relevant health care policy issues.  Each team will do a presentation, with handouts and visual aids and turn in to faculty a detailed biblio and executive summary.  Please format presentations using formats other than lecture, e.g., utilizing creative seminar or workshop formats.

note: Calendar is an abbrevated overview and will not convey entire Syllabus requirements
calendar

III. EVALUATIONS, CREDIT

A. Credit

    Students will receive graduate or undergraduate credit based upon satisfactory and on-time completion of all course requirements and assignments. Decisions to deny credit will be make by faculty. Plagiarism, failing to complete one or more assignments, completing one or more assignments late (without having made special arrangements in advance of the due date), or more than two program absences may constitute automatic denial of credit. (NOTE: More than two (2) program absences requires that you arrange the completion of make up work with faculty).

B. Evaluations

    All students will receive a written evaluation of their academic performance by faculty. Faculty will evaluate students based on their seminar contributions, written assignments, team projects and class participation. Faculty will consider the learning goals/objectives in the "Program Description" in preparing evaluations. Each student is expected to participate in an evaluation conference mid quarter and at the end of the quarter.  For the end of quarter conference, each student is expected to complete and bring to the conference a written self-evaluation - a written and signed evaluation of the faculty member must be turned into the program secretary at the same time. These two evaluations are part of the requirements of the course and must be completed to obtain full credit.  A Self and Faculty evaluation must be completed prior to the final evaluation appointment.

IV. Covenant within a Learning Community

The class is designed to be an active/experiential learning community. We employ a variety of formats – lectures, seminars, interactive workshops, and other techniques to ensure that the learning environment is one in which all participants play a role in its success. In particular, the content of the program -- exploring health reform options-- especially lends itself to active in class participation.

A successful learning community requires that students attend class, arrive prepared to be engaged in the activities for the evening, and submit assignments when they are due. Students will receive graduate or undergraduate credit based on satisfactory and timely completion of all course requirements and assignments. Credit denial decisions will be made by the faculty. Plagiarism (i.e., using other peoples’ work as your own), failing to complete one or more assignments, completing one or more assignments late (without having made special arrangements before the due date), or multiple absences may constitute denial of total credit. Arriving late or leaving early may be considered as absences.

In turn, students can expect the faculty members to be prepared for classes and seminars, to be available for office hours as posted, to respond to telephone or email messages in a timely manner, and to provide timely feedback on assignments.

In furtherance of our learning community, we expect students and faculty to:

In addition, faculty agree to: Both students and faculty agree to discuss any problems involving others in the learning community directly with the individuals involved, with the right to support from other program members during those discussions, if that seems helpful. For example, students must first discuss any problems involving a faculty member directly with the faculty.
 

The overall goal of this class is individual participant fulfillment and learning community success. Let us strive together for such a balance.