ButlerUniversity

Honors30005IntroductiontotheU.S.HealthcareSystem
Mon.6:308:20P.M.

Rm155JordanHall

ThomasMoteM.D.,M.P.H.(AdjunctProfessorandstaff
anesthesiologistatI.U.Health)
MichaelVance,Ph.D(ProfessorofPharmacologyintheButler
U.SchoolofPharmacology)
ForDr.Mote
Email:trmote@att.net
PREFERABLYUSETHISEMAILANDNOTButleremailTOREACHME.
(317)3638946CellPhone
(317)3129042DigitalPager
OfficeLocation:Noneoncampus
OfficeHours:Afterclassorbyappointment

ForDr.Vance
9409347
Emailmvance@butler.edu
OfficeLocation:313DPharmacyBuilding
OfficeHours:Afterclassorbyappointment

AimsoftheCourse

To understand differing definitions of health, know the

determinants of health including social factors, and metrics to
measure health
To be able to understand the history and structure of the U.S.
healthcare system and its components, including; hospitals,
insurance companies, government agencies, healthcare
personnel, financing,/payment systems, and Pharma.
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An understanding of the differences between the medical care

system and public health and how they historically diverged and
under the Accountable Care Act (ACA or Obamacare) are
reconverging
Knowing how the U.S. system differs from that in selected other
countries
Being able to deconstruct any health care system using the four
As of (1) Affordability (controlling cost), Accessibility (covering
as many as possible), Accountability (providing quality care), and
Acceptability (what a countrys citizens want and are willing to
pay for).
Using the four As to compare the U.S. system to other countries
and eachs strengths and weaknesses
Using the four As to evaluate the Accountable Care Act
(Obamacare)

Theformatwillbelotsofreadingandagenerallyalecturethefirsthalfofclass.
Becausewehaveonlyoneclassaweekthesecondhalfwillsometimesbeanotherlecture
butalsomightbeaDVDonhealth,studentgrouppresentations/studentleddiscussionof
readings,orapresentationbyaguestspeaker.Therewillbeamidtermandafinalpaper
evaluatingtheACA
WewillMoodleonlineresourceforannouncementsandupdates,assignments,and
linkstoonlinereading.
Attendancewillbetaken.

Course Materials
1.EssentialsoftheU.S.HeealthCareSystemthirded.
ByShiandSingh
2.TheHealingofAmerica
T.R.Reid
AComparisonofoursystemtothoseinothercountries
3.HealthCareReform
JonathanGruber
InacomicbookformatthisMITeconomicsprofessorwhodesignedmuchof
theAccountableCareActdescribesit
TherewilladditionallybearticlesandDVDsassignedfordiscussion.Thesewillbe
postedonMoodleaswellastheDVDsbeingonreserveinthesciencelibrary.

Organization
SecondarytosomepreviouscommitmentsDrs.MoteorVancewillbeoutoftownbut
notbothatthesametime.Wewilltrytosticktotheschedulebelowbutbecausewehope
tohavesomeoutsidespeakerssomethingsmightchange.
Dr.Moteslectureslideswillbehandedoutoremailedtoyouandareabitunusualas
theyareintendedasyourclassnotesandnotasbulletpointsformytalk.Insomecases
therearealargenumberoftheseandIwillpointoutthoseofparticularimport.andtry
andputaButlerlogointherightlowercorner.YoucouldalsomarkthesewithaN.B!
whichisashorthandversionofLatinexpressionNotaBene,orNoteWell.

CourseRequirements
Yourcoursegradewillbebasedon:

Attendance/Participation & Student Group Led Discussions

-20% (You may be called on to discuss the outside
readings)
Midterm 30%
Group presentation 20%
Final paper deconstructing the ACA using the four As 30%

ThefollowingisverbatimfromacoursesyllabusofProf.JeffreyHollanderofDePauw
U.andseemsappropriate:
YourgetanFforparticipationifyoumisslotsofclasses,rarelyspeakwhenyou
arethereandshowlittleevidenceofhavingdonethereading.
YougetaDforparticipationifyoucomeirregularlyandrarelyshowsignsof
havingdoneorthoughtaboutthereadings.
YougetaCforparticipationifyoucometoclassregularlybutrarelyspeak,orif
youareactiveindiscussionbutirregularinattendance,orifyouparticipatein
discussioninawaythatshowslittleofhavingdoneorthoughtmuchaboutthe
readings.
YougetaBforparticipationifyouarealwaysinclassandtakeathoughtfulpart
inourdiscussions,participatingactivelyandwell,andoccasionallytaking
leadershipforthedirectionofthediscussion.
YougetanAforparticipationifyouarealwaysinclass,showevidenceofhaving

readandthoughtaboutthereadingaheadoftime,listenwelltootherstudents,
andhelpfocusourdiscussionswiththoughtfulcommentsandquestionsaboutthe
implicationsofthereadings.

B+;8789%
C+:7779%
D+:6769%
F:<60%

A:93100%
B:8386%
C:7376%
D:6366%

A:9092%
B:8082%
C:7072%
D:6062%

Academic Integrity
Documentation
Asperanyacademicinstitutioncheatingisforbidden,asisplagiarism.Allresources
usedandquotationsshouldbedocumented.TheUniversitypolicyisintheStudent
Handbook.

Miscellaneous
Attendance&Assignments
Attendanceisexpectedandassignmentsshouldbeontime.Exceptionalcircumstances
suchasdeathsinthefamilyorstudenthospitalizationwillbeconsidered.Itisexpected
thatyouwillattendtheclassesjustbeforeandafterthebeginningorendofavacation
period.Ifyouparticipateinathleticsandhavetotraveloutoftownandmissclassletme
knowatthestartofthesemesterthetentativedatessowecanmakeallowances.

AmericanDisabilitiesAct
Shouldyouneedspecialconsiderationssuchaslongertestperiodspleasehavethe
Universitycoordinatorletmeknowatthestartofthesemester.
Food&DisruptiveElectronicItems
Idontmindbeveragesandsnacks(butnotameal)exceptwhenwehaveoutside
speakersIwouldaskyoutoforgotheseoutofrespectforthem.Andforallclasses

pleaseturnoffcellphones,pagers,etc.Reviewingyouremailduringclassisnot
acceptable.NOLAPTOPCOMPUTERSINCLASS.

2014 Guest Speakers

Lisa Harris M.D. C.E.O. of Ezkanazi Hospital
The Role of Safety Net Hospitals (Invited)
C.E.O. of Healthnet Community Health Centers
The Role of Community Health Centers and Primary Care
(Invited)
Speaker from the Damien Center
The Role of the Healthcare System for those infected with
HIV (Invited)

Schedule
(All Mondays)
#1 Jan 13 Class organization, What is health?, What are the
determinates of health including social factors,
how medical care and public health differ and
their historical relationship. how to be a
policy pundit and deconstruct any system
using
the four As of Affordability (being
able to pay
for care), Accessibiliy (how many
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of the
population have Care),
Accountability (Quality
of care), and
Acceptibility (what people want in
a system and
are willing to pay for).
Assignment: Chap 1-2 of U.S. Healthcare
System (Dr. Mote)
Assignments:
(1) Chap 1-3 in U.S. Healthcare System
(2) pp. 190-200 in T.R. Reids The Healing
of America
Jan 20 MLK Day, no classes
#2 Jan 27 Overview of the U.S. healthcare system, a bit of
its history, and the challenges it faces (Dr. Mote)
Student Grp #1 presentation & discussion of
healthcare disparities
Assignment:
(1) Chap 4-5 of U.S. Healthcare System
(2) DVD on U.S. Healthcare System
on reserve in the Science Bldg library
(60 long)
(3) Baicker et al. The Oregon Experiment Effects
of Medicaid on Clinical Outcomes NEJM
368(18), 2013:1713-1722.
http://www.statecoverage.org/files/NEJM_OR_Experiment.pdf

#3 Feb 3 Pharma (Dr. Vance)

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Affairs,

Assignments:
(1) Frank RG. Prescription Drug Prices: Why Do
Some Pay More Than Others Do? Health
20(2): 115-128, 2001.

http://content.healthaffairs.org/content/20/2/115.full.pdf
(2)

Kaiser Family Foundation. Prescription Drug

Trends, May 2010.

http://kaiserfamilyfoundation.files.wordpress.com/2013/01/3057-08.pdf

#4 Feb 10 Financing and reimbursement, the four As in

depth (Dr. Mote)
Student Grp #2 presentation & discussion of
the value of medical spending and cost control
Assignment:
(1) Chap 6 & 12 in U.S. Healthcare System
(2) Atul Gawande The Cost Conundrum New
Yorker June 1, 2009
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPa
ge=all

(3) Cutler et all The value of medical spending in

the United States NEJM 2006 Aug 31; 355:
920-27
http://www.nejm.org/doi/pdf/10.1056/NEJMsa054744

(4) Anderson et al Its the Prices, Stupid

Health Affairs, 22, no. 3 (2003); 89-105
http://content.healthaffairs.org/content/22/3/89.full.pdf+html

#5 Feb 17 Outpatient Services and Primary Care (Dr. ?)

Guest Speaker- Director of Healthnet Community
Health centers
Assignment:
(1) Chapter 7 in U.S. Healthcare System
#6 Feb 24 Hospitals (Dr. Mote)
Guest Speaker- Lisa Harris M.D.. C.E.O. of
Eskenazi Hospital
Assignments:
(1) Chap 8 in U.S. Healthcare System
(2) FAQs on ACOs: A Primer by the Kaiser
Family Foundation
http://www.kaiserhealthnews.org/stories/2011/january/13/aco-accountable-careorganization-faq.aspx

#7 March 3 Managed Care, Integrated Systems, &

Provider Reimbursement (Dr. Mote)
Student Grp #3 presentation & discussion of
the assigned papers
Assignments:
(1) Chap 9 in U.S. Healthcare System
(2)
(3) Chernew, M.E. et al. The Specter of Financial
Armageddon Health Care and Federal Debt
in the United States, NEJM 362(13), 2010:
1166-1168.
http://comedsoc.org/images/HCR
%20Financial%20Armegeddon%20Cher

new%20N EJM%204-1-10.pdf

March10 Spring Break, no classes

#8 March 17 Populations with Special Health Needs
(Dr. Vance)
Outside Speaker from Damien Health Center
Assignments:
Chap 11 in U.S. Healthcare System
#9 March 24 Metrics to Determine the Best Healthcare
System in the World (Dr. Vance)
Assignments:
(1) Appendix in T.R. Reids The Healing of
America
#10 March 31 Health Policy and the Future of Health
Services Delivery
Student Grp #4 presentation & discussion of
the assigned DVD
Assignments:
(1) Chap 13 & 14 in U.S. Healthcare System
(2) DVD Healthcare Reform 60
On reserve in the Science Library
#11 April 7 Picking from the best of other countries
healthcare systems Part 1
Assignments:
(1) Chap 2, 3, 4 in T.R. Reids The Healing of
America
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#12 April 14 Picking from the best of other countries

healthcare systems Part 2
Assignment:
(1) Chap 12 & 13 T.R. Reids The Healing of
America
(2) DVD Sick Around The World 60
On reserve in the science library
#13 April 21 The Accountable Care Act (ACA)
(1) J Gruber Health Care Reform
By a MIT economist who is an architect
of the Accountable Care Act. Entire book
can be read in a couple of hours. Take note of
key points and how you would analyze the act
using the four As for your paper and presentation.
#14 April 28 Student presentations of the hightlights of your
papers on deconstructing the ACA using the
Four As (7 each, i.e. an elevator
presentation)
Resources

I.

Resources
Websites:
www.rwjf.org Robert Wood Johnson Foundation (the
nations largest philanthropy devoted exclusively to
health and health care)

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www.cdc.gov
CentersforDiseaseControl
www.APHA.org
AmericanPublicHealthAssociation
www.kaiser.org
KaiserFamilyFoundation
www.kff.org/newsmedia/npr.cfmWashingtonPost/Harvard/Kaiser
www.hcp.med.harvard.eduHarvardHealthCarePolicy
www.hcp.med.harvard.edu/Sloan/indes.htmlHarvardHealthCare
Policy
www.who.int/homepage/WorldHealthOrganization
www.apha.org/publichealth/AmericanPublicHealthAssociation
http://web.health.gov/healthypeople/PublicationsHealthyPeople2010
documents
www.populationinstitute.orgThePopulationInstitute
www.cdc.gob/nchs/NationalCenterforHealthStatistics

1.

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