Comparative Healthcare Systems And Policies In Great Britain, Europe, And The United States

Center:

London

Program(s):

London - Health Practice & Policy [1]

Discipline(s):

Health Studies

Course code:

HL 300

Terms offered:

Fall

Credits:

Language of instruction:

English

Instructor:

Dr. Yolanda Eraso

Description:

Health care is a priority and source of concern worldwide. Every country irrespective of its private, public or mixed health care system faces similar challenges with regard to quality, delivery and cost of services. This course examines both global health issues and health systems from a comparative perspective.

The first part of the course will introduce global health themes, including international health organizations, right to health, and major international health issues, such as HIV/AIDS and women’s and children’s health. The structure and function of health care systems will be defined and explored. The basic tools and conceptual frameworks needed to analyze a health system such as the role of government, goal-setting and judging performance, and allocation of resources prepares students for the second part of the course, which focuses on select health care systems in Britain, Europe and the US. The structure and functioning of their health care systems will be reviewed in detail. The course will explore country-level debates on issues such as access to care and funding. It will also highlight how a country’s history has influenced the development of its health system to reach its present day functioning. One class session is devoted to Jamaica as an example of health care in a developing country, to prepare students for their extended field study.

Learning outcomes:

Upon completion of the course, students will be able to compare the structure and management of selected health systems around the globe. Specifically, they will be able to:

Explain the factors that determine the quality, delivery, and costs of health services for individuals, communities and populations in a comparative, global context.
Identify the principal organizations, institutions and services involved in the provision of health care in health systems throughout the world.
Evaluate methods of financing, provider payment regulation, historical, and social-cultural elements affecting the accessibility, quality, organization, performance, and outcomes of the health care system in an international comparative context.
Describe how ethical values relate to and inform the structure and reform of health care systems
Assess the health situation of a country through analysis of a range of epidemiologic, population, economic, environmental, and social indicators

Method of presentation:

Group discussions, lectures, other media such as film and documentaries, and experienced guest speakers in the 30 contact hours (2.5 per week).

Required work and form of assessment:

In this course, you will be required to: 1) participate fully in discussions and prepare for the class; 2) complete a mid-term assessment project/exam; 3) submit a final paper, and 4) make an oral presentation.

Class Participation (20% of Grade)
Students are expected to attend each class having read the required material in preparation for class discussion, and participate actively in discussions that arise in class (poor attendance and lack of punctuality will reduce the final grade).
Research Paper (60% of Grade) will consist of an ‘Individual Country Health Services and Status Assessment Project.’ The project will be a 4000 words paper (plus end notes). The research paper will require you to analyze the health system for one country chosen by you. Any country can be chosen but no more than two students may choose a particular country, and all assignments must be completed independently. Your country project should include the following segments:

Demographic Information and present political situation.
Current Health Status and brief history of health system development.
Discussion of the components of the system, financing, resources, delivery, healthcare spending, quality, access etc.
Health situation of the chosen country and comparison between selected country’s health services system and to others in the region (e.g., Central Asia, Middle East, etc).
Top challenges and priorities of the chosen country system and suggestions to address those issues.

Completing the assignment requires searching for data on the Internet, including WHO and/or embassy websites, exploring current scientific literature, and incorporating concepts discussed in the lectures. The IES Abroad Academic Integrity Code is in effect for this course, as with all other IES Abroad London courses. The code prohibits academic dishonesty, including plagiarism, which is defined in part as copying or paraphrasing passages from books, periodicals, the Internet, or other sources without appropriate citations. Your instructor can provide instructions on correct citation of sources if you are uncertain.

Oral presentation of Research Project (20% of Grade). Presentations will be made in weeks 11-12.

content:

Week 1: Introduction: Course Overview and Requirements; Approaches to Study Comparative Health Systems
Why is it important to study other approaches to financing and delivery of care? What are student interests/objectives? Why do health systems matter?
Discussion of global health themes: definitions, international health organizations, right to health, significant international health issues; and definition of health systems.
Readings:

Johnson & Stoskopf (2001). Ch 1
The World Health Report (2000). Ch 1
http://www.worldbank.org/mdgs/ [2] - Millennium Development Goals

Week 2: International Health
International Health: Introduction to international health, international health organizations, human rights and health, including women’s sexual and reproductive rights, mental health, older persons, persons living with HIV/AIDS, etc.
Readings:

Please take the E-learning course on human rights and health availability found on the Pan American Health Organization (PAHO) Website. Available at: http://new.paho.org/hq/index.php?option=com_content&task=view&id=1774&It... [3].
The duration of the course is up to 4 hours. Students should take Modules 1 and 2 of the E-learning course. Please use the course map for a description of the different sections. Module 1 is entitled “Relationships Between Health and Human Rights in the Context of PAHO and WHO Strategies.” The second module is entitled “The Right to Health and Other Related Human Rights and Fundamental Freedoms.” Module 3, “The Human Rights Based Approach as a Transformative Strategy of Health Systems,” is strongly recommended.

Week 3: Health Systems Overview
Health Systems Overview: Key elements, functions and goals of Health Care Systems; Configuration of International Health Systems. What resources are available to get data and information?
Readings:

The World Health Report 2000. Ch 2-4
Statistical Annex – WHO World Health Report 2000 – Ch 1
World Bank, Health Financing Revisited. Ch 1
Social Health Insurance Re-examined.

Week 4: Evaluating Health Systems
Evaluating Health Systems: Where do you start?
How to assess health system performance. Comparative Financing Systems: what role does government play in design, financing and governance of health systems?
Judging Performance: Ethical theory in health system analysis.
Readings:

The World Health Report 2000. Ch 5
Lassey, Lassey and Jinks, 1997. Ch 17
Roberts & Reich, 2002.
Chen & Berlinguer, 2001.

Week 5: Evaluating Health Systems
Evaluating Health Systems (cont). Choosing performance goals: Health status, Satisfaction, Risk protection, Cost issues, Healing versus Curing, Cultural context. Assessing performance: Efficiency, Access, Quality, and Benchmarking.
Readings:

Roberts, Hsiao et al. 2004 pp. 90-109
Arnesen & Nord, 1999
Reinhardt, 2001
Lee & Goodman 2002
Lewis, 2007

MIDTERM ASSESSMENT/EXAM

Week 6: Health Systems in Developed Industrial Countries
Health systems in developed industrial countries. The United Kingdom system: the National Health System (NHS). Group discussion: The politics of healthcare policies in Britain. Mrs. Thatcher and the private sector.
Readings:

Comparative Health Systems, Chapter 5 (United Kingdom).
The National Health System. Public announcement, 1947.
Great Britain: A Leader in Preventive Medicine, Frontline – Sick around the world, 2008. Video http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/view/main.html [4]
DH- Department of Health, United kingdom.

Week 7: Health Systems in Developed Industrial Countries
Health systems in developed industrial countries (cont.): The United States. How/Why the U.S. is different; U.S. Health System and Reform.
Readings:

The Commonwealth Fund, 2007
Written Statement to Senate Special Committee, 2009.
Johnson J, and Stoskopf C, 2010, Ch 21 (U.S.).
Klein, 2003.
US Health Care Reform: Affordable Care Act (ACA)

Week 8: Health Systems in Developed Industrial Countries
Health systems in developed industrial countries (cont). Trends in Europe. Health Care in Sweden, Germany, France. (Guest Speaker TBD).
Readings:

Lassey, Lassey, and Jinks, 1997. Ch 7 (France) & 9 (Sweden).
Johnson J, and Stoskopf C, 2010, Ch 8 (Germany).
NHS Choice. Accessing healthcare in Sweden.
Cody, 2009.

Week 9: Health Systems in Growing and Developing Countries
Health Systems in Growing and Developing Countries. The Jamaican system: medical practices and policy; community health care and comparative systems in the UK and Jamaica. Public-private partnerships, meeting local and regional health care needs; the role of traditional medicine in immigrant
communities.
Guest Speaker: TBD (Invited: Prof. Morgan Myfanwy - Division of Health and Social Care Research, King's College London).

Week 10: Theoretical Constructs
Addressing the students’ questions and applying theoretical constructs. Group discussion: Future of primary health care.
Readings:

Global Health Watch, 2008
Kickbush, 2004

Weeks 11-12: Final Presentations
Final Projects presentations– ‘Individual Country Health Services and Status Assessment Project’ presentation will be made in class.

Required readings:

NOTE: The course materials will be available electronically on Moodle, and will contain hand-out summaries, and chapter sections from a variety of sources, including either copies of, or references to, journal papers.

http://www.worldbank.org/mdgs/ [2]
Arnesen, T. and E. Nord 1999. "The value of DALY life: problems with ethics and validity of disability adjusted life years." BMJ: British Medical Journal 3197222: 1423.
Chen, L. C. and G. Berlinguer 2001. Health equity in a globalizing world. Challenging inequities in health: from ethics to action. T. Evans, M. Whitehead, F. Diderichsen, A. Bhuiva and M. Wirth. New York, Oxford University Press: 35-44.
Cody E, 2009. For French, U.S. Health Debate Hard to Imagine, The Washington Post, Sept. 23.
DH- Department of Health. United Kingdom. Available at: http://www.dh.gov.uk/en/index.htm [5].
Global Health Watch, 2008. Available at: http://www.ghwatch.org/ [6].
Great Britain: A Leader in Preventive Medicine, Frontline – Sick around the world, 2008.
Available at: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/view/main.html [4]
Johnson J, and Stoskopf C, 2010. Comparative Health Systems, Global Perspectives.
Kickbush, I. 2004. "From Charity to Rights: Proposal for Five Action Areas of Global Health." Journal of Epidemiology and Community Health 58: 630-631.
Klein R . 2003. Lessons for (and From) America, American Journal of Public Health, January 2003, Vol 93, No. 1, pp.61-63.
World Bank, Social Health Insurance Re-examined. Available at: http://www- [7] wds.worldbank.org/servlet/WDSContentServer/WDSP/IB/2007/01/09/000016406_20070109161148/Rendered/PDF/wps4111.pdf
Lassey, Lassey and Jinks, 1997. Health Care Systems Around the World, Characteristics, Issues, Reforms.
Lee, K., S. Fustukian, et al. 2002. An Introduction to Global Health Policy. Health Policy in a Globalizing World. S. H. Lees, K. Buse and S. Fustukian. Cambridge, Cambridge University Press: 3-17.
Lewis, S. 2007. "Toward a General Theory of Indifference to Research‐Based Evidence." Journal of Health Services Research & Policy 12 166-172.
Reinhardt, U. E. 2001. "Can Efficiency in Health Care Be Left to the Market?" Journal of Health Politics, Policy & Law 265: 967.
Roberts, M. J., W. Hsiao, et al. 2004. Getting Health Reform Right: A Guide to Improving Performance and Equity. New York, Oxford University Press.
Roberts, M. J. and M. R. Reich 2002. "Ethical analysis in public health." Lancet 3599311: 1055.
Statistical Annex – WHO World Health Report 2000. Chapter 1: Health Transitions, disease burdens, and health expenditure patterns. Available at: http://www.who.int/whr/2000/en/whr00_annex_en.pdf [8]
The Commonwealth Fund, Mirror Mirror On the Wall: An International Update on the Comparative Performance of American Health Care , May 2007.
The National Health System. Public announcement. 1947. You tube Video. Available at: http://www.youtube.com/watch?v=qG_DH5Yl88o&feature=related [9]
The World Health Report (2000). Available at: http://www.who.int/whr/2000/en/whr00_en.pdf [10]
US Health Care Reform: Affordable Care Act (ACA); Kaiser Family Foundation ACA Summary (www.kff.org [11]).
Written Statement to Senate Special Committee on Aging, by Mark Pearson, Head, OECD Health Division, Disparities in Health Expenditures Across OECD Countries: Why Does the U.S. Spend So Much More Than Other Countries, Sept. 30, 2009.

Brief Biography of Instructor:

Dr. Yolanda Eraso holds a Ph.D. and a M.A. in the History of Medicine from Oxford Brookes University. She has been Wellcome Trust Research Fellow (2007-2010) with a project investigating female cancer from a transnational perspective. She is completing a monograph on this topic examining the medical exchanges between South-America, Europe and the US that lay the foundations for key developments in cancer diagnosis, treatment, and control. She has published numerous articles and edited volumes on a range of topics, which includes women’s health, welfare, cancer, and mental health policies from national and international health contexts. Her forthcoming book on maternity in Argentina is published by Rodopi: Clio Medica Series. Since 2009 she has developed Postgraduate courses and currently teaches on the MSc in Cancer Studies and the MSc in Palliative Care: Global Perspectives at the Department of Clinical Health Care (Oxford Brookes University).

Resource:

Yolanda_Eraso_CV.pdf [12]