HEALTH SYSTEMS ANALYSIS (PGSP11431)

COURSE HANDBOOK

BY THE END OF THIS COURSE, YOU WILL:

HAVE THE ABILITY TO EVALUATE HEALTH SYSTEMS AND POLICIES IN ANY COUNTRY OR REGION OF THE WORLD

HAVE A DETAILED KNOWLEDGE OF ECONOMIC PRINCIPLES AND HOW THESE CAN BE APPLIED BY POLICYMAKERS IN HEALTH

Dr. Mark Hellowell and Dr. Emily AdrionGlobal Health Policy

Department of Social PolicySchool of Social and Political Science

Emily.Adrion@ed.ac.uk

Table of Contents

Course Overview.........................................................................................................................1

Course Structure and Timetable............................................................................................2

Online interaction...................................................................................................................3

Assessment...................................................................................................................................4

Blog portfolio (30%) - due – 27th March 2017................................................................4

Assessment criteria.......................................................................................................5

Essay (70%) - due – 3rd April, 2017...................................................................................6 Assessment criteria.......................................................................................................6

Word length.......................................................................Error! Bookmark not defined.

UNIT 1: FOUNDATIONS..............................................................................................................9

Essential Readings..................................................................................................................9

UNIT 3: FINANCING...................................................................................................................10

Essential Readings................................................................................................................10

O’Dougherty et al (2009), ‘Case-Based Hospital Payment Systems’, In: Langenbrunner et al (eds), Designing and Implementing Health Care Provider Payment Systems: How to Manuals, World Bank, Washington DC.....................12

Meessen, B Soucat, A and Sekabaraga, C (2011), ‘Performance-based financing: just a donor fad or a catalyst towards comprehensive health-care reform?’, Bulletin of the World Health Organization; 89: 153-156. doi: 10.2471/BLT.10.077339.....................................................................................................12

Dredge, R (2009), ‘Hospital Global Budgeting’. In: Langenbrunner et al (eds), Designing and Implementing Health Care Provider Payment Systems: How to Manuals, World Bank, Washington DC..........................................................................12

UNIT 5: MOBILISING RESOURCES FOR HEALTH..............................................................12

UNIT 8: FISCAL SPACE.............................................................................................................14

COURSE HANDBOOK

BY THE END OF THIS COURSE, YOU WILL:

HAVE THE ABILITY TO EVALUATE HEALTH SYSTEMS AND POLICIES IN ANY COUNTRY OR REGION OF THE WORLD

HAVE A DETAILED KNOWLEDGE OF ECONOMIC PRINCIPLES AND HOW THESE CAN BE APPLIED BY POLICYMAKERS IN HEALTH

Dr. Mark Hellowell and Dr. Emily AdrionGlobal Health Policy

Department of Social PolicySchool of Social and Political Science

Emily.Adrion@ed.ac.uk

Course OverviewThis course aims to provide students with the ability to analyse health systems and health policies in any country or region of the world. Increasingly, those who wish to influence, formulate or implement policies need a sound understanding of economic concepts and how they can be applied in productive (and unproductive) ways. Accordingly, a subsidiary aim of this course is to enable students to develop their knowledge of economic concepts and principles and their ability to deploy these in the analysis of health systems and health policies.

The organisers of this course are Dr. Mark Hellowell, Senior Lecturer in Global Health Policy, and Dr. Emily Adrion, Lecturer in Global Health Policy. Dr. Hellowell, who has organised and contributed the online lectures for this course, is on sabbatical this term. Dr. Adrion will be convening the course in his absence. The three live Collaborate sessions will be run by Dr. Adrion, and all course communication should be directed to her at Emily.Adrion@ed.ac.uk.

The objectives of this course are to enable students to develop:

A critical understanding of the strengths and limitations of economic approaches to health policy.

An ability to evaluate the various models of health system governance, with a particular focus on the evaluation of market vs. planned approaches.

An ability to evaluate the organisation and delivery of health systems, with a focus on human/ pharmaceutical resources and use of information.

An ability to identify and evaluate methods by which resources are allocated or channelled to individual and institutional providers of health services.

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Demonstrating the analytical skills required to present, communicate and debate issues in health systems and health policy from an informed point of view.

An ability to analyse the concepts of economic and fiscal sustainability, in contexts of socio-economic/ demographic change and resource constraint.

Course Structure and Timetable

The course is structured around 10 course units. Each week, you will watch two video lectures, in which the topic of the unit and important concepts and data will be outlined. You will also be set a number of related readings for each unit and use these to prepare for blog posts and other contributions to the discussion forums.

Course textbooks and Resources

Morris, S et al, Economic Analysis in Health Care, 2012 ed. Carrin, C et al (eds), Health Systems Policy, Finance and

Organization, 2009 ed.

Both of these textbooks are available in electronic format from the University of Edinburgh library website. These texts should be regarded as

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key sources for most of the core concepts covered on the course. They will help you formalise your understanding of the topics introduced in lectures, and reading the set chapters will be a key part of your preparation for online discussions and essays.

In addition, all other Essential Readings for each unit will be provided in the corresponding folder in Learn.

Tutor support and feedback

The course tutors, Evan Shirley, Megan Arthur and Justyna Bandola-Gill will provide guidance and feedback on blog posts for each of the groups. You can edit and improve your blog posts before submitting them for assessment, following feedback from course tutors or from your fellow students.

Dr. Adrion will also run three Collaborate sessions – during week 1, week 5, and week 9 - in which there will be an opportunity to ask questions and receive answers in real time. Questions will be taken on the discussion board in advance of each Collaborate session. You will be consulted on the specific times of these sessions in due course. Each session will be recorded, so that those unable to participate live will be able to access a recording.

Online interaction

Discussion Boards will be used for all online interaction. Note that you may use the discussion boards for two different types of online interaction:

(i) There are general forums available on the discussion board in which you can raise and respond to questions about course content, reflect on your readings, or discuss topical issues informally with your classmates.

(ii) There will also be group-specific blog forums on the discussion board, in which you will be expected to contribute your weekly blogs and read and respond to the blogs posted by others in your allocated group. You will be contributing one formal blog post each week; you will be given clear guidance on the topic of your posts in the weekly course materials section of the course site (where you access the films for each unit). As well as posting a

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weekly blog, you should also make time to read and respond to others’ posts. Each student is expected to contribute one initiated post and at least one response to another group member in each session.

Whatever the nature of the blog, you are encouraged to keep your posts fairly short (less than 450 words). Don’t feel your ideas have to be fully developed before you post them, or that you can’t change your mind after making a post; most of us develop our ideas by sharing them with others and reflecting on their responses and contributions. Try to think about how the ideas you are discussing relate to the broader course material (including material from other units of the course). Be sure to indicate where you have taken arguments, theories or evidence from specific authors or sources by using citations and including references in your blog posts. You may wish to draw on other relevant material and, if so, this can be linked to or posted on the discussion board.

For each week, you should prepare and post your blog by the deadline outlined in the course schedule (typically a Sunday), and you should take the next few days after that to read and respond to at least one other post from a member of your group.

NOTE: Appendix 1 at the end of the handbook contains more information on writing and submitting your blog posts.

Assessment

Blog portfolio (30%) - due – Monday 27th March 2017 by 11:59am (GMT)After the final online discussion session, you will prepare a portfolio made up of your four best initiated blog contributions, comprising a total of no more than 1,500 words. It should also include a short introduction, of around 200 words, in which you record the total number of initiating and responding posts you made on the forum, and explain why you chose the specific contributions included in the portfolio, e.g. how they reflect your engagement with particular concepts or debates, specific areas of professional or academic interest, or changing understandings arising from your reading.

Although there is some flexibility about the length of individual posts, you should ensure you structure these to allow you to put together a portfolio of the required length. Hence, on average, you should try to ensure your blog posts are less than 450 words. However, we want the blogosphere to operate as a genuine interactive learning space, in which: (a) your ideas do not have to be fully developed before you post them; (b)

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you can reflect on the responses and contributions of your peers and the course teaching team; and (c) you can change your mind on a topic or question after making a post. Therefore, you will have the opportunity to edit your posts before submitting them as part of your portfolio.

The scope of that edit, however, can relate only to three aspects of the post:

(i) its length (i.e. you can reduce the word count of a post);

(ii) the extent of referencing (i.e. this needs to be comprehensive in the portfolio, as in any piece of assessed work at the postgraduate level, and should include in-text citations as well as a full reference list at the end of each post); and

(iii) refinement of your ideas/arguments and the correction of any conceptual errors or typographical mistakes.

The deadline for submission of your portfolio is Monday 27th March 2017 at 11:59am GMT (UK time). Please see the portfolio template (on Learn) for guidance on formatting. Please note that the maximum word length for the portfolio is 1,700 words, including your explanatory introduction. Blog portfolios in excess of this word limit will attract a penalty as specified below.

Assessment criteria

Your blog portfolio will be assessed against three key categories, with a maximum of 10 marks available in each category:

(i) Effective communication (max 10 marks)

• Regularity of contributions• Writing easy to follow and concepts clearly expressed• Appropriate engagement with others’ ideas and arguments• Key sources listed

(ii) Engagement with course content (max 10 marks)

• Shows awareness of key concepts and debates• Demonstrates understanding of materials used• Appropriate use of sources and examples• Evidence of reading beyond essential materials

(iii) Critical analysis (max 10 marks)

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• Arguments clearly stated and appropriately supported• Shows awareness of different perspectives, including their strengths and limitations• Appropriate evaluation of sources• Evidence of reflection and independent thought

Essay (70%) - due – Monday 3rd April, 2017 by 11:59am (GMT).You will also be asked to produce a written essay of up to 3,000 words responding to one of a list of possible essay questions, to be made available via Learn after the 5th week of the course.

Assessment criteria

Essays submitted to all courses in the School of Social and Political Science are assessed against six main criteria:

• Critical and conceptual analysis• Strength and cohesion of argument• Use of sources and appropriate evidence• Structure and organisation• Breadth and relevance of reading• Clarity of expression and presentation and referencing

All six are interrelated: an effective conceptual analysis must be grounded in knowledge of relevant literature, and is in turn critical to the strength and cohesion of your argument; an argument has to be supported by critical evaluation of evidence, and is conveyed best in a well-structured and clearly presented paper. Lastly, your evidence will carry most weight when sources are properly cited and referenced.

Submission of Coursework

Coursework is submitted online using our electronic submission system, Turnitin. Marked coursework, grades and feedback will be returned to you via Turnitin. 

Further detailed guidance on the essay deadline and instructions for submitting the assignment will be available on the course Learn page.

Occasionally, there can be technical problems with a submission. We request that you monitor your university student email account in the 24 hours following the deadline for submitting your work. If there are any

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problems with your submission the course secretary will email you at this stage.

If there are any unanticipated delays, it is the course organiser’s responsibility to inform you of the reasons.

All our coursework is assessed anonymously to ensure fairness: to facilitate this process put your Examination number (on your student card), not your name or student number, on your coursework or front sheet. If you do not know your exam number, please email the Programme Administrator at mph.dl@ed.ac.uk.

Penalties for late submission

All deadlines for submission are at 11:59am GMT (UK time), and submitting even a minute after that deadline will incur a penalty. If you miss the submission deadline for any piece of assessed work, 5 marks will be deducted for each calendar day, or part thereof that work is late, up to a maximum of five calendar days (25 marks). After that, a mark of 0% (zero) will be given. It is therefore in your interest always to plan ahead, and if there is any reason why you may need an extension, to discuss this with the Course Organiser in advance of the deadline. Please note that a mark of zero may have very serious consequences for your degree, so it is always worth submitting work, even if late.

If you have any queries, you should contact the Programme Administrator before the submission deadline.

Extension procedure

Extension requests should normally be made no more than two weeks prior to the deadline and should indicate the duration sought and require a separate application for each course. Extensions cannot be retrospectively granted after a deadline has passed and instead special circumstances need to be submitted.

All extension requests must use this process. You are welcome to discuss any issues affecting your studies with your Programme Director/Personal Tutor prior to submission. However, all extension request decisions are made by the course organiser, and any informal advice from any other member of staff does not equate to a final decision.

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In cases where medical evidence is required please note that your work will be considered as late until evidence is submitted and confirmed.

The following are circumstances which would USUALLY be considered:

• Serious or significant medical conditions or illness (including both physical and mental health problems).• Exceptional personal circumstances (e.g. serious illness or death of an immediate family member or close friend, including participation in funeral and associated rites; being a victim of significant crime).• Exceptional travel circumstances beyond your control.• Ailments such as very severe colds, migraines, stomach upsets, etc., ONLY where the ailment was so severe it was impossible for you to submit your work.

This list is not exhaustive

The following are examples of circumstances NOT normally considered for coursework extensions:

• Minor ailments such as colds, headaches, hangovers, etc.• Inability to prioritise and schedule the completion of several pieces of work over a period of time.• Problems caused by English not being your principal language.• Poor time management or personal organisation (e.g. failure to plan for foreseeable last-minute emergencies such as computer crashes, printing problems or travel problems resulting in late submission of coursework).• Circumstances within your control (e.g. a holiday; paid employment if you are a full time student; something considered more important).• Requests without independent supporting evidence.• Requests which do not state clearly how your inability to hand in your assessment on time was caused.

Penalties for Exceeding the Word Length

The word lengths of your assessments are specified above. All coursework submitted by students must state the word count on the front. All courses in the Graduate School have a standard penalty for going over the word length.

If you go over the word length, 5% of the total marks given for that assignment will be deducted, regardless of by how much you do so (whether it is by 5 words or by 500!). This deduction will take place after

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any other potential penalty has been applied. For example, if any essay gets 78 but is 2 days late and 100 words too long, the final mark will be (78-10) x 0.95 = 64.6, which is rounded up to 65. Also note that a course organiser may decide that any text in excess of the word length will be excluded from the assignment when marked.

Word length includes footnotes and endnotes, appendices, tables and diagrams, but not bibliographies. Given that footnotes and endnotes are included, we require you to use the Harvard referencing system.

Academic Misconduct in Submission of Essays

Coursework submitted via Turnitin will be regarded as the final version for marking. Cases of plagiarism, including self-plagiarism, will be treated as cases of academic misconduct and will be referred to the School Academic Misconduct Officer. Further details regarding academic misconduct are available in the Programme Handbook.

UNIT 1: FOUNDATIONS

A health care system can be seen as the organised response of a country to the health problems of its inhabitants. Societies differ in the way they organise this response. This course unit considers the location of health systems in their social and political context, explains some of the most important ways in which system designs differ between different countries, and provides a framework for grouping health systems according to some of these characteristics. The key learning outcomes focus on the development of a comprehensive understanding of how the hardware of health systems can be designed to better meet public policy goals.

In the discussion fora this week, we will apply the concepts and frameworks developed in the lecture and reading material to describe and categorise the health systems of the various countries and regions represented in the room. We will organise students into groups according to broad classifications and explore diversity within these. We will seek to provide some initial assessment of the capacity of these different categories of health systems to meet policy objectives.

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Essential Readings

Stevens, FCJ and J. van der Zee (2011), Health System Organization Models (Including Targets and Goals for Health Systems, in Carrin, C et al (eds), Health Systems Policy, Finance and Organization, pp. 275-284.

Goodwin, N (2011), National Health Systems: Overview, in Carrin, C et al (eds), Health Systems Policy, Finance and Organization, pp. 393-408.

NB. There are no other readings for this week.

UNIT 2: THE ROLE OF THE STATEThe neo-classical school of economics concentrates on market solutions to the fundamental problem of scarcity. Where there is scarcity there are choices to be made. A basic axiom of economics is that under certain specified conditions markets ensure that society chooses the most beneficial distribution of resources. This claim has important implications for health systems. It gives us a framework for considering the extent to which governments should intervene in the markets for health-related products and services, and how that intervention should be structured. We consider the utility of this framework for policymakers and the extent to which it is adequate given the complexity of policy goals.

Essential Readings

Le Grand et al (2008), The Economics of Social Problems. Chapters 1 and 2.

Morris et al (2012), Economic Analysis in Health Care. Chapters 1 and 5.

Recommended Readings

Morris et al (2012), Economic Analysis in Health Care. Chapter 9.

Haas-Wilson, D. (2001), Arrow and the information market failure in health care: the changing content and sources of health care information. Journal of Health Politics and Law, 26(5), 1031e1044.

UNIT 3: FINANCING

How money is raised from and pooled across the population has major implications for the ability of health systems to meet policy goals. The lecture differentiates between different mechanisms of raising money for

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health care and examine key funding concepts. We consider various forms of market failure alongside other challenges that relate to financing.

In the discussions, we will consider how we might best configure the policy response to these challenges with a view to moving towards a more equitable and accessible financing system. In approaching these questions, we consider the dimensions of a concept that is becoming increasingly important in contemporary global health discourse: universal health coverage.

Essential Readings

Morris et al (2012), Economic Analysis in Health Care. Chapters 5 and 6.

Hurley, J (2001), ‘Ethics, economics, and public financing of health care’, Journal of Medical Ethics, Vol.27, pp. 234-239.

Recommended readings

Musgrove, P (1999), ‘Public spending on health care: how are different criteria related?’, Health Policy, 47, pp. 207-223.

World Health Organisation (2010), Health Systems Financing – The Path to Universal Coverage. Geneva. World Health Organisation. Chapters 1 and 2.

Kutzin, J. (2013), ‘Health financing for universal coverage and health system performance: concepts and implications for policy’, Bulletin of the World Health Organization, 91: 602–611.

Normand, C and S. Thomas (2011), ‘Health Care Financing and the Health System’, in Carrin, C et al (eds), Health Systems Policy, Finance and Organization, pp. 149-163.

UNIT 4: PURCHASINGAll countries can do something to improve the technical efficiency of their health systems, thereby releasing resources that could be used to cover more people for more and better services. Some of these actions would aim to improve efficiency in a particular area of the health system, such as medicines. Others would address the incentives inherent in the system, and in particular how services are bought and providers are paid. In this lecture, we identify a range of payment mechanisms and institutional structures; compare payment structures in market and non-market

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systems; identify types of third party payer systems and methods of cost-sharing; and examine the role of purchasing as a driver of efficiency.

Essential readings

Morris et al (2012), Economic Analysis in Health Care, chapter 6 (see esp. pages 148-162).

World Health Organisation (2010), Health Systems Financing – The Path to Universal Coverage. Geneva. WHO. Chapter 4: More health for the money.

Recommended readings:

Langenbrunner et al (2009), ‘What, How, and Who: An Introduction to Provider Payment Systems’, In: Langenbrunner et al (eds), Designing and Implementing Health Care Provider Payment Systems: How to Manuals, World Bank, Washington DC.

Carrin and Hanvoravongchai (2003), ‘Provider payments and patient charges as policy tools for cost-containment: How successful are they in high-income countries?’, Human Resources for Health; 1:6.

Cashin et al (2009), ‘Primary Health Care Per Capita Payment Systems’, In: Langenbrunner et al (eds), Designing and Implementing Health Care Provider Payment Systems: How to Manuals, World Bank, Washington DC.

O’Dougherty et al (2009), ‘Case-Based Hospital Payment Systems’, In: Langenbrunner et al (eds), Designing and Implementing Health Care Provider Payment Systems: How to Manuals, World Bank, Washington DC.

Meessen, B Soucat, A and Sekabaraga, C (2011), ‘Performance-based financing: just a donor fad or a catalyst towards comprehensive health-care reform?’, Bulletin of the World Health Organization; 89: 153-156. doi: 10.2471/BLT.10.077339

Dredge, R (2009), ‘Hospital Global Budgeting’. In: Langenbrunner et al (eds), Designing and Implementing Health Care Provider Payment Systems: How to Manuals, World Bank, Washington DC.

UNITS 5 and 6: MOBILISING RESOURCES FOR HEALTH

These two sessions explore how societal resources are mobilised in pursuit of health policy objectives, with a focus on the markets for two key factors of production: labour and pharmaceuticals. We examine formal economic models for the analysis of labour markets and discuss the

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application of economic theory to the demand for and supply of pharmaceuticals.

Essential Readings

Labour

Dussault, G and M. Vujicic (2011), Demand and Supply of Human Resources for Health, in Carrin, C et al (eds), Health Systems Policy, Finance and Organization, pp. 296-302.

McPake, B et al (2013), Why do health labour market forces matter? Bulletin of the World Health Organization, 91:841-846, doi: http://dx.doi.org/10.2471/BLT.13.118794

Pharmaceuticals

Kanavos, P et al (2011), Differences in costs of and access to pharmaceutical products in the EU, European Commission: Brussels. See particularly pages 34-59.

Scherer, F.M. (2004), The Pharmaceutical Industry - Prices and Progress, New England Journal of Medicine, 351;9, p.927-932.

Recommended Readings

You may wish to refer to Chapter 8 of the Morris et al (2012) textbook, which provides a more formal treatment of the conceptual frameworks utilised above – though this is optional.

Yadav, P (2015), Health Product Supply Chains in Developing Countries: Diagnosis of the Root Causes of Underperformance and an Agenda for Reform, Health Systems & Reform, 1(2): 142-154.

UNIT 7: SERVICESDifferent health care systems organise their health systems in different ways and with different roles afforded to planning versus the market and the public and private health care sectors. In this lecture we examine the cases for a hierarchical versus market approach to governance in delivery; discuss the significance of ownership as a determinant of health system efficacy; look at the role of competition and choice in enhancing efficiency and quality and assess the extent to which different models can achieve health system goals.

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In the discussion forums this week, we will examine some of the philosophical foundations of the market equilibrium analytical approach and to what extent this can help us understand how to meet health systems objectives, including efficiency (of various kinds) and equity.

Essential readings

Propper, Wilson and Burgess (2006), ‘Extending choice in English health care: the implications of the economic evidence’, Journal of Social Policy, 35, 4, pp. 537-557.

Le Grand (2009), ‘Choice and competition in publicly funded health care’, Health Economics, Policy and Law, 4, pp. 479-488.

Recommended readings:

Dixon, A, Le Grand, J (2006), ‘Is greater patient choice consistent with equity? The case of the English NHS.’ Journal of Health Service Research and Policy, Vol. 11, pp. 162-166.

Bevan, G. & van de Ven, W. P. M. M., 2010, ‘Choice of providers and mutual healthcare purchasers: can the English National Health Service learn from the Dutch reforms?’, Health Economics, Policy and Law, vol. 5, no. 3, pp. 343-363.

Hunter, D.J. (2009), ‘The case against choice and competition’. Health Economics, Policy and Law. 4, 489-501.

Bevan, G. and Skellern, M. (2011), ‘Does competition between hospitals improve clinical quality? A review of evidence from two eras of competition in the English NHS’. British Medical Journal. 343.

UNIT 8: ALLOCATING RESOURCES

In this unit, we will look at the scale of expenditure on health as a percentage of GDP in different countries, and examine the composition of this expenditure (i.e. who pays and how do they pay). From a government-wide perspective, the goal of economic policy is to maximise the magnitude and growth of GDP (all else being equal). The goal in health policy is often rather different: here, policy-makers are often seeking to maximise healthcare (or health), while minimising expenditure. We examine empirical evidence relating to the cost-effectiveness of health expenditure, and consider the different techniques for doing so.

In this week’s discussions we will consider the strengths and weaknesses of the different models for assessing the efficiency of health spending,

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comment on their conceptual foundations and discuss how these might be applied by health policy-makers and scholars. We consider a number of crucial questions relating to the standard approaches of cost-effectiveness measurement and their utility for policy-makers and analysts. Do you think health care systems aim to maximise economic benefits in reality? Are there differences between health system types, e.g. between planned/market systems? Should health care systems maximise welfare or health? How might equity be incorporated in an economics-informed approach?

Essential readings

Morris et al (2012), Economic Analysis in Health Care. Chapters 10 and 11

Musgrove, P. 1999. Public spending on healthcare: how are different criteria related? Health Policy 47: 207-223.

Recommended readings

Martin, D and Benatar, S (2011), ‘Resource allocation: international perspectives on resource allocation’, In Carrin, C et al (2011), Health Systems Policy, Finance and Organization, Elsevier.

Evans, D (2011), ‘Cost-influenced treatment decisions and cost-effectiveness analysis’, In Carrin, C et al (2011), Health Systems Policy, Finance and Organization, Elsevier.

Shah, KK (2011), Is the aim of the health system to maximise QALYs? An investigation into what else matters in the NHS. OHE Research Paper 11/3.

Drummond, M and F Rutten (2008), New Guidelines for Economic Evaluation in Germany and the United Kingdom: Are we any closer to developing international standards? OHE Briefing No.46.

UNIT 9: FISCAL SPACE

There is a clear tendency for health spending to rise faster than economic growth, such that spending takes a progressively greater proportion of national income. This implies that the gap between what we, as policymakers, may wish to do and what we actually have the resources to do may grow over time. In this unit, we look at demand-side and supply-side explanations of rising health expenditure and assess the feasibility of achieving policy goals.

Essential readings

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Appleby, J (2013), Spending on health and social care over the next 50 years. Why think long term? London, King’s Fund (focus esp. on the literature review, pages 8-11).

Baumol, W (1996), The Cost Disease, New Haven, Yale University Press, Chapters 1-4.

Recommended readings

Focus on demand-side explanations

Pauly (2008), ‘Should We Be Worried About High Real Medical Spending Growth In The United States?’, Health Affairs – Web Exclusive – placed on Learn.

Nandakumar, A and Farag, M (2011), ‘Determinants of national health expenditure’, in Carrin, C et al (eds), Health Systems Policy, Finance and Organization, pp. 245-250.

Seshamani M, Gray AM (2004), ‘A longitudinal study of the effects of age and time to death on hospital costs’. Journal of Health Economics, 23, pp. 217-235.

Costa-Font et al (2002), Re-visiting the Health Care Luxury Good Hypothesis: Aggregation, Precision, and Publication Biases? HEDG Working Paper 09/02, University of York.

Newhouse J P. (1977), ‘Medical Care Expenditure: A Cross-National Survey. Journal of Human Resources, 12(1), pp. 115-25.

Focus on supply-side explanations

Smith S, Newhouse JP, Freeland MS (2009), ‘Income, insurance, and technology: why does health spending outpace economic growth?’ Health Affairs, vol. 28, no 5, pp 1276–84.

Cutler DM, McClellan M (2001), ‘Is technological change in medicine worth it?’ Health Affairs, vol 20, no 5, pp 11–29.

Hartwig, J (2008), ‘What drives health care expenditure? – Baumol’s model of ‘unbalanced growth’ revisited’, Journal of Health Economics, Vol. 27, pp. 603-623.

Pauly, M. V. (1988), ‘Is medical care different? Old question, new answers’, Journal of Health Politics, Policy and Law, 13(2): 227-237.

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UNIT 10: CASE STUDY - INDIAIndia has the world’s largest private healthcare sector, which accounts for a majority of all treatments delivered in the country. Public expenditure on health is one of the lowest in the world on a per capita basis, and the vast majority of health-related products and services are paid for out-of-pocket, raising financial barriers to access and impoverishing many of those who require healthcare. Although the federal government is working to address this problem, having launched a nationwide health insurance scheme called the Rashtriya Swasthya Bima Yojana (among others), such efforts are constrained by limited public funding. The aim of this unit is to illustrate how the health system concepts and principles can be used to evaluate the strengths and limitations of a specific health system - in this case, one which is demonstrably failing to meet common health system goals. In the discussion fora, we will draw on the concepts and principles we have covered in previous units to consider how we might improve on the government’s policy response to these problems.

Essential Readings

Yip, W and Mahal, A (2008), The Health Care Systems Of China And India: Performance And Future Challenges, Health Affairs, July, vol. 27 no. 4 921-932, doi: 10.1377/hlthaff.27.4.921

Wagstaff, A (2013), What exactly is the public-private mix in health care? Let’s Talk Development, 02/12/2013. Available at: http://blogs.worldbank.org/developmenttalk/what-exactly-public-private-mix-health-care

Recommended Readings

Das, J, Holla, A, Mohpal, A et al (2015), Quality and Accountability in Healthcare Delivery: Audit-Study Evidence from Primary Care in India, NBER Working Paper No. 21405.

Devadasan N, Ghosh S, Nandraj S, Sundararaman T (2014) Monitoring and Evaluating Progress towards Universal Health Coverage in India. PLoS Med 11(9): e1001697. doi:10.1371/journal.pmed.1001697

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Appendix 1Guidance for Online Interaction and Blog Posts

I. Accessing and posting blogs:

You have all been assigned to specific blog groups, and should now have access to a ‘Group’ Letter page. (Note that this page is accessible only to members of your particular blog group.) To access your blog group’s discussion board, click on ‘Group Discussion Board’ under ‘My Groups’ (see arrow below).

You can take part in online discussions in two ways: a) Contributing an original, initiated blog post by starting a new discussion thread for your weekly blog

assignment, or b) By responding to someone else’s post, or subsequent replies to that post.

To post a blog, go into the relevant discussion Forum and click the ‘Create Thread’ button (see large circle below). Under ‘Forum Information’, use the ‘Name’ box to describe the task your post is responding to (eg ‘Example thread’). Type (or paste) your blog into the text box, and click ‘Submit’. Your post should now appear within the relevant Forum session.

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The easiest way to read and respond to others’ posts is to select the relevant discussion thread (see small arrow above) and click on the ‘Collect’ button (see small circle above). This presents the original post and any subsequent replies in a single continuous thread. You can then post your response by clicking the ‘Reply’ button, writing your response in the text box and clicking ‘Submit’.

II. Information on Blogs

Expectations:You are encouraged to keep your posts fairly short (less than 450 words). Don’t feel your ideas have to be fully developed before you post them, or that you can’t change your mind after making a post; most of us develop our ideas by sharing them with others and reflecting on their responses and contributions. Try to think about how the ideas you are discussing relate to the broader course material (including material from other units of the course). Be sure to indicate where you have taken arguments, theories or evidence from specific authors or sources by using citations and including references in your blog posts. You may wish to draw on other relevant material and, if so, this can be linked to or posted on the discussion board.

For all weeks, you should prepare and post your blog by the deadline outlined in the course schedule (typically a Sunday), and you should take the next few days after that to read and respond to at least one other post from a member of your group.

Further information on blogs, including examples:

The sort of blogs you will be writing and posting for this course will not be personal blogs, but instead will resemble the many academic and policy blogs that have surfaced in recent years. These academic blogs are a way for academics and policy makers to discuss issues in health policy as they are happening. The popularity of academic and policy blogs in part emerged out of a frustration with the slow pace associated with publication of journal articles.

There are a number of extremely high quality health policy blogs out there, which you may wish to review to get a better sense of what we are expecting as part of this course. Here are some great ones:

Health Affairs Blog: http://healthaffairs.org/blog/

The Incidental Economist: http://theincidentaleconomist.com/

London School of Economics’ Health and Social Care Blog: http://blogs.lse.ac.uk/healthandsocialcare/

Nuffield Trust Blog: http://www.nuffieldtrust.org.uk/blog

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