2019 Health Policy Course

The 2019 TMC Health Policy Course is a first-of-its-kind collaboration between the Texas Medical Center’s academic institutions. The course, now in its second year, teaches students the fundamentals of U.S. health policy and provides them with the background and context they need to analyze the most pressing health policy challenges facing the country today.

 

The course includes 13 sessions organized by the TMC Health Policy Institute and led by experts from across the Texas Medical Center. The sessions complement students’ studies at their home institutions, from which they may earn course credit.

For more information on the course, contact Stephen.H.Linder@uth.tmc.edu.

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Available Starting Jan. 15, 2019

Course Schedule

Click on each session for details including moderators, panelists, topics to be discussed and assigned readings. Please note that instructors continue to update this information on a regular basis.

1. Beliefs and Myths About U.S. Health Care – Jan. 15

Discussion citations

Far too often in the world of health policy, we accept half-truths as indisputable facts. But what happens when we take a deeper dive and really scrutinize the data? Dr. Arthur “Tim” Garson, Jr., director of the TMC Health Policy Institute and author of the book Health Care Half Truths, will challenge panelists and audience members to reconsider what they think they know about health care.

For example, many of us think the U.S. has the best health care system in the world. But what do the numbers tell us? We’ve all heard over and over again that preventive care saves money. But do the dollars really add up? Garson will discuss those myths and misconceptions, and others, with experts from across Texas Medical Center in what’s sure to be a fun and informative discussion.

Moderator:

Arthur “Tim” Garson, Jr.
Director, Texas Medical Center Health Policy Institute
Former Dean, Baylor College of Medicine
Former University Provost, University of Virginia

2. State and Local Health Policy Objectives and Methods – Jan. 22

Topics:

  • Evolving objectives
  • Mechanisms, forms, types, and sources
  • Comparison of Texas with other states

Moderator:

Charles Begley
Professor, UT School of Public Health

Questions:

  • What is the role of state and local health policy?
  • How does it relate to federal health policy?
  • What is the basis for distribution of responsibilities?
  • How does a bill get created? Become law?
  • What are the state and local agencies
  • that implement policy? How are they organized and funded?
  • What are the hot topics in state and local health policymaking relationships, authority, responsibility?

Readings:

3. How Health Policy is Made – Jan. 29

Topics:

  • Institutions and processes
  • Interest groups and lobbyists
  • Sources of influence

Moderator:

Aisha Morris Moultry
Professor and Associate Dean of Academic Affairs, Texas Southern University College of Pharmacy and Health Sciences

Panel Questions:

  • Explain the various stages of health policy development.
  • What are the roles of various interest groups in healthcare public policy?
  • What is the difference between presidential, congressional, and state roles in health care public policy debate, establishment, and implementation?
  • What changes have you seen in the policymaking process as a result of changes in presidential administration?
  • What are some strategies/tactics used by interest groups to influence public policy?
  • How can interest groups and political parties influence government policy in modern day America?
  • Please explain the “Iron Triangle” model of policy-making involving Congress, the bureaucracy, and interest groups.

Recommended Pre-Reading:

  • Rice T, Unruh LY, Rosenau P, Barnes AJ, Saltman RB, van Ginneken E. Challenges facing the United States of America in implementing universal coverage. Bulletin of the World Health Organization. [Internet]. 2014 Dec 1 [cited 2018 Jan 25];92(12):894–902. Available from: http://www.who.int/entity/bulletin/volumes/92/12/14-141762.pdf

4. Access to Care and Health Insurance Coverage – Feb. 5

Topics:

  • Objectives of coverage
  • Insurance coverage policies/provisions
  • Characteristics of the uninsured/underinsured
  • Gaps in coverage
  • Access barriers
  • Insurance reform

Moderator:

Ben Raimer
Senior Vice President, Health Policy & Legislative Affairs, UTMB

Readings:

5. Financing, Payment, and Cost – Feb. 12

Topics:

  • Public and private health expenditures
  • Sources of financing
  • Provider payment and payment reform
  • Cost containment policies
  • Performance

Moderator:

Osama Mikhail
Professor of management, policy and community health at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health

6. Quality of Care – Feb. 19

Topics:

  • Definition and measurement
  • Determinants
  • Quality improvement policies
  • Value-based performance

Moderator:

Lee Revere, PhD, MHA
Director, Fleming Center for Healthcare Management, UTHealth School of Public Health

Required Pre-Reading

Berwick DM, Nolan TW, and Whittington J. (2008) The Triple Aim: Care, Health, And Cost: The remaining barriers to integrated care are not technical; they are political. Health Affairs, 27 (3): 759-769.

Institute of Medicine. (2001) Crossing the Quality Chasm: a New Health System for the 21st Century.

Institute of Medicine. (1999). To Err is Human: Building a Safer Health System.

Optional Pre-Reading

Das A, Norton EC, Miller DC, Ryan AM, Birkmeyer JD, and Chen LM. (2016). The Effects of Adding a Spending Measure to the Hospital Value-Based Purchasing Program. Health Affairs (Millwood). 2016 May 1; 35(5): 898–906.

Porter ME and Lee, TH. (2013). The Strategy That Will Fix Health Care. Harvard Business Review. 2013 October.

7. Safety Net Programs – Feb. 26

Topics:

  • Medicare
  • Medicaid
  • FQHCs
  • Veteran’s Administration and other federal
  • Local public/private providers and uncompensated care

Discussion Objectives:

  • Describe a brief history and key features of safety net programs in the U.S.
  • Identify types of providers of safety net programs and services.
  • Identify the target population for safety net programs and population served per year.
  • Discuss how safety net programs are funded; annual expenditures and the financial challenges.

Moderator:

Abida Solomon
Associate Professor, College of Nursing, Prairie View A&M University

Discussion Questions:

  • What are the key features of safety net programs in the U.S.?
  • Who are the target population for these safety net programs?
  • Who are the providers of services in these safety net programs?
  • What are the funding sources for safety net programs?
  • What are the annual expenditures and number of people served?
  • What are the challenges in safety net programs?

Readings:

8. The Public Health System – March 5

Topics:

  • Objectives
  • Agencies and roles
  • Coordination and conflict

Moderators:

Tanweer Kaleemullah
Public Health Policy Analyst – Health System Transformation, Harris County Public Health

Questions:

  • What is public health and how does it compare to healthcare? What is their relationship?
  • What is health equity and how is addressed in the public health system?
  • What institutions at the federal, state, and local level as well as in the academic and private sector should people be aware of that have PH roles? Describe their interaction with each other.
  • With responsibilities related to ebola, vector control, chronic diseases, vaccinations, environmental health, tobacco, climate change, substance abuse, mental health, and so on, how are national, state or local priorities set, and to what extent do they encourage (or discourage ) interaction across players in the public health system?
  • How does funding affect the public health system? What are some of the other primary challenges?
  • How does the legal environment affect the public health system? Describe some of the authorities and mandates, and how well they ensure the public is protected from public health threats.
  • What are the challenges in implementing laws and policies at the State and local levels given disinterest or conflicting ideologies/worldviews?
  • What are some of the challenging and emerging legal issues in public health?
  • What does public health innovation look like across the various actors in the system (e.g. law/policy, government, academia, business, nonprofits)?
  • How well is the public health system understood by the public or elected officials? What can be done to help build awareness about the importance of public health?
  • What tensions exist between public and private institutions (e.g. legal, political, ethical) when there are competing public and private interests (e.g. oil & gas, drug development, etc)
  • Extremely poor populations are often overlooked, but certain businesses are leveraging this very population for business entrepreneurship. Please give examples.

For the case study on the issue of vaccines, several of the questions above would be repeated in that context.  Additional questions:

  • What’s been the domestic and global public health impact of vaccines?
  • Where have we made public health gains on vaccines?  Where are we failing?
  • With sustainability and funding a challenges (and other challenges), what are some ongoing and emerging innovations that institutions should be aware of and try to tap into?
  • Scientific hurdles aside, what are the economic and geopolitical barriers to developing new vaccines?
  • What’s been the impact of the antivaxxer movement, in Harris County, Texas, US, globally?
  • What local, state, national, global public policies need to be implemented to counter the antivaxxer movement?

Required Readings:

Optional Readings:

9. U.S. Health Policy Methods – March 12

Topics:

  • Evolving objectives
  • Mechanisms, forms, types and sources
  • Federalism
  • Comparison of US with other countries

Moderator:

Jessica Mantel
Co-Director, Health Law & Policy Institute, University of Houston Law Center

Questions:

  • Bovberg identifies various factors that guide the analysis of which level of government — state or federal — is better suited to address a particular policy issue. These factors can be grouped into three categories:  political philosophy, political and economic competition among the states, and pragmatic considerations.  Which political philosophical considerations favor federal action and which favor state action?  When might competition among states for residents/businesses promote “better” policies, and when might competition among states prove detrimental to public concerns? What pragmatic considerations favor federal action over state action, and vice versa?
  • What factors does Lester Salamon identify for evaluating the advantages and disadvantages of different regulatory approaches?
  • Congress is currently debating Medicaid’s future.  Presently the federal government gives funding to state Medicaid programs and establishes eligibility, coverage, and other parameters that all states must abide by, with states retaining flexibility within those parameters. Republicans have proposed a smaller role for the federal government, with less federal funding for Medicaid and states having greater flexibility as to how they structure and operate their state Medicaid programs.  In contrast to Republican proposals, some scholars have proposed removing states from the Medicaid picture and operating the Medicaid program as a federal-only program (similar to Medicare).  Which approach do you favor?

Reading Assignments

10. Social Determinants of Health – March 26

Topics:

  • Social factors that influence health
  • Food insecurity in Houston
  • Policy response to population health management
  • Clinical and community response to population health
  • Integrating health care and public health

Moderator:

Tanweer Kaleemullah
Public Health Policy Analyst – Health System Transformation, Harris County Public Health

Questions:

  • What are the social determinants of health, and how do they fit into today’s approach to public health & healthcare?
  • What are the pros (benefits, possibilities) and cons (limitations, barriers) of screening/intervening for SDHs and ACEs?
  • How can the health community appropriately address sensitive situations (e.g. IPV, food insecurity) in an effective manner given the complexity of the situations and the limited time with community members and patients?
  • How does this translate into something practical for providers and other clinicians in their everyday work and approach to caring for community members and patients? [e.g. clinical and community efforts to address SDHs including screening]
  • What are the financial realities of screening, diagnosing, intervening on SDHs whether in a clinical setting or community efforts?
  • Additional/replacement questions
    • What can healthcare do for SDHs like housing and the built environment? (this could be the initial question to follow the introduction of what social determinants is)
    • How does screening for SDHs affect liability concerns?
    • How do you see – if at all – the evolving relationship of public health and healthcare with SDH emerging?
    • What are the dangers/cautions of SDH migrating into healthcare? What are the limits of healthcare’s involvement?
    • What are the opportunities with this migration of SDH into healthcare?
    • Are there data that screening and referring for SDH/ACEs improves the targeted behaviors/outcomes for a population (i.e. does broad screening in a pediatric office for poverty, lower the poverty rate of the community it serves)
    • Is there a different way to think about SDH than the conventional “screen-and-refer” model?

Reading Assignments:

Required

Optional:

 

11. Ethical Dilemmas in Health Policy – April 2

Topics:

  • Rationing
  • End of life care
  • Other selected topics

Moderator:

Joslyn Fisher
Associate Professor of Medicine & Medical Ethics, Baylor College of Medicine
Chair, Ethics Committee, Harris Health System

Questions:

  • How can individual autonomy be balanced with the ethical and medical responsibilities of clinical teams?
  • What are the duties of medical professionals in allocating scarce resources related to end of life care?
  • What role do patients and their families have in determining their care plan/treatment options in end of life care?
  • Who determines treatment options in patients with terminal or irreversible conditions?
  • How can federal, state, and local healthcare systems develop policies which ethically address challenges in the provision of high quality end of life care?
  • How does the Texas Advance Directive Act impact patients and the clinicians caring for them?
  • How is rationing relevant in the provision of end of life care?

Suggested Readings:

Additional Suggested Readings:

  • IOM (Institute of Medicine). 2015. Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: The National Academies Press.
  • Melissa D. Aldridge, PhD, MBA, and Amy S. Kelley, MD, MSHS The Myth Regarding the High Cost of End-of-Life Care. Am J Public Health. 2015;105:2411–2415. doi:10.2105/AJPH.2015.302889
  • Dzeng E, Colaianni A, et al. Influence of Institutional Culture and Policies on Do-Not-Resuscitate Decision Making at the End of Life. JAMA Intern Med. 2015;175(5):812-819. doi:10.1001/jamainternmed.2015.0295. Published online April 6, 2015. Corrected on May 6, 2015.

12. Health Care Workforce – April 9

Topics:

  • Supply and demand of physicians and mid-level practitioners
  • Licensing and regulation
  • Education and training

Moderator:

Trevor Burt
Vice President, Education Administration, Methodist Hospital System

Questions:

  • Supply and Demand: Are training institutions adequately training the quantity and type of healthcare providers needed to meet the healthcare workface needs in the US?
  • How do we ensure each profession in the healthcare workforce is performing at the full capacity of their licensure and respective disciplines?
  • What role does the current landscape of healthcare reform play in dictating the scope of work for each profession as a part of team-based approach to care?
  • How do we manage the human response to culture change that is required for the future of team-based care?

Reading Assignments:

13. National Health Reform – April 16

Moderator:

Stephen Linder
Associate Director, TMC Health Policy Institute

Director, Institute for Health Policy at The University of Texas Health Science Center at Houston School of Public Health

Topics:

  • Medicaid funding and coverage expansion
  • Insurance regulation and mandates
  • Taxes and tax subsidies
  • Federal budget
  • Impact on Texas

2019 Health Policy Course Partners

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Course Details

Course Directors:

Arthur Garson, Jr., MD, MPH, Director, TMC Health Policy Institute

Stephen H. Linder, PhD, Co-Director, TMC Health Policy Institute

Course Goal: The TMC Health Policy Institute Health Policy course will train teach students (participants) about fundamental key concepts related to the development, implementation, and evaluation of (U.S.) health policy in an innovative format.

Course Objectives: By the end of the semester, students will be able to:

  • Describe the complex roles of the many participants in policymaking,
  • Summarize and discuss key components of healthcare policy, and
  • Assess competing positions on selected health policy controversies.

Course Overview: The TMC Health Policy Institute Health Policy course is an inter-institutional, inter-professional introductory health policy course for graduate students or advanced undergraduate students.

The Health Policy Institute will produce 13 seminar sessions (see topics below.) Each session will be led by an individual from a TMC member institution, and will select 3-4 others from TMC member institutions to participate in the seminar, to include diverse, inter-professional perspectives from local experts in the form of panel discussions, debates, and other interactive teaching modalities. Recommended pre-session readings will be provided ahead of time to course participants. The course is organized in three parts: (1) Policy Institutions and Processes (2) Policy Topics in US Health Systems issues (3) Emerging Topics & Controversies in Health Policy.

Course Leadership and Evaluation: Each participating institution will have a local course director who will be responsible for planning the course in terms of which TMC sessions to include (i.e. one institution may decide to include 10 TMC HPI course sessions and have 3 additional sessions of their own), and which additional readings, meetings, and other course work will be required. Assessment, evaluation, grading, and feedback will be entirely under the purview of the institution-specific course director and the institution’s curriculum committee.

Target Audience/Participants: This course is designed for students in all areas served by the TMC (such as nursing, pharmacy, medicine, PhD in research and advanced undergraduates); however, the TMC course will also be open to the public.

Time: Sessions meet once weekly (Tuesdays) for 13 weeks January 2019 – April 2019. Sessions run 5:30 p.m. to 7:00 p.m.

Location: Texas Medical Center headquarters at 6550 Bertner Ave., 6th Floor, Houston. Additional live broadcasts and recording will be posted on this website. Audience participation will be encouraged; for students taking the course for credit who are watching streaming video will be permitted to ask questions using distance technology.

Light refreshments will be served.

Cost: Free for participants

Steering Committee: Chuck Begley, Trevor Burt, Joslyn (Joey) Fisher, Tanweer Kaleemullah, Peggy Landrum, Jessica Mantel, Aisha Morris, Binata Mukherjee, Ben Raimer, Frances (Lee) Revere, Rocaille Roberts, Umair Shah, Abida Solomon, Sujit Sansgiry

Teaching Assistant: Adele Semaan

Communications Director: Ryan Holeywell

Course Directors

Students interested in obtaining course credit from their home institution for participation in the TMC Health Policy Course are encouraged to contact the appropriate faculty member listed below.

Course DirectorE-MailTMC Institution
Gautam Nayergnayer@yahoo.comUniversity of St. Thomas
Cecilia Ganduglia CazabanCecilia.M.GandugliaCazaban@uth.tmc.eduUTHealth School of Public Health
Gloria Rosegmrose@pvamu.eduPrairie View A&M University
Sharisse Hebertsahebert@pvamu.eduPrairie View A&M University
John Prochaskajoprocha@UTMB.EDUUTMB
Susan RuppertSusan.D.Ruppert@uth.tmc.eduUTHealth School of Nursing
Nina Fredlandnfredland@twu.eduTexas Woman’s University
Robin Tomsrtoms@twu.eduTexas Woman’s University
Peggy Landrumplandrum@twu.eduTexas Woman’s University
Terry Kirktdkirk2@Central.UH.EDUUniversity of Houston College of Nursing
Isabelle KustersKusters@UHCL.eduUniversity of Houston – Clear Lake
Aisha M. Moultrymorris_ma@TSU.EDUTexas Southern University College of Pharmacy and Health Sciences