健康保險與醫療體系議題研討

Course Learning Objectives: This course provides an opportunity for students to learn main features of health care systems, basics of health system reforms, review current literature in health system research in relation to the critical system changes occurring in the health sector worldwide. A series of papers will be used to identify sources of revenue for the health sector, provider organization, provider payment mechanisms, health delivery systems, and evaluation frameworks. The discussions will main draw examples from China, Taiwan and the United States. By the end of the course, each student should have done the following tasks: 1. To understand the major components of health care systems and how each component interacts with intermediate and ultimate goals of health care systems. 2. To learn the differences in financing, organizing, delivering health care services. 3. To acquire analytical skills in evaluating and making recommendation for how countries could reform their health sectors in a variety of countries and settings.

Session 1: 1. Hsiao, WC (2003). What is a Health Systems? Why Do We Care? Mimeo. HSPH. 2. Roberts, Hsiao, Berman and Reich (2008). “Chapter 6: Assessing health system performance”. Getting Health Reform Right. Oxford University Press. 3. Health System Performance Assessment: A Framework for Policy Analysis. World Health Organziation.2022. https://iris.who.int/bitstream/handle/10665/352686/9789240042476-eng.pdf?sequence=1 4. GBD 2019 Universal Health Coverage Collaborators. (2020). “Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.” Lancet, 396(10258): 1250-1284. Optional: 1. Fried B et al. (2012) “World health systems: Challenges and perspectives.” Health Administration Press, Chapter 1&2. 2. Johnson, Stoskopf and Shi (2017). Comparative Health Systems: A Global Perspective. Jones & Bartlett Learning, Chapter 1 & 27. 3. Blumenthal D et al., (2020). “The Affordable Care Act at 10 years- Its coverage and access provisions.” N Engl J Med, 382(10): 963-969. 4. Yip W et al., (2023). “Universal health coverage in China part 1: progress and gaps.” Lancet Public Health, 8(12): e1025-1034. 5. Yip W et al., (2023). “Universal health coverage in China part 2: addressing challenges and recommendations.” Lancet Public Health, 8(12): e1035-1042. Session 2: 1. Kutzin J. (2013). “Health financing for universal coverage and health system performance: concepts and implications for policy” Bull World Health Organ, 91:602–611 2. Nuscheler R and Roeder K. (2015). “Financing and funding health care: Optimal policy and political implementability.” J Health Econ, 42:197-208 3. Wouter S, et al., (2016) “Medical savings accounts: assessing their impact on efficiency, equity, and financial protection in health care.” Health Economics, Policy, and Law, p.1-15. 4. Bichay N. (2020). “Health insurance as a state institution: The effect of single-payer insurance on expenditures in OECD countries.” Soc Sci Med, 265:113454. 5. Meng Q et al., (2015). “Consolidating the social health insurance schemes in China: towards an equitable and efficient health system.” Lancet, 386(10002):1484-92. 6. Miller S and Wherry LR. (2017). “Health and Access to Care during the First 2 Years of the ACA Medicaid Expansions.” N Engl J Med 2017; 376:947-956. Session 3: Organization and Service Delivery 1. Newhouse JP. (1970). “Toward a theory of non-profit institutions: an economic model of a hospital.” American Economic Review, 60(1): 66-74.***** 2. Burns LR et al., (2002). “Integrated delivery networks: A Detour on the road to integrated health care?” Health Aff (Millwood), 21(4): 128-143. 3. Furukawa MF. (2020). “Landscape of Health Systems in the United States.” Med Care Res Rev, 77(4): 357–366. 4. Baker LC et al., (2014). “Vertical integration: hospital ownership of physician practices is associated with higher prices and spending.” Health Aff (Millwood), 33(5):756-63. Optional: 1. Shen YC et al. (2007). “Hospital ownership and financial performance: what explains the different findings in the empirical literature?” Inquiry, 44(1): 41-68. 2. Eggleston K et al. (2008). “Hospital ownership and quality of care: What explains the differences in the literature?” Health Economics, 17(12): 1345-1362. 3. Wu FM et al., (2016). “Assessing differences between early and later adopters of accountable care organizations using taxonomic analysis.” Health Serv Res, 51(6):2318-2329 4. Kirsten BD. (2019). “Integrating social care into the delivery of health care.” JAMA, 322:1763-1764. Session 4: Health Care Financing, Organization and Delivery (Student Discussion) 1. van Ginneken E et al., (2013). “Health insurance exchanges in Switzerland and the Netherlands offer five key lessons for the operations of US exchanges.” Health Aff (Millwood), 32(4):744-52. 2. Hsiao WC et al., (2017). “What can be achieved with a single-payer NHI system: The case of Taiwan.” Soc Sci Med, 233:265-271. 3. Yin JDC and He AJ. (2018). “Health insurance reforms in Singapore and Hong Kong: How the two aging Asian tigers respond to health financing challenges?” Health Policy, 122:693-697. 4. Zhou G et al., (2022). “Equity in healthcare financing following the introduction of the unified residents’ health insurance scheme in China.” Health Policy and Planning. 37 (2): 209-217. 5. Yip W and Hsiao WC (2014). “Harnessing the privatisation of China's fragmented health-care delivery.” Lancet, 384(9945):805-18. 6. Kranz AM et al., (2020). “Health system affiliation of physician organizations and quality of care for Medicare beneficiaries who have high needs.” Health Serv Res, 55(Suppl. 3):1118–1128. Session 5: Payment and Incentives 1. Newhouse JP. (1996). “Reimbursing health plans and health providers: efficiency in production versus selection.” Journal of Economic Literature, 34: 1236-1263. 2. Langenbrunner JC et al., (2009). “Designing and Implementing Health Care Provider Payment Systems: How To Manuals.” The World Bank, page 1-27. 3. Conrad DA et al., (2016). “The Theory of Value-Based Payment Incentives and Their Application to Health Care.” Health Serv Res, 50 Suppl 2:2057-89. 4. Blumenthal D & Abrams M. (2020). The Affordable Care Act at 10 years- Payment and delivery system reforms.” N Engl J Med, 382(11): 1057-1063. Optional: 1. Emanuel EJ et al., (2016). “Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care.” Ann Intern Med. 164(2):114-119. 2. Markovitz AA et al., (2017). “Pay-for-Performance: Disappointing Results or Masked Heterogeneity?” Med Care Res Rev, 74(1): 3–78. 3. Feldman R. (2015). “The Economics of Provider Payment Reform: Are Accountable Care Organizations the Answer?” J Health Politic Policy Law, 40(4):745-60. Session7: Payment and Incentives (Student Discussion) 1. Mulcahy A. et al., (2018). “Associations Between the Patient Protection and Affordable Care Act Medicaid Primary Care Payment Increase and Physician Participation in Medicaid.” JAMA Intern Med. 178(8):1042-1048. 2. Jian W et al., (2019). “Beijing's diagnosis-related group payment reform pilot: Impact on quality of acute myocardial infarction care.” Soc Sci Med. 243:1-7. 3. Huang YC et al., (2016). “Disease-specific pay-for-performance programs: Do the P4P effects differ between diabetic patients with and without multiple chronic conditions?” Med Care, 54(11):977-983. 4. Chou SY et al., (2020). “Provider responses to a global budgeting system: The case of drug expenditures in Taiwan hospitals.” Health Econ, 29(10):1270-1278. 5. Adler-Milstein J et al., (2022). “Longitudinal participation in delivery and payment reform programs among US Primary Care Organizations.” Health Serv Res, 57: 47-55. 6. Gaspar K et al., (2020). “Global budget versus cost ceiling: a natural experiment in hospital payment reform in the Netherlands.” Eur J Health Econ, 21(1):105-114. Session 8: Utilization and Access to Care 1. McLaughlin CG and Wyszewianski L. (2002). “Access to Care: Remembering Old Lessons.” Health Serv Res, 37(6): 1441-1443. 2. Ronald M Andersen et al., (2013) “Chapter 2: Improving Access to Care.” In Book: Changing the U.S. Health Care System: Key Issues in Health Services Policy and Management, 4th Edition, pp.33-70. 3. Aron-Dine A et al., (2013), “The RAND health insurance experiment, three decades later.” Journal of Economic Perspectives, 27(1): 197-222. 4. Han HW et al., (2019). “Patient cost sharing and healthcare utilization in early childhood: Evidence from a regression discontinuity design.” American Economic Journal: Economic Policy, 12(3): 238-78. Session 9: Health Care Spending 1. Newhouse, JP. (1993). “An iconoclastic view of health cost containment.” Health Aff (Millwood), Supplement: 152-171. 2. Papanicolas I et al., (2018). “Health care spending in the United States and other high-income countries.” JAMA, 319(10):1024-1039. 3. Cutler DM et al., (2019). “Explaining the slowdown in medical spending growth among the elderly, 1999-2012.” Health Aff (Millwood), 38(2): 222-229. 4. Shrank WH et al., (2019). “Waste in the US health care system: Estimated costs and potential for savings.” JAMA, 322(15):1501-1509. 5. Blumenthal D et al., (2020). “Covid-19 — Implications for the Health Care System.” N Engl J Med, 383 (15): 1483-1488. Session 10: Quality of Care 1. Committee on Quality of Health Care in America, Institute of Medicine (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Executive Summary, pp. 1-22. 2. Newhouse JP. (2002). “Why is there a quality chasm?” Health Aff (Millwood), 21(4):13-25. 3. Donabedian A. (2005). “Evaluating the Quality of Medical Care.” The Milbank Quarterly, 83(4): 691–729. 4. Sandmeyer B et al., (2016). “New Evidence on What Works in Effective Public Reporting” Health Serv Res, 51 Suppl 2:1159-66. 5. GBD 2019 Healthcare Access and Quality Collaborators. (2022). “Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019.” Lancet Glob Health, 10(12): e1715–e1743 6. Chatterjee P et al., (2021). “Medicaid Expansion Alone Not Associated With Improved Finances, Staffing, Or Quality At Critical Access Hospitals.” Health Aff (Millwood), 40(12):1846-1855.

Case Study 50% Student Discussion 30% Class Participation 20% Special Notes for Student Discussion 1. Everyone has to read all the assigned papers. 2. The presenter will be responsible to summarize the paper and lead the discussion of that particular paper. 3. For other students, be prepared to answer the following questions: i. What are the pros and cons for the main features/mechanisms or schemes discussed in each system or country? ii. Whether are the particular features/mechanisms discussed in each system or country applicable or relevant to the country of your interest?

Recommended Textbook 1. Roberts, Hsiao, Berman and Reich (2008). Getting Health Reform Right. Oxford University Press. 2. Fried B et al. (2012) World Health Systems: Challenges and Perspectives. Health Administration Press. 3. Johnson, Stoskopf and Shi (2017). Comparative Health Systems: A Global Perspective. Jones & Bartlett Learning.