比較醫療照護體系

Course Objectives: This course is intended to provide 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 both developed and developing countries. By the end of the course, each student should have done the following tasks: 1. To understand main conceptual frameworks for health systems 2. To learn the differences in financing, organizing, delivering health care services among countries at different levels of income and development 3. To acquire analytical skills in diagnosing, evaluating and making recommendations of major issues in health care systems

Session 1: Framework of Health Systems 1. Hsiao, WC (2003). What is a health systems? Why do we care? Mimeo. HSPH. 2. Roberts, Hsiao, Berman and Reich (2008). “Getting health reform right.” Oxford University Press. Ch 6-7: Assessing health system performance. 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. 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. 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. Schütte S et al., (2018). “Health systems around the world - a comparison of existing health system rankings.” J Glob Health, 8(1):010407. Session 2: Financing: 1. Pauly MV et al., (2006). “Private Health Insurance in Developing Countries.” Health Affairs, 25(2): 369-379. 2. WHO. (2010). “Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies.” Chapter 5: Health Financing, 71-84. 3. WHO. (2013). “Research for universal health coverage: World health report 2013.” Chapter 1: The Role of Research for Universal Health Coverage, 5-30. 4. Wouter S, et al., (2016) “Medical savings accounts: assessing their impact on efficiency, equity, and financial protection in health care.” Health Econ Policy Law, p.1-15. 5. Patenaude BN. (2021). “The relationship between development assistance for health and public health financing in 134 countries between 2000 and 2015.” Health Policy Plan, 36(4):369-383. Session 3: Organization and 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, 21(4): 128-143. 3. Pan American Health Organization. (2010). "Integrated Health Service Delivery Networks: Concepts, Policy Options and a Road Map for Implementation in the Americas.” In Series: Renewing Primary Health Care in the Americas. 4. Mackintosh M et al., (2016). “What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries.” Lancet, 388: 596-605. 5. Morgan R et al., (2016). “Performance of private sector health care: implications for universal health coverage.” Lancet, 388:606-612. 6. Coveney L et al., (2023). “Do private health providers help achieve Universal Health Coverage? A scoping review of the evidence from low-income countries.” Health Policy and Planning, 38:1050-1063. 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 Econ, 17(12): 1345-1362. Session 4: Financing, Organization and Delivery (Student Discussion) 1. Reeves A et al., (2015). “Financing universal health coverage--effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries.” Lancet, 386(9990):274-80. 2. 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. 3. 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. 4. Yip W and Hsiao WC (2014). “Harnessing the privatization of China's fragmented health-care delivery.” Lancet, 384(9945):805-18. 5. 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. 6. Hsiao WC and Yip W. (2023). “Financing and provision of healthcare for two billion people in low-income nations: Is the cooperative healthcare model a solution?” Social Science & Medicine. 327: 115730. 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. Vilcu I et al., (2020). “Purchasing reforms and tracking health resources, Kenya.” Bull World Health Organ, 98(2):126-131. 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. Singh NS et al., (2021). “A realist review to assess for whom, under what conditions and how pay for performance programmes work in low- and middle-income countries.” Soc Sci Med, 270: 113624. Session 6: Payment and Incentives (Student Discussion) 1. Yip W et al., (2014). “Capitation combined with pay-for-performance improves antibiotic prescribing practices in rural China.” Health Aff (Millwood), 33(3):502-510. 2. Yuan B et al., (2017). “Payment methods for outpatient care facilities.” Cochrane Database Syst Rev, 3(3):CD011153 3. Tan SY et al., (2018). “Do prospective payment systems (PPSs) lead to desirable providers' incentives and patients' outcomes? A systematic review of evidence from developing countries.” Health Policy Plan, 33(1):137-153. 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. Swami M and Scott A (2021). “Impact of rural workforce incentives on access to GP services in underserved areas: Evidence from a natural experiment.” Soc Sci Med, 281:114045. 6. Lai Y et al., (2021). “Hospital response to a case-based payment scheme under regional global budget: The case of Guangzhou in China.” Soc Sci Med, 292:114601. 7. Sambodo NP et al., (2023). “Effects of performance-based capitation payment on the use of public primary health care services in Indonesia.” Soc Sci Med, 327: 115921 Session 8: Access to and Utilization of 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. Levy H and Janke A. (2016). “Health Literacy and Access to Care.” J Health Commun. 21 Suppl 1:43-50. 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. Pratley P. (2016). “Associations between quantitative measures of women's empowerment and access to care and health status for mothers and their children: A systematic review of evidence from the developing world.” 169:119-131. 2. Strasser R, et al., (2016). “Rural health care access and policy in developing countries.” Ann Rev Public Health. 37:395-412. 3. Hollard G and Sene O. (2016) “Social capital and access to primary care in developing countries: Evidence from Sub-Saharan Africa.” J Health Econ, 45:1-11. Session 9: Expenditure 1. Newhouse JP. (1993). “An iconoclastic view of health cost containment.” Health Aff, Supplement: 152-171.***** 2. Raciborska DA. (2008). “Accounting for health spending in developing countries.” Health Aff (Millwood). 27(5):1371-80. 3. Xu K., et al., (2011). “The Determinants of Health Expenditure: A Country-Level Panel Data Analysis.” WHO Working Paper. 4. Global Burden of Disease Health Financing Collaborator Network, (2017). “Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050.” Lancet, 393(10187):2233-2260. Session 10: Quality 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, 21(4):13-25. 3. Donabedian A. (2005). “Evaluating the Quality of Medical Care.” Milbank Q, 83(4): 691–729. 4. Sandmeyer B and Fraser I. (2016). “New Evidence on What Works in Effective Public Reporting.” Health Serv Res, 51:3 Part II, 1159-1166. 5. GBD 2016 Healthcare Access and Quality Collaborators. (2018). “Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016.” Lancet, 391(10136):2236-2271. 6. Berwick D et al., (2018). “Crossing the Global Health Care Quality Chasm: A Key Component of Universal Health Coverage.” JAMA, 320:1317-1318.

Class Participation 20% Student Discussion 30% Case Study (group project) 50% Special Notes for Student Discussion: 1. Everyone must read all the assigned papers. 2. The presenter will be responsible to summarize the paper and lead the discussion of that 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 features/mechanisms discussed in each system or country applicable or relevant to the country of your interest?

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