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

Please read all assigned materials prior to the class session. Session 2: 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 3: Financing: 1. WHO. (2010). “Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies.” Chapter 5: Health Financing, 71-84. 2. WHO. (2013). “Research for universal health coverage: World health report 2013.” Chapter 1: The Role of Research for Universal Health Coverage, 5-30. 3. 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. 4. 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. Optional 1. 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. Session 4: 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. Yip W and Hsiao WC (2014). “Harnessing the privatisation of China's fragmented health-care delivery.” Lancet, 384(9945):805-18. 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. 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. 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. 3. Berenson RA et al., (2016). “A Typology of Payment Methods: Payment Methods and Benefit Designs: How They Work and How They Work Together to Improve Health Care.” Urban Institute. 4. 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. 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. Session 7: 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. Chen S et al., (2022). “Health insurance coverage in low- and middle-income countries remains far from the goal of universal coverage.” Health Affairs, 8:1142-1152. 3. Hsiao WC and Yip W. (2024). “Financing and provision of healthcare for two billion people in low-income nations: Is the cooperative healthcare model a solution?” Soc Sci Med, 345:115730. 4. Tan CC et al., (2021). “Singapore’s health-care system: key features, challenges, and shifts.” Lancet, 398: 1091–1104 5. 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 Plan, 38:1050-1063. 6. Gonz’alez P et al., (2025). “Impact of private practice of public health workers on public health provision: Evidence from a natural experiment.” Soc Sci Med, 366:117625. 7. Ghazaryan E et al., (2021). “Effectiveness of hospital payment reforms in low- and middle-income countries: a systematic review.” Health Policy Plan, 36(8):1344-1356. 8. 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. 9. Dzampe AK and Takahashi S, (2024). “Financial incentives and health provider behaviour: Evidence from a capitation policy in Ghana.” Health Econ, 33(2):333-344. 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. Strasser R, et al., (2016). “Rural health care access and policy in developing countries.” Ann Rev Public Health. 37:395-412. 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. Levy H and Janke A. (2016). “Health Literacy and Access to Care.” J Health Commun. 21 Suppl 1:43-50. 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 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. Berwick D et al., (2018). “Crossing the Global Health Care Quality Chasm: A Key Component of Universal Health Coverage.” JAMA, 320:1317-1318. 6. 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. 7. 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.

Class Participation 20% Student Discussion 30% Case Study 50% Special Notes for Student Discussion: 1. Everyone must read all the assigned papers. 2. The presenter will be responsible for summarizing the paper and leading 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 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.