Healthcare Systems: A Comparative Approach B

 

Semester & Location:	Summer 2024 Session 2 - DIS Copenhagen
Credits:	3 credits
Course Study Tour:	Amsterdam
Major Disciplines:	Pre-Medicine/Health Science, Public Health, Public Policy
Faculty Member:	Lone Bilde and Priyanka (Priya) Ranganath (current students please use the Canvas Inbox to contact)
Program contact:	Science and Health Department shsupport@dis.dk
Program Director:	Susana Dietrich
Time & Place:	Time varies, refer to Canvas calendar for lecture times  Classroom: Fi44-Kosmo 405

 

Faculty

Lone Bilde M.Sc. (Economics and Languages) 1993, B.Sc. (Economics and Languages). Postgraduate education in health economics, epidemiology, measurement of health-related quality of life, and (bio) statistics, as well as coaching and leadership. Lone is an experienced consultant, advisor and leader of health care research projects. Her area of expertise is health economics, epidemiology, financing, organization, and the management of the health sector. She has carried out several research projects for - and together with - multiple stakeholders in Denmark as well as internationally. She has held senior positions at the Danish Institute for Health Services Research (DSI), the Danish Institute for Local and Regional Government Research (KORA), the Danish Institute for Applied Social Research (VIVE), Novo Nordisk, Nycomed, and the Danish Cancer Society. Lone has been with DIS since December 2022 and also teaches the elective semester course "Health Economics and Health Policy in Europe".

Priya Ranganath Ph.D Student, Center for Alcohol and Drug Research (Aarhus University, 2019-2023). Master in Sociology (Trinity College Dublin, 2017-2018). Master in International Business (Monash University, 2007-2009). Bachelor in Management (Tourism) (University of Technology, Sydney 2002-2005). With DIS since 2022.

 

Course Description

Different countries choose different approaches to the provision of healthcare. Through this course, you will gain insight into how healthcare is organized and financed in Denmark and Northern Europe, and you will investigate the impact of the social, economic, and political history on the present systems.  You will analyze principles of priority-setting in healthcare, and discuss and assess possible solutions to challenges such as aging populations, inequality in health, and rising healthcare expenditures.

 

Expected Learning Outcomes

After successful completion of this course, students will be able to:

• Understand the organization and financing of the Danish healthcare system and know its key stakeholders
• Examine access to healthcare, and discuss pros and cons of user payments in healthcare
• Understand why the healthcare market differs substantially from other markets and how it is /can be regulated
• Analyze and compare health systems across (Northern European) countries
• Explain, compare, and discuss different ways of prioritizing in healthcare
• Explain and examine determinants of inequality in health and discuss measures to reduce inequality
• Assess existing and future challenges in healthcare delivery and discuss possible solutions

 

Evaluation and Grading

To be eligible for a passing grade in this class, all of the assigned work must be completed. The factors influencing the final grade and the proportional importance of each factor is shown below:

 

Component	Weight
Participation	20%
Check-out quizzes	20% (each 10%)
Study Tour Assignment	30%
Cumulative essay exam	30%

A word about grades: we realize that grades are important to you, but try not to let your anxiety about grades deter you from taking intellectual risks and learning just for the joy of learning. Also, we do not grade to punish or reward you, just as our grade is not an indication of our evaluation of you as a person. We grade you to give you our honest assessment of your academic performance at this point in time.

Below you can read more about the individual parts:

Class and study tour participation

This is intended to be an interactive class. Primarily because it provides for a better learning experience, but also because it makes classes more fun. In order to participate, students are required to attend all classes, read and prepare before each class, and to participate actively in class.

Before the study tour you will be provided with information and links about the academic visits on the tour. During the tour it is important that all students participate and show interest and enthusiasm – whether it’s a course specific or a cultural visit. The more active participation from students, the better the learning experience for everyone.

Study Tour Assignment

In groups, students will create a 10-15 minute presentation based on their observations from 1 academic visits on the study tour. More information will be given in class and on Canvas.

Check-out quizzes

There will be two open-book "check-out quizzes" each covering the topics taught during the first and the third week of class (after the study tour) respectively. These two quizzes will be available by the end of each week and are multiple choice tests. For each of the quizzes, you will have two attempts and the attempt with the most correct answers will count in your grade. 

Cumulative essay

The cumulative essay exam is an open book take home exam, will be available at the end of the course. It will consist of four questions covering the entire course. You will be asked to answer these in an essay style using a 400-500 words for each of the answers. As references please use the readings and other class (or study tour) material as well as other references you may know of or find.  

The tests will be made available/conducted through the Canvas platform in due course.

 

Study Tour

This program will include a study tour to the Netherlands. You will travel with your classmates and DIS faculty and staff. The study tour is an important part of the program, where we take the classroom on the road and see how theory presented in the classroom is translated to practice in the field. There will be academic visits to various relevant sites in The Netherlands, as well as cultural visits and sightseeing. Attendance and active participation in all activities are required on the study tour. 

 

Expectations for study tours

• Participate in all activities
• Engage in discussions, ask questions, and contribute to achieving the learning objectives
• Respect the destination, the speakers, DIS staff, and your fellow classmates
• Represent yourself, your home university, and DIS in a positive light

 

While on a program study tour, DIS will provide transportation to/from the destination(s), accommodation, approx. 2 meals per day, and entrances, guides, and visits relevant to your area of study or the destination. You will receive a more detailed itinerary prior to departure.

 Travel policies: You are required to travel with your group to the destination. If you wish to deviate from the group travel plans on the way back, you need approval from the assistant program director. Please see specific travel dates in the course schedule below.

 

Teaching Methods

The course will be a mix of interactive lectures, class discussions, group work, student presentations, and feedback sessions. While we as the faculty are responsible for the overall structure of the class, all of us will contribute to the production of knowledge. All students are expected and encouraged to engage actively in class sessions.

 

Workload

This is an intensive course, and in just three weeks, you will receive three credits. In order to merit this you should expect a high workload. You should expect to use on average 2-3 hours preparing for each day of classes.

 

Policies

Class room etiquette
A good learning environment requires that everyone is present, prepared, and participating. Out of respect for both faculty and fellow students we expect you to be on time and to participate in the full duration of the class.

Laptops and phones in class: You may use your laptop for note‐taking or fact‐checking. Usage of laptops or phones not related to the class is unacceptable, and will reduce your participation grade significantly.

Assignments
Assignments and tests will be submitted via Canvas. Submissions exceeding the word limit will be penalized by a third of a grade per additional page or part thereof (A- becomes B+, B becomes B- etc.).

Late assignments will be accepted, but your grade will be reduced by 2 thirds of a grade for each day or part thereof that it is late (A- becomes B, B becomes C+ etc.).

 

Academic Regulations 

Please make sure to read the Academic Regulations on the DIS website. There you will find regulations on:

• Course Enrollment and Grading
• Academic Expectations and Honor Code

 

DIS - Study Abroad in Scandinavia - www.DISabroad.org

 

Required Readings (available on Canvas)

• Brook RH et al. (2006). The Health Insurance Experiment. A Classic RAND Study Speaks to the Current Health Care Reform Debate. RAND Corporation: Research Briefs. Web-only.
• Christiansen T, Bech, M (2013). “Denmark”. In: Siciliani L, Borowitz M, Moran V (eds.). Waiting Time Policies in the Health Sector: What works? OECD Publishing: 121-129.
• Diderichsen F, Andersen I, Manuel C, et al. (2012). Health inequality - determinants and policies. Scan J Pub Health 40 (8 Suppl):12-105.
  • Chapter 1-4.4 (pp. 12-28) (Everybody).
  • Chapter 4.4.1-5 (28-105) (See Canvas for assigned readings for each group).
• Donaldson C, Gerard K (2005). Economics of Health Care Financing: The Visible Hand. Basingstoke: Palgrave Macmillan: 29-52 and 55-72.
• Esping-Andersen G (1990). The Three Worlds of Welfare Capitalism. New Jersey: Princeton University Press: pp. 18-29.
• Goldman DP (2006). Cutting Drug Co-Payments for Sicker Patients on Cholesterol-Lowering Drugs Could Save a Billion Dollars Every Year. RAND Corporation: Research Briefs. Web-only.
• Jørgensen T et al. (2014). Effect of screening and lifestyle counselling on incidence of ischemic heart disease in general population: Inter99 randomised trial. BMJ 348:g3617:1-11.
• Krasnik A et al. (1990). Practice Observed: Changing Remuneration Systems: Effects on Activity in General Practice. BMJ, 300:1698-1701.
• Krogsbøll et al. (2012). General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ 345:e7191:1-13.
• Kronborg C, Björneskov Pedersen L, Draborg E, Kristensen T (2013). Consumer fees and inequality (translated from Danish) Månedsskrift for Almen Praksis, 91(11):911-918.
• National Health Committee (2004). Prioritising Health Services. A Background Paper for the National Health Committee. 4-29.
• Oberlander J, Marmot T, Jacobs L (2001). “Rationing medical care: rhetoric and reality in the Oregon Health Plan”. Can Med Assoc J 164(11):1583-1587.
• Olejaz M, Nielsen AJ, Rudkjøbing A, Birk HO, Krasnik A, Hernández-Cuervo C (2012). Denmark: Health System Review. Health Systems in Transition, 14(2). Read: Executive Summary: xvii-xxii
• Pedersen KM, Andersen JS and Søndergaard J (2012). General Practice and Primary Health Care in Denmark. J Am Board Fam Med, 25(Suppl_1):s34-s38.
• Rice T, Rosenau P, Unruh LY, Barnes AJ. Saltman RB, van Ginneken E (2013). United States of America: Health System Review. Health Systems in Transition, 15(3). Read: Executive Summary: xxi-xxix
• Saltman RB, Vrangbæk C (2009). Looking forward, future policy issues. In: Magnussen J, Vrangbæk K, Saltman RB (eds.) (2009). Nordic health care systems. Recent reforms and challenges. European Observatory on Health Systems and Policies: 78-104
• Vallgårda S (2008). Comparative studies. In: Vallgårda S, Koch L (eds.) (2008). Research methods in public health (1st ed). Copenhagen: Munksgaard: 201-218.
• Willems DL (2001). Balancing rationalities: Gatekeeping in health care. Med. Ethics, 27(1):25-29
• Winblad U, Vrangbæk K, Östergren K (2010). Do the waiting-time guarantees in the Scandinavian countries empower patients? IJPSM 23(4):353-363