Course Syllabus

 

Healthcare Systems: A Comparative Approach B

 

Semester & Location:	Spring 2024 - DIS Copenhagen
Type & Credits:	Core Course - 3 credits
Core Course Study Tour:	Denmark and Estonia (Tallinn) +Finland (Helsinki)
Major Disciplines:	Pre-Medicine/Health Science, Public Health, Public Policy
Pre-requisites:	None
Faculty Members:	Lone Bilde (current students please use the Canvas Inbox to contact)
Program contact:	Science and Health Department: shsupport@dis.dk
Program Director:	Susana Dietrich
Time & Place:	Mondays and Thursdays, 10:05 – 11:25 in N7-C24

 

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, including health economic evaluation. 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 course "Health Economics and Health Policy in Europe".

 

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 health care, 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, you will be able to:

• Understand the organization and financing of the Danish healthcare system and know its key stakeholders
• Analyze, compare and contrast health systems across 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

 

 After successfully completing the Public Health Semester Group Project, you will be able to:

• Frame and design a research question
• Search, select, and study a number of relevant sources and apply them to your research question
• Write a structured paper that contains a critical and comparative analysis and discussion of a specific topic of relevance to the course focus
• Present your results and conclusions to an audience in a scientific and engaging manner

 

Teaching Methods

The course will be a mix of interactive lectures, class discussions, group work, student presentations, and feedback sessions. While we as 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.

 

Evaluation and Grading

To be eligible for a passing grade in this class, all of the assigned work must be completed. Please note that 'extra credit' or 'make-up work' is not possible in this course.

The factors influencing the final grade and the proportional importance of each factor is shown below:

Component	Weight
Participation	15%
Reading Reflections	5%
2 small MC quizzes (5% each)	10%
Take Home Essay	10%
Study Tour Assignment (STA)	15%
Cumulative Essay Exam	25%
Semester Project	20%

 

A word about grades: I 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, I do not grade to punish or reward you, just as my grade is not an indication of an evaluation of you as a person. I grade you to give you my honest assessment of your academic performance at this point in time.

Below you can read more about the individual components.

 

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.

 

Reading reflections

The evening before selected classes, you must submit brief answers to the reading questions provided on Canvas.

 

Check-out quizzes

The course includes two short quizzes to test your knowledge on some of the basic concepts and ideas that we're discussing in class. All questions will be "self-grading" multiple choice or matching type questions, and focused on the themes that we’ve covered in the class sessions so far.

The tests will be open book, not timed, and you can do them at a time that works for you. Once you finish the test, you will be able to immediately see your responses and points. Incorrect answers will be marked, but you will not be able to see the correct answer. You will have 2 attempts, and will keep the highest score of the 2.

Please answer the questions on your own, without consulting with your classmates.

The quizzes will be conducted through the Canvas platform. 

 

Study Tour Assignment (STA)

In groups, students will create a presentation based on their impression from their assigned visits on the study tours.

More information is given in class but please note that this assignment will be graded according to group performance and not individual performance. 

 

Take Home Exam and Cumulative Essay Exam

These assignments are open book, take home exams.

The first take home exam will consist of 1 essay question.

The Cumulative Exam consists of 3 essay questions. As the term "cumulative" implies, the essay questions will cover material taught throughout the semester. 

More details about the format will be shared in class.

 

Semester Project

Students in the class will brainstorm a number of course related topics. In groups, students will then phrase and investigate a research question of their own choice.

The project paper is the core of the semester project. The paper will be handed in twice. First as a draft version for feedback and secondly as a final version.

On Canvas, you will find a separate document that describes the semester project in more detail. In class, we will discuss how to write the project paper.

More information is given in class but please note that this assignment will be graded according to group performance and not individual performance. 

 

Core Course Week and Study Tours

Core Course Week and study tours are an integral part of the core course.  We take the classroom on the road and see how theory presented in the classroom translates into practice in the field. You will travel with your classmates and DIS faculty/staff on two study tours: a short study tour in Denmark during Core Course Week and a Long Study Tour to Tallinn and Helsinki.

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.

 

Policies

Attendance

You are expected to attend all DIS classes and activities when scheduled, and we will actively monitor attendance. Absences will jeopardize your grade and your standing at DIS. Excused absences include only serious illness and participation in religious holidays.

If you miss multiple classes, the Director of Academic Support, and the Director of Student Affairs will be notified and they will follow-up with you to make sure that all is well. In the case of multiple absences, you will need to provide a doctor’s note.

Missing class: You must always notify your instructor about an absence a reasonable time in advance. Each failure to notify your faculty of an absence in advance will result in a deduction of 2 points off your final participation grade.

 

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.

Make-up classes: There are a few open slots for make-up classes in the syllabus. Please note that there may be organized mandatory classes during these time slots.

 

Assignments

Assignments and tests are 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

Required Readings

1. Andersen JG (2012). Welfare States and Welfare State Theory.  Aalborg: Centre for Comparative Welfare Studies, Institut for Økonomi, Politik og Forvaltning, Aalborg Universitet. CCWS Working Paper

2. Arcaya MC, Arcaya AL, Subramanian SV (2015). Inequalities in health: definitions, concepts and theories. Glob Health Action 8: 8: 27106. Please focus on the following pages: (page 1-6 (stop at "geographic..."), page 9-10 (from "explaining health inequalities”). Rest of paper is optional.

3. Christiansen T and Vrangbæk K (2018). Hospital centralization and performance in Denmark - Ten years on. Health Policy 122:321-328.
4. The Commonwealth Fund (2020). The U.S. health care system. In Tikkanen R, Osborn R, Mossialos E, Djordjevic A & Wharton G (Eds.), International profiles of health care systems (pp. 211-223). The Commonwealth Fund.
5. Cylus J, Nolte E, Figueras J and McKee M.  2016. What, if anything, does the EuroHealth Consumer Index actually tell us?  Blog post on the thebmjopinion.
7. Diderichsen F (2012). Health Inequality - Summary.  Scandinavian Journal of Public Health,  40 (Suppl 8). pp. 6–8

8. Esping-Andersen G (1990). The Three Worlds of Welfare Capitalism. New Jersey: Princeton University Press: pp. 18-29.

9. Goroll AH. (2015). Toward Trusting Therapeutic Relationships - I Favor of the Annual Physical. NEJM 373;16;1487-1489.

10. Habicht T, Reinap M, Kasekamp K, Sikkut R, Aaben L, van Ginneken, E (2018). Estonia: Health System Review. Health Systems in Transition, 15(6). Read: Executive Summary: xvii-xxiv

11. Health Consumer Powerhouse (2016). European Health Consumer Index. Report 2016.
    

12. Krasnik A et al. (1990). Practice Observed: Changing Remuneration Systems: Effects on Activity in General Practice. BMJ, 300:1698-1701.

13. 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.

14. Mehrotra A and Prochazka A. (2015). Improving Value in Health Care  - Against the Annual Physical. NEJM 373;16;1485-1487.

15. National Health Committee (2004). Prioritising Health Services. A Background Paper for the National Health Committee. 4-29.

16. Nordic Federation of General Practice (2016). Position Paper: Overdiagnosis and related medical excess

17. 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.

18. 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.

19. Vallgårda S (2008). Comparative studies. In: Vallgårda S, Koch L (eds.) (2008). Research methods in public health (1^st ed). Copenhagen: Munksgaard: 201-218.

20. Vallgårda S (2008). Social inequality in health: Dichotomy or gradient? A comparative study of problematizations in national public health programs. Health Policy 85:71-82. 
    

21. Vrangbæk K (2020). The Danish health care system. In Tikkanen R, Osborn R, Mossialos E, Djordjevic A & Wharton G (Eds.), International profiles of health care systems (pp. 47–59). The Commonwealth Fund
    

22. Vuorenkoski L, Mladovsky P, Mossialos E (2008). Finland: Health System Review. Health Systems in Transition, 10(4). Read: Executive Summary: xv-xix.

23. Willems DL (2001). Balancing rationalities: Gatekeeping in health care. Med. Ethics, 27(1):25-29

 

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