THE AMERICAN HEALTHCARE SYSTEM

MAS 6VO2 501 - Spring 2006 – SOM 1.117

Course Instructor
John F. McCracken office: SOM 1.704
phone: (972) 883-6252 email: jfm@utdallas.edu

Course Objective:
This course is an introduction to the structure, operation, current state and future direction of the
American healthcare system. It examines the ways in which services are organized, financed and
delivered; the factors that determine the allocation of care and the establishment of priorities; and
the forces that impact health policy decisions. Some of the key issues that will be discussed
include:
♦ Who are the major industry participants and how do they interact?
♦ How is healthcare financed?
♦ How are health services allocated ?
♦ What happens to those who fall through the cracks in the system?
♦ What is the future of healthcare technology?
♦ Why does healthcare cost so much?
♦ What is the outlook for healthcare reform?

Resources
Text: Essentials of the U.S. Health Care System, L. Shi and D. Singh, Jones & Bartlett
Publishers, 2005, available for purchase in the UTD Bookstore.
Articles: Several current articles are assigned for this course. Six of them are bound and
available for purchase in the UTD Bookstore. The rest are posted on Web CT.
Web CT: All articles (except those required to be purchased) are available on WebCT at
http://webct.utdallas.edu/webct/public/home.pl Go to “The American Healthcare
System” to download both the syllabus and the articles.

Evaluation and Grading

Students will be evaluated
♦ 50% on class participation
♦ 50% on a written research project

Class participation includes diligent preparation of required readings, active contribution to class
discussion and a minimum of two in-class reports on key articles included in the syllabus. The
final written research project will address structural change and reform of the current healthcare
system. Criteria for both the in-class reports and final research paper will be distributed on the
first day of class.

This course is still evolving, and we may spend more time on some topics and less on others.
Please stay flexible. I’ll let you know as early as I can if/when we plan to deviate from the
schedule below.

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MAS 6VO2 501 - Spring 2006 – SOM 1.117

HEALTH SYSTEM OVERVIEW

Introduction to the U.S. Healthcare System January 11

System Overview: Characteristics, Values and Beliefs January 18

Required Reading
♦ Essentials: Chs. 1-3
♦ J. Oberlander, “The US Health Care System: On a Road to Nowhere?,” Canadian
Medical Association Journal, July, 2002.
Recommended Reading
♦ L. Sandy, “Homeostasis Without Reserve—The Risk of Health System Collapse,”
New England Journal of Medicine, December, 2002.
♦ R. Putsch, “Distributive Justice in American Healthcare: Institutions, Power and the
Equitable Care of Patients,” The American Journal of Managed Care, September
2004.

HEALTHCARE PROVIDERS

Physicians and Hospitals January 25

Required Reading
♦ Essentials: Chs. 4, 8
♦ P. Budetti, “Physician and Health System Integration,” Health Affairs, Jan./Feb.
2002.
♦ Issue Brief, “Rising Pressure: Hospital Emergency Departments as Barometer of the
Health Care System,” Center for Studying Health System Change, November 2005.
Recommended Reading
♦ A.E. Cuellar, “How the Expansion of Hospital Systems has Affected Consumers,”
Health Affairs, Jan./Feb. 2005.
♦ J. Goldsmith, “Integration Reconsidered: Five Strategies for Improved Performance,”
The Healthcare Strategist, November 1998.

Specialty Hospitals and Outpatient Care February 1

Required Reading
♦ Essentials: Ch. 7
♦ L. Casalino, “Focused Factories? Physician Owned Specialty Facilities,” Health
Affairs, Nov./Dec. 2003.
♦ K. Deavers, “Specialty Hospitals: Focused Factories or Cream Skimmers,” Center for
Studying Health System Change, April 2003.
Recommended Reading
♦ United States General Accounting Office, “Specialty Hospitals—Report to
Congress,” October 2003, Pgs. 1-28.

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MAS 6VO2 501 - Spring 2006 – SOM 1.117

HEALTHCARE FINANCING AND A LLOCATION

Overview: the Third Party Payment System February 8

Required Reading
♦ Essentials: Ch. 6
♦ R. Herzlinger, “Note on Financing of the U.S. Health Care Sector,” Harvard Business
School, August, 2005.
Recommended Reading
♦ V. Fuchs, “What’s Ahead for Health Insurance in the United States,” New England
Journal of Medicine, June 2002.

Managed Care, Markets and Rationing February 15-22

Required Reading
♦ Essentials: Ch. 9
♦ “Note on Managed Care,” Harvard Business School Note, September 1999.
♦ R. Kuttner, “Must Good HMOs Go Bad: The Commercialization of Prepaid Group
Health Care,” New England Journal of Medicine, May 1998.
♦ G. Annas, “The Prostitute, the Playboy and the Poet: Rationing Schemes for Organ
Transplantation,” American Journal of Public Health, February 1985.
♦ “Britain Stirs Outcry by Weighing Benefits of Drugs Versus Price,” Wall St. Journal,
November 22, 2005.
Recommended Reading
♦ R. Kuttner, “Must Good HMOs Go Bad: The Search for Checks and Balances,” New
England Journal of Medicine, May 1998.
♦ W. Mariner, “Business vs. Medical Ethics: Conflicting Standards for Managed Care,”
Journal of Law, Medicine and Ethics, Fall, 1995.
♦ R. Hurley, “A Widening Rift in Access and Quality: Growing Evidence of Economic
Disparities,” Health Affairs, December, 2005.

Employer Based Insurance March 1

Required Reading
♦ U. Reinhardt., “Employer-Based Health Insurance: A Balance Sheet,” Health Affairs,
Nov/Dec 1999.
♦ L. Bergthold, “In Loco Parentis: The Purchaser Role in Managed Care,” California
Management Review, Fall 2000.
Recommended Reading
♦ A. Enthoven, “Employment-Based Health Insurance is Failing: Now What?” Health
Affairs, May, 2003.
♦ Heritage Foundation, “Health Care Tax Credits: Designing an Alternative to
Employer Based Coverage, November, 2005.

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Medicare and Medicaid March 15

Required Reading
♦ J. Iglehart, “The American Health Care System: Medicare,” New England Journal of
Medicine, January 1999.
♦ J. Iglehart, “The American Health Care System: Medicaid,” New England Journal of
Medicine, February, 1999.
Recommended Reading
♦ L. Brown, “Medicare and Medicaid: The Unanticipated Politics of Public Insurance
Programs,” Health Affairs, Jan./Feb. 2003.
♦ J. Robinson, “The Death of TennCare,” Health Affairs, November 2005.

SPECIAL TOPICS

The Role and Future of Healthcare Technology March 22

Required Reading
♦ Essentials: Ch. 5

♦ “Better Medicine Through Information Technology,” Stanford Business School,

October, 2004.
Recommended Reading
♦ J.D. Kleinke, “Dot-Gov: Market Failure and the Creation of a National Health
Information Technology System,” Health Affairs, Sept./Oct. 2005.

The Aged, the Underinsured and the Uninsured March 29

Required Reading
♦ Essentials: Chs. 10-11
♦ U. Reinhardt, “Is There Hope for the Uninsured,” Health Affairs, August 2003.
♦ “Chinese Doctors Tell Patients to Pay Upfront, or No Treatment,” Wall St. Journal,
December 5, 2005.
Recommended Reading
♦ T. Gilmer, “It’s the Premiums, Stupid: Projections of the Uninsured through 2013,”
Health Affairs, April 2005.

HEALTHCARE R EFORM

Why Does Healthcare Cost So Much April 5

Required Reading
♦ Essentials: Ch. 12

♦ D. Altman, The Sad History of Health Care Cost Containment as Told in One Chart,”
Health Affairs, January 2002.
♦ H. Aaron, “The Unsurprising Surprise of Renewed Health Care Cost Inflation,”
Health Affairs, January 2002.

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Recommended Reading
♦ G. Anderson, “It’s the Prices, Stupid: Why the United States is so Different from
Other Countries,” Health Affairs, May/June, 2003.
♦ S. Altman, “Escalating Health Care Spending: Is it Desirable or Inevitable,” Health
Affairs, January 2003.

The Outlook for Reform April 12-19

Required Reading
♦ Essentials: Chs. 13-14
♦ M. Porter, “Redefining Competition in Healthcare,” Harvard Business Review, June
2004.
♦ R. Herzlinger, “Let’s Put Consumers in Charge of Healthcare,” Harvard Business
Review, July 2002.
♦ J. Oberlander, “The Politics of Health Reform: Why do Bad Things Happen to Good
Plans,” Health Affairs, August 2003.
Recommended Reading
♦ V. Fuchs, “Health Care Reform: Why, What and When,” Health Affairs, Nov./Dec.
2005.
♦ L. Nichols, “Are Market Forces Strong Enough to Deliver Efficient Health Care
Systems: Confidence is Waning,” Health Affairs, March/April 2004.