Course Syllabus Human Biology 120

Health Care in America:

An Introduction to U.S. Health Policy
Fall quarter 2016-17
Donald Barr, M.D., Ph.D.
Professor of Pediatrics and Human Biology
e-mail: barr@stanford.edu Office phone: 723-2884
Office hour sign-ups posted outside my office Building 20, Room 22R

This course will offer an overview of the health care system in the United States. As a
central focus of the course, we will discuss the recent reform process triggered by passage
in 2010 of the Affordable Care Act, and relate the actions taken by the legislation to
central health policy issues.

The learning goals for the course and the sequence of lectures and readings are
described on the following pages. Each week there will be required readings from the
textbook. As the structure of the textbook is based on the structure of the course, these
readings will parallel the weekly lectures fairly closely. In addition to the text, each week
I will post a few additional reading assignments, all of which will be available on-line by
5pm on the Friday of the previous week. I will post these on the Files page on the
courses Canvas website.

There will be a term paper for the course. The focus of the paper will be on the recent
national health care reform process. It will be due by 5pm on Friday, November 18. I
will give you more information about the paper in the 2nd week of the course.

The course will meet on Tuesdays and Thursdays from 10:30 to 11:20. It is offered for
4 units. The general format for the class will be lectures on the scheduled topics as well as
discussion of the assigned readings. Students are expected to attend a one-hour discussion
section each week. There will be a mid-term exam and a final exam.

The textbook for the course will be available in the bookstore:

Introduction to U.S. Health Policy 4th edition, by Donald Barr
(Johns Hopkins University Press 2016 ISBN: 9781421420721)
Grading for the course will be based on the following: Section participation 10%;
Mid-term exam 20%; Term paper 30%; Final exam 40%.

Given the recent health care reform process and the timing of the presidential election,
this should be an important opportunity to study U.S. health care. I look forward to
sharing the course with you.
 Learning Goals for this course

My hope is that by the end of the quarter, you will be able:

a) To distinguish between different ways of defining and measuring the quality and
performance of our health care system;
b) To explain how the historical and cultural background of the United States is
reflected in our system of health care, using the Canadian system as a comparison;
c) To describe the different levels of care provided in our health care system, and the
ways professional ethics and norms influence this care;
d) To discuss the historical development of health insurance in the U.S., and the
different models of health insurance that have developed in the last few decades;
e) To provide an analysis of the principal forms of publically funded health insurance
(Medicare, Medicaid, CHIP), how they affect the cost of care and access to care,
and how they have been changing;
f) To analyze the benefits and harms of the profit motive in health care, including the
impact of the profit motive on pharmaceutical policy;
g) To describe our system of long-term care and the potential challenges it faces;
h) To explain the ways social inequality affects health care access and quality;
i) To discuss the steps the Affordable Care Act included to address these issues, the
relative success of these steps to date, and future steps that may need to be taken to
further reform our health care system.
 Schedule of lectures and readings

Week 1 Sept 27, 29 Class introduction; The dilemma of American health care: Cost,
Quality, and Access to Care; the Affordable Care Act and the controversy surrounding it
Textbook Preface, Chapter 1, Chapter 2
Week 2 Oct 4, 6 Historical, cultural, and political perspectives on health care Comparing
the U.S. and Canadian systems of care
Textbook Chapter 3
Week 3 Oct 11, 13 The health professions and the organization of care Primary care;
specialty care; hospitals; medical education
Textbook Chapter 4
Week 4 Oct 18, 20 Health Maintenance Organizations and the Managed Care Revolution
Textbook Chapter 5
Week 5 Oct 25, 27 Medicare and the role of Accountable Care Organizations
Textbook Chapter 6
Week 6 Mid-Term Exam Tuesday November 1
November 3 Medicaid
Textbook Chapter 7
Week 7 Nov 8 CHIP health insurance for children from low income families
Nov 10 The uninsured Who are they, and how have they been affected by the ACA?
Textbook Chapter 11
Week 8 Nov 15 The Rise of For-Profit Care Can market based systems of care control costs
while maintaining quality?
Textbook Chapter 8
Nov 17 Pharmaceuticals and Pharmaceutical Policy
Textbook Chapter 9

Week 9 Nov 29 Long Term Care

Textbook Chapter 10
Dec 1 Health disparities and factors other than insurance that affect access to care
Textbook Chapter 12
Week 10 Dec 6, 8
Where do we go from here? What has the Affordable Care Act accomplished to date? Will
the Affordable Care Act solve the policy problems inherent in our system of care? If not,
why not? What else will need to be done in the future?
Textbook Chapter 13, Chapter 14