Course Syllabus

 

Health Delivery and Prioritization A, Spring 2017

DIS Copenhagen

 

Mondays and Thursdays, 8:30 – 9:50

Location: V10-D14, unless another time and/or place is mentioned

Type & Credits: Core Course - 3 credits

Study Tours: Western Denmark and Tallinn-Helsinki

Major Disciplines: Public Health, Pre-Medicine/Health Science, Public Policy

 

Instructors

	Louise Bagger Iversen M.Sc. and B.Sc. Public Health (University of Copenhagen, 2011/2007). Consultant in the Planning Department (Quality and Development, Region Sjælland, 2011-2014). Board member of the Danish Association for Public Health Science (2015-present). Assistant Program Director at DIS since 2014.
	Laura Toftegaard Pedersen M.Sc. and B.Sc. Public Health (University of Copenhagen, 2012/2008), Exchange student (University of California, Berkeley, 2010). Consultant (Danish Regions, 2012-2014). Senior consultant/team leader (Danish Regions, 2015-2016). Special advisor (Ministry of Health, 2016-present). With DIS since 2015.

Course description

Through this course students will gain insight into the organization and provision of healthcare in Northern Europe, and of the historical, social, economic, and political background of the current healthcare systems. Furthermore, the course provides an understanding of the priority-setting for public health policy, the relationship between stakeholders involved in policy making and provision of health services and an introduction to what determines health and health inequalities. Social and political dilemmas in the field of healthcare will be examined. 

In most countries, health and healthcare issues are high on the public and political, agenda. Most Western contemporary democracies face similar challenges; demographic changes leading to increased demand, unequal access to healthcare, high expectations to the performance of medical technologies and higher patient expectations -- all leading to challenges with containing healthcare expenditures while delivering high quality healthcare. Yet, different countries choose different approaches when organizing, financing, and providing healthcare. Throughout the course cases from Denmark and other Northern European countries will be applied.

 

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
• Analyze and compare 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
• Examine access to healthcare and discuss pros and cons of user payments in healthcare
• Analyze and discuss current trends in quality improvement, patient safety and patient involvement
  

 After successfully completing the Public Health Semester Project, students will be able to

• Develop an interview guide and conduct an interview with a stakeholder in the Danish healthcare sector
• 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 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. The factors influencing the final grade and the proportional importance of each factor is shown below:

Participation	15%
Midterm Test	20%
Study Tour Reflection Essay	10%
Semester Project (draft paper, final paper, poster)	30%
Final test	25%

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 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. Missing classes will be reflected in the participation grade – unless there is a valid reason.

Study tour participation
Before both study tours 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.

TUMBLR: During tours, you will upload a group post from CCW and a group post from long study tour to the TUMBLR account for the Public Health core course. More information is given during CCW orientation.

Study tour reflection essay
The 600 word reflection essay is a free written assignment based on your observations from the academic visits on short and long study tour. Please see grading rubric for further instructions.

Semester Project
In groups of 3-5 students you will be assigned a stakeholder within the Danish healthcare sector. You will interview the stakeholder to learn more about them, and to develop a research question for your project.

Assignments: First you hand in a draft of your paper. This paper will receive an “indicative” grade, but will not factor into the grade for the semester project. Based on constructive feedback from faculty you will revise and hand in a final version of your paper. You will finish the project by presenting the results of your work at a poster presentation by the end of the semester. Furthermore, as part of the group process, each student is required to hand in a peer- and self evaluation when handing in the draft and again when handing in the final paper.

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.

Midterm test and final test
The midterm and final test each consist of two short answer questions and one long answer question based on course material. The final test will only cover class material from the midterm and onward. No notes, books, internet etc. are allowed.

Please be aware that the tests will be typed, not hand-written, so please bring a computer.

 

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.

 

Academic Excellence Award

Each semester one student from the Public Health program may be recognized with an Award of Academic Excellence. It is reserved for an outstanding student who has distinguished her- or himself through diligence, commitment, academic performance, and who contributes to a good, collaborative learning environment in class.

 

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.
You must always notify your instructors 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 1 point off your final participation grade.

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.

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 test 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 Honesty: Plagiarism and Violating the Rules of an Assignment
DIS expects that students abide by the highest standards of intellectual honesty in all academic work. DIS assumes that all students do their own work and credit all work or thought taken from others. Academic dishonesty will result in a final course grade of “F” and can result in dismissal. The student’s home universities will be notified. DIS reserves the right to request that written student assignments be turned in electronic form for submission to plagiarism detection software. See the Academic Handbook on Canvas for more information, or ask your instructor if you have questions.

Disability and resource statement
Any student who has a need for accommodation based on the impact of a disability should contact the Office of Academic Support (acadsupp@dis.dk) to coordinate this.  In order to receive accommodations, students should inform the instructor of approved DIS accommodations within the first two weeks of classes.

 

Office Hours and Contacts
The instructors have no set office hours, but you may contact them or the program assistant, Victoria Stepanova, with any DIS questions or to schedule an appointment.

DIS Science & Health contact info
Victoria Stepanova, Science and Health Programs Assistant, vs@dis.dk, Tel: +45 3376 5428
Lisbeth Borbye, Director of Science & Health Programs, lbo@dis.dk
Science & Health Office: Vestergade 10-B12

 

Canvas

Canvas is a web-based system that allows you to access course resources and communicate with your classmates and faculty. To access Canvas, you can go to the DIS homepage and click the ‘Canvas’ link on the bottom of the website, or go to: https://canvas.disabroad.org/login/canvas. You can also download the Canvas App (By: Instructure) on iPhone and Android smart phones.

 

Readings (available on Canvas)

1. Accreditation and quality improvement in the Danish Hospital Sector.
2. Berwick D. (1989). Continuous quality improvement as an ideal in healthcare, N Engl J Med 320(1): 53-56.
3. Bogh S B, Falstie - Jensen A M, Bartels P, Hollnagel E, Johnsen S P (2015). Accreditation and improvement in process quality of care: a nationwide study.  Int J Quality Health Care, 27(5):336-343.
4. 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.
5. 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.
6. Diderichsen F, Andersen I, Manuel C, et al. (2012). Health inequality - determinants and policies. Scan J Pub Health 40 (8 Suppl):12-105.
7. Donaldson C, Gerard K (2005). Economics of Health Care Financing: The Visible Hand. Basingstoke: Palgrave Macmillan:15-52.
8. Esping-Andersen G (1990). The Three Worlds of Welfare Capitalism.  New Jersey: Princeton University Press: pp. 18-29.
9. Fosse E (2011). Health Promotion in Three Welfare States. Int J Health Services, 41(2):255–272.
10. 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.
11. 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.
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. 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.
15. Lai T, Habicht T, Kahur K, Reinap M, Kiivet R, van Ginneken, E (2013). Estonia: Health System Review. Health Systems in Transition, 15(6). Read: Executive Summary: xvii-xxiii.
16. Martin H M, Navne L E, Lipczak H (2013). Involvement of patients with cancer in patient safety: a qualitative study of current practices, potentials and barriers. BMJ Qual Saf, 22(10):836-42
17. Mehrotra A and Prochazka A. (2015). Improving Value in Health Care  - Against the Annual Physical. and Groll AH. (2015). Toward Trusting Therapeutic Relationships - I Favor of the Annual Physical. NEJM 373;16;1485-1489.
18. National Health Committee (2004). Prioritising Health Services. A Background Paper for the National Health Committee. 4-29.
19. NHS Health Check Expert Scientific and Clinical Advisory Panel (2014). Inter99 trial: a statement from the NHS Health Check Expert Scientific and Clinical Advisory Panel.
20. 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.
21. 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
22. 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.
23. Reason J (1995). Understanding adverse events: human factors. Quality in Health Care, 4:80-89.
24. 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
25. Vallgårda S (2008). Comparative studies. In: Vallgårda S, Koch L (eds.) (2008). Research methods in public health (1^st ed). Copenhagen: Munksgaard: 201-218.
26. Vuorenkoski L, Mladovsky P, Mossialos E (2008). Finland: Health System Review. Health Systems in Transition, 10(4). Read: Executive Summary: xv-xix.
27. Willems DL (2001). Balancing rationalities: Gatekeeping in health care. J. Med. Ethics, 27(1):25-29
28. Winblad U, Vrangbæk K, Östergren K (2010). Do the waiting-time guarantees in the Scandinavian countries empower patients? IJPSM 23(4):353-363.