1

COLLEGE OF HEALTH AND HUMAN SERVICES

California State University, Long Beach

Department of Health Care Administration

HCA 300 – The Health Care System

Fall 2015

Instructor: Jim Lott, PsyD, MBA

E-mail: James.Lott@csulb.edu

Phone: (213) 324-3262 Fax: (213) 947-1602

(OK to call 9 am – 9 pm 7 days/week)

Office: TBD

Office Hours: Before class, by appt only.

Section Number: 5 Class Number: 11138

Class Meets: Aug 25th

– Dec 15th

Day/ Time: Tuesdays, 7:00 – 9:45 p.m.

Classroom: SPA-210

Additional Contact Information:

HCA Program Administrative Coordinator:

Deby McGill, dmcgill@csulb.edu, HHS2-118

Tel. 562/985-5694; fax 562/985-5886

Course Description

Overview and developmental summary of the American health care system and its driving

forces: Organizational forms; financing mechanisms; principal industry stakeholders;

professional groups and workforce issues; public health and government (Lecture).

Letter grade only (A-F).

Course Learning Objectives

Students who have completed this course should be able to:

1. Describe the organization, administration and financing of the U.S. health care delivery

system and the principal state (California) and local (county) health care programs and

administering agencies.

2. Describe the types and interrelationships of health care facilities, services and personnel

3. Know the major historical events that shaped the U.S. health care system.

4. Obtain, analyze and synthesize information relevant to major contemporary U.S. health care

issues.

5. Demonstrate competencies both in writing and oral communication skills.

Learning Objectives, Domain, Competencies and Assessments

The Health Care Administration Department has adopted a competency-based curriculum, based

on the American College of Health Care Executives (ACHE) Competencies Assessment Tool

and the Healthcare Leadership Alliance (HLA) Competency Directory. As HCA 300 is one of

the first courses that students majoring in Health Care Administration take, the emphasis is on

acquiring competencies in HLA Domain 4, knowledge of the healthcare environment, and in

communicating effectively on major local and U.S health care issues.

2

The following table describes how the course learning objectives and related competencies could

be acquired and measured.

Learning

Objectives

Domain Competencies Activity (A1),

Assignment (A2) or

Assessment (A3)

1, 4, 5 Knowledge

of the Health

Care

Environment

Regulatory and administrative

environment in which the organization

functions (e.g., antitrust; Stark I and II;

accreditation; organized labor)

A1. Lecture & class

discussion

A2 & A3. Exam,

Research Paper

1, 4, 5 The interrelationships among access,

quality, cost, resource allocation,

accountability, and community

A1. Lecture & class

discussion

A2 & A3. Exam

2, 4, 5 Workforce issues

A1. Lecture & class

discussion

A2 & A3. Exam

1, 4, 5 Funding and payment mechanisms of the

healthcare system

A1. Lecture & class

discussion

A2 & A3. Exam,

Research Paper

2, 3 Governmental, regulatory, professional,

and accreditation agencies (e.g., CMS;

JCAHO; NCQA) related to healthcare

delivery

A1. Lecture & class

discussion

A2 & A3. Exam

1, 4, 5 Interaction and integration among

healthcare sectors

A1. Lecture & class

discussion

A2 & A3. Exam,

Research Paper

1, 4, 5 Legislative issues and advocacy

A1. Lecture & class

discussion

A2 & A3. Exam

1, 2, 4, 5 Organization and delivery of healthcare

(e.g., acute care, ambulatory care, medical

practice, ancillary services)

A1. Lecture & class

discussion

A2 & A3. Exam,

Research Paper

2, 3, 5 Socioeconomic environment in which the

organization functions

A1. Lecture & class

discussion

A2 & A3. Exam,

Research Paper

3

Required Text:

Niles, N.J. (2015), Basics of the U.S. Health Care System (2

nd ed.). Burlington, MA: Jones &

Bartlett Learning

American Psychological Association (2009). Publication manual of the American Psychological

Association (6th

ed.). Washington, DC: Author.

Recommended:

Yesalis, C.E., Holt, H.D. & Politzer, R.M. (2013). Fundamentals of U.S. Health Care. Clifton

Park, NJ: Delmar Cengage Learning.

Strunk, Jr., W., & White, E.B. (2008). The elements of style: 50th

anniversary edition. Upper

Saddle River, NJ: Pearson/ Longman.

Course lecture notes and additional readings will be available on BeachBoard. Lectures will

include additional information from instructor’s explanations and current events.

Other Requirements: E-mail address and Internet access to use the online BeachBoard course

software system. If you have problems with BeachBoard, contact the CSULB Technology Help

Desk at 562-985-4959, via e-mail at helpdesk@csulb.edu or in-person at the Horne Center.

Course Assignments:

Class Preparation, Participation and Attendance

The class format will be a limited lecture and interactive discussion of the assigned readings and

other relevant materials. You are expected to have read the assigned readings (text chapters

and web sites) before the class session, and to be prepared to discuss them. Lectures cover

highlights of the reading and supplementary information. If you have trouble understanding what

you read or hear, please ask for clarification in class or make an appointment with me to discuss

the problem area(s). Disabled students requiring special accommodations, please advise

instructor when you first attend class. Attendance policy conforms to University policy:

http://www.csulb.edu/divisions/aa/grad_undergrad/senate/documents/policy/2001/01/.

Research Paper (Written)

This assignment supports the following outcomes:

Describe the historical origins of the American healthcare system.

Outline the role of various healthcare delivery systems and the organizational structure of

these systems.

Discuss the financing of healthcare in the United States.

Analyze the social forces that influence healthcare today.

4

Research current policies and issues related to healthcare in the United States.

Defend your preferred way of organizing and financing healthcare.

Deliverable. Write a research page paper on all of the following topics:

1. Introduction to healthcare

Explain why healthcare delivery has evolved from the traditional family doctor

providing the majority of the care to a team of healthcare professionals across a

continuum of care.

Describe the three basic elements of the American healthcare system: provider,

government, and insurer.

Describe your personal interest in working in healthcare.

2. Professions in healthcare

Compare the roles of two different healthcare professionals.

As a healthcare manager, how do you see yourself interacting with one of these

professionals?

3. Where healthcare is provided

Describe two sectors where healthcare is administered (e.g. public health, private

physicians, group practices).

Compare the advantages and disadvantages of each sector.

As a consumer of healthcare, which sector do you prefer? Why?

4. Who pays for healthcare

Describe the origins of health insurance.

In your opinion, was it necessary to implement the managed care system?

5. How healthcare is regulated

Select one of the following healthcare topics: HIPAA, medical ethics, or technology.

Research and describe a healthcare policy enacted within the last 10 years.

6. Social forces that influence healthcare today

Select one of the following areas of healthcare: (a) the development of medical

techniques; (b) advances in medicine and pharmacology; (c) financing of the

healthcare industry; or (d) preparation and training of healthcare professionals. In

your opinion, what social forces are influencing this area of healthcare? What is the

impact?

7. How healthcare should be organized and financed

In your opinion, based on what you have learned thus far, what is the most effective

way of organizing and financing healthcare today?

5

Grading Criteria. Developing writing competence is an intensive process that includes

developing ideas and synthesizing source materials to support your thinking and reasoning on the

subject of your studies. Therefore, you will need to submit a research (term) paper. A rubric

will be provided.

Minimum/Maximum length = 3500/4500 words. That is a min/max of 10/13 type-written,

doubled-spaced pages, not counting cover/title pages, abstract or summary pages, reference

pages or any attachments or addendums. In addition, a minimum of 10 references from current

(2009 or later) sources in addition to the websites listed below. Failure to meet these

requirements will reduce your assignment value by 25 percent; that is, your earned score

for your final paper will be reduced by 25 points.

Use APA format consistently and correctly. Be sure to include a correctly formatted

title/cover page, but do not include dedications, keywords, abstracts or executive summaries.

Submit all deliverables through the BeachBoard DropBox. Turnitin is a plagiarism prevention

service available in BeachBoard. Students submit their papers electronically, and Turnitin

compares the text of those papers to the text in millions of other documents on the Internet, in

papers submitted by other students around the world, and in commercial databases of journal

articles and periodicals. Whenever similarities between the text in a student's paper and the text

in an existing document are found, Turnitin highlights those similarities, providing an annotated

document showing both the student's paper and the original source. The similarity index for

your papers should be less than 30%.

NOTE: In addition to uploading your research paper online, please bring a hard copy to class

for me on the dates due. Use a staple, but no fancy covers or binders needed.

Research Paper (Oral)

You will make an oral presentation of your research to the class during our Week 12 meeting

(November 10, 2015). Your presentation must be no less than 5 minutes but no greater than 10

minutes long. You may but are not required to deliver a PowerPoint presentation. A grade

rubric will be provided, but know that no greater than a “C” grade will be given if all or most of

your presentation is delivered from a script or notes read to the class. The key here is to know

and rehearse your material so that you present it with confidence and with minimum reliance on

your written notes.

Midterm and Final Exams

Most of the exam questions will be based on the textbook, supplemental readings and lectures

but exams may also include information from guest speaker and student presentations. Exams

will contain short-answer, fill-in-the-blank and multiple-choice questions. You may use your

hand-written and/or type-written notes (open-notes), but you may not use your text book or

pages copied and/or extracted from your text, and electronic devices may not be used.

Disabled students requiring special accommodations for exams, please advise instructor at the

beginning of the course.

6

APA Quiz

You will be given an open-book, open-notes quiz on your knowledge and comprehension of

APA requirements for writing college papers. No electronic devices may be used. This will be

given at the start of class in Week Five, and it will be worth 20 points, 5 percent of your course

grade. You will be required to provide short answers to the questions I ask.

Assignment Policies and Grading:

ALL assignments are due by the start of class on the dates specified. Late assignments lose

10% of points for each day past the deadline unless otherwise specified. NO ASSIGNMENTS

ACCEPTED AFTER LAST DAY OF CLASS. Exceptions will be made if and only if either a

verifiable death in your immediate family occurred or you were ill and provide me with

verifiable (need phone number) note from a physician on his or her office letterhead or

prescription pad. Otherwise, submit all assignments through Beachboard when due. This also

applies for missing our scheduled midterm or final exam. Disabled students, who qualify for

alternative testing arrangements, please advise the instructor at least 2 weeks prior to the exams.

NOTE: Please do not take this class if you already know or believe you are at high-risk for

having to miss class sessions or need to reschedule exam dates. I will not make allowances for

your competing priorities, and that includes job commitments. Make certain your employer is

able to commit to your course schedule.

Other Class Norms:

1. Attendance will be graded (see ICE assignments) for the class session where we are not

having a quiz, exam or student presentations. Please do not sign in for a classmate who is

either expected to come to class late or is absent. So doing qualifies as fraud and the

perpetrator will have his or her entire course grade reduced by 25 percent, meaning that if

you are an “A’ student, the highest grade you will receive for the course is a “C” grade.

Repeat occurrences will result in the perpetrator receiving an “F” grade and referral to

University officials for further disciplinary action.

2. Cheating and Plagiarism. Please be aware of and ensure that your behavior conforms to

University Policy. See

http://www.csulb.edu/divisions/aa/grad_undergrad/senate/documents/policy/2008/02/

3. Withdrawal policy. Per University policy:

http://www.csulb.edu/divisions/aa/grad_undergrad/senate/documents/policy/2002/02/.

Withdrawal after 2nd

week and before final 3 weeks “permissible for serious and

compelling reasons;” instructor will evaluate student withdrawal requests on a case by

case basis.

7

4. Key Class Norm: You must put away and not use your cell phone, smartphone, tablet

computer, laptop or any other electronic device during class meetings, except when you

are giving a presentation or if you require special accommodations with authorization

from the university. Please do not ask for an exception.

5. Please check and make certain that your email address is correct on BeachBoard, and

know that I will respond to all emails I receive within 24 hours of your having sent them.

Therefore, it would be correct for you to assume that I did not receive your

communication if you have not received a response from me within that timeframe. So,

please follow-up by calling me directly at (213) 324-3262; do not send another email. If

you receive my voicemail, slowly input your name, repeat your phone number twice,

and leave a good time for me to return your call.

Course Grades:

Assignment Due date Points Percent

APA Quiz Week 5 20 05

Research (Term) Paper (Written)

Research (Term) Paper (Oral)

Week 14

Week 12

100

40

25

10

In-Class Exercises (ICE) (10 @ 8 points each) Ongoing 80 20

Midterm Exam Week 8 80 20

Final Exam Week 17 80 20

Total 400 100

Final Course Grade Computation:

360+ = A 320-359 = B 280-319 = C 240-279 = D <240 = F

Commitment to Inclusion: California State University, Long Beach is committed to maintaining an inclusive learning community that values diversity and fosters mutual respect. All students have the right to participate fully in university programs and activities free from discrimination, harassment, sexual violence, and retaliation. Students who believe they have been subjected to discrimination, harassment, sexual violence, or retaliation on the basis of a protected status such as age, disability, gender, gender identity/expression, sexual orientation, race, color, ethnicity, religion, national origin, veteran/veteran status or any other status protected by law, should contact the Office of Equity and Diversity at (562) 985-8256, University Student Union (USU) Suite 301, http://www.csulb.edu/depts/oed.

8

CLASS TOPIC AND ASSIGNMENT SCHEDULE

Week # -

Date

Topic/Activity Text, Reading

Assignments1

Tasks, Deliverable(s)

1 Aug 25 Course Overview; Introductions; APA

Presentation

Handouts

2 Sept 01 History of the U.S. Healthcare System;

County Profile Paper (Term Paper); Film

Chapter 01

3 Sept 08 The Affordable Care Act Review

Chapter 02 ICE #01

4 Sept 15 Organization of Health Services

Chapter 03 ICE #02

5 Sept 22 Government’s Role in U.S. Healthcare Chapter 04 APA Quiz 6 Sept 29 Public Health

Chapter 05 ICE #03

7 Oct 06 Inpatient & Outpatient Services

Chapter 06 ICE #04

8 Oct 13 Midterm Exam

Chps. 1-6; Weeks 1-7

9 Oct 20 U.S. Healthcare Workforce

Chapter 07 ICE #05

10 Oct 27 Healthcare Financing

Chapter 08 ICE #06

11 Nov 03 Managed Care

Chapter 09 ICE #07

12 Nov 10 Healthcare Information Technology Chapter 10 Oral Presentations

13 Nov 17 Healthcare Law & Ethics

Chapters 11& 12 ICE #08

Nov 24 Thanksgiving Holiday Break Enjoy! 14 Dec 01 Mental Health Services

Chapter 13

Research (Term)

Paper Due;

ICE #09 15 Dec 08 Health Policy; Course Recap

Handouts ICE #10

Dec 15 Final Exam Chps 07-13; Weeks 9-

16

1 In addition to the text chapter(s) and articles, review the websites for each topic listed in the bibliography.

9

Pertinent Web Sites. Just a few of many web sites with information pertinent to this

course, by topic:

Topic Web Sites

Health policy (national) Department of Health and Human Services: www.hhs.gov/

Healthcare.gov: www.healthcare.gov/index.html

Medicare: www.medicare.gov

Office of Consumer Information and Insurance Oversight:

www.hhs.gov/ociio/index.html

Academy for Health Services Research & Health Policy: www.academyhealth.org/

Health Reform GPS: Navigating Implementation: http://www.healthreformgps.org/

Health policy (California) California HealthCare Foundation: www.chcf.org

Insure The Uninsured Project: www.itup.org

Health Access: health-access.org/

Public Policy Institute of CA: www.ppic.org

California Health Reform Implementation: http://www.healthcare.ca.gov/.

Health Consumer Alliance: http://healthconsumer.org Information resources National Library of Medicine: www.nlm.nih.gov

Virtual reference style manuals: www.csulb.edu/library/eref/vref/style.html

APA electronic citations: www.apastyle.org/apa-style-help.aspx. Health policy formation, agenda setting Robert Wood Johnson Foundation: www.rwjf.org

The Urban Institute: www.urban.org; Families USA: www.familiesusa.org

Center for Health Care Strategies: www.chcs.org

Center for Studying Health System Change: www.hschange.com

Policy implementation & modification National Academy for State Health Policy: www.nashp.org

UCLA Center for Health Policy Research: www.healthpolicy.ucla.edu

California HealthCare Foundation: www.chcf.org

Kaiser Family Foundation: www.kff.org; Rand Corporation: www.rand.org

Mathematica Policy Research: www.mathematica-mpr.com/ The Commonwealth Fund: www.commonwealthfund.org/Health-Reform.aspx

Financing health services Center for Medicare & Medicaid Services: www.cms.gov

Center on Budget & Policy Priorities: www.cbpp.org

CA Legislative Analyst's Office: www.lao.ca.gov

Healthcare Financial Management Assn: www.hfma.org

Managed care, insurance & benefits Employee Benefits Research Institute: www.ebri.org

America’s Health Insurance Plans: www.ahip.org

CA Assn. Of Health Plans: www.calhealthplans.com

CA Dept. of Managed Health Care: www.dmhc.ca.gov

CA Office of the Patient Advocate: www.opa.ca.gov/index.aspx

National Governors Association: www.nga.org/

National Association of Insurance Commissioners: www.naic.org/

Ambulatory health services

American Academy of Urgent Care Medicine: www.aaumc.com

National Association for Ambulatory Care: http://www.urgentcare.org/

Medical Group Management Association: www.mgma.com

Hospitals & health systems American Hospital Assn.: www.aha.org;

Blue Cross/Blue Shield Assn.: www.bluecares.com

Association for Community Health Improvement:

http://www.communityhlth.org/communityhlth_app/index.jsp

Long Term Care; Politics of Aging &

Disability American Association of Retired Persons: www.aarp.org

10

Topic Web Sites

Disability Rights Education & Defense Fund: www.dredf.org

Mental health

National Institute of Mental Health: www.nimh.nih.gov

Bazelon Center for MH Law: www.bazelon.org

Medline Plus: www.nlm.nih.gov/medlineplus/mentalhealth.html

Pharmaceuticals Pharmaceutical Research & Manufacturers of America: www.phrma.org

American Society of Health-System Pharmacists: www.ashp.org/

Public health Centers for Disease Control & Prevention: www.cdc.gov

American Public Health Association: www.apha.org

Health professionals Am. Medical Assn.: www.ama-assn.org; Am. Nurses Assn. www.ana.org

Am. Academy of Physician Assistants: www.aapa.org

Am. Pharmaceutical Assn.: www.pharmacist.com Quality of care Institute of Medicine: www.iom.edu

National Committee for Quality Assurance: www.ncqa.org

Joint Commission (accreditation): www.jointcommission.org

California Healthcare Foundation Quality Initiative: www.chcf.org

Robert Wood Johnson Foundation: National Quality Directory:

http://www.rwjf.org/qualityequality/product.jsp?id=71857 Ethical issues Alliance for Health Reform: www.allhealth.org

Hastings Center: www.thehastingscenter.org

Bibliography (updated July 2012)

Books and Articles: Burke, S. (2011, June). The U.S. Congress and Health Policy. Retrieved from: http://www.kaiseredu.org/Tutorials-

and-Presentations/US-Congress-and-Health-Policy.aspx.

Campbell, C.G. & Zinner, D.E. (2010). Disclosing industry relationships - toward an improved federal research

policy. New England Journal of Medicine, 363, 604-606. DOI: 10.1056/NEJMp1006973

Craig, R.L., Felix, H.C., Walker, J. F., & Phillips, M. M. (2010). Public health professionals as policy entrepreneurs:

Arkansas’ childhood obesity experience. American Journal of Public Health, 100, 2047-2052. DOI:

10.2105/AJPH.2009.183939

Donabedian, A. (2003). An introduction to quality assurance in healthcare. Cary, NC: Oxford University Press.

(Classic)

Gawande, A. (2009, 1 June). The cost conundrum: What a Texas town can teach us about health care. The New

Yorker. Retrieved from: gawande.com/articles.

Hollingsworth, J.M., Ye, Z., Strope, S.A., Krein, S.L., Hollenbeck, A.T., & Hollenbeck, B.K. (2010). Physician

ownership of ambulatory surgery centers linked to higher volume of surgeries. Health Affairs, 29, 683-689.

Hsu, R.Y., Kellerman, A.L., & Shen, Y. (2011). Factors associated with closures of emergency departments in the

United States. Journal of the American Medical Association, 305, 1978-1985.

Illich, I. (1975). Medical Nemesis: The expropriation of health. New York: Pantheon. (Classic)

11

Joynt, K.E., Orav, E.J., & Jha, A.K. (2011). Thirty-day readmission rates for Medicare beneficiaries by race and site

of care. Journal of the American Medical Association, 305, 675-681.

Kaye, H.S., Harrington, C. & LaPlante, M.P. (2010). Long-term care: Who gets it, who provides it, who pays and

how much? Health Affairs, 29, 11-21. DOI: 10/13777/hlthaff.2009.0535.

Kongstvedt, P. (2009). Managed care: What it is and how it works. Sudbury, MA: Jones & Bartlett.

Long, P. & Gruber, J. (2011). Projecting the impact of the Affordable Care Act on California. Health Affairs, 30, 63-

70. doi:10.1377/hlthaff.2010.0961

Metzl, J.M. (2010). The protest psychosis: How schizophrenia became a black disease. Boston: Beacon Press.

Meyer, H. (2011). Coding complexity: U.S. health care gets ready for the coming of ICD-10. Health Affairs, 30,

968-974. DOI: 10/13777/hlthaff.2011.0319.

Neumann, P.J. (2005). Using cost-effectiveness analysis to improve health care: Opportunities and barriers. New

York: Oxford University Press.

Picard, A. (2008). The making of the American mouth: Dentists and public health in the twentieth century.

Piscataway, NJ: Rutgers University Press.

Pipes, S. (2011). The truth about Obamacare. Washington, DC: Regnery Press.

Saranson-Kahn, J. (2011, November). Primary care, everywhere: Connecting the dots across the emerging health

landscape. Oakland, CA: California HealthCare Foundation. Retrieved from:

http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/P/PDF%20PrimaryCareEverywhere.p

df.

Sisko, A.M., Truffer, C.J, Keehan, S.P., Poisal, J.A, Clemens, M.K. & Madison, A.J. (2010). National health

spending projections: The estimated impact of reform through 2019. Health Affairs, 29, 1933-1941. DOI:

10/13777/hlthaff.201.0788.

Starr, P (2011). Remedy and reaction: The peculiar American struggle over health care reform. New Haven: Yale

University Press.

Warnock, M. & MacDonald, E. (2008). Easeful death: Is there a case for assisted dying? New York: Oxford

University Press.

Wilson, K.B. (2011, May). Health Care Costs 101, 2011 Edition. California HealthCare Foundation. Retrieved

from: http://www.chcf.org/publications/2011/05/health-care-costs-101.

12

Journals: Most available online through COAST e-journal collections:

http://coast.library.csulb.edu/.

American Journal of Managed Care American Journal of Medical Quality

American Journal of Public Health Business and Health

Harvard Business Review Cambridge Quarterly of Healthcare Ethics

Evaluation and the Health Professions Health Education & Behavior

Health Affairs Health Care Financing Review

Health Policy Health Services Research

Health Technology Trends Inquiry

International Journal of Health Services J of the American Medical Assn. (JAMA)

J of Behavioral Health Svcs. & Research J of Health Services Research & Policy

Journal of Community Health Journal of Health and Social Behavior

Journal of Health, Politics, Policy and Law Medical Care Research & Review

Medicine and Health Milbank Memorial Fund Quarterly

New England Journal of Medicine Qualitative Health Research

Journal of Health Care Finance Family & Community Health

Frontiers of Health Services Management Hospital & Health Services Administration

Journal of Ambulatory Care Management J of Health Care for the Poor & Underserved

Public Health Reports Journal of Public Health Policy

Modern Healthcare2 J of the American Geriatric Society

Hospitals & Health Networks

2 Free student subscription available at: http://www.aupha.org/i4a/forms/form.cfm?id=51&pageid=3829&showTitle=1