TAS210 Transatlantic Health Care Systems: Structure, History, Future Trends

Teacher responsible:

Brief course description:

The United States and each European country has taken its own unique path to health insurance coverage of its citizens. The United States has just passed legislation to bring universal coverage—which all European countries have had for decades. But actual healthcare coverage varies everywere, based on resources, capabilities, etc. Healthcare access, quality, and cost are the three issues that define most health policy issues.
Healthcare coverage has to be seen in historical context. This will be explored for the USA, several Western European countries (UK, Germany, France, etc) and Eastern Europe (represented by Poland).


Students will be introduced to comparative healthcare system analysis.  A brief history of progress in medicine and healthcare's role in society will lead into analysis of healthcare systems in the United States, Western Europe, including the United Kingdom, and Eastern Europe, represented by Poland. Differences in payments and coverage by country will be examined. Major issues in the future of healthcare design and delivery will be reviewed, with students examining these issues in depth in their final written essay.


I. Introduction and Overview

Current healthcare systems can only be seen within the history of medicine and public health, which have seen extraordinary advances in the past two hundred years specifically and in each decade since World War II. Definitions of morbidity and mortality and the major determinants of health are the basic terminology of health policy and healthcare systems can only be seen within the context of these definitions of health.The overview of the course will lay this information into the structure of healthcare systems themselves, using the students' experiences as anchoring points.
History of Medicine and Public Health

II. International Comparisons

III. Structure of Healthcare Systems
The United States has an entrepreneurial based system, based upon employer based insurance, coupled with government insurance for the elderly, the disabled, and the poor. Almost 50 million Americans currently are not covered by health insurance. President Obama's health reform act will increase coverage immensely. European countries have close to universal health coverage, paid through a variety of tax and employer contributions.

IV. Country Health Systems

V. Major Issues in Health Policy

Reading list:

International Profiles of Health Care Systems, The Commonwealth Fund, 2010.
Paul Starr, The Social Transformation of American Medicine, Basic Books, 1982
NHS London, A Framework for Action, London, 2007
Alison Talbot-Smith & Allyson M. Pollock, The New NHS: A Guide, 2007, Jessica Kingsley Publishers.
Kasturi Sen, editor, Restructuring Health Services, Changing Contexts & Comparative Perspectives, Zed Books, 2003.
Susan Dentzer, Lessons on Health Reform from across the Waves, Health Affairs, August 2010, Vol 29, Issue 8, p. 1428-xxx. (note: Spain)
Fidler, Armin, Innovations in Health Services delivery From Transitional Economies in Eastern Europe and Central Asia, Health Affairs, Jul/Aug 2009, vol 28, Issue 4, p. 1011-1021.
Rechel, Bernd and McKee, Martin, Health reform in central and eastern Europe and the former Soviet Union, Lancet, 10/3/2009, Vol 374, Issue 9696, p1186-1195, 10p.
Maarse, Hans, The privatization of healthcare in Europe: An 8 country Analysis, Journal of Health Politics, Policy & Law, Oct 2006, Vol 31, Issue 5, p.981-1014, 34p.
Grandos, Jose. A. Tapia, Politics and health in eight European countries: A Comparative study of mortality decline under social democracies and right wring governments, Social Science and Medicine, Sep 2010, Vol 71, Issue 5, p.841-850.
Mark A. Rodwin, Conflicts of Interest and The Future of Medicine, The United States, France and Japan (Oxford University Press USA), March 2011 (est.)
Richard Wilkinson and Kate Pickett, The Spirit Level: Why More Equal Societies Almost always do Better, Allen Lane, 2009.
G. F. Anderson and d. A. Squires, Measuring the U.S. Health Care System: A Cross-National comparison, The Commonwealth Fund, June 2010. (multiple downloads)
Paul Krugman, Wilie Sutton Wept, The New York Times, February 17, 2011. (budget issues are: "health care, health care, health care, revenue")
Polish Health Services, Warsaw Voice, June 15, 2005
Nathalie Girouard and Yutaka Imai, The Health Care System in Poland, Economics Department working Papers No. 257, OECD, Sep 2000.
Krzysztof Kuszewski and Christian Gericke, Health Systems in Transition: Poland, The European Observatory on Health Systems and Policies, 2005