OVERVIEW

This seminar addresses current issues in health policy with special emphasis on health issues and policies affecting poor and disadvantaged people, and introducing the critical analysis of health problems, health care, and mental health. The primary focus is on the nature of health problems, current governmental policies/ provisions/ regulations, planning processes, policy analysis, and assessment of service delivery.

Topics covered include: epidemiology of specific diseases and conditions, prevention, health promotion, accessibility, cost, and systems of service delivery. Specific attention is given to the health effects of discrimination and stigmatization on vulnerable populations, especially people of color, immigrant populations, the elderly, and people with long term disabling physical and mental illnesses and conditions.

Our discussions will explore the following questions:

• How do underlying American values shape our national and policy choices and patterns of service delivery?
• How do public and private financing systems affect delivery of health and mental health services?
• How are poor and disadvantaged populations excluded from the "American Opportunity State" because of their health deficits?
• How do inequality of access and lack of holistic and social approaches to health care further disadvantage certain populations?
• How are promises of "opportunity" and civil rights played off against lack of economic rights and social protections?
• What are the implications of the rapid growth of managed care organizations (MCOs)?
• What are some promising service delivery possibilities of current interest to policy makers?

OBJECTIVES

1. To provide an understanding of the provisions for health in the American social welfare system, its policies and services, particularly those of the public sector and its contractual arrangements.
2. To introduce students to the many components of the policy making process which shape health care and services, planning and delivery, preparing them to influence policy.
3. To develop analytic skills to critically evaluate how problems are defined, solutions are proposed, and programs are designed in the health and mental health field.
4. To assess particular health problems at a societal or population level, with particular attention to the economically disadvantaged, people of color, immigrants, the elderly and people with long term care needs.
5. To critically evaluate health care programs and proposals in ways useful to real policy makers and practitioners.
6. To explore the implications of the rapid corporatization occurring in health care delivery by examining the many forms of managed care.

REQUIRED TEXTS containing key required readings:

Lee, Phillip & Carroll Estes. 1994. The Nation's Health, 5th Ed. Boston: Jones & Bartlett Publishers.

Laurie Abraham. 1993. Mama might be better off dead: The failure of health care in urban America. University of Chicago Press.

Other readings will be handed out in class. Some documents may be on Reserve at Golda Meier Library.

COURSE FORMAT, REQUIREMENTS & EXPECTATIONS

As a graduate seminar, each session will usually include a lecture by the instructor and presentation of assigned readings by students. As time allows, students will report briefly on their own research and analyses of current health policy developments.

Expectations will be greater for the 3 credit students in terms of the number of analytic research papers, current events articles, and in class presentations; other expectations will be the same for both 2 and 3 credit students.

READINGS

All students are expected to prepare for and participate regularly in class discussion. (Absenses will be noted and may affect your grade.) Reading assignments are substantial, but the presentation of assigned readings and discussion of current events (an integral part of each class session) will be used to clarify, raise questions and critique these issues. Read the articles; any student may be called upon to comment on the assigned readings for a given session. This may be challenging to some students, so if the reading gets to be too onerous, we will jointly agree on how to divide it up or reduce it. (Please be prepared to speak up on your own behalf.)

Discussion of each assigned reading from the Lee & Estes text will be guided by two students who will briefly present its highlights and pose one or two questions for discussion. The presentation should aim to link this content to other relevant readings for that topic or current events. Each student will present at least one assigned reading for class discussion.

Students are expected to

• Digest as well as ingest the readings (reading ahead will allow you time to do this),
• Critically evaluate the author's viewpoint,
• Connect the readings to observations of real practice (ala media or your experience),
• and Become thoughtful observers of popular media representations of health care and mental health (see below).

FOLLOWING CURRENT EVENTS

Students are encouraged to follow and bring to class news items and agency bulletins about

current policy issues at the federal, state and local levels. Special attention will be given to local developments in health care, local corporations, implementation of W2, GAMP, "Badger Care," COP and Family Care, and other health care issues or controversies in your own county.

All students will write a brief critical essay on one current news item (2 credit students attach one news article; 3 credit students attach at least 2 articles). Your critical analysis must draw on one or two of our required readings, citing principles, and commenting on what you believe this "story" is "really about."

This analysis is due on or before Dec. 7.

ASSIGNMENTS

In addition to regular participation in class discussion and the current events analysis (noted above), all students will lead a discussion of at least one assigned reading and complete an analysis of a specific health or mental health problem (8 -10 pages each). In addition, three credit students will complete a 6-8 page program analysis and present two additional readings. (Examples of papers from previous classes are available from the instructor.)

The health problem analysis may be done individually or as a group; individuals/groups may present their analyses to the class. It should demonstrate the student's ability to identify and define a significant health problem in society, research and synthesize appropriate current theoretical and empirical research literature, conduct a cursory analysis of data, and consider possible directions for the resolution of this health problem, including typical protocols for prevention, treatment, and care.

Written assignments are due in class on the due date. The instructor will return them promptly and provide you with feedback; rewrites are allowable within two class periods, but only for papers initially submitted on time. The current events analysis may be submitted at any point during the semester before December 7.

EVALUATION

of two credit students:

of three credit students:

Organization of the Sessions

I. Introduction, Purposes & Background Regarding Study of Health Policies (1,2)

II. American Social Protection Against Illness: Provisions, Insurance & Inequities (3,4,5)

III. The Currently Competitive Environment/Delivery System (6, 7, 8, 9)

#1 HealthProblem Analysis due Session 7, Oct. 19.

IV. Looming Issues: Mental Health, LTC, Consumer Empowerment, Ethics (10, 11, 12, 13)

Current Events analyses due on or before Dec. 7.

V. Evaluating Policies (14, 15)

#2 Program Analysis due Dec. 21

Policy letter due Dec. 21.

TOPICS and schedule of readings

Readings should be prepared in advance of the class discussion on which assigned.

Readings listed BOLD are required; those marked • are supplemental and recommended. HO: Handout from Instructor.

I. Introduction, Purpose & Background for Policies (1-2)

1. Sept. 7. Social Policy: The Framework for the Course

Definitions, Structures, Logic and Societal Values
How do American's view the role of their Government?
Our Framework:

The Historical View: The Common Good vs. Commodification
The Insider's View: Anthropological Perspective
The Policy View: Structures and Criteria

Access
Cost
Quality
Efficiency and Appropriateness

Marmor. American "crisis" of the welfare state, pp 164-172 in Lee & Estes 3rd Ed.

Marmor, T., Mashaw, J. & Harvey, P. America's Misunderstood Welfare State: Ch. 1.
SW Policy under siege, Ch. 2.
The opportunity/insurance state, pp. 1-52.

Friedman, Milton. Capitalism and Freedom. Chpt 1 The Relation Between Economic and Political Freedom and Chpt 2 Role of Government in a Free Society.

Gilbert, Neil & Specht, Harry. Dimensions of Social Welfare Policy. Prentice-Hall, Inc. pp. 1-53.

HO. Keigher. 1995. Naive, not stupid, Health & Social Work, 20 (1).

2. Sept. 14. Health Status & Its Determinants; Poverty and the Health Care System

Abraham, pp. 1-43. Intro, Ch 1. The Banes Family and Their Neighborhood , and Ch. 2. Rigors of kidney dialysis for Robert Banes.

Lee & Estes. Ch. 1 Health & Health Care: Its Determinants & Inequalities, pp 1-40
McKeown. Determinants of Health Care, 9-17.
Adler et al. Inequalities , 8-31.
Navarro. Race/Class Mortality Differentials, 32-36

Ch 2. McGinnis & Lee. Healthy People 2000, 38-52.

Lee & Estes. Ch. 3. Foundations and Future of Public Health, 56-66

Ch 4. Policy Issues: Behavior, Environment & Human Biology, 68-75.
Thacker et al. Environmental Health, 137-146.
Hubbard & Lewontin, Genetic Testing, 147-151.

Discuss Assignment 1: Health Problem Analysis (Due Oct. 19)

II. Social Protection Against Illness: the American System of Provision, Insurance, and Inequity (3-5)

3. Sept. 21. Social Protection Against Illness: Government Provisions

HO: Social Security Around the World
HO: USDHS, SSA. Social Security Programs in the United States (Federal)

Abraham. Ch. 3. The gaps in Mrs. Jackson's insurance, 44-59.
• Marmor, Mashaw & Harvey. Ch. 6. Misunderstanding Medical Care, pp.175-212.

4. Sept. 28. Social Protection Against Illness: Health Insurance & Managed Care

The Milwaukee Medical Marketplace.

Who's Covered, Who's Not?

HO. Keigher. Managed Care. H& SW
Lee & Estes Ch 8. Intro, 274-282, and 9 Managed Care, 324-325.
Enthoven & Kronick, Incentive Reform, 326-333.
Immershein & Estes. Medicaid Markets, 358-375.

5. Oct. 5. Inequities in Access to Health Care

The un- and under-insured, uncompensated care and charity care, and racism.
Children's health, maternal health and poverty. Older women's health issues, homelessness, outreach, community clinics, special programs: what works?
The ER, Mental Health, Primary Care

Abraham, pp. 60-110. Ch 4. Mrs Jackson's fitful primary care; Ch 5. Mrs. Jackson's Melancholia; Ch. 6. The Inner City Emergency Room

Lee & Estes (4th Ed) S.M. Miller in Lee & Estes, Racism in the health of America, pp. 359-372.

Lee & Estes. Ch. 10, Quality and Access
Davis. Coverage of the Uninsured, 406-410
Luft. Managed Competition, 334-348.
Rother. Consumer Protection, 349-357.

III. The Current Competitive Environment/Delivery System (6-9)

6. Oct. 12. Health Care Politics and Policy.

Agenda setting processes; Role of the media
The medicalization of health problems
The Congress and its objectives.

1992 Clinton's Health Care Reform Proposal

1994

Abraham Ch. 7. One hospital's story, 111-133;

Lee & Estes. Ch 6, Health Care Politics and Policy, 196-236.
Estes. Privatization, 199-209.
Nestle. Food Lobbies, 210-222.
Glantz. Preventing Tobacco Use, 223-228.
Estes & Linkins. Long Term Care, 229-236.

7. Oct. 19. Federal Health Care Reform and the States

1996: Kennedy-Kassebaum, & welfare block grants

State Medicaid choices, experimentation &Managed Care initiatives

The NGA Proposals to Block Grant Medicaid

Wisconsin's Policies: W2, Badger Care, GAMP

Abraham Ch. Ch. 8. Who is responsible for Tommy Markham's health? 134-145;
Ch. 9 Jackie Bane's "patient"-an example of Catch 22's in caregiving, 146-166.

Lee & Estes. 8, Health Care Reform
Donelon, et al. Health Insurance Crisis? 283-291.
Kaiser, Medicaid & LTC, 308-

HO: Keigher. Reform: Our greatest opportunity yet!
HO: Keigher. The hole in the sweater

Due: Assignment #1 Health Problem Analysis

8. Oct. 26. Medicare Reform Proposals: Implications for Equity, Barriers to Reform

Prospects for a Clinton success . . an in class debate.
What's at stake? What role for government?
Who shall finance long term care????? . . . .

Lee & Estes: Moon & Davis. Medicare, 292-307.

HO: Medical Savings Accounts

9. Nov. 2. Interorganizational and Interprofessional Challenges: Collaboration, Competition, and the Impacts of Managed Care.

Hospital downsizing
The changing roles of nurses, social workers, ancillary health professionals
Where is Prevention and Public Health in all this?
How widely used are Outcomes Measures in practice, evaluation, and documentation?

Lee & Estes. 381-405
Brook et al. System Reform & Quality, 381-
Sackett et al. Evidence Based Medicine, 395-
Wennberg. Small Area Variation, 399-405.

Abraham Ch 10, 12. Ch 10. Preventive care for children, 167-178; Ch 12. Fear of white doctors, 198-212.

IV. Looming Issues (10-13)

10. Nov. 9. Mental Health Issues: Chronic Mental Illness, and Behavioral Health Care in Medical Primary Care

A continuum of mental health services for prevention, tertiary and primary care, and life long care. A seamless web? Mental health and the Kennedy Kassebaum bill. . .

• HO. Rose & Keigher. Managed care and Mental health, Health & Social Work
• HO. Anderson & Berlant, Managed MH and Substance Abuse Services, Ch 14 of Kongsvedt, Essentials of Managed Health Care.
• HO. Boyle & Callahan. Managed Care in MH: The Ethical Issues, Health Affairs, Fall 1995, pp. 7-22.
• HO. Exec Sum. Master Plan for Mental Health Services in Milwaukee County (December 1993)

Abraham, Ch 6. The Emergency Room

Policy Letter assignment distributed. Due on Dec. 21

11. Nov. 16. "Consumer" Empowerment & Community Care: Social Integration of Persons with Disabilities, Chronic Illness, & Needs for "Institutional" Care

Are there philosophical approaches that entitle users to care, yet respect choice?
Dilemmas among market approaches and capped public budgets.

Smith & Eggleston. Medical vs. Social Care
HO. Keigher & Stone. Family care in America: Evolution and evaluation.
HO. Keigher. Health care reform and LTC: uneasy political partners, H&SW,
Barnes, M. Communities, Care, and Citizens.

Nov. 23. NO CLASS

12. Nov. 30. Preparing for an Aging Society: International Year of Older Person, Caregiving, Long Term Care and Gender Equity, and Institutional Interests.

Societal aging and the incidence, prevalence of acute and chronic illness
Projections regarding needs for LTC, services
Government initiatives:

The Pepper Commission

OBRA 1987

Nursing home reimbursement fomuli and issues: T19, SSI, MN

Clinton's LTC proposal of 1993; Medicare and pharmaceutical reform.

What future for caregiving in a stressed, fully employed society?

Abraham. Ch. 9 Jackie Bane's patient, 146-166.
Lee & Estes (4th Ed.) LTC Insurance, p. 350-358.
HO. Osterbusch & Keigher. Community care and gender justice
Lee & Estes. Estes & Close. Public Policy and LTC, 177-191.

13. Dec. 7. Ethics, Quality Assurance, Appropriateness, and Care in the Home

Video: Who lives, who dies? vs. The right to die
NASW video on Ethics or other recent video on Ethics of Managed Care.
Presentation on Legal Cases on Managed care?

Abraham. pp. 179-231, Ch 11. Robert Banes plays the transplant game, Ch 12. The Banes family and white doctors, Ch 13. Life sustaining technology.

L & S, Ethics and Managed Care

Current Events Analysis Due.

V. Evaluating Policies

14. Dec. 14. Evaluating Current Intervention Programs: How Effective Are They?

Presentations of students' program/policy analysis papers. Classmates will provide feedback, questions. Authors have until next class to polish up & submit papers.

Abraham. Ch. 14. Amazing Grace and Epilogue, pp 232-260.

15. Dec. 21. Reflections on American Health Care: Access, Cost, Quality, & Efficiency +
Appropriateness, Adequacy, Equity.

Discussion building on presentations of student program analyses last week will consider the impacts of current health programming. How adequately is society served, given our needs? What prospects for new problems, new diseases? What impacts of further privatization? Prospects for socialization of care?

• Global changes affecting health in the future
• Impacts of material inequality on health.
• Biomedical research
• A role for social work?

Due: Assignment #2. Program Analysis Paper

Policy Letter

SELECTED BIBLIOGRAPHY

Abel, E. & Nelson. Circles of Care: Women, Work and Caring.

Califano, Joseph, Jr. (1986). America's Health Care Revolution: Who Lives? Who Dies? Who Pays? NY: Random House. Califano's "prescription" addressing the needs of corporate America, focusing specifically on the case of Chrysler Motors.

Callahan, Jas. & Wallack, Stanley. (1981). Reforming the Health Care System. University Health Policy Consortium. DC Heath & Co.

Consumers Reports. (1992). The Health Care Crisis: Affordable Protection for All Americans. Consumers Union

DeVault, ML (1991). Feeding the Family: The Social Organization of "Caring" as Gendered Work. U of Chicago Press.

Deacon, Bob. (1997) Global Social Policies: International Organizations and the Future of Welfare. London: Sage.

Diamond, Tim. (1992). Making Gray Gold: Narratives of Nursing Home Care. University of Chicago Press.

Encyclopedia of Social Work., 19th Ed. (1995). NASW, Washington, DC.

Estes, C., Jas. Swan & Assoc. (1993). The Long Term Care Crisis: Elders Trapped in the No -Care Zone. Sage.

Finch, J & Groves, D. (1983). A Labour of Love: Women, Work and Caring. Boston: Routledge & Kegan Paul.

Friedman, Milton. Capitalism and Freedom.

Friedman, Milton & Rose Friedman. Free to Choose. Chpt 4. "Crade to Grave" and Chpt 8 "Who Protects the Worker."

Friere, Paulo. Pedagogy of the Oppressed, trans. Myra Bergman Ramos (NY: Continuum, 1990.

Germain, Carel. (1984). Social Work Practice in Health Care: An Ecological Perspective. New York: The Free Press.

Gilbert, Neil & Specht, Harry. Dimensions of Social Welfare Policy. Prentice-Hall, Inc. pp. 1-53.

Goldsmith, Seth B. (1995). Managed Care. Journal of Ambulatory Care Management. Aspen Publications.

Harrington, C., Newcomer, R., Estes, C. & Assoc. (1985). Long Term Care of the Elderly: Public Policy Issues. Sage.

Haseltine, F.P. & Jacobson, B.G. (Editors). (1997). Women's Health Research: A Medical and Policy Primer. Washington, DC: Health Press International.

Holahan, John & Cohen, Joel. (1986). Medicaid: The Trade-off between Cost Containment and Access to Care. Urban Institute Press.

Hudson, R. (1998). The Future of Age-Based Entitlements. Johns Hopkins University Press, Baltimore

Kane, R.A. & Art. Kaplan. Everyday Ethics: Resolving Dilemmas in NH Life. NY: Springer-Verlag, 1989.

Kane, R.L. & Kane, R.A.. (1985). A Will and a Way: What the US Can Learn from Canada about Long Term Care. Columbia University Press.

Karger, & Stoesz, David. (1990). American Social Welfare Policy: A Structural Approach. New York: Longman.

Kerson, Toba Schwaber. (1989). Social Work in Health Settings: Practice in Context. Haworth Press. Contributed articles by a wide range of practitioners on specific acute conditions and adaptation to medical settings, public health services, mental health, long term care, personal and professional roles.

Kingdon, J. Agendas, Alternatives and Public Policies. Boston: Little Brown, 1984.

Kongstvedt, P. R. (1995). Essentials of Managed Health Care. Aspen Publications.

La Puma, J. & Schiedermayer. (1996). Pocket Guide to Managed Care. McGraw Hill.

Leichter, H.M. (1992). Health Policy Reform in America: Innovations from the States. Among, NY: M.E. Sharpe.

Lee, Phillip & Carroll Estes. (1990). The Nation's Health, 3rd Ed. Boston: Jones & Bartlett Publishers.

Lindblom, C. The Policy-Making Process

Linsk, Keigher, Simon-Rusinowitz, England. (1992). Wages for Caring: Compensating Family Care. Praeger Press.

Marmor. (1980). The Politics of Medicare. University of Chicago Press

Marmor, T., Mashaw, J. & Harvey, P. America's Misunderstood Welfare State: Persistent Myths, Enduring Realities. Basic Books. 1990

McKinley, JOhn B. (1981). Health Care Consumers, Professions and Organizations. Cambridge: MIT Press.

McCormack, Thomas. (1990). The AIDS Benefits Handbook. Yale Univ. Press

Mechanic, David. (1986). From Advocacy to Allocation: The Evolving American Health Care System. NY: Free Press.

Menzel, Paul. Medical Costs, Moral Choices: A Philosophy of Health Care Economics in America.

Menzel, Paul. (1990). Strong Medicine: The Ethical Rationing of Health Care. NY: Oxford University Press.

Morris, R.; Caro, F. & Hansan, J. (1998). Personal Assistance Services, Johns Hopkins University Press, Baltimore.

Offe, Claus. Contraditions of the Welfare State. MIT Press, 1984.

Rivlin, Alice & Wiener, Joshua. (1988). Caring for the Disabled Elderly. Washington, DC: Brookings Inst.

Savishinsky, Joel. (1992) The Ends of Time: Life and Work in a Nursing Home. NY: Bergin and Garvey.

Saltzman & Proch. Law in Social Work Practice. Nelson Hall.

Schorr, Alvin. (1986). Common Decency: Domestic Policies After Reagan. New Haven: Yale University Press.

Scull, Andrew. Decarceration: Community Treatment and the Deviant, a Radical View. (2nd Ed.) Rutgers Univ. Press, 1984.

Shilts, Randy. (1987). And the Band Played On: Politics, People and the AIDS Epidemic. Penguin Books.

Sidel, Victor & Sidel, Ruth, Editors. (1984). Reforming Medicine: Lessons of the Last Qarter Century. NY: Pantheon Books.

Skocpol, T. (1997). Boomerang: Health Care Reform and the Turn Against Government. NY: Norton.

Starr, Paul. The Transformation of Amrican Medicine.

Stone, Deborah. (1984). The Disabled State. MIT Press.

Chpt 1. The Distributive Dilemma, Ch 2. The Origins of the Disability Category, Ch 3. Mechanisms for Restricting Access to the Disability Category.

Titmus, Richard. The Gift Relationship.

U.S. Department of Health and Human Services, PHS. Health 1990. US Government Printing Office.

U.S. Department of Health and Human Services. (1996). Healthy People 2000. Jones & Bartlett Publishers.

U.S. Department of Health and Human Services. Social Security Programs in the United States, 1997. US Government Printing Office.

U.S. Department of Health and Human Services. Mental Health, United States, 1998. US Government Printing Office.

U.S. House of Representatives. (1998, May 18). 1998 Green Book: Background Material and Data on Programs within Jurisdiction of the House Committee on Ways and Means, 105^th Congress, 2^nd Session, U.S. Government Printing Office, Washington, DC.

Vladeck, B. (1980). Unloving Care: The Nursing Home Tragedy. NY: Basic Books.

Waitzkin, Howard. The Second Sickness: Contradictions of Capitalist Health Care, Free Press, NY, 1983.

West, J. The Americans with Disabilities Act: From policy to practice. Special issue of Milbank Quarterly, vol. 69 (Suppl 1/2), 1991.

Weston, Kath. (1991). Families We Choose: Lesbians, Gays, Kinship. New York: Columbia Univ. Press.

Wilkenson, R.G. (1996). Unhealthy Societies: The Afflictions of Inequality, Routledge.

Zarubel, Evitar. (1979). Patterns of Time in Hospital Life (U of Chicago Press).

Journal Abbreviations

Journal Articles

Barnard, B.O. & Ryner, M. Trends in Medicaid eligibility: 1975-85, HA, winter 1987, pp. 30-45.

Bell, Nora. (1989). What setting limits may mean. Hypatia 4 : 169-77.

Bloche, Gregg & Francine Cournos. Mental Health Policy for the 1990s: Tinkering at the Interstices. JHPPL 15 (2) summer 1990.

Brecher, C & Knickman, J. (1985). A reconsideration of long term care policy, JHPPL, 10 (2): 245-

Brown, L. The national politics of Oregon's rationing plan. HA, 10 (2) summer '91, pp. 28-51..

Brown, E. R. (1984). Medicare and Medicaid: Band-aids for the Old and Poor. In Reforming Medicine by Sidel & Sidel (see below) . .

Colby & Cook. Epidemics and agendas: the politics of nightly news coverage of AIDS, JHPPL 16 (2) summer '91, pp. 215-250.

Estes, Swan, Bergthold, & Spohn. (forthcoming) Running as fast as they can: Organizational changes in home health care. Home Health Care Services Quarterly.

Feder, Judith . Health Care of the Disadvantaged: The Elderly. JHPPL 15 (2) sum 1990.

Fox, D & Leichter, H. Rationing care in Oregon: the new accountability, HA, 10 (2) summer '91, pp. 7-27.

Davis. K. Inequality and access to health care. MQ 69 (2) 1991, pp. 253-274 (How research shapes policy, cost containment research lead to decreased access . .)

Gorins, S & Morniz, C. The national health care crisis: an analysis of proposed solutions. H&SW 17 (1), Feb 92, pp. 37-44.

Gostin, L & Weir, R. Life and death choices after Cruzan: case law and standards of professional conduct. MQ 69 (1), 1991, pp. 143-174.

Johns, L & Adler, G.S. Evaluation of recent changes in Medicaid, HA, 8(1), (1989, spring), pp. 171-181).

Kane, R., Penrod, Davidson, Moscovice & Rich. (1991, June). What cost case management in long-term care? SSR, 65 (2), pp. 281-303.

Kane, Robt. A nursing home in your future? New England Journal of Medicine 324 (1991): 627-29. P. 628 notes that "in fact the average resident receives less than three hours of care in all per day. In this context, "regulations to protect frail elderly people now restrict their options and raise costs for the very people we want to serve."

Keigher, S. (1994). Naive, not stupid, Health & Social Work, 20 (1)

Keigher, S. (1994). Health care reform and long term care: uneasy political partners, Health & Social Work, 19 (3): 223-226.

Keigher, S. & Stone, R. (1995). The US Case. In Evers, A., Pijl, M., & Ungersson, C. Paying for Care. Averbury/Aldershot European Centre on Social Welfare Research and Training, Vienna.

Keigher, S. & Stone, R. (1994). Family care in America: Evolution and evaluation, Ageing International, 21 (1): 41-48.

Lambert, David & Thomas McGuire. Political & Economic Determinants of Insurance Regulation in Mental Health. JHPPL 15 (1) spring 1990.

Maines, David. Time and biography in diabetic experience" Mid-American Review of Sociology 8 (1983): 103-17. on the passage of time in medical settings.

Mizrahi, T. The right to treatment and the treatment of mentally ill people. H&SW 17 (1), Feb 1992, pp. 7-11.

McAuliffe, Wm. . Health Care Policies in the Drug Abuser Treatment Field. JHPPL 15 (2) summer 1990.

Nelkin, D. AIDs and the news media. MQ 69 (2), 1991. pp. 293-308.

Osterbusch, Keigher, Miller &Linsk. Community care and gender justice, International Journal of Health Services Research, 17 (2): 217-232.

Rovner, J. Medicaid: a safety net riddled with holes. CQ Weekly Report, Feb 20, 1988.

Ruggie, Mary . Retrenchment or Realignment? Mental Health Policy & DRGs. JHPPL 15 (1) spring 1990.

Sardell, Alice. Child Health Policy in the US: The Paradox of Consensus. JHPPL 15(2) summer 1990.

Sidel, V. & Sidel, R. (1984). Reforming Medicine: Lessons of the Last Quarter Century. NY: Random House, Pantheon Books.

Smith & Eggleston, R. (1989, summer). Long-term care: The medical vs. the social model, Public Welfare.

Szasz, Andrew. The Labor Impacts of Policy Change in Health Care: How Federal Policy Transformed Home Health Organizations and their Labor Practices. JHPPL 15 (1) spring 1990.

Stone, D. German unification: East meets West in the doctor's office, JHPPL 16(2), Sum 91, pp. 401-412.

Straus, A., Fagerhaugh, S, Suczek, B & Wiener, C.(1982). "The work of hospitalized patients." Social Science and Medicine 16 : 977-86.

Vladeck. Health Care and the Homeless: a Political Parable for our Time, JHPPL, Vol 15 (2) summer l990.

Weissert, W. & Musliner, L. Access, quality & cost consequences of case-mix adjusted reimbursement for nursing homes: review of the evidence. AARP Public Policy Inst, Ref. 1992, #9109.

Woohandler, Steffie & David U. Himmelstein, The deteriorating administrative efficiecy of the US health care system., New England Journal of Medicine 324 (1991): 1253-58. They estimate that by adopting a Canadian like nationalized system of health care, the US wouuld save $100 billion in administrative costs.

Assignment. Health Problem Analysis

Part I. Both 2 and 3 credit students

Purpose: To understand a current health problem affecting people at a societal level in a way that can be made relevant to a policy maker.

1. Choose from the attached list a health or mental health problem of interest to you. (Note: some topics are broad, e.g. homicide; infant mortality; depression, and you may wish to select a more narrow focus, e.g. juvenile homicide, black infant mortality, bipolar disorder).

2. Briefly describe the epidemiological aspects of the problem:

a. The magnitude of the problem (how many people are affected; costs to society, etc.)

b. Sociodemographic characteristics of the population affected (gender, race/ethnicity, sexual orientation, socioeconomic status, age, etc.)

c. Etiologic factors (causes and risk factors, if known)

d. Technology currently available to deal with the problem:

1. Prevention
2. Early detection and treatment
3. Rehabilitation and/or continuing care

The purpose of this part of the paper is to familiarize you with the data base used to establish the need for policies, programs and services to deal with a given health problem, and the appropriate content of such policies and programs.

3. Limit this report to 8-10 typewritten pages. Your analysis should provide facts and guidance to a real policy maker. At least 6 references should be cited. References must be as current as possible (i.e., 1992 or later). You may need to gather relevant research data and reports at a medical library and through contacts with experts on this subject. This assignment is due October 19.

4. Suggested references include any current professional medical, nursing, social work, or public health reference book or journal, government or foundation reports. Prof. Keigher has a large collection of government reports and can suggest other documents that are relevant.

Assignment. Program Analysis

Part II. to be done by 3 credit students

Purpose: To critically assess the adequacy of an actual care or service program relative to the social/health need for it that exists in the community.

1. Locate a program or agency that has developed to deal with the health or mental health problem you investigated in Part I.

2. Describe how the program developed: its historical background, any relevant legislation affecting it, mandates and legal authority.

3. Identify the goals of the program and describe the organization of service delivery. Are the services provided consistent with the needs you identified previously? What provision is made for prevention, if any? Is the spectrum of services comprehensive?

4. How is the program financed? Sources? Strings attached? What can you learn about its projected funding picture? Any federal/state policy struggles pending? Handsnet is a great source for such information; Dr.Keigher will provide access to this and other useful on-line sources.

5. What personnel are needed? Is this appropriate, given the needs identified previously?

6. What is the role of the social worker (goals, function, relationship to other health care professionals and providers, etc.?) What is the history of the social work position? (How was it developed? How is it funded?) What specialized knowledge or experience is necessary for this position and how has the social worker acquired it? Briefly critique the social worker position. What are its strengths and weaknesses? What suggestions would you make to enhance the position, if any?

7. What measures are employed to assure that people of color and poor people will have access to the program?

8. What provisions are made for consumer participation? How is program effectiveness evaluated?

9. How are clients' rights protected?

10. How does the program compare on some of these dimensions with others described in the professional literature?

11. What are the major issues or problems currently facing the program?