UNIVERSITY OF ALBERTA

Course Guide SPH 500 Introduction to Health Policy and Management

Wednesdays (1300 hrs. to 1550 hrs.) Room: ECHA L1 140

Instructors: Stephanie Montesanti, PhD Office: Room 3-266 Email: [email protected] Elaine Hyshka, PhD Office : Room 3-262 Email: [email protected] Aslam Bhatti Office: Room 3-317 ECHA Email: [email protected]

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Information about the course Welcome to SPH 500! This is a core course requirement for all students registered for an MPH program at the University of Alberta. The course will cover three main topics: health systems in Canada, health policy and health care management. The three components are integrated in practice hence the course will be presented as much as possible integrating the three components. Specifically, the course will deal with the historical development of Canada’s health systems within the constitutional framework of the country. Particular emphasis will be placed on how history and constitutional constraints have led to today’s set of health systems across the country and the limits that these will place on health reform initiatives. The second part will focus on fundamentals of health policy, and why and how health policies are developed. This will include discussions on the concept of the ‘policy cycle’, the roles of different stakeholders and groups, and the media as well as scientific evidence in health policy making. The third section will discuss key topics in health management, such as governance, organizational structures and models and roles and responsibilities. Every effort will be made to incorporate current ‘real world’ examples and experiences through the course, and especially through the breakout sessions. Please note that the activities currently listed for the breakout sessions are subject to change. Learning Objectives: At the end of this course, students should have learned to: 1. Discuss the historical development of health services in Canada 2. Discuss the ideological, institutional and economic pressures that have shaped the Canadian health care system and its structures 3. Outline the processes of health policy-making and how the notion of a ‘policy cycle’ translates into the ‘real world’ 4. Identify the different stakeholders who should/could be involved in developing health policy in different domains (e.g., seniors’ health, health promotion, etc.) 5. Provide informed comments on current debates and initiatives in the field of health care policy. 6. Describe the financing model for health 7. Comparative analysis of Canadian system and select other countries. 8. Describe the functions and role of management in contemporary healthcare organizations.

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Course readings: There is no required textbook for this course. Readings for each session are listed below in this Course Guide, and are available through the university libraries or the web. Students are expected to read specified material prior to the session for which they are listed. Course Evaluation: Mid-term examination (week 7) Participation Group presentation (week 13) Individual policy brief

25% 20% 25% 30%

Grading in graduate classes Descriptor Excellent Good Satisfactory Failure

Academic Integrity

Letter Grade A+ A AB+ B BC+ C CD+ D F

Grade Point Value 4.0 4.0 3.7 3.3 3.0 2.7 2.3 2.0 1.7 1.3 1.0 0.0

Plagiarism is a serious offence. The University of Alberta is committed to the highest standards of academic integrity and honesty. Students are expected to be familiar with these standards regarding academic honesty and to uphold the policies of the University in this respect. Students are particularly urged to familiarize themselves with the provisions of the Code of Student (online at www.ualberta.ca/CodeofStudentBehaviour) and avoid any behaviour which could potentially result in suspicions of cheating, plagiarism, misrepresentation of facts and/or participation in an offence. Academic dishonesty is a serious offence and can result in suspension or expulsion from the University. University of Alberta policy about course outline can be found in Section 23.4(2) of the University Calendar. (GFC 29 SEP 2003)

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Course Evaluation Elements 1. The mid-term examination will be held on Oct. 26th for the first 1 ½ hours). It will be closed book. Students who have an excused absence for this examination will be given an entirely different examination prior to the class on Oct. 26. 2. Participation: 20% will of the final mark will be constituted from participation which will be heavily weighted during small group discussions and therefore active participation is encouraged. 3. Each student will have to select a Policy Topic from a list that will be provided during week 4 (28 Sept). Students must indicate their choice by week 8 (26 Oct.). There will be 2 evaluation elements associated with the topic. First, students who picked the same topic will have to work as a small group to prepare a 10 minute presentation focussing on the central issue in the topic they have chosen. Presentations will be made by all groups in week 14 (Dec. 7th.). All students in the same small group will receive the same mark for their presentation. Guidelines for the presentations will be provided to students by week 5 (5 Oct.); there will be penalties for presentations that exceed the time limits and these will be detailed in the guidelines. 4. The second product from the selected policy topic would be an individual Policy Brief. Guidelines for the Brief will be provided to students by week 5 (5 Oct.). Policy Briefs will be due 1 week after the last class (i.e., 14 Dec.). There will be penalties for failure to submit the Brief by the due date, and details of these will be included in the guidelines. SUMMARY OF COURSE SCHEDULE

Date

Topic

Instructor

September 7

Introduction; Macro overview of Canadian health system

September 14 September 21

From Confederation to the Canada Health Act Public Health Policy and Ethics

September 28

From the Canada Health Act to the Present: Significant Changes in the Canadian Health System Health system financing and resource allocation

Stephanie Montesanti Elaine Hyshka Guest Speaker: Tania Bubela (*confirmed) Stephanie Montesanti Aslam Bhatti

October 5

October 12

Health Policy This session will draw on public health policy and examples

Guest speaker: Dee-Jay King – Alberta Health perspective (*To Be Confirmed) Elaine Hyshka

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October 19 October 26

November 2 November 9 November 16 November 23 November 30 December 7

from the mental health system. Health Policy – Cont’d Stephanie This session will focus on the role of institutions and interest Montesanti groups and policy actors in shaping health policy decisions. Mid-term (half class only) Stephanie Montesanti Writing for policy makers (this session will be begin at 2:30pm) Policy reforms in Canadian health systems (Policy reports Stephanie 2000s to present; Regionalization, Consolidation, Montesanti Adjustments and Results) No Class – Reading Week Aslam Bhatti Management – accountability and governance Management- organizations, management competencies Aslam Bhatti Comparative Analysis: Canada and other countries Don Philippon (*confirmed) • Examples from the U.S, the UK and Australia Group Presentations DETAILED COURSE OUTLINE

Week 1 (7 Sept. 2016) • •

Introduction to the course and TAs/instructors; discussion of expectations and evaluations Macro overview of the Canadian health system.

Readings: 1. Canada’s Health Care System, available at http://www.hc-sc.gc.ca/hcs-sss/pubs/systemregime/2011-hcs-sss/index-eng.php 2. Gregory P. Marchildon, Health Systems in Transition, Canada, Second Edition (2013), (pages 1-17) Week 2 (14 Sept. 2016): From Confederation to the Canada Health Act • •

Examine the significant political developments that created the basis for the health system that we have today Review the significant changes in the Canadian health system in 1970s and early 1980s leading up to the Canada Health Act in 1984

Readings: 1. Marchildon GP. Making Medicare: New Perspectives on the History of Medicare in Canada (2012), (pages 3 -16, 21- 40, 89 - 109) 2. Government of Canada. Canada Health Act; http://laws-lois.justice.gc.ca/eng/acts/C-6/

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Week 3 (21 Sept 2016): Public Health Policy and Ethics Guest Lecture: Dr. Tania Bubela • •

Introduce students to the concept of ‘Healthy Public Policy’ Introduce students to an ethical framework for policy and public health practice

Readings: 1. De Leeuw, E. Clavier, C. Healthy public in all policies. Health Promotion International (2011), 26 (suppl 2): ii237-ii244. 2. Public health: ethical issues. Nuffield Council on Bioethics, 2007. Chapters 1-3; http://nuffieldbioethics.org/wp-content/uploads/2014/07/Public-health-ethical-issues.pdf 3. Childress JF, Faden RF, Gaare RD, Gostin, LO et al., 2002. Public Health Ethics: Mapping the Terrain. Journal of Law, Medicine & Ethics, 30: 170-178. 4. AFMC Primer on Population Health, Chapter 14 Decision Making: Policies and Ethics in Health Care and Public Health Week 4 (28 Sept 2016): From Canada Health Act to Present •

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Review the significant changes in the Canadian health system in 1970s and early 1980s leading up to the Canada Health Act in 1984, The Health for All Report in 1986 and the significant changes in financial arrangements Group exercise #1 (topics to be determined)

Readings: 1. Marchildon GP. Making Medicare: New Perspectives on the History of Medicare in Canada (2012), (pages 110-134) 2. Flood CM, Choudhry S (2003). Strengthening the foundations: Modernizing the Canada Health Act, in The Governance of Health Care in Canada, (ed: McIntosh T, Forest P-G, Marchildon G.P.) pp. 347-387. 3. Hutchinson, B.G., Abelson, J., and Lavis, JN. (2001). Primary Care Reform in Canada: So Much Innovation, So Little Change. Health Affairs, 20(3): 116-31 Week 5 (5 Oct 2016) Health System Financing and Resource Allocation •

Sources of health financing in Canada; resource allocations (evidence, ethics, and accountability) and issues encountered are examined.

Readings: 1. Marchildon GP, Health Systems in Transition, Canada, Second Edition (2013), (pages 23-29, 61-79) 2. Livio Di Matteo and Greg Marchildon; Five challenges for bending the cost curve in Canada; http://umanitoba.ca/outreach/evidencenetwork/archives/22750 6



3. Myth: User fees ensures better use of health services; Canadian Foundation for Healthcare Improvement/Mythbusters/November 2012 4. Myth: Canada has a communist style health care system; http://www.cfhifcass.ca/Migrated/PDF/myth18_e.pdf

Week 6 (12 Oct 2016): Health Policy • •

Health policy – what it is, why we need it, whose responsibility is it, who should be involved and types of policies Examples of public health policy interventions

Readings: 1. Torjman, S. (2005). What is Policy? Ottawa, ON: Caledon Institute of Social Policy. http://www.caledoninst.org/Publications/PDF/544ENG.pdf2. (Pages 1-6) 2. MacKay M, Shaxton L. Understanding and applying basic public policy concepts. http://www.uoguelph.ca/omafra_partnership/ktt/en/worktogether/resources/understanding andapplyingbasicpublicpolicyconcepts.pdf 3. Exworthy, M. (2008). Policy to tackle the social determinants of health: using conceptual models to understand the policy process. Health Policy and Planning, 23, 318-327. Week 7 (19 Oct 2016): Health Policy – continued • •

The policy cycle, policy development and implementation Engaging citizens in health policy decision making

Readings: 1. Pierson, P. (1993). When Effect Becomes Cause: Policy Feedback and Political Change. World Politics, 45: 595-628. 2. Fafard, P. (2012). Public Health Understandings of Policy and Power: Lessons from INSITE. Journal of Urban Health, 89:6 pp 905-914 3. Williamson, DL, Milligan, CD, Kwan, B, Frankish, CJ and Ratner, P. Implementation of provincial/territorial health goals in Canada. Health Policy, 2003:173-191. http://scholarsportal.info/pdflinks/06111311051429240.pdf 4. Smith BL (2002). Public policy and public participation. Engaging citizens and community in the development of public policy. http://www.phacaspc.gc.ca/canada/regions/atlantic/pdf/pub-_policy_partic_e.pdf. (pages 14-18, 49-54) 5. Maxwell, J., Rosell, S., and Forest, P.G. (2003). Giving Citizens a Voice in Healthcare Policy in Canada.” British Medical Journal, 326: 1031033. Week 8 (26 Oct 2016): Midterm Examination

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Writing for policy makers (Dr. Stephanie Montesanti). This session will begin at 2:30pm, following the mid-term examination.

Week 9 (2 Nov 2016): Policy Reforms in the Canadian Health Systems • • •

Review the recommendations and directions emanating from major Commission reports in late 1980s and 1990s that provided the foundation for major reforms in 1990s. Review the major structural change in the form of Regionalization that were implemented and adjusted in the 1990s and early 2000s. Group exercise #2 (topics to be determined)

Readings: 1. The Royal Commission on the Future of Health Care in Canada (2002). (The Romanow Report). http://publications.gc.ca/site/archiveearchived.html?url=http://publications.gc.ca/collections/Collection/CP32-85-2002E.pdf. Executive Summary, pp. 242-255. 2. Alberta: Report of the Premier’s Advisory Council on Health (2001). (The Mazankowski Report) www.health.alberta.ca/documents/Mazankowski-Report-2001.pdf. pp. 1-11 3. Tuohy, CH. “The Costs of Constraint and Prospects for Health Care Reform in Canada,” Health Affairs 21, 3 (2002): 32-4. 4. Lewis S, Kouri D (2004) Regionalization: making sense of the Canadian experience. Healthcare Papers 5(1):12-31 5. Mulvale G, Abelson J and Goering P. Mental health service delivery in Ontario, Canada: how do policy legacies shape prospects for reform? Health Economics, Policy and Law 2007; 2(4); 363- 89. 6. Dutton, D. Emery, H., Mullie, T., Zwicker, J. (2015)Bending the Medicare Cost Curve in 12 Months or Less: How Preventative Health Care Can Yield Significant Near-Term Savings For Acute Care in Alberta. Available at: http://www.policyschool.ca/wpcontent/uploads/2016/03/preventative-health-care-emery-dutton-mullie-zwicker.pdf Week 10 (9 Nov 2016): Management – Accountability and Governance • •

Administration and delivery of public health care in Canada; regulation and governance of providers Decentralization and centralization of health care

Readings: 1. Emanuel, E.J., & Emanuel, L.L. (1996). What is Accountability in Health Care? Annals of Internal Medicine, 124: 229-239. 2. Deber, R.B. (2014). Thinking about Accountability http://www.ncbi.nlm.nih.gov/pubmed/25305385 3. Davidson J.; Review of the Alberta Health Services Organization and Structure, and Next Steps http://www.albertahealthservices.ca/org/ahs-org-report-on-structure.pdf

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4. Report of the Health Governance Review Task Force February 2013 - Working Together to Build a High Performance Health System (Pages 19-33) http://www.health.alberta.ca/documents/High-Performance-Health-System-2013.pdf Week 11 (16 Nov 2016) No Class Week 12 (23 Nov 2016): Management - Organizations, management competencies • •

Health care organizations; dimensions of organizational design; models of organizational structure; types of healthcare organizations in Canada; Competencies for managers; the various roles of managers; inter-professional management; physicians and managers; human resources management; managing in complex organizations; priority-setting; current management trends

Readings: 1. Bohmer RMJ (2011). The four habits of high-value health care organizations, New England Journal of Medicine, 365:2045-2047 2. The Europeon Journal of Public Health, 1-6; 2014: Public Health in the 21st Century:working differently means leading and learning differently 3. Guo KL (2003). A study of the skills and roles of senior-level health care managers, The Health Care Manager, 22(2):152-158 4. Kabene SM, Orchard C, Howard JM, Soriano MA, Leduc R (2006). The importance of human resources management in health care: a global context, Human Resources for Health, 4:20 Week 13 (30 Nov 2016): Comparative Analysis: Canada and other countries – policy and management choices Guest Lecture: Don Philippon •

Review the performance of the Canadian Health System as compared to several other countries that also have universal health systems

1. OECD Health at a Glance 2015. Available online 2. 2015 International Profiles of Health Care Systems. Selected pages 3. Conference Board of Canada Health Care System Sustainability, 2004. Selected pages Week 14 (7 Dec. 2016): Group Presentations

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