Author Interviews: Additional Resources & Discussion

In support of the 11th edition of Health Care Delivery in the United States, the editors Drs. James Knickman and Anthony Kovner engaged some of their contributing authors in a brief question and answer interview. We hope that you will use this additional content to enhance your classroom discussion and further explore with your students such critical issues in health care, highlighted in the new edition.

Chapters with Author Q&As

Chapter 4: Comparative Health Systems

Q&A with chapter co-authors

Michael K. Gusmano headshot

Michael K. Gusmano, PhD
Research Scholar, The Hastings Center

Victor G. Rodwin headshot

Victor G. Rodwin, PhD, MPH
Professor, New York University

Q: What discussion question would you lead off with in teaching your chapter?

Begin discussion with the question:

What is the best health care system?

Although this is often the first question raised to those who study health care systems abroad, the more challenging and implicit question is: “How would you know?”  The answer to this question revolves around contentious issues having to do with alternative definitions of health care systems, assumptions about their contributions to population health, and disagreement in how to weight different criteria for evaluating the performance of health care systems.

Q: Do you have any additional recommended reading?

Thomson S, Osborn R, Squires D, eds. International Profiles of Health Care Systems. New York, Commonwealth Fund, 2015.

This publication presents an up-to-date overview of the health care systems in Australia, Canada, Denmark, England, France, Germany, Italy, Japan, the Netherlands New Zealand, Norway, Singapore, Sweden, Switzerland, and the United States.

Universal Health Coverage for Inclusive and Sustainable Development: A Synthesis of 11 Country Case Studies. Washington DC; World Bank, 2014 (http://www.worldbank.org/en/topic/health/publication/universal-health-coverage-for-inclusive-sustainable-development)

This publication summarizes the experience of 11 nations—Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam—in attempting to provide their population with universal health care coverage.

Chapter 6: Public Health: A Transformation for the 21st Century

Q&A with chapter co-authors

Laura C. Leviton headshot

Laura C. Leviton, PhD
Special Adviser for Evaluation, Robert Wood Johnson Foundation

Paul Kuehnert headshot

Paul Kuehnert, DNP, RN
Team Director, Bridging Health and Health Care Portfolio, Robert Wood Johnson Foundation

Kathryn E. Wehr headshot

Kathryn E. Wehr, MPH
Program Officer, Robert Wood Johnson Foundation

Q: What discussion question would you lead off with in teaching your chapter?

I would lead off with the first discussion question—it gets students thinking:

What examples of public health and prevention can you identify in your daily life? How do you believe they have affected your health?

The prevention fund within the Affordable Care Act continues to be reduced and reduced, in part because people generally do not understand public health the way they understand health care, so there is no powerful constituency to protect what is arguably a vital piece of health care reform.

Q: Do you have any additional recommended reading?

Jonathan Fielding and Steven Teutsch (editors), Public Health Practice: What Works

The author has a great writing style, and the book focus is on LA county and the wide array of public health problems and solutions.

F. Douglas Scutchfield and William Keck, Principles of Public Health Practice, 3rd or 4th edition

The 3rd Edition is available now, the 4th Edition is coming out later this year.

Chapter 7: Health and Behavior

Q&A with chapter co-authors

Elaine F. Cassidy headshot

Elaine F. Cassidy, PhD
Senior Consultant, Equal Measure

Matthew Trujillo headshot

Matthew Trujillo, PhD
Research Associate, Robert Wood Johnson Foundation

C. Tracey Orleans headshot

C. Tracy Orleans, PhD
Senior Scientist, Robert Wood Johnson Foundation

Q: What discussion question would you lead off with in teaching your chapter?

Use the following question to start discussion:

In their 2015 Annual Review of Public Health article “Translating evidence into population health improvement: Strategies and barriers,” Woolf, et al. describe the challenge of translating the growing evidence base for population health promotion – for improving health behaviors and the social and environmental conditions that shape them – into everyday clinical practice and real-world community and organizational change efforts. They describe the varied strategies needed to translate existing research evidence into the information real-world decision makers need to act on this evidence and create change. They outline four ingredients for successful research-to-practice translation: (1) making research responsive to user needs; (2) gaining insight into the decision-making environment; (3) engaging decision makers and stakeholders in research design; and (4) strategically communicating research results.

How would you apply these four ingredients to the case study presented at the end of Chapter 7?

Q: Do you have any additional recommended reading?

Woolf, S. H., Purnell, J. Q., Simon, S. M., Zimmerman, E. B., Camberos, G. J., Haley, A., & Fields, R. P. (2015). Translating evidence into population health improvement: Strategies and barriers. Annual Review of Public Health, 36(21): 1-21.

Chapter 8: Vulnerable Populations: A Tale of Two Nations

Q&A with chapter co-authors

Jacqueline Martinez Garcel headshot

Jacqueline Martinez Garcel, MPH
Vice President, New York State Health Foundation (NYSHealth)

Elizabeth Ward

Elizabeth A. Ward
Program Assistant, New York State Health Foundation (NYSHealth)

Lourdes Rodriguez headshot

Lourdes Rodriguez, PhD
Program Officer, New York State Health Foundation (NYSHealth)

Q: What discussion question would you lead off with in teaching your chapter?

I would lead discussion with question #2:

Who are considered vulnerable populations, and what does this tell us about the nature of the problems that predisposes and enables vulnerability in the United States?

The term “vulnerable populations” is often times misused to refer to individuals with personal characteristics that put them in that category (poor people, children, or elderly).  As the chapter argues, however, the term encompasses a much complex set of contextual factors that lead to vulnerability.  Practitioners and policy makers must consider the factors that exist outside of the healthcare system proper.  By doing so, solutions can be identified that help address the predisposing and enabling factors; especially since many of these solutions will require collaborations with sectors outside of health care.

Q: Any further comment you want to make on the chapter’s content, perhaps occasioned by some new development since you wrote?

To the extent that readers/students can identify themselves with vulnerable populations (i.e. reflecting on their own vulnerabilities or the vulnerability of persons close to them), they will be more effective in helping identify solutions to the complex needs of vulnerable populations.  A popular saying is that “the personal becomes political.”

Q: Do you have any additional recommended reading?

Bruce S. Jansson, “Becoming an Effective Policy Advocate, Seventh Edition,” Brooks/Cole, Cengage Learning 2014, 544 pages.

Jansson provides examples that go beyond the traditional approach to policymaking, to illustrate what it takes to conduct policy-practice “in vivo.”

Chapter 10: The Health Workforce

Q&A with chapter co-authors

Joanne Spetz headshot

Joanne Spetz, PhD
Professor, University of California, San Francisco;
Associate Director for Research Strategy, UCSF Center for the Health Professions;
Director, USCF Health Workforce Research Center

Susan Chapman headshot

Susan A. Chapman, PhD, RN, FAAN
Professor, University of California, San Francisco

Q: What discussion question would you lead off with in teaching your chapter?

Lead off with the question:

If changes to scope of practice regulations could help to abate health worker shortages, why are such changes not made?

We recommend this question because many states are considering changes to scope of practice for various professionals, and thus most faculty can use current policy proposals in their states to motivate the discussion.

Q: Any further comment you want to make on the chapter’s content, perhaps occasioned by some new development since you wrote?

The U.S. Health Resources and Services Administration recently released forecasts of primary care shortages, and they included calculations of how much smaller the shortages would be if nurse practitioners and physician assistants provided more care. This finding highlights the problem with simple forecasts – they usually ignore the potential for other professionals and new strategies of delivering care to alter projected shortages and surpluses.

In addition, the Center for Medicare and Medicaid Services issued a new rule that allows Community Health Worker services to be billed to Medicaid. This policy change demonstrates the national interest in supporting integration of care, especially when integration can improve the quality of care and reduce costs.

Q: Do you have any additional recommended reading?

Phalen, Judy, and Rebecca Paradis. How Community Health Workers Can Reinvent Health Care Delivery in the U.S. Health Affairs Blog, January 16, 2015. http://healthaffairs.org/blog/2015/01/16/how-community-health-workers-can-reinvent-health-care-delivery-in-the-us/

This is a short and clear post about the importance of new payment roles that allow CHWs to be reimbursed. This highlights the importance of the broader “public health” workforce and strategies to improve integration of care.

Ross, Martha, Nicole Prchal Svajlenka, and Jane R. Williams. Part of the Solution: Pre-Baccalaureate Healthcare Workers in a Time of Health System Change. Washington DC: Brookings Institution. 2014. http://www.brookings.edu/research/interactives/2014/healthcare-workers#/M10420

This report reviews the importance of jobs that do not require baccalaureate degrees in the delivery of health care services, and also in providing job opportunities.

Chapter 15: Health Information Technology

Q&A with chapter author

Nirav Shah headshot

Nirav Shah, MD, MPH
Chief Operating Officer for Clinical Operations, Kaiser Permanente’s Southern California Region

Q: What discussion question would you lead off with in teaching your chapter?

I would lead off with this question:

Why has the health care sector been slower than other industries to adopt health IT?

Numerous factors, including time & expense of adoption, confusion about product offerings, lack of clarity around regulatory requirements, lack of interoperability of products, and physician culture have impeded adoption.

Q: Any further comment you want to make on the chapter’s content, perhaps occasioned by some new development since you wrote?

Realizing the promise of EHRs (higher quality care at lower cost) has taken longer than expected, in part because of the absence of a robust software architecture to accelerate interoperability. This was highlighted in an important report released in the summer of 2014, which made 7 recommendations:

1. CMS should embrace Stage 3 Meaningful Use as an opportunity to break free from the status quo and embark upon the creation of a truly interoperable health data infrastructure.

2. An immediate goal, to be sought within 12 months (including time for consultation with stakeholders), should be for ONC to define an overarching software architecture for the health data infrastructure.

3. To achieve the goal of improving health outcomes, Stage 3 Meaningful Use requirements should be defined such that they enable the creation of an entrepreneurial space across the entire health data enterprise.

4. The ONC should solicit input from the biomedical research community to ensure that the health data infrastructure meets the needs of researchers.

5. The adopted software architecture must have the flexibility to accommodate new data types that will be generated by emerging technologies, the capacity to expand greatly in size, and the ability to balance the privacy implications of new data types with the societal benefits of biomedical research.

6. The ONC should exert leadership in facilitating international interoperability for health data sharing for research purposes.

7. Large-scale data mining techniques and predictive analytics should be employed to uncover signatures of fraud. A data enclave should be established to support the ongoing development and validation of fraud detection tools to maintain their effectiveness as fraud strategies evolve.

(source: A Robust Health Data Infrastructure. AHRQ Publication No. 14-0041-EF April 2014. Available at http://healthit.gov/sites/default/files/ptp13-700hhs_white.pdf)

Q: Do you have any additional recommended reading?

A Robust Health Data Infrastructure. AHRQ Publication No. 14-0041-EF April 2014. Available at http://healthit.gov/sites/default/files/ptp13-700hhs_white.pdf

Chapter 16: The Future of Health Care Delivery and Health Policy

Q&A with chapter co-authors and 11th Edition editors

James Knickman headshot

James R. Knickman, PhD
President and Chief Executive Officer, New York State Health Foundation (NYSHealth);
Professor (emeritus), New York University;
Vice President of Research and Evaluation (emeritus), Robert Wood Johnson Foundation

Anthony Kovner headshot

Anthony R. Kovner, PhD
Professor, New York University;
Senior Program Consultant (emeritus), Robert Wood Johnson Foundation;
Senior Health Consultant (emeritus), United Autoworkers Union

Q: What discussion question would you lead off with in teaching your chapter?

Begin discussion with the question:

What are the forces leading to changing the way hospitals and doctors are paid for providing medical care? What are the options facing health care organizations as they respond to these forces?

The forces include demands by payers and consumers and legislators all demanding more value for the money spent purchasing medical care services. Responses will be highly affected by local circumstances: such as payor mix, competition, required capital investments, and so forth.

Q: Any further comment you want to make on the chapter’s content, perhaps occasioned by some new development since you wrote?

Although enthusiasm remains high, the lack of positive evidence for higher value relative to outcomes from ACOs has led to some second thoughts about this interventionist response. Should the rules regarding ACO organization, such as consumer governance, be changed or the methods of payment and incentives be altered? These changes can be made within the context of the Affordable Care Act or outside of it.

Q: Do you have any additional recommended reading?

Bush, Jonathan, Where Does it Hurt?: An Entrepreneur’s Guide to Fixing Health Care, Portfolio/Penguin 2014.