Like a Phoenix from the Ashes…The Senate’s Health Reform Efforts Live On

by Sara Wilensky, JD, PhD
Author of Essentials of Health Policy and the Law, 3rd Edition

With the passage of the American Health Care Act (AHCA) in the House on May 4, 2017, the health reform debate moved to the Senate.   The Senate completely scrapped the House bill and released its own version of health reform, the Better Care Reconciliation Act of 2017 (BCRA).  Despite important differences, AHCA and BCRA followed roughly the same contours. Both bills reduced taxes, eliminated government mandates, lowered federal government spending, lowered premiums for some people while increasing them for others, phased out Medicaid expansion under the Affordable Care Act (ACA), and ended Medicaid as an entitlement program. According to the nonpartisan Congressional Budget Office (CBO), the effect of the bills would be to increase the number of uninsured, reduce the deficit, lower costs for young and healthy consumers, and increase costs for older and poorer consumers.[1],[2] Unlike the House, however, the Senate could not muster enough Republican support to pass BCRA (or the Senate’s other two bills), stalling the health reform debate in Congress.  After a month of relative quiet, the Senate is trying again with its consideration of the Graham-Cassidy bill to repeal and replace the ACA.

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Mass Casualties and Health Care Managers

By Sharon Buchbinder, RN, PhD
Author of Introduction to Health Care Management, 3rd Edition
(This article originally published May 2015)

When we think about mass casualty events, we usually think about natural disasters, such as tornadoes, hurricanes, wildfires, and earthquakes. As noted in my blog on bioterrorism, we healthcare management educators tend not to dwell on or prepare for these and other disasters, such as chemical, biological, radiological, nuclear, and civil unrest. Living in Baltimore, Maryland, recent events have brought the matter home to our healthcare organizations in a way we have not seen since 1968. Peaceful marches and protests simmered in rage and boiled over into violence and fires. Currently, all the players—politicians, gang leaders, pastors, and community members are struggling to pull together to keep our beloved city calm and to support community members who are suffering from mental health issues associated with this tumult. As it became evident that mass casualties could occur, local hospitals were put on alert to receive injured protestors and police officers. But were they prepared? Continue reading

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Lessons Learned: What Can We Learn from Hurricane Harvey and Will We Really Learn Them This Time?

By Suzet M. McKinney, DrPH, MPH
Author of the Forthcoming text: Public Health Emergency Preparedness: Practical Solutions for the Real World

It’s hard to believe that it has been over 10 years since Hurricane Katrina tore through the Gulf Coast region, leaving damage and devastation that would take years to repair. I think it’s safe to say that Katrina was the most devastating storm ever seen here in the U.S.; a category 5 hurricane of epic proportions. The all too vivid images of entire neighborhoods underwater, desperate pleas for rescue scribbled across rooftops, and deceased bodies floating down the streets turned urban rivers, seemed more like a scene from a third world country, than a beloved, modern day American city.  At the time, not many of us thought we’d ever see anything like it again in our lifetimes. And now comes, Harvey.

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Why Should We Study the Health Care Systems of Other Nations?

By James A. Johnson, PhD, MPA, MSc
Author of Comparative Health Systems, 2nd Edition

Students in the U.S. and in many other countries as well, too often have a limited view of health care and population health, many times failing to see beyond their own borders. This is especially so when we consider the myriad health systems that emerged in the widest range of cultures and social contexts imaginable. Each of the countries of the world has a responsibility to its citizens and residents to provide for health and well-being. Some take this responsibility seriously and others do not. Some have severe resource constraints and others do not. Given the diversity of socio-political circumstances and variations in culture and history, we now see many variations.

Why Study the Health Care Systems of Other Nations?The World Health Organization (WHO), with its nearly 200 member countries, has stated that a well-functioning health system working in harmony is built on having trained and motivated health workers and leaders, a well-maintained infrastructure, and a reliable supply of medicines and technologies, backed by adequate funding, strong health plans, and evidence-based policies.

Students in health administration, public health, and health policy programs at all levels, would be wise to broaden their perspectives by undertaking a studying the health system around the world. By undertaking the study of comparative health systems, students can expect to gain a better understanding of the global context of health, along with valuable knowledge and insights into various health systems that function in disparate social, political and economic conditions across countries.

More specifically students can expect to accomplish the following in such a course or program of study:

Learning from others—the health systems of the world all can serve as laboratories of learning. Each one is a social experiment attempting to accomplish certain goals. In the U.S. for example these goals are articulated in Healthy People 2030. We learned about primary care centers from South Africa and national health insurance from Germany. Likewise, there are many health systems in the world today that are more efficient and have better outcomes than we do in the U.S. We only have to look to our neighbor, Canada to see such an example.

The way of knowledge—we see comparative studies in other fields such as science and medicine. For example, an experiment, tested procedure, or new technology developed in one country utilized or imported by another country. It is no surprise that many Nobel Prizes are won by people working in international teams.

Our shared global village—we live in an increasingly interdependent world that “shrinks” in the face of rapid developments in connective technologies such as telemedicine, social media, and distance education. This also includes the ability to cross borders and span oceans in real time for meetings, diagnostic consultations, or disease surveillance. As oft stated, disease respects no borders and I suggest that our minds not create walls, but vistas instead.

Urgency of systems thinking—the future belongs to systems thinkers. By studying comparative health systems, students take a big step toward inculcating this valuable skill and perspective into their own future careers. They enhance their own capabilities in the widest range of domains, including management, leadership, and policy by better understanding interconnections and unintended consequences.

The future is now—whether one looks at climate change, pandemics, the aging global population, or any number of other challenges heretofore relegated as “the future”, we are facing all of these now and will continue to do so in the coming decades. There is a certain urgency for students and faculty to better know the world they occupy. Health challenges are real and present. Health systems are part of the solution and the ability for these systems to effectively adapt can be a matter of life and death.

Innovation is unexpected—the next most salient innovation in health care, public health, or health policy can occur anywhere at any time. Health systems need to innovate in order to survive, thrive, and assure their nation’s health. The innovations can be small or large, but when taken from a systems thinking perspective, the ripple effect can actually be global in scope. We certainly saw this with vaccination in the last century and will likely see many innovations that improve health outcomes in the years (or perhaps days) ahead.

It is fun—studying comparative health systems is enjoyable for almost all students. I have taught this subject for twenty years and consistently have students tell me it was their favorite course. Many went on to extend their comparative study with courses in global health, international affairs, and study abroad experiences. The current generations in college and graduate school are eager to learn about other cultures and are predisposed to learning from divergent perspectives. There seems to be an embrace of diversity and the valuing of differences. A course in comparative health systems provides just such an enriched learning opportunity.

Columbia University professor, Jeffery Sachs in his recent book, Building the New American Economy: Smart, Fair, and Sustainable, states:

“Sooner or later the United States will have to learn from the better performance of Canada, Japan, and Europe, where health care coverage, affordability, and outcomes are far better than those enjoyed by Americans.”

The time to learn is now and the clear path for the way forward is through the study of comparative health systems.  Enjoy!


James A. Johnson, PhD, MPA, MS

James A. Johnson, PhD, MPA, MS

James A. Johnson, PhD, MPA, MS, is the author of Comparative Health Systems: A Global Perspective, Second Edition (with co-authors Carleen Stoskopf, ScD, and Leiyu Shi, DrPh, MBA, MPA). He is also the author of Health Organizations: Theory, Behavior, and Development, Second Edition.

Dr. Johnson is a medical social scientist and health policy analyst who specializes in organizational and system development. He is a Full Professor of Health Administration at Central Michigan University where he teaches courses in comparative health systems, international health, organizational behavior, and health systems thinking. He is also a Visiting Professor at St. George’s University in Grenada, West Indies, and the former Chairman of the Department of Health Administration and Policy at the Medical University of South Carolina.

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4th Edition of Issel’s Health Program Planning and Evaluation Stays True to Prior Editions with Several Improvements

Excerpted from the Preface of Health Program Planning and Evaluation, 4th Edition,
by L. Michele Issel, PhD, RN, University of North Carolina College of Health and Human Services Department of Public Health, Charlotte, North Carolina

Health Program Planning and Evaluation by L. Michele Issel, PhD, RN published on August 4, 2017.

Health Program Planning and Evaluation by L. Michele Issel, PhD, RN published on August 4, 2017.

The fourth edition of Health Program Planning and Evaluation has stayed true to the purpose and intent of the previous editions. This advanced- level text is written to address the needs of professionals from diverse health disciplines who find themselves responsible for developing, implementing, or evaluating health programs. The aim of the text is to assist health professionals to become not only competent health program planners and evaluators but also savvy consumers of evaluation reports and prudent users of evaluation consultants. To that end, the text includes a variety of practical tools and concepts necessary to develop and evaluate health programs, presenting them in language understandable to both the practicing and novice health program planner and evaluator.

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How Health Insurance Actually Works

By Kristina M. Young, MS & Philip J. Kroth, MD, MS
Authors of Health Care USA, 9th Edition

Amidst all the rhetoric and bluster of the health care debate, public discourse suggests that many lawmakers and the American public have little understanding of the fundamental principles of how insurance actually works.  Regarding the ACA, calls to end its “individual mandate” because it infringes upon personal rights, suggestions to segregate people with pre-existing conditions into high-risk pools, and proposals to cap life-time health insurance benefits are only three examples of what seem to bespeak an enduring ignorance. In the face of all controversies, health insurance market principles remain grounded in insurers’ management of risk and how insurance works.

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The Quest for Universal Health Coverage

By Richard Skolnik, MPA
Author of Global Health 101

The quest for Universal Health Coverage (UHC) is central to all efforts in global health. Indeed, all high-income countries, except the United States, have had a system of universal health coverage for some time and all low-and middle-income countries have at least a commitment in principle to achieving UHC as soon as possible.

In this context, it is important for those of us who teach global health to understand the concept of UHC, some of the key reference materials that deal with UHC, and some of the countries that we want our students to study to best understand the “quest for universal health coverage.”

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Informatics for Health Professionals is “an effective introduction to informatics”

Informatics for Health ProfessionalsInformatics for Health Professionals by Kathleen Mastrian and Dee McGonigle recently received a 4-star review. David M. Liebovitz, MD, from the University of Chicago Medicine, writes for Doody’s Review Service that it is,

“…an effective introduction to informatics for a broad audience of allied health professionals. The pairing of the online site with the book…augments the high quality through reinforcing key concepts.”

Informatics for Health Professionals is an excellent resource to provide healthcare students and professionals with the foundational knowledge to integrate informatics principles into practice. Learn more at our website.

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Health Care Quality as a Scientific Endeavor

by Donald M. Berwick, MD, MPP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement

Excerpted from the Foreword of Quality Health Care: A Guide to Developing and Using Indicators, Second Edition, by Robert C. Lloyd. (Available Sept. 1, 2017)

In the now 30-year history of bringing modern quality methods into the control, improvement, and planning of health care, skeptics sometimes comment on the “religious” tone of that movement.  Leaders and others in the workforce who get the quality “bug,” seem to buzz with their enthusiasm.  They adopt phrases like “joy in work,” “pursuing perfection,” and a “never-ending journey,” and sprinkle their vocabulary with unfamiliar technical expressions, like “PDSA cycles,” “high reliability organizations,” and “statistical process control.”  And, they seem to think they are right, lamenting together that too many others so not see what they, at last, see.

So it does, indeed, seem to newcomers as if a religion, or at least a cult, has arrived in town.  The “immune reaction” can be strong.

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The Effort to Repeal and Replace the ACA Moves to the Senate

By Sara Wilensky, JD, PhD
Co-author of Essentials of Health Policy and Law, 3rd Edition

In a political surprise (how many have there been?), the House of Representatives passed a modified version of the American Health Care Act (AHCA) on May 4, 2017 by a vote of 217 to 213.  Every Democrat and 20 Republicans voted against the bill. Most of AHCA remained the same as described in a previous post.  While the original AHCA did not even make it to a vote, two amendments allowed the modified version to pass through the House with the support of the conservative Freedom Caucus as well as some moderate Republicans.

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