TRINITY UNIVERSITY

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TRINITY UNIVERSITY SPRING SEMESTER, 2008 ADMN
641,EVC PUBLIC AND COMMUNITY HEALTH- 3
CREDITS COURSE SYLLABUS Class meetings
Wednesdays 630-1000 P.M., March 20th- May 8th,
2008 Texts Leavitt, J.W., Typhoid Mary Captive
to the Publics Health Beacon
Press, 1996. ISBN - 0-8070-2103-2
Shilts, R., And the Band Played On
St. Martins Press,1988 ISBN 0-312-24135-6 Instr
uctor Stuart Henochowicz, M.D., M.B.A.,
F.A.C.P. 6035 Burke Centre Parkway, Suite
120 Burke, Va. 22015 Tel. [phone] (office
and after hours) Fax [phone] E-Mail
henochmd_at_burkemed.net
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Course Description
Provides an overview of concepts and issues in
public and community health, with a focus on the
skills and knowledge required for the management
and development of community health services. The
course addresses epidemiological, policy, and
ethical issues in preventive health services, and
discusses the history, purpose, and results of
public and community health activities.
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Course Goals
To understand the historical background of modern
public and community health To understand past
and current major medical concerns in public
health To become acquainted with the
governmental public health infrastructure To
understand the broad policy issues in public and
community health To develop competence with the
economics and management issues that are
essential for providing community health services
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• Course Objectives
• After completion of this course, the student
  will
• Identify the contemporary major public issues in
  the U.S., and be able to enter into public and
  community health policy discussions
• Be able to synthesize a medical disaster
  management plan for residents affected by Katrina
  
• Identify the major U.S. governmental agencies
  that impact on community health services
• Understand the issues involved in managing HIV
  disease in the community
• Be able to formulate a strategy for community
  health management using the principles of COPC (
  Community Oriented Primary Care)
• Develop a comprehensive public health strategy
  for a hypothetical mid- sized American city

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Attendance Policies
Students should make every effort to get to
class on time. Students should notify Dr.
Henochowicz of planned absences from class due to
conflicting work obligations at least 1 week
prior to such an absence. Absences amounting to
one-third or more of the class periods may result
in a lower grade.
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Academic Integrity
This course will operate according to the
standards set forth in the Trinity University
Honor Code. The Honor Code states as follows
I realize the responsibility involved in
membership in the Trinity College community.
I agree to abide by the rules and regulations of
this community. I also affirm my intention to
live according to the standards of honor, to
which lying, cheating, and stealing are opposed.
I will help others maintain this responsibility
in all matters essential to the common good of
the community. Academic dishonesty may result
in a failing grade and dismissal from the
graduate program, in accordance with the honor
system ( See policy in the Student Handbook and
Academic Policy Handbook).
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Who Am I?

• Physician in Private Practice- Burke, Va. Board
  Certified in Internal Medicine and
  Allergy/Immunology
• Clinical Associate Professor- Georgetown U.
  Medical School
• Senior Scholar, Dept. of Health Policy, Jefferson
  Medical College, Phila., PA.
• Member, Board of Directors, Unity Health,
  Washington, D.C.
• Relevant Background NIH AIDS Program (88-89),
  Clinical Research in Asthma (89- 95), M.B.A.,
  Johns Hopkins (02-05), Adjunct Faculty, Trinity
  U. (05- present)
• Father of 4 children- ages 15-24.

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COURSE OUTLINE
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(No Transcript)
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ASSIGNMENTS 2 page reflection on
community and public health 2 page paper
on Post-Katrina Health Care Issues 6-8
page paper on community health care- focus on
Immigrant Care Group Presentations- groups
of 3-4 to give half hour presentation on
Community Health Care design for a hypothetical
mid sized American city Completed assignments
should be e-mailed to henochmd_at_burkemed.net

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EVALUATION Grading will be weighted in the
following manner Class Participation
20 2 Assignments 10 Paper
40 Presentation
30 The grading scale is as follows A
93-100 points A- 90-92 points B
87-89 points B 83-86 points B-
80-82 points C 77-79 points C
73-76 points
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Web Sites

• Kff.org- Kaiser Family Foundation
• Cdc.gov- Centers for Disease Control and
  Prevention
• Nih.gov- National Institutes of Health
• Ahrq.gov- Agency for Healthcare Research and
  Quality. Contains U.S. Public
• Health Task Force Recommendations
• Apha.org- American Public Health Organization
• Fda.gov- Food and Drug Administration

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Web Sites
AcademyHealth
http//www.academyhea
lth.org Agency for Healthcare Research and
Quality http//www.ahrq.gov Americ
an Accreditation HealthCare Commission
http//www.urac.org American Medical
Association
http//www.ama-assn.org Centers for Medicare
Medicaid Services
http//www.cms.gov Center for Quality Improvement
and Patient Safety, AHRQ http//www.ahrq.gov Commo
nwealth Fund
http//www.cmwf.org Government
Accountability Office
http//www.gao.gov Government Relations
HIMSS
http//www.himss.org/advocacy Henry J. Kaiser
Family Foundation
http//www.kff.org
Source commonwealthfund_at_cmwf.org
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Web Sites
Healthcare Improvement
http//www.ihi.org/ihi Institute of
Medicine
http//www.iom.edu JCAHO

http//www.jcaho.org Kaiser MGH Institute for
Health Policy http//www.mgh.harvard.edu/healthpo
licy National Academy for State Health
Policy http//www.nashp.org National Committee
for Quality Assurance http//www.ncqa.org National
Quality Forum
http//www.qualityforum.org National Patient
Safety Foundation
http//npsf.org Robert Wood Johnson Foundation
http//www.rwjf.org VA National
Center for Patient Safety http//www.patientsa
fety.gov
Source commonwealthfund_at_cmwf.org
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KAISER FAMILY FOUNDATION

• Five Basic Facts on Immigrants and Their Health
  Care
• As discussions on national health care reform
  move to the forefront, some have focused on the
  role of immigrants in the health care system,
  including their impact on the nations uninsured
  problem, their participation in public health
  coverage programs, and their use of hospital
  emergency rooms.

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• To address questions about how immigrants use
  and affect the health care system, this brief
  draws on available research and data to highlight
  five key facts about immigrants health coverage
  and care from a national perspective.
• http//www.kff.org/medicaid/7761.cfm

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Max Weber- 1864-1920
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Max Weber

• German theoretician and sociologist- late 19th
  and early 20th century
• Bureaucracy is the natural outgrowth of modern
  organizations
• Bureaucracy- efficient, impersonal, follows legal
  and accounting principles

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Bulger- Technology, Bureaucracy, and Healing in
America

• Contemporary physician
• Bureaucracy in health care inevitable- in private
  as well as public sector
• Bureaucracy-method of achieving control over
  costs, utilization

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Calabrese and Bobbitt (1978)- Tragic Choices

• Tragic choices made in allocation of scarce
  resources
• 2 types of determinations 1st and 2nd levels
• 1st level- How much?
• 2nd level- Who?

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Calabrese and Bobbitt (1978)- Tragic Choices

• 4 types of allocations
• Pure Market
• Accountable Political Process
• Lottery
• Customary Approach

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Calabrese and Bobbitt (1978)- Tragic Choices

• Pure Market-
• Advantages
• Decentralized decision making
• Individual freedom to choose
• Disadvantages
• Social and moral goals not accounted for (the
  costs of costing)
• Not egalitarian

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Calabrese and Bobbitt (1978)- Tragic Choices

• Accountable Political Process-
• Advantages
• Choices made according to societal standards
• Disadvantages
• Centrally measures social usefulness
• Dependent on the fairness of the political
  process

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Calabrese and Bobbitt (1978)- Tragic Choices

• Lottery- choosing not to choose
• Used for 2nd order determinations
• Variation- First come, first served
• Advantages
• Egalitarian
• Disadvantages
• Absurd results

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Calabrese and Bobbitt (1978)- Tragic Choices

• Customary approach-
• Advantages
• Incorporates societally determined norms
• Avoids overt making of tragic choices
• Disadvantages
• Dishonest approach
• Bolsters status quo

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Heuristics

• A heuristic is a replicable method or approach
  for directing one's attention in learning,
  discovery, or problem-solving. It is originally
  derived from the Greek "heurisko" (e???s??, the
  verb from which Archimedes's famous exclamation
  of "eureka" was derived ), which means "I find
• Sourcehttp//en.wikipedia.org/wiki/Heuristic

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Calabrese and Bobbitt (1978)- Tragic Choices

• What approach should be used?
• Military conscription
• Influenza vaccine
• Kidney transplants

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Tragic Choice Cancer Chemotherapy

• 1st order determination- how much?

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• Market- drug development, sales, patient demand
• Political process-funding for research
• Drug reimbursement

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Cancer Chemotherapy

• 2nd order determination- whom?

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• Private insurance differences
• Ability to pay out of pocket costs
• Early diagnosis of those with private insurance
• Family and social support- transportation, home
  management
• Use of clinical trials to provide access to drugs

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Tax Exempt Organizations

• IRS- 501(c)3 section of the tax code
• Charitable organizations
• Requirements
• Purpose- charitable or public good
• No private inurement
• Must be corporation, community chest, foundation,
  charitable trust
• Ref. http//www.irs.gov/charities/charitable/i
  ndex.html

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Tax Exempt Organizations

• Assets of organization used for exempt purpose
• Upon dissolution- assets go to exempt purpose or
  to government for a public purpose
• Restricted political activity- cannot be involved
  in political campaigning

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Tax Exempt Organizations

• Examples
• Churches
• Scouting organizations
• PTA
• Examples in health care
• Hospitals
• Kaiser Permanente
• Unity Health Care

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Tax Exempt Organizations

• Legal Problems-
• Harding Hospital, Inc. v. United States
• Hospital may not contract to a restricted
  physician group composed solely of hospital staff
• it is impermissible for hospitals to secure the
  loyalty of their existing staff members.

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Tax Exempt Organizations

• Hospital-Joint Ventures General Counsel
  Memorandum (GCM) 39862 (1991) Joint ventures
  cannot be a shell type of arrangement where the
  hospital continues to own and operate the
  facilities in question and the joint venture
  invests only in a profits interest.

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Tax Exempt Organizations

• Feldstein(2002)- Comparison of profit and not for
  profit hospitals
• No clear differences with respect to quality of
  care, pricing, and amount of uncompensated care
• Not for profits- teaching, donations, community
  board members
• For profits- profits distributed to shareholders

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Tax Exempt Organizations

• What would happen to non profit health
  organizations if there was universal,
  comprehensive health insurance?