Health Sciences

School of Public Health

Comparative and Historical Study of Health Systems - PHE4CHS/PHE5CHS

Coordinator

Associate Professor David Legge

Unit Details

PHE4CHS/PHE5CHS

Timetable

Timetable

Outline

2006

The tutorials will take place on the Wednesdays indicated, Group One at 8.00 am and Group Two at 5.00pm.

Outline

The School of Public Health at La Trobe University offers Comparative and Historical Study of Health Systems in Distance Education mode.

This unit (which has been developed with the assistance of the Commonwealth PHERP program, see below) is one of a suite of health policy units presented through the School of Public Health at La Trobe University for postgraduate students in public health, health services management, health policy, health promotion and related disciplines. This subject is suitable for postgraduate students in public health, health policy and health services management programs.

This unit explores the comparative and historical study of health system development and health sector reform. It has a strong policy orientation including a focus on policy analysis and policy development. Students are encouraged to study the problems and options facing their their own national health care systems in the context of a review of health system development in a number of other countries focusing on key episodes and key features of other health systems. This includes focused study of key health policy issues including topics such as: health care financing and health insurance; primary health care and community health; health promotion and pharmaceuticals policy. We explore themes and issues in health sector reform world wide, including links with economic reform.

The distance education version of the subject is presented through seven modules across 13 weeks, each module comprises annotated Powerpoint presentations, prescribed reading, short exercises and online discussion. The materials for the subject are provided on a CD backed up by a dedicated website and links to relevant internet resources.

The subject is credited as a 15 credit point (one eighth of a full-time year) postgraduate elective subject in the La Trobe School of Public Health and may be able to be credited at other universities.

Credit arrangements for other universities should be discussed with your course coordinator at your home university.

The subject is offered both on a HECS basis and full fee, depending on the basis of course enrolment. Students can also enrol in this subject on a single subject basis.

For further information on the subject please contact the subject coordinator.

Rationale for Comparative and Historical Study of Health Systems

Policy is the practice of history. Policy practitioners need to understand the dynamics through which health systems evolve. The comparative and historical study of health systems (CHS) contributes to contemporary policy practice at all levels from description, interpretation, explanation and prediction to prescription.

CHS contributes richly to the languages, concepts and frameworks which we use to describe health systems. Terms such as managed care or internal markets derive from particular places and times but are taken into the technical jargon of health system description. CHS contributes to interpretation, explanation and prediction as a source of insights and generalisations about the dynamics of health systems operations and development. CHS contributes to prescription in the form of policy models and strategies for change; derived in one jurisdiction and applied with varying degrees of success in others.

Health systems cannot be contained within laboratory conditions. Generalisations about the dynamics of health system change and the principles of health system reform can only be based on the careful study of the performance and evolution of different health systems, operating in different circumstances and under different pressures.

Learning Objectives

At the completion of their study in this subject we hope that the students participating in this subject will:

• be able to describe the key features of selected national health systems, including histories of development and the contemporary sociopolitical context;

• be able to discuss systematically the generic features of health systems (and associated generic policy issues) as a framework for thinking about (describing, comparing, evaluating) health systems across jurisdictions;

• be able to address a range of current policy issues in their own jurisdictions and draw lessons from comparative and historical policy study with respect to causes and possible reform strategies;

• have advanced skills in policy analysis and policy development; and

• understand and be able to apply the key principles of comparative and historical policy analysis.

Structure, media and platforms

This subject is taught through distance education media across the thirteen weeks which comprises the La Trobe semester.

Students are provided with a CD containing the subject guide, the lectures, some key references and internet links. In addition we using a forum site (bulletin board) to post our small exercises and we have an email list.

A key feature of this subject are the internet mediated audo teleconference tutorials using Paltalk. You will need to practice in the use of this facility before our first tutorial. The Paltalk conference room will be open every morning during the week prior to start of semester for student practice. You will need to procure a microphone headset (with earphones and microphone) that plugs into your computer to participate in these teleconferences. You will need to be connected to the internet during these tutorials; broadband is preferable but not necessary.

The study program comprises seven modules, outlined in more detail below, each of which involves 1-5 units plus a tutorial. The tutorials are mediated by audio (internet) teleconferencing and synchronous chat. Each unit comprises a lecture, recommended reading and websites and a small exercise.

Study Program

Module One: Learning from other countries

The purpose of this module is to introduce the idea of 'learning from other countries', to introduce the Australian Healthcare system (and some of its challenges) and to explore the application of comparative and historical method to the Australian states and territories. The units cover:

• Introduction to this subject
• The Australian Health Care System
• The Australian states and territories

Module Two. The history of Australian health care

The purpose of this module is to review the development of the Australian health care system in historical terms. There is only one topic but it is presented in two parts:

• History of Australian health care (Part A)
• History of Australian health care (Part B)

Module Three. UK, US and Canada

The focus of this module is on three health systems which have been particularly influential in Australia (and internationally). All students will study all of the following:

• The UK health care system
• The US health care system
• The Canadian health care system

Module Four. Elective countries

This module provides students with the opportunity of scanning a range of different systems and focusing in detail on the health system of a country of their choice, including:

• Germany
• Japan
• Thailand
• France
• Chile
• Singapore
• Indonesia
• China
• Malaysia
• Eastern Europe

Module Five. Hospitals

The focus of this module is on hospital systems. The topics studied include:

• Significance of hospitals
• Trends in hospital services
• Paying for hospital care
• Regulating clinical performance
• Investing in hospitals

Module Six. Other sectors of health care

The focus of this module is on the study of particular sectors or features of health systems. These include:

• Health care financing
• Governance, stewardship and management
• Primary health care, general practice and community health
• Pharmaceuticals
• Public health and health promotion
• Aged care and services to people with disability
• Mental health programs

Module Seven. Theory, methods and application

The purpose of this module is to explore the idea of 'learning from other countries'; what it might involve and how we might benefit from other countries' experience whilst avoiding some of the traps of 'naive borrowing'. ... on sector wide reform. We consider the following topics:

• Methods in comparative and historical study of health systems
• Health systems: frameworks for describing and questioning and restructuring
• Applying the lessons of comparative and historical study of health systems in policy practice
• The idea of 'health sector reform'

Thanks to

This subject has been developed with the assistance of the Commonwealth Department of Health and Aging through a PHERP Innovations grant.

Subject development has been coordinated by David Legge, of the La Trobe School of Public Health in association with Ms Deb Gleeson, Professor Vivian Lin, Ms Alison Hughes of Planning Paradigms Pty Ltd, Dr Jenny Lewis, of the University of Melbourne and Professor Judith Healy of the European Observatory on Health Care Systems and Visiting Fellow at the National Centre for Epidemiology & Population Health, Australian National University.

Further lectures and suggestions have been provided by Dr Simon Barraclough, Ms Lisa Gold, Dr Sandy Leggat, Dr Chris King, Ms Nitita Prazopa-Plaizier, Dr Pei Likun and Dr Ken Harvey.

Development and production has been assisted by Ms Penny Wong, Ms Kirsty Irving and Mr Marcus de Rijk.

Lecture Notes

Lecture notes are included on the CD provided to enrolled students.