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Online meeting link: https://sas.elluminate.com/m.jnlp?sid=2009377&password=M.8431E3CDA26FAA6378538ACE4AB670 Course Description:

This course is an overview of the historical, conceptual, ethical, organizational, and political context for health care delivery in the US. It explores current trends, practices and issues in the delivery of health care services in both the public and private sector. We will compare the US health care system to other countries’ health service systems and we will also pay particular attention to Hawaiian health services and to relevant health care access and delivery issues in Asian, Native Hawaiian, and other Pacific Islander populations. Learning Objectives: By the end of the course, each student should be able to: 1. Identify, summarize, present, and discuss components of the health services in the United States including: managed care, health care institutions, health care professionals/personnel, public health promotion, and disease prevention, Medicare, Medicaid, health care economics and financing, long term care, pharmaceuticals, medical technologies, health planning and management.

Office of Public Health Studies Department of Public Health Sciences

University of Hawai‘i at Mānoa Course Syllabus

PH 602: Introduction to U.S. Health Care Services

Summer 2015

Course Time/ Room Weds: 5:45PM-9:00PM Online Credit:

3 credits

Instructor: Tetine Sentell, PhD

Office: Biomed T 102

Phone: (808) 965-5781 (office)

(510) 325-4059 (cell)

Email: tsentell@hawaii.edu

Office Hours: Mondays from 10AM – Noon, and by appointment

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2. Review, analyze, and evaluate health service problems, practices, differences, limitations, and/or trends in health service in the U.S. 3. Critically compare and contrast the U.S. health services system with those from other countries. 4. Critically analyze the structure and functionality of the current health services delivery system in the U.S., particularly in terms of access, cost, politics, health disparities, and quality of care. 5. Research, summarize, and present on the status of various local health care organizations in Hawaii. Required Texts:

Books: Shi, L. & Singh, D.A. (2015). Delivering Health Care in America: A Systems Approach. (Sixth Edition). Jones & Bartlett Publishers, MA. Cohn, J. (2007). Sick: The Untold Story of America’s Health Care Crisis- and the People who Pay the Price. Harper Collins, NY. ($11.66 on Amazon.com) Articles (on Laulima): Liu DK, Blaisdell RK, Aitaoto N Health Disparities in Hawai‘i: Part 1. Hawaii Journal of Public Health. 1: 5-13. Online at http://www.nnaapc.org/pdf/Current-Articles/Hawaii-Public-Health-Journal.pdf Lantos, J. (2010). Cruel Calculus: Why Saving Premature Babies Is Better Business Than Helping Them Thrive. Health Affairs. 29: 2114-2117 http://content.healthaffairs.org/cgi/reprint/29/11/2114.pdf Gawande, A. (2015). Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it? Annals of Health Care. May 11, 2015 Issue. New Yorker. http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande Required Movies: 1) Michael Moore, Erin O'Hara, Christopher Seward, and Geoffrey Richman (2007) Sicko.

Weinstein Company (You just have to watch this. You don’t have to own it.) 2) TR Reid. (2008). Frontline report: Sick Around the World

Available at http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/ 3) Obama’s Deal (2010). Available at: http://www.pbs.org/wgbh/pages/frontline/obamasdeal/ Optional Books and Resources:

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(You are not required to read any of these books, but they offer more personal insights and discussion about issues discussed in class, and are very interesting and well written.) 1) Sered S.S. & Fernandopulle, R. (2007). Uninsured in America. University of California

Press, CA. 2) Abraham, L.K. (1993). Mama Might be Better off Dead: The Failure of Health Care in

Urban America. The University of Chicago Press, IL. 3) Fadiman, A. (1997). The Spirit Catches You and You Fall Down: A Hmong Child, Her

American Doctors, and the Collision of Two Cultures. Farrar, Straus, and Giroux, NY. 4) TR Reid (2009.) The Healing of America: A Global Quest for Better, Cheaper, and

Fairer Health Care. The Penguin Press.

Evaluation: This course is designed to provide students with a foundation for understanding the U.S. Health Care System. Evaluation will be based on the following criteria:

1. Participation: Each student is expected to attend class regularly. This class requires you to be an active participant in your own and your peers’ learning process. You should come to class prepared to discuss the readings each week, and openly exchange ideas in the class. You will have in-class activities to complete as well. You will also have a few homework assignments that are included in this grade. Each student is expected to attend our on-line class weekly. You are expected to be an active participant in your own and your peers’ learning process. You should come to class prepared to discuss the readings each week, and be prepared to openly exchange ideas in class. We will have small group discussions. Also, we will have in-class assignments. Much of the content of this course rests on the quality of your preparation and participation. Thus, class participation carries 20% of the course grade and will be based heavily on the successful completion of your assignments and discussions. Class participation carries 20% of the course grade.

2. Quizzes: Two scheduled quizzes will be given to assess the student’s understanding of

course material, including lectures and readings The vocabulary for each quiz is attached. (10% each for 20% of the course grade)

3. Round-Table Presentations: Each student will participate in three round-table

presentations over the course of the semester. These will concern: (1) another country’s health care system, (2) a local health care organization, and (3) a health care policy issue action. Students will able to choose which country, organization, and issue they would like to cover. Detailed guidelines are included. (10% each for 30% of course grade)

4. Final Presentation and Paper: Sick is a powerful book because of the way the author

ties an insightful analysis of the health care system with moving description of individuals’ personal experiences within the US health care system. For this project, you will interview someone who has had an important interaction with the US health care

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system. This experience can be positive or negative or both. You will use this interview as the basis of a 6-7 page analysis of the US health care system, which will draw from the themes, concerns, and information we will have discussed in class. This final project will make up 30% of your course grade.

Make-up examination policy: Make-up exams will be permitted only under extenuating circumstances. Students will have to provide proof/documentation for consideration. Late papers will be marked down at 25% per missed class. Academic Integrity: Plagarism is unacceptable and will result in a failing grade for the assignment and possibly for the course. Please be familiar with the Hawaii Student Conduct Code. http://studentaffairs.manoa.hawaii.edu/policies/conduct_code/ Grading: At the end of the course, a letter grade will be assigned based on the following grading criteria:

Participation 20% Quizzes 20% (2*10%) Round Table Presentations 30% (3*10%) Final Paper and Presentation 30% Course Grade A+ = 98 – 100 % A = 93 – 97 % A- = 90 – 92 % B+ = 88 – 89 %

B = 83 – 87 % B- = 80 – 82 % C+ = 78 – 79 % C = 73 – 77 % C- = 70 – 72 % F = Below 70%

Disability Accommodation: Any student who feels s/he may need an accommodation based on the impact of a disability is invited to contact me privately. I would be happy to work with you, and the KOKUA Program (Office for Students with Disabilities) to ensure reasonable accommodations in my course. KOKUA can be reached at (808) 956-7511 or (808) 956-7612 (voice/text) in room 013 of the Queen Lili'uokalani Center for Student Services. Writing Resources and Campus Writing Center: I want to see clear, concise, well-edited work for your policy action letter and especially your final paper. It is essential that, as public health professionals, you are able to write clearly and edit your work. When you turn in your final paper, I will grade down if there are numerous grammatical errors, typos, and examples of non-standard English. You have plenty of time to start this process early and to find someone who can help you meet these goals. You do not need to do this alone. In fact, most writers do not. We are happy to look at earlier drafts and provide advice and guidance, though I will not provide detailed editing for you. If you need assistance with this, please contact the writing center and work with a writing tutor there. You should also

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work with your peers to provide editing and constructive advice for each other. This is how I often get excellent advice on my own writing and other work. Here is a link to the Campus Writing Center website. They list information about their services and have online resources as well. Please use them, if you need help! They are a great resource. http://www.english.hawaii.edu/writingcenter/ Other Matters:

• This class schedule may need to be revised as the semester progresses.

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Schedule of Classes, Readings and Examinations (Please note that the course calendar is “subject to change with fair notice”)

Date Topic Readings by Chapters to be done BEFORE the class week for which they listed.

5/27

Course Overview A Distinctive System of Health Care Delivery System Framework

(1) Text: 1 (2) Sick: Intro, 1

Systems Foundations

6/3

Health Care Reform Beliefs, Values, and Health

(1) Send Picture! (2) Text: 2 (3) Sick: 2 (4) Health Affairs Article: Cruel

Calculus (5) In Class 1: Debate Social

Justice

6/10

Cost, Access, and Quality The Evolution of Health Services in the United States Health Care Reform

(1) Text: 3, 12 (2) Sick: 3 (3) New Yorker article (4) In Class 2: Debate HC

Reform

6/17

Other Countries’ Health Care Systems: Round Table and Discussion

(1) Frontline Documentary: Sick Around the World

System Resources

6/24

Health Services Professionals Medical Technology

(1) Text: 4, 5 (2) Sick: 4 (3) In Class 3: Types of health care professionals

7/1

Health Services Financing

(1) Text: 6 (2) Sick: 5, 6 (3) In Class 4: Who will insure me? Make sure you have your textbook during class this day!

7/8

Outpatient and Primary Care Services Inpatient Facilities and Services Quiz #1

(1) Text: 7, 8 (2) In Class 5: Outpatient and

Inpatient Settings

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System Processes

7/15

Hawaiian Health Services Round-Table and Discussion Discussion of Ideas for Final Projects

(1) Sick: 7, 8 (2) Lui et al, 2009

7/22 Virtual Class Virtual Class

7/29 Long Term Care Managed Care and Integrated Organizations

(1)Text: 9 (2)Text: 10 (3) Tell the Story of Tutu

System Outcomes and Outlook

8/5

Health Services for Special Populations Quiz #2

(1) Text: 11 (2) In Class 6: Health Services for Special Populations (1) Sicko (the movie)

8/12

Health Policy Action Round-Table and Discussion Health Policy Sicko Discussion Future of Health Service Delivery

(1) Prepare letter (2) Frontline Movie: Obama’s Deal (3) Text: 14

8/15 Final Papers due

Turn in hard copy to me or email

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FINAL PROJECT This project follows the model of the book Sick and allows you to construct an analysis of the US health care system using a case study. You will have a detailed interview with a person about an important interaction they have had with the US health care system. The person you chose to interview can be someone you know well or someone you don’t know well, but they must be someone who has had a significant interaction with the health care system. This experience can be routine, but intense (e.g., having a baby), frightening (e.g., cancer diagnosis/treatment), long-term (e.g., diabetes care), or even about someone else (e.g., description of end-of-life choices for parent). It does not have to be a negative experience. It could be with someone who got extremely high-tech care that saved his/her life. It could also be not about an interaction with a health problem, per se, but an issue with insurance, such as someone with a pre-existing condition who struggled to find insurance or someone uncertain about their insurance after a job loss. These are just some examples. You should find an issue that is important to you. This paper should be about 6-7 pages, 12 pt., double-spaced. Please note that, even though this paper is not particularly long, this should not be taken as an invitation to write it carelessly and quickly. It should be short b/c it’s written clearly, with cogent argumentation. Please use specific examples and insightful analyses. Guidelines: Please include the following. They do not have to be in exactly this order, but try to cover as much of these subjects as are relevant to your topic. I. Description (approx. 2 pgs) 1. A description of the subject. (You can make up a name, or use the person’s real name,

depending on your preference) 2. A description the subject’s health care coverage. 3. A description of the subject’s health care issue 4. A description of the specific interaction with the health care system that will be the focus of

your analysis. 5. Any other relevant background info (e.g., a description the cost of care and/or impact on

finances) II. Analysis (approx. 4 pgs) 1. How does this person’s experience meet up with what we have discussed, and what you

believe should be the integral mission (and component parts) of a health care system? 2. What does this person’s experience bring you to conclude about social vs. market justice as a

philosophical position about health care access? 3. How does this person’s experience show the strengths and/or weaknesses of the US health

care system?

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4. What do think worked well and what did not work well in your subject’s health care experience? Does your subject agree with this analysis?

5. Considering this person’s issues specifically, what do you think could change in the US health care system to help fix these problems? What might such a change mean to the larger health care system?

6. Do you the provisions in the Affordable Health Care Act address these issues? 7. What else do you think could be done to the US health care system to address these

concerns? III. Conclusion (approx. 1 pg.) 1. Update on how subject is doing. 2. A concise summary of your analysis. 3. Any final conclusions about the US health care system as it as, and/or as you think it should

be.

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ROUND-TABLE DISCUSSIONS Over the course of the semester, we will have 3 round-table discussions where you will each prepare a short, structured presentation about each of the topics below that should last no more than 5 minutes. The time line will be tight, so you should prepare your presentation carefully. We will then discuss what we have learned and ask questions.

Round Table 1: Other Countries’ Health Care Systems Our first round-table discussion will concern the specifics of other countries’ health care systems, and compare them with the US. You can pick a country of your choice. This selection will be confirmed in our class in September. You should cover:

1) The country’s location 2) The country’s population 3) The country’s total cost for health care 4) The country’s total cost/person for health care 5) The average life expectancy in your country 6) The country’s style of health care system according to models discussed in class 7) The country’s major health issues 8) Anything else you feel is critical

Round Table 2: Hawaiian Health Care Organizations From the list of local organizations to be distributed in class, you will choose one and will provide specifics of that organization. You should cover:

1) Name and location of the organization 2) Target clientele 3) Operating budget and funding sources 4) Major programs, activities, services 5) Anything particularly noteworthy or interesting about the organization 6) If you can bring in a pamphlet from the organization, that would be nice.

Round Table 3: Health Care Action This is a very exciting and dynamic time in US health care reform. I want you to join this debate using the information you have gathered from this class and your final project preparation, as well as other courses, your professional experience, and your personal experience. I want your voice heard about a health care issue you care about. Please pick a publication or a policy-maker of your choice, and write a letter addressing what you feel is a critical factor in health care today. This should be written in a highly digestible and accessible form and should be no more than one page. It would be great if you can link this letter to a specific article or a specific bill that is pending. Depending on your topic of choice,

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however, this may not be feasible and is not required. (A preliminary selection of the issue you plan to discuss should be confirmed in our class on September, though you will be able to change it, if something else strikes your fancy during the course of the semester.)

I will post links with advice about writing a good letter to an editor or policy-maker on our laluima site and we will discuss this as well.

For our final round-table discussion, we will read and discuss these letters in class. After class, you should make any changes you would like to make based on our discussion and your classmates letters, if you have any to make, and then you should mail them! Also, please turn in a final copy to me. And, of course, let me know if it get published or mentioned again!

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VOCABULARY FOR QUIZ #1 Here is the vocabulary you should pay attention to in your reading and in class in preparation for the first quiz. 1 Adverse Selection 2 Categorical programs 3 Clinical information systems 4 Cost-benefit analysis 5 Cost-containment 6 Defensive medicine 7 First-dollar coverage programs 8 Indemnity plan 9 Maldistribution 10 Market Failure 11 Means Test 12 Medicaid Medicare 13 Medical Arms Race 14 Moral Hazard 15 National health expenditures 16 National health insurance (NHI) 17 National health systems (NHS) 18 Non-Profit 20 Physician extenders 21 Reinsurance 22 Single-payer system 23 Social health insurance (SHI) systems 24 Supplier-induced demand 25 Technological imperative

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VOCABULARY FOR QUIZ #2 Here is the vocabulary you should pay attention to in your reading and in class in preparation for the second quiz. 1 Managed Care Organization 2 HMO- Staff Model 3 HMO- Group Model 4 HMO- Network Model 5 HMO - IPA 6 PPO 7 Pay or Play 8 Non-Profit 9 Prospective Reimbursement 10 Retrospective reimbursement 11 Supply-Side rationing 12 Demand-side rationing 13 Provider-Induced demand 14 Medicare Part A 15 Medicare Part B 16 Medicare Part C 17 Medicare Part D 18 Community Rating 19 Experience Rating 20 Insurance Mandate 21 Underinsured 22 capitation 23 POS 24 Medicaid 25 Carve Out

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MPH  Competencies  This  course  (602)  meets  the  interdisciplinary  MPH  competencies  listed  below.    HEALTH  POLICY  AND  MANAGEMENT  COMPETENCIES  H1.   Identify  the  components  and  issues  of  the  organization,  financing  and  delivery  of  health  services  and  PH  systems  

in  the  U.S.  H2.   Discuss  the  policy  process  for  improving  the  health  status  of  populations.    SOCIAL  BEHAVIORAL  HEALTH  SCIENCES  COMPETENCIES  S2.   Interpret  the  causes  of  social  and  behavioral  factors  that  affect  health  of  individuals  and  populations.    DIVERSITY  AND  CULTURE  COMPETENCIES  D1.   Describe  the  roles  of  history,  power,  privilege  and  structural  inequality  in  producing  health  disparities.  D2.   Demonstrate  ability  to  interact  respectfully  and  effectively  in  diverse  groups.    SYSTEMS  THINKING  COMPETENCY  T1.   Recognize  system-­‐level  properties  that  result  from  dynamic  interactions  among  human  and  social  systems  and  

how  they  affect  the  relationships  among  individuals,  groups,  organizations,  communities,  and  environments.    ETHICS  AND  PROFESSIONALISM  COMPETENCIES  P1.   Apply  public  health  ethical  standards  of  practice  into  all  interactions  with  individuals,  organizations,  and  

communities.  P2.   Demonstrate  professionalism  in  public  health  research  and  practice  based  on  principles  of  professional  conduct  

and  ethical  practices  of  public  health  (available  in  the  Practicum  Handbook).    Health  Policy  and  Management  Competencies    This  course  (602)  also  meets  the  following  Health  Policy  and  Management  Competency  HEALTH  POLICY  &  MANAGEMENT  SPECIALIZATION  COMPETENCIES    HPM3.   Apply  quality  and  performance  improvement  concepts  to  improving  health.  HPM4.   Demonstrate  leadership  skills  for  building  partnerships.  HPM5.        Analyze  and  translate  the  impact  of  current  and  proposed  policy  on  public  health.  

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IN-CLASS ACTIVITIES General Instructions: You have been assigned THREE of these activities according to the schedule attached. You are welcome to trade, but all topics must be covered. These panels are a critical part of lecture. You will have 3 minutes, and you should be prepared. Please use slides, but have no more than two. Send your slides to me by WEDS AT NOON via email so I can compile them before class.

#1 (Week 2): Market vs. Social Justice Debate

We are going to debate market vs. social justice related to health care. You will have a position to defend, and you should defend it well even if you don’t agree with the position you have.

#2 (Week 3): Health Care Reform Debate This will provide a dynamic understanding of the current political landscape related to health care reform. We will debate features of the PPACA.

#3 (Week 4): Health Care Provider Employment Options Panel

You will be given a job category. You will explain the role of this job and the prospects for the future as if you were trying to recruit individuals for this job. #4 (Week 5): Health Care Financing Activity

You will be given a description of a person. You will need to determine who, if anyone, is responsible for the payment of your basic health care. You will describe yourself to you classmates and explain who pays for your coverage and how the ACA may or may not address their health care access. #5 (Week 6): Outpatient and Inpatient Settings You will be given an inpatient or outpatient clinical setting. You will explain the role of this clinical setting and the prospects for the future. #6 (Week 7): Health Care Services for Special Populations You will have a specific population group. You will give an overview of this population and their unique health care need.

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WRITING ASSIGNMENT: FINAL PROJECT This project follows the model of the book Sick and allows you to construct an analysis of the US health care system using a case study. You will have a detailed interview with a person about an important interaction they have had with the health care system. The person you chose to interview can be someone you know well or someone you don’t know well, but they must be someone who has had a significant interaction with the health care system. This experience can be routine, but intense (e.g., having a baby), frightening (e.g., cancer diagnosis/treatment), long-term (e.g., diabetes care), or even about someone else (e.g., description of end-of-life choices for parent). It does not have to be a negative experience. It could be with someone who got extremely high-tech care that saved his/her life. It could also be not about an interaction with a health problem, per se, but an issue with insurance, such as someone with a pre-existing condition who struggled to find insurance or someone uncertain about their insurance after a job loss. These are just some examples. You should find an issue that is important to you. This paper should be about 7-8 pages, 12 pt., double-spaced. Please note that, even though this paper is not particularly long, this should not be taken as an invitation to write it carelessly and quickly. It should be short b/c it’s written clearly, with cogent argumentation. Please use specific examples and insightful analyses. Guidelines: Please include the following. They do not have to be in exactly this order, but try to cover as much of these subjects as are relevant to your topic. IV. Description (approx. 2 pgs) 6. A description of the subject. (You can make up a name, or use the person’s real name,

depending on your preference) 7. A description the subject’s health care coverage. 8. A description of the subject’s health care issue 9. A description of the specific interaction with the health care system that will be the focus of

your analysis. 10. Any other relevant background info (e.g., a description the cost of care and/or impact on

finances) V. Analysis (approx. 4 pgs) 8. How does this person’s experience meet up with what we have discussed, and what you

believe should be the integral mission (and component parts) of a health care system? 9. What does this person’s experience bring you to conclude about social vs. market justice as a

philosophical position about health care access? 10. How does this person’s experience show the strengths and/or weaknesses of the US health

care system? 11. What do think worked well and what did not work well in your subject’s health care

experience? Does your subject agree with this analysis?

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12. Considering this person’s issues specifically, what do you think could change in the US health care system to help fix these problems. What might such a change mean to the larger health care system?

VI. Conclusion (approx. 1/2 a pg.) 4. Update on how subject is doing. 5. A concise summary of your analysis. 6. Any final conclusions about the US health care system as it as, and/or as you think it should

be.

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IN-CLASS ACTIVITY #1 (WEEK 2): MARKET VS. SOCIAL JUSTICE

We are going to debate market vs. social justice related to health care. You will have a position to defend, and you should defend it well even if you don’t agree with the position you have. Considering you only have 3 minutes, you should focus on a few critical points, rather than many. # Your Topic 1 Our market justice approach to health care distribution is doing a good job in many ways 2 Our market justice approach to health care is doing a terrible job in many ways 3 Access to basic health care is a fundamental human right and should be available to all,

like education. 4 Social justice sounds nice, but “socialized” health care just isn’t politically feasible in the

US. Just take a look at the recent debates about health care reform. 5 The private market is the best source of efficient health care delivery. The government

always messes things up. 6 We will never have cost-effective, equitable health care system unless we move to a

government run, single-payer plan. For those of you who need to defend the market-justice approach and are not sure of this logic, some starting places to look online are: The Heritage Foundation, comments sections in health care reform blogs and articles (see James Edward Hicks III comments to States’ Health Care Reform Efforts Doomed to Fail on The Alan Katz Health Care Reform Blog), and Fortune Magazine (see Why McCain has the best health-care plan- March 11, 2008).

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IN-CLASS ACTIVITY #2 (WEEK 3): Health Care Reform Debate We are going to debate specific issues from the ACA. You will have a position to defend, and you should defend it well even if you don’t agree with the position you have. Considering you only have 3 minutes, you should focus on a few critical points, rather than many. # Your Topic 1 Medicaid expansion should be mandatory in all 50 states to make health care reform

really work. 2 The states have the right to decide if they should decide to expand Medicaid and it’s

important for them to have this choice. 3 I am the governor of (pick a state that did expand Medicaid) and I expanded Medicaid for

these reasons. 4 I am the governor of (pick a state that did NOT expand Medicaid) and I did NOT expand

Medicaid for these reasons. 5 The individual mandate to buy insurance is critical to the success of the ACA. 6 The individual mandate to buy insurance is ridiculously unfair and I should be able to

make my own choices.

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IN-CLASS ACTIVITY #3 (WEEK 5): Health Care Provider Employment Options Panel You have a job category. You will explain the role of this job and the prospects for the future as if you were trying to recruit individuals to start training for this job. # Job 1 Hospitalist 2 Physician’s Assistant 3 Certified Nurse Midwife 4 Clinical Research Administrator 5 Health Information Manager 6 Primary Care Physician

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IN-CLASS ACTIVITY #4 (WEEK 6): HEALTH CARE FINANCING

You will be given a description of a person. You will need to determine who, if anyone, insures you. You will describe yourself to you classmates, explain who pays for your coverage, and explain what your eligibility is based on. If you don’t have coverage, you can describe where you might seek care. Also, please address whether or not PPACA addresses your access to care. # Name Age Family Income Job Health

Issue Other info

1 Joe Smith 68 $12,000/year Retired Diabetic 2 Maria Lopez 68 $300,000/year Retired Brain

tumor

3 Katie Hughes 61 $15,000/year Out of work Brain tumor

Just lost job before diagnosis

4 Bud Sanders 55 $25,000/year Retired Veteran

Diabetic

5 Karen Davis 25 $36,000/year Active Duty Air Force

Traumatic Brain Injury

6 Brandon Ames 25 $12,000/year Seasonal Snowboard Instructor

Broken Leg

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IN-CLASS ACTIVITY #5 (WEEK 7): Outpatient and Inpatient Settings

Here are options you can receive in inpatient or outpatient clinical settings. Please briefly explain these options and their role in the future. If you can, please give a little information regarding the costs and relevant options in these categories, and also a sense of how long these options have been available. TOPIC 1 Outpatient Chemotherapy 2 Inpatient Chemotherapy 3 Outpatient Surgery 4 Inpatient Surgery 5 Outpatient Dialysis/ Dialysis at home 6 Inpatient Dialysis

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IN-CLASS ACTIVITY #6 (WEEK 11): Health Care Services for Special Populations You will have a specific population group. You will give an overview of this population and their unique health care need.

# Topic 1 Individuals with Limited English Proficiency 2 Undocumented Immigrants 3 Women 4 Individuals with Mental Illness 5 Individuals living with HIV 6 Adolescents

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IN-CLASS ASSIGNMENT SCHEDULE You are welcome to trade, but these topics must all be covered. We will go in order. Also, if you can’t find good information about your topic, please feel free to contact me. Activity

#1 Activity

#2 Activity

#3 Activity

#4 Activity

#5 Activity

#6 Cooper 1 1 1 Friedman 2 2 2 Harrison 3 3 3 Karing 4 4 4 Lindstrom 5 5 5 Peter 6 6 6 Pitt 1 1 1 Rodrigues 2 2 2 Schlather. 3 3 3 Serrano 4 4 4 Yu 5 5 5 Hilts 6 6 6

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Virtual Class PH 602 Sentell 1. Activity 1 (~45 mins) Your beloved 83-year-old grandmother, Tutu Cupcake, has fallen and broken her hip. She also has mild dementia. She has been living alone, but she will now no longer be able to take care of herself. She needs to move into an assisted living facility that would be convenient to you so you can visit her regularly (since you are her very favorite of all her 27 grandchildren, or at least that’s what she always tells you). Please identify and consider at least 2 realistic options here in Hawai‘i and use these to answer the following questions.

1. What are the names and locations of the places you picked? 2. Why did you pick these two places? 3. How much would it cost per day? Can you tell? Why or why not? 4. What else would you want to know, if this really was your grandmother and she really

needed care? 5. What did you learn from this exercise?

2. Activity 2 (~30 mins) Choose two of these drugs and find 4 cost options for you to buy them. Some possibilities: Out of pocket at a pharmacy, with insurance at a pharmacy, online through a Canadian pharmacy, and/or any other realistic options. You can consider generics vs. brand names if you like. 1. Xanax (alprazolam) 1mg 2. Viagra (sildenafil) 100mg 3.  Zoloft  (sertraline)  100mg  4. Amoxicillin 500mg 5. Metformin 500mg 6. Lipitor (atorvastatin) 7.  Lexapro  (escitalopram)  10  mg  8. Zyvox (linezolid) 600mg 9. Pick your own Fill in the table and answer the following question: Drug 1 Location to Purchase Cost Source for Info Drug 2 Location to Purchase Cost

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1. What was your best choice for drug 1 in terms of cost? What was your best choice for drug 2 in terms of cost?

2. What do you need to do to get them legally from another country? 3. Can they be reimbursed by your insurance if you get them from another country? 4. What issues did you come across in considering this question? 5. What did you learn from this exercise?

3. Activity 3 (~30 mins) Pick a state Medicaid program (you can do Hawaii or somewhere else), download the relevant application, and apply for aid in 20 minutes or less. You can fill it out as yourself or as a pretend person. You do not need to upload the completed application for the class to see, but please do go through the process of filling it out.

1. Was this hard or easy for you? 2. What challenges might someone have who doesn’t speak English well? 3. What challenges might someone have who doesn’t read well? 4. What other groups might be challenged? 5. If you really needed to fill this out, what else would you need? 6. How long do you think it would take to fully complete this document? 7. What did you learn from this exercise?

4. Activity 4 (~30 minutes) Congrats! You are going to have a baby! You want to start planning right away and put money aside! You also want to find out all your options. Please find out how much an uncomplicated, vaginal delivery and a c-section are likely to cost you (or your female partner). You can consider your personal insurance status, if you have that information. Total

Cost Cost to you Insurance Status Source for Info

Uncomplicated Vaginal Delivery

C-Section

1. What challenges did you have in finding this information? 2. What else would you want to know to really calculate this? 3. What did you learn from this exercise?

5. Activity 5 (~10 minutes) By midnight on July 24, please post your information in a message in the discussion section of Laulima.

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5. Activity 6 (~20 minutes)

By Tues July 28, please read and comment thoughtfully on two other persons' activities. Some ideas: You can mention something you found interesting, something that related to what you found, something else they could think about, etc.