Teaching Health Policy Eric Henley MD MPH Deanna

Teaching Health Policy Eric Henley, MD, MPH Deanna Willis, MD, MBA

Teaching Health Policy n The United States faces growing crises n n n Healthcare disparities Healthcare finance Challenge of engaging and empowering learners n n Break complex issues into segments or modules that can be integrated with other curricular elements Learners to feel like they personally can make an impact

Objectives n n n Recognize an array of relevant health policy topics that can be taught to students and residents Review and discuss various strategies for organizing and teaching health policy to students and residents Learn how other family medicine educators around the country are approaching the education of students and residents about health policy

Lecture Discussion Schedule Introduction/Review of Objectives n Example of Health Policy Curriculum for Medical Students n Example of Engaging Students in the Impact of Health Policy n Group Discussion n

Teaching health policy to medical students Eric Henley MD, MPH Professor and Head Dept of Family and Community Medicine U of Illinois COM at Rockford

Format Three 2 -hour sessions n Part of ‘EPC’ course n Lecture/discussion n Student presentations on international health systems n

Medical students and US health system National survey of M 1 and M 4 s n 14 health policy questions 4 questions about health policy curriculum n Response rates: n n n 295 M 1 s (57%) 474 M 4 s (56%) Acad Med 2006; 81: 721 -727

Results 40% underestimated # of uninsured n 32% thought US had highest life expectancy n 26% did not know US had highest health cost/person of any nation n 96% thought health policy knowledge important to their careers n 54% were dissatisfied with the health policy curriculum in their school n

Health Policy Session #1 n Organization and financing n Paying for health care n n Government and private health care n n Terminology, payment systems, community/experience rating Medicare, medicaid, SCHIP, safety net system Reimbursing providers

Learning Objectives n n n Introduce health policy curriculum Review the role of government and private insurance in financing health care. Describe covered services and financing of Medicare and Medicaid. Discuss the role of managed care in the US Examine various systems for paying physicians and hospitals for health care.

Readings n n Robinson J. Reinvention of Health Insurance in the Consumer Era. JAMA 2004; 291: 1880 -1886. n An excellent review of changes in the private health insurance industry in response to the backlash in the US against more restrictive health plans. Porter E. Health care for all, just a (big) step away. NY Times, Dec 18, 2005. n Quick read on the problem with employer-based health insurance.

Health Policy Session #2 n n Consumer-directed health care (CDHC) The Uninsured The Medicare prescription drug bill International health overview

Objectives n n Explain and analyze the consumer-directed health care movement Describe the problem of the uninsured in the US Discuss the implementation of the Medicare prescription drug bill of 2003. Review comparative health data from developed countries: financing, health status, and consumer views.

Readings n n n Insuring America’s Health: Principles and Recommendations. Institute of Medicine; 8 pages. 2004 http: //www. iom. edu/Object. File/Master/17/732/0. pdf n Summary of the last of a series of reports on the uninsured. Gladwell M. The Moral-Hazard Myth. The New Yorker, Aug 29, 2005. n Interesting article on the current state of the US health insurance debate from the author of “The Tipping Point. ” Henley E. The Medicare prescription drug bill: Resources to inform and equip your patients. J Fam Prac 2006; 55: 41 -44. n Summarizes implementation issues for the new Medicare drug program

Health Policy #3 n n n International health presentations Primary care Variation in health care by geographic and cost

Objectives n n n Workshop to review alternative health care systems in developed countries. • Volunteers will work in small groups to present an overview of three health systems: UK, Germany, and Canada. (extra credit awarded to presenters) Define primary care and describe the relationship between primary care, health care costs, and health outcomes Review influences on student career choice

Readings n Fuchs F and Ezekiel E. Health Care Reform: Why? What? When? Health Affairs Nov/Dec, 2005; 24: 1399 -2014. (available through UIC ecollection) n Excellent overview of various national health insurance options

Evaluation Students are very interested in these topics n Many actively participate in the discussions n Formal evaluations: generally 4+/5; not as high last year n

Health Policy Review for R 1 s 2 -hour session during orientation n Topics: n n n Organization and financing of health care The Uninsured Medicare Part D Value of primary care International health comparisons

Resources n n n Bodenheimer T and Grumbach K. Understanding Health Policy. 4 th ed. , 2005. Lange FMDRL Kaiser Family Foundation n www. kff. org n www. kaiseredu. org Commonwealth Fund: www. cmwf. org Organization for economic cooperation and development: www. oecd. org Series on the uninsured: www. iom. edu

Teaching Health Policy: Engaging and Empowering Learners Deanna R. Willis, MD, MBA Assistant Professor of Family Medicine Indiana University

Program Examples across the learning continuum Pre-Med Students: Service Learning to experience the impact of policy on safety net hospitals n Medical Students: Student led forum promotes smoking ban implementation n Resident Physicians: Lecture series on Underserved populations and the impact of healthcare finance policy n

Pre Medical Education on Health Policy n Learners generally are: n n n Extremely altruistic Desirous of experiential learning Naïve about health policy Amenable to alternative learning formats Uncomfortable with pliable structures and rules Extremely capable and enthusiastic

Example of Pre-Medical Education on Health Policy n n n Service Learning course in medically underserved primary care clinic at the county (safety net) hospital 3 hours pass/fail Monthly class meetings n n On line weekly discussion forums Multidisciplinary shadowing n n n n Provides framework for course Provides reflective material Dietitians Social workers Financial Counselors Front desk/Check out Medical Records Physician Service Project

Health Policy Underpinnings n Initial class lecture on Care of Medically Underserved n n n Simulation experience “The Scramble” n n Allow students to witness first-hand impact of health policy on individual patients Weekly discussion forums n n Allows students to experience impact of disparate healthcare resources Shadowing n n Presents national health policy issues related to safety net care Presents impact of those policies on safety net hospitals Students asked to post examples of patients impacted by health policies Service Projects n Allow students to become engaged in health policy issues n Student appointed to Mayor’s community task force on healthcare

Perceived impact by students n Qualitative Analysis of semester end essays n Sample quotation n n “I was tremendously impacted by serving underprivileged individuals. It made me realize that everyone suffers and needs help when they are down. I can’t wait to become a doctor and I will always remember this service learning class. It allowed me to look past all the technical things in the medical world and to get down to what really matters; helping people. ” Interest in Providing Healthcare in Medically Underserved Area: n n 59% (22/37) responded yes on pre-course survey if interested in providing healthcare in a medically underserved area 2/22 (9%) reported that they were no longer interested in working in a MUA Remaining 15 students, 60% (9/15) responded that they were interested in practicing in medically underserved setting on post course survey, which was statistically significant X 2 = 4. 26 (continuity corrected), p = 0. 039 PRE No Grand Total 29 POST Yes 20 9 29 No 2 6 8 Total 22 15 37

Medical Student Education on Health Policy n n 6 year Combined Degree MD/MBA students MD/MBA forum: n n n Students address health policy issues n n Student run Roundtable format with local Physician Executives Develop position statement Develop action plan May include lobby efforts at State Legislature Students played an important roll in implementation of 2006 Smoking Ban policy

Resident Education on Health Policy n Lecture series part of Practice Management curriculum n n n Education on state Medicaid structure and rules, including eligibility and coverage Education on state indigent care programs Education on Medicare structure and rules Education on Healthcare disparities and care of underserved populations Perceived benefit from Residents n Routinely 5/5 ratings on post-lecture evaluations

Summary Health policy can be taught across entire continuum of medical education n Health policy can be taught with variety of learning mechanisms n Health policy teaching can be well received by learners n

Discussion Topics What health policy topics are you teaching or would you like to teach? n Where does health policy fit into your predoc or graduate curriculum? n What additional ideas do you have for teaching health policy? n