HMO. PPO. Utilization review. Ask any doctor who has had an insurance company breathe down her neck and she’ll tell you that being a skilled physician now takes more than correctly diagnosing the patient. The alphabet soup and work-talk of health care financing and policy permeate the examination room as do symptoms and disease
Beginning this September, the formerly elective Introduction to Health Care Policy will be a required course for all medical students in the new integrated curriculum (with exceptions such as dental students) in their fall semester.
“Health policy directly affects how our students will be practicing medicine when they’re out in the real world,” said Haiden Huskamp, HMS associate professor of health economics. “Understanding how the policies will affect their clinical decision-making and their patients is important. Knowing how these policies get made, and how they may be able to help influence future policy, is also important. Some students in the past said that their first interaction with these issues—for example, what’s their patient’s insurance and how does that affect the services they can provide?—doesn’t come up until they’re dealing with patients directly. They’re learning after the fact. We want to give them more information up front.”
Being deemed educationally essential posed an instant challenge to course directors Huskamp and Barbara McNeil, chair of the Health Care Policy Department: the intimacy of a course that once had only 30 students had to make way for new teaching approaches when upwards of 150 will now pack the lecture hall.
“Whereas in the past, every session was taught with the full group of students, now we’ll have more of a lecture format, with case discussions, and then we’ll break up into small groups where students can dig into some of the issues with one or two faculty from around the Medical School,” said Huskamp. Nine discussion groups, each with 15 or so students and led by faculty from throughout the Medical School and its affiliated hospitals, will enable these in-depth explorations.
Health policy directly affects how our students will be practicing medicine when they're out in the real world. Understanding how the policies will affect their clinical decision-making and their patients is important. Most of the topics covered by the course are similar to those in the prior course, from how the U.S. health care system is structured and financed to how doctors are paid to what defines quality care and the politics of reforming health care. But with developments in health policy coming as fast as the expansion of medical knowledge, important, topical new material will be added. Three topics the discussion groups will chew on—whether the United States overspends on health care, new ways of preventing medical errors, and the commonwealth’s landmark health reform law—are newcomers to the syllabus.
In another project, small teams of three or four will be assigned to write policy “memos,” as if they were advising lawmakers on a pressing topic. Whether Medicare should negotiate lower drug prices, for example, is one topic likely to be used in the course. The memos will be presented in the discussion sections, and students will debate the memos’ conclusions.
With many policy issues controversial, professors will take care not to evangelize, said Huskamp. When the School of Public Health’s Katherine Swartz lectures on alternatives to U.S. health care financing, for instance, she will not endorse a particular approach. “She’ll say, ‘Here’s what we know about how different systems are likely to work.’” With this information, students will be able to participate in an intelligent debate and discussion with those who propose one view or another.