The Economics of Canadian Health Care ECON 317 Instructor Lectures

ECON 317
The Economics of Canadian Health Care
SPRING 2016 COURSE OUTLINE
Instructor
Lectures
Office Hours
Course Site
Christopher Willmore ( [email protected] )
9:30 – 10:20 Tue/Wed/Fri, Cornett Building B143
10:30 - 11:20 Tue/Fri, BEC 390
http://coursespaces.uvic.ca
Contents of this course outline
University Policy on Inclusivity and Diversity
Course objectives and essential course rules
University Policy on Accessibility
Regarding punctuality and courtesy
University Policy on Attendance
Lectures
Electronic Devices
Assignments
Quizzes
University Policy on travel and the Final Exam
Relationship between letter grades and number grades
Lecture schedule and due dates
Evaluation and Assessment
Evaluation
Assignments
Quizzes
Final Exam
Required Textbook
Free and Recommended Textbooks
On Plagiarism and Academic Integrity (IMPORTANT)
Course Experience Survey
2
2
2
3
3
3
4
4
5
6
6
7
9
9
9
9
10
10
11
12
16
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University Policy on Inclusivity and Diversity
The University of Victoria is committed to promoting, providing and protecting a positive,
supportive and safe learning and working environment for all its members.
Instructor addendum: While I expect most of you will treat your peers with the traditional BC
kindness and respect, I’d like to take a moment to remind you all in writing that this course and its
associated web site and meeting space are intended to be a safe and comfortable place for
everyone to learn in. Systematic disrespect or other ill treatment of a person or group of people
will not be tolerated.
Course objectives
Economics studies the allocation of limited resources among unlimited needs and wants. This course will
introduce students to how this takes place in the context of contemporary Canadian health care.
By the end of the course, students will understand how Canada’s health system is organized, and be able
to conduct basic economic evaluations of health care.
Essential Course Rules
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“Be excellent to each other.” –Bill & Ted
Give credit where credit is due
Give all course components an honest try
Don’t keep concerns bottled up
Ask for help if you need it
University Policy on Accessibility
Are you a student with a learning disability, ADHD, mental health issue or long-term recurring
physical or sensory disability? Do you have chronic health issues? If you do, and you need support
with accessing your courses, or need academic accommodations to address barriers to your
education, you need to register with the Resource Centre for Students with a Disability (RCSD).
After you register, the RCSD office will work with you, your instructors and others to create
learning environments that are equitable, inclusive and usable.
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Instructor addendum: I’ve had to deal with a number of disabilities myself. If you are a student
who needs this sort of accommodation, don’t hesitate to contact me personally. Once you do, I’ll
work with you one-on-one and do my best to come up with a custom plan that will hopefully let
you get the most benefit possible from this course.
Regarding Punctuality and Courtesy
University Policy on Attendance
Students are expected to attend all classes in which they are enrolled (University Policy). Students
who do not attend classes must not assume that they have been dropped from a course by a
department or an instructor. Courses that are not formally dropped will be given a failing grade,
students may be required to withdraw, and will be required to pay the tuition fee for the course.
An instructor may refuse a student admission to a lecture or laboratory because of lateness,
misconduct, inattention or failure to meet the responsibilities of the course. Students who neglect
their academic work, including assignments, may be refused permission to write the final
examination in a course.
Instructors must inform students at the beginning of term, in writing, of the minimum attendance
required at lectures and in laboratories in order to qualify to write examinations.
Students who are absent because of illness, an accident or family affliction should report to their
instructors upon their return to classes.
Lectures
Lectures officially begin at 9:30. As a courtesy to other students and the instructor, students are asked to
stay quietly in their seats until 10:20 or an explicit ‘class dismissed!’.
While you are strongly encouraged and expected to attend all lectures in person, it is not a requirement
for sitting the final exam.
What if I’m late to class?
Everyone’s had days where despite their best intentions, they can’t make it to class on time, but don’t
wish to miss the lecture entirely. In these cases, please use common sense and politeness to quietly make
your way to a seat with as little disruption to others as possible.
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What if I miss a class?
If you miss a lecture due to choice or circumstances, you may download the lecture notes on the course
web site. The course forums (also on the site) are a good place to discuss course topics with other
students.
Electronic Devices
Use common sense. In general, I have no problem with the use of electronic devices during the lecture as
long as it does not disturb other students. If a student complains about a peer’s use of a device, the device
must be turned off immediately.
I’m open to allowing students to record portions of the entirety of the lecture as audio, video, or both for
personal use, but please ask and obtain my explicit permission before doing so. You are NOT allowed to
post course materials or lecture recordings to social media or the wider web. If you feel you absolutely
must do so, please see me (the instructor) in person first to obtain permission.
The gist: If YOU wouldn’t be comfortable with someone else doing it to you (stealth-recording a video of
you and uploading it to YouTube, taking your unedited class notes and putting them on the web with your
name on them, texting loudly while sitting next to you in class) then you should probably ask before doing
it, if only for the sake of politeness.
The use of any and all electronic devices is forbidden during quizzes and the final exam.
Exceptions will only be made for documented reasons of accessibility, as detailed in the
university policy on accessibility.
Assignments (Individual and Group)
There are two types of assignments: individual assignments and group assignments. Individual
assignments are to be completed by each student independently. Group assignments are to be completed
in groups of 3 to 5 students. Students will self-select into groups shortly after the start of the course.
Students with a need or strong preference for working alone should contact the instructor to be placed
into a one-student group. Group assignments completed by individual students will be held to the same
standard as those completed by groups.
The 10 individual assignments are submitted electronically via the ECON 317 Coursespaces web site. No
paper submission option is available. Students who require accommodation should contact the instructor
and the RCSD.
Individual assignments are composed entirely of multiple-choice questions that will be marked
automatically by Coursespaces. These questions will provide practice with models covered in class, and
also assess the student’s intuitive grasp of core concepts. Some questions will check that the student has
completed and understood recent required readings.
Full solutions to individual assignments will be released online immediately once the assignment is due.
Because of this, it is not possible to accept individual assignments past the deadline.
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The 3 group assignments can also be submitted electronically via the ECON 317 Coursespaces web site.
Although electronic submissions are preferred, paper versions of group assignments may be handed in at
the start of class on the due date.
Students are allowed to work with other members of their group on group assignments, but are required
to complete individual assignments on their own. Failing to do so is considered a breach of academic
integrity and will lead to a mark of zero on the assignment, and possibly other penalties (see below).
What if I miss an assignment?
If you have a valid excuse (medical, family crisis, etc.) then you are of course excused from the assignment
upon the instructor’s receipt of appropriate information or documentation. If you don’t, the assignment
will receive a mark of zero.
Can I turn in an assignment early?
The online components of assignments may be turned in early. Assignments may be completed and
submitted on the course web site at any time before the assignment’s due date. For logistical reasons,
paper submissions may only be turned in at the start of class on the assignment’s due date.
Quizzes
Quizzes take place in class. They start promptly at 9:32 (allowing two minutes for seating) end at 10:20.
Students should have their student cards out for inspection.
While each quiz will focus on the topics covered since the last quiz, familiarity with all previous course
material is assumed.
What if I’m late to a quiz?
If you are late, please make your way quietly to the instructor to be handed a copy of the quiz. You will
then have to write the quiz in the remaining scheduled time. Unfortunately, due to room bookings and
the fact that the answer key may be posted immediately after the quiz, it is not possible to extend the
allowed time.
What if I miss a quiz?
Students with valid excuses will be accommodated, either by being excused from a quiz, or being allowed
to write it early. Students who miss a quiz without a valid excuse will receive a mark of zero.
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University Policy on Travel and the Final Exam
Students are advised not to make work or travel plans until after the examination timetable has been
finalized. Students who wish to finalize their travel plans at an earlier date should book flights that
depart after the end of the examination period. There will be no special accommodation if travel
plans conflict with the examination.
Relationship between letter grades and number grades
A+
90-100
A
85-89
A80-84
B+
77-79
B
73-76
B70-72
C+
65-69
C
60-64
D
50-59
F or N
0-49
The table on the following page shows quiz dates, assignment due dates and lecture
coverage for the course. If a textbook chapter is not listed for a topic, supplemental
readings will be provided on the course web site.
Preliminary Assignment and Quiz Coverage
Intended quiz and group assignment coverage as of the start of the course is listed below. This
may change as the course progresses. Individual assignments will typically cover the week’s
lectures.
Lectures
Covered
Assignments
1
2
3
1-11
12-22
23-32
Quizzes
1
2
3
1-5
6-16
17-27
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LECTURE SCHEDULE AND DUE DATES, ECON 317 SPRING 2016
(Preliminary: subject to change)
MONTH
January
February
DATE
5
6
8
12
13
15
DAY
T
W
F
T
W
F
19
T
20
22
W
F
26
T
27
W
29
F
2
T
3
5
9
10
12
W
F
T
W
F
QUIZ
ASSIGNMENT
ASSIGNMENT 1
ASSIGNMENT 2
ASSIGNMENT 3
GROUP 1
ASSIGNMENT 4
LECTURE
TOPIC
1
Assessment/Recent Reforms
2
Organization I
3
Organization II
4
Financing
5
Provision of Services
QUIZ 1
Demand for Health, Care and
6
Insurance
7
Physicians as Agents
8
Physician-induced demand?
Rationality, bounded
9
and other
10
Social demand for health
Market Failure
11
and Health Care
Measuring Benefits
12
and Outcomes
13
Measuring Costs
14
Time Preference
READING BREAK
CHAPTER
HIT 1,6,7
HIT 2
HIT 2
HIT 3
HIT 5,4
HE 2,7
HE 17
HE 6
HE 13
HE 8,18
HE 7
HE 10
HE 4,9
HE 7
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LECTURE SCHEDULE AND DUE DATES, ECON 317 SPRING 2016 (CONT.)
(Preliminary: subject to change)
MONTH
February
March
April
DATE
16
17
19
DAY
T
W
F
23
T
24
W
26
F
1
T
2
4
8
9
11
15
16
18
W
F
T
W
F
T
W
F
22
T
23
25
29
W
F
T
30
W
1
F
QUIZ
ASSIGNMENT
ASSIGNMENT 5
ASSIGNMENT 6
ASSIGNMENT 7
GROUP 2
ASSIGNMENT 8
ASSIGNMENT 9
GROUP 3
ASSIGNMENT 10
LECTURE
TOPIC
15
Benefit/Cost Analysis
16
Decision Trees
QUIZ 2
The Production of
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Health Care
Physicians
18
as Providers
19
Hospitals
Prices, Pills
20
and Patents
21
Regulated Prices
22
Negotiated Prices
23
Special Topic 1
24
Special Topic 2
25
Special Topic 3
26
Special Topic 4
27
Special Topic 5
QUIZ 3
Out of Pocket
28
Payment
29
Private Insurance
GOOD FRIDAY
30
Public Insurance
Taxes and
31
Transfer Payments
Is there an
32
optimal mix?
CHAPTER
HE 3
HE 16
HE 14,15
HE 5,7
HE 16
TBA
HE 20,23
HE 20
HE 19
HE 19
HE 22
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Evaluation and Assessment
Evaluation
Individual Assignments
Group Assignments
Quizzes
Final Exam
10%
21%
30%
39%
Assignments: 10% (1% per assignment)
Your assignment mark is the average of your marks over the ten assignments listed in the lecture schedule.
Each assignment carries the same weight, regardless of the number of questions.
Assignments will be posted on the course web site by the day of the first lecture they cover.
Multiple choice questions on assignments are marked electronically, and you will usually receive feedback
immediately after the assignment is due.
Group Assignments: 21% (7% per assignment)
Your group assignment mark is the average of your marks over the three assignments listed in the lecture
schedule. Each assignment carries the same weight, regardless of the number of questions. All students
in a group will receive the same mark.
Group assignments are open-ended, and will be marked by hand according to a rubric provided with the
assignment. Due to the nature of these questions and the need to include feedback, marking may take
one to three weeks.
All assignments (group and individual) are cumulative. While the focus of each assignment is material that
has not yet been covered in a previous assignment, the questions will assume mastery of all previous
topics in the course.
Quizzes: 30% (10% per quiz)
Your quiz mark is the average of your marks over the three quizzes listed in the lecture schedule. Each
quiz carries the same weight, regardless of the number of questions. Quiz questions will be similar in
format to assignment questions, but will be more open-ended and typically not be multiple choice.
In most cases, quizzes will be marked and returned in class within a week of the due date. Students are
only allowed to pick up their own quiz.
All quizzes are cumulative. While the focus of each quiz is material that has not yet been tested, the
questions will assume mastery of all previous topics in the course.
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Final Exam: 39%
The exam is cumulative and consists of questions similar to those on the assignments and quizzes. It is
not necessary to pass the exam in order to pass the course.
Required Textbooks
This course assumes that you may access the required textbooks at will.
Health Economics: An international perspective (Third Edition) [HE]
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By Barbara McPake, Charles Normand and Samantha Smith
ISBN 978-0-415-68088-2
Other editions are not supported by the course.
Either an electronic (e.g. Kindle) or a print copy is acceptable. Used copies are fine.
Health Systems in Transition: Canada (Second Edition) [HIT]
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By Gregory P. Marchildon
ISBN 978-0-802-09721-7
Other editions are not supported by the course.
Either an electronic (e.g. PDF) or a print copy is acceptable. Used copies are fine.
A legal PDF version is available for free at http://www.euro.who.int/en/aboutus/partners/observatory/publications/health-system-reviews-hits/full-list-of-countryhits/canada-hit-2013
Supplementary Textbooks
The following texts are not required, but will be referenced at several points throughout the
course.
Vasiliki Douglas, Introduction to Aboriginal Health and Health Care in Canada: Bridging Health
and Healing, Springer, 2013. Print and Kindle versions available.
Manal Guirguis-Younger, Ryan McNeil and Stephen Hwang (editors), Homelessness & Health in
Canada, University of Ottawa Press, 2014. Print and PDF versions available. Legal, full and free
PDF version available at http://www.ruor.uottawa.ca/handle/10393/30952 .
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Free e-textbooks available from the UVic Library
These textbooks discuss the models presented in the course in more detail than the required
textbook. They are available for free via the UVic library site, as long as you are connecting from
a UVic computer or VPN.
To access them, go to http://www.uvic.ca/library/ , type the textbook title into the ‘search
everything’ box and hit ‘Search’. On the results page that follows, click on any of the links labeled
‘eBook: Full Text Online’. In many cases, the text will be available in the form of a downloadable
PDF for each chapter. In others, you may be restricted to viewing the text in your browser,
without the ability to save.
Textbook Title
Encyclopedia of health economics
Cost-benefit analysis and
health care evaluations
Valuing health for regulatory
cost-effectiveness analysis
Making choices in health:
WHO guide to cost-effectiveness analysis
Statistical methods in healthcare
Analyzing markets for health workers:
insights from labor and health economics
Authors
Culyer, A. J
Brent, Robert J.
Miller, Wilhelmine; Robinson, Lisa A;
Lawrence, Robert S.
Edejer, Tessa Tan-Torres
Faltin, Frederick W; Kenett, Ron;
Ruggeri, Fabrizio
McPake, Barbara; Scott, Anthony;
Edoka, Ijeoma
Recommended textbooks
The following textbooks are not required, but are recommended for students who would like more detail
on a topic, or just a second opinion. They are very good investments for any student planning to work in
a field related to health care.
Methods for the Economic Evaluation of Health Care Programmes, 4th edition
• By Michael F. Drummond, Mark J. Sculpher, Karl Claxton, Greg L. Stoddart and George W.
Torrance.
• ISBN 978-0-19-966588-4
• THE gold standard for texts on the economic evaluation of health care. If you only have
room in your shelf for one book on the topic, this should be it.
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Oxford Handbooks in Health Economic Evaluation
• A series of texts with a very practical focus. Very useful reading for anyone who finds
themselves in the position of actually having to create and report on an economic
evaluation of a health care program.
• Less academic than Drummond, with more of a ‘this is how you do it’ feel.
• Applied Methods of Cost-Benefit Analysis in Health Care, by McIntosh et al.
• Applied Methods of Cost-effectiveness Analysis in Health Care, by Gray et al.
• Decision Modelling for Health Economic Evaluation, by Briggs et al.
• Economic Evaluation in Clinical Trials, by Glick et al.
On Plagiarism and Academic Integrity
UVic Policy on Plagiarism
A student commits plagiarism when he or she:
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submits the work of another person as original work
gives inadequate attribution to an author or creator whose work is incorporated into the
student's work, including failing to indicate clearly (through accepted practices within the
discipline, such as footnotes, internal references and the crediting of all verbatim passages
through indentations of longer passages or the use of quotation marks) the inclusion of
another individual's work
paraphrases material from a source without sufficient acknowledgement as described
above
Students who are in doubt as to what constitutes plagiarism in a particular instance should consult
their course instructor.
The University reserves the right to use plagiarism detection software programs to detect
plagiarism in essays, term papers and other assignments.
(Source: http://web.uvic.ca/calendar2011/FACS/UnIn/UARe/PoAcI.html )
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All ECON 317 students are required to read and become familiar with the Policy
on Academic Integrity detailed at the URL cited in the box above. A brief summary
is at http://www.uvic.ca/library/research/citation/plagiarism/index.php .
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UVic Guideline on Plagiarism in Assignments
Multiple instances of inadequate attribution of sources should result in a grade of zero for the
assignment. A largely or fully plagiarized assignment should result in a grade of F for the course.
While plagiarism detection software is not currently used in ECON 317, the
instructor reserves the right to use it without notice. Students should complete
their quizzes and assignments as if such software were in use.
Some consequences of breaches of Academic Integrity
A breach of academic integrity (including plagiarism) will result in a mark of zero
on the assignment, quiz or final exam in which it is detected. A second breach of
academic integrity in the same category will result in a mark of zero for the entire
category (quiz mark or assignment mark). Additional penalties may also apply.
When taking quizzes or the final, use of unauthorized materials counts as a breach
of academic integrity. Each assignment and quiz will require the student to agree
to a basic honor code. Violating this honor code will be considered a breach of
academic integrity.
Give credit where credit is due
As far as this course is concerned, the rules are simple: if you use someone else’s work, you should give
them credit. It doesn’t matter whether it’s a classmate, a textbook writer, an internet forum poster, the
host of a TV show or a relative. If you used their insights, they deserve a tip of the hat.
For example, let’s say you’ve been trying to solve an assignment question for days, without much
progress. You run a web search on related topics, and come across a five-year-old forum post by
Haxxorz1337 that contains a clever, original way to perform one of the required calculations. If you end
up using that method in your assignment answer, you should add a line like the following: “Economic
lifetime calculation method courtesy of Haxxorz1337. (Source: <url> )”
If you use someone else’s words, you should ALWAYS put them in quotation marks and add a note saying
where you’ve taken them from. The citation should make it possible for someone reading your work to
find the original source and see it for themselves. For example, “The cold never bothered me, anyway.”
(Source: ‘Let it go,’ Disney’s Frozen, lyrics available at <url>).
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When in doubt, point it out
There are some sources you don’t need to cite, because it is assumed that you are using them. These
include lecture notes, the required textbook and the assignment or quiz questions themselves. If you
quote directly from them, then you should write a citation acknowledging that those specific words aren’t
yours, but it’s okay to take general concepts and solution methods from them.
If you use any other source to obtain results or knowledge you could not have found on your own, then
you should point it out. If you’re not sure whether you need to cite them or not, that’s probably a sign
that you should do so.
The meme test
These guidelines can all be boiled down to treating others like you would like to be treated. Let’s say you
came up with a really clever saying, or a new, cool way to solve a common problem. How would you feel
if a few weeks later, your phrase or idea went viral, and everyone was talking about it… but everyone
thought it was someone else’s, because the person who made it popular didn’t cite you? I’m guessing
you wouldn’t be very happy.
What about my grade? If I cite my sources, does that mean I won’t get credit?
Not at all. The way it works is very much like the end credits in a movie. Avengers: Age of Ultron is a
recent film directed by Joss Whedon. Thousands of other people worked on the movie, and they’re all
credited at the end, in a list that takes several minutes to scroll by. The list not only gives their names,
but also states what they contributed to the movie – everything from acting to catering. Despite the fact
that all of these contributors are clearly cited, Age of Ultron is still considered to be Joss Whedon’s movie,
and he gets the bulk of the credit (or blame) for how it turned out.
The same is true of your work. As long as you’re not taking the answer wholesale from another source,
you’re still the one responsible for putting together all your different sources and using them in a way that
adds up to a solution.
You’ll get credit for building an original solution, even if you do so using blocks made by someone else.
Another example: if you build a castle out of Lego, it doesn’t matter that the Lego Company made the
bricks; it’s still your castle, and you’ll get credit for the originality and effort that went into its design and
construction… Unless the castle is built following an existing blueprint designed by someone else, in which
case all you did was follow that person’s instructions. In either case, claiming that the Lego bricks were
your own invention, or implying it by not pointing out they were Lego bricks, would be wrong and a bit of
a brick move.
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What about my classmates? Can I use their work if I cite them?
The answer is almost always ‘no’. All of you are here to learn, and as the instructor I’d like to avoid a
situation where a small number of people do all the work and everyone else just ‘adapts’ it.
The only exception is group assignments, where you are allowed to work with your study group and are
indeed expected to submit the same answer as other students in your group. These assignments will be
clearly labeled as such. If an assignment is not so labeled, then you are to work on it independently.
This doesn’t mean that you can’t study together, or help each other out with assignments – it just means
that such collaboration should stop short of something that would absolutely require citation, such as a
direct quote or a duplicate, non-obvious solution method.
Good idea:
You: “Hey, Sam. I’m stuck on Question 6. I tried using the method in the lecture notes, but my answer’s
too small and the sign is wrong.”
Sam: “Did you convert all the costs to annual values? I got the same mistake until I did that.”
You: (several minutes later) “You’re right! That fixed it. Thanks, Sam.”
Bad idea:
You: “Hey, Sam. I’m stuck on Question 6. I tried using the method in the lecture notes, but my answer’s
too small and the sign is wrong.”
Sam: (hands over a paper) “Here, take a look at my answer. I had that mistake, too, but then I fixed it.”
You: (after going over Sam’s solution line by line, you cross out your old answer and write a new one using
the same method) “Thanks, Sam. That worked. You can have your assignment back.”
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UVic Statement on the Course Experience Survey
I value your feedback on this course. Towards the end of term you will have the opportunity to
complete a confidential course experience survey (CES) regarding your learning experience.
The survey is vital to providing feedback to me regarding the course and my teaching, as well as
to help the department improve the overall program for students in the future. When it is time
for you to complete the survey, you will receive an email inviting you to do so. If you do not receive
an email invitation, you can go directly to http://ces.uvic.ca.
You will need to use your UVic NetLink ID to access the survey, which can be done on your laptop,
tablet or mobile device. I will remind you nearer the time, but please be thinking about this
important activity, especially the following three questions, during the course.
1.
What strengths did your instructor demonstrate that helped you learn in this course?
2.
Please provide specific suggestions as to how the instructor could have helped you learn
more effectively.
3.
Please provide specific suggestions as to how this course could be improved.

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project