CALIFORNIA STATE UNIVERSITY, LONG BEACHCOLLEGE OF HEALTH AND HUMAN SERVICES

HEALTH CARE ADMINISTRATION DEPARTMENT

HCA 300 - The Health Care SystemFall 2018

Instructor: E. Erlyana M.D., Ph.D.E-mail: erlyana.erlyana@csulb.eduPhone: 562-985-5800Office: ET 213

Office Hours: Wednesdays & Thursdays 2 – 3:30 PMOr by appointment

Class Number: 4423 (Sec 1)Class Meets: Mondays & Wednesdays, 11 AM – 12:15 PM, VEC 326

Additional Contact Information:HCA Dept. Administrative Coordinator: Deby McGill, Deby.M cgill@csulb.edu Tel. 562/985-5694; fax 562/985-5886

Course Description

Overview and developmental summary of the American health care system and its driving forces: Organizational forms; financing mechanisms; principal industry stakeholders; professional groups and workforce issues; public health and government (Lecture).Letter grade only (A-F).

Course Learning Objectives

Students who have completed this course should be able to:

1. Describe the organization, administration and financing of the U.S. health care delivery system and the principal state (California) and local (county) health care programs and administering agencies.

2. Describe the types and interrelationships of health care facilities, services and personnel.3. Know the major historical events that shaped the U.S. health care system.4. Obtain, analyze and synthesize information relevant to major contemporary U.S. health care

issues.5. Demonstrate competencies both in writing and oral communication skills.

Learning Objectives, Domain, Competencies and Assessments

The Health Care Administration Department has adopted a competency-based curriculum, based on the American College of Health Care Executives (ACHE) Competencies Assessment Tool. As HCA 300 is one of the first courses that students majoring in Health Care Administration take, the emphasis is on acquiring competencies in knowledge of the health care environment, and in communicating effectively on major local and U.S health care issues.

HCA 300, Fall 2018, Instructor: ErlyanaThe following table describes how the course learning objectives and related competencies could be acquired and measured.

Learning Objectives Domain Competencies

Activity (A1), Assignment (A2) or Assessment (A3)

1, 4, 5

Knowledge of the Health Care Environment

Regulatory and administrative environment in which the organization functions (e.g., antitrust; Stark I and II; accreditation; organized labor)

A1. Lecture & class discussionA2 & A3. Chapter issue presentation

1, 4, 5

The interrelationships among access, quality, cost, resource allocation, accountability, and community

A1. Lecture & class discussionA2 & A3. Chapter issue presentation

2, 4, 5 Workforce issues

A1. Lecture & class discussionA2 & A3. Exam, Chapter issue presentation

1, 4, 5 Funding and payment mechanisms of the healthcare system

A1. Lecture & class discussion A2 & A3. Exam, Chapter issue presentation

2, 3

Governmental, regulatory, professional, and accreditation agencies (e.g., CMS; JCAHO; NCQA) related to healthcare delivery

A1. Lecture & class discussionA2 & A3. Exam

1, 4, 5 Interaction and integration among healthcare sectors

A1. Lecture & class discussionA2 & A3. Chapter issue presentation

1, 4, 5 Legislative issues and advocacy

A1. Lecture & class discussionA2 & A3. Chapter issue presentation

1, 2, 4, 5

Organization and delivery of healthcare (e.g., acute care, ambulatory care, medical practice, ancillary services)

A1. Lecture & class discussionA2 & A3. Exam, County profile, Chapter issue presentation

2, 3, 5 Socioeconomic environment in which the organization functions

A1. Lecture & class discussionA2 & A3. County profile

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HCA 300, Fall 2018, Instructor: Erlyana

Required Textbook:

Niles, N.J. (2016), Basics of the U.S. Health Care System (3rd Ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284102888

Recommended Readings:

American Psychological Association (2010). Publication Manual of the American Psychological Association (6th Ed). Washington, DC: Author.

California HealthCare Foundation, California HealthLine. Free daily electronic newsletter. Available at: www.californiahealthline.org.

Suggested Resources and websites for current health article papers.• Kaiser Family Foundation- www.ff.org (kff.org)• The Commonwealth Fund- www.commonwealthfund.org/publication• Foley & Lardner LLP- www.foley.com/publications• California Hospital Association News- news@calhealth.org• American Hospital Association News- Daily Report for Healthcare Executives

Ahawashdc@aha.org• Medical Group Management Association- www.mgma.com

The national membership association providing information, networking, and professional development for the individuals who manage and lead medical group practices.

Course lecture notes and additional readings will be available on BeachBoard. Lectures will include additional information from instructor’s explanations and current events.

Access Requirements:

You must have your CSULB student e-mail address and Internet access to use the online BeachBoard course software system to receive and check major announcements and updates. If you have problems with BeachBoard, contact the CSULB Technology Help Desk at 562-985-4959, via e-mail at helpdesk@csulb.edu or in-person at the Horne Center.

Course Assignments:

Class Preparation and Participation

The class format will be a combination of lecture, interactive discussion of the assigned readings and other relevant materials, and student presentations. You are expected to have read the assigned readings (text chapters and web sites) before the class session, and to be prepared to discuss them. If you have trouble understanding what you read or hear, please ask for clarification in class or on the discussion boards on our course website, or make an appointment with me to discuss the problem area(s). Class participation will be worth up to 15 points, based on the frequency and quality of your participation.

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HCA 300, Fall 2018, Instructor: ErlyanaGroup Assignments:

Chapter Issue Presentation. For this assignment, work in a team (of 3-4 students). Select and present a current health care issue related to a specific chapter of the textbook.

a. Your presentation should contain NEW information (e.g., California-specific, recent developments, new legislation or policy proposals); DO NOT repeat material covered in the textbook. You can find new information on the websites & journals listed in the bibliography and, in popular media.

b. Each group will do a 15-minutes presentation class on the day (week) we cover the chapter. c. Your individual grade for the group presentation will be based on instructor's evaluation.d. Submit a copy of any slides, multimedia presentations or handouts (1 member of the group can

do this for the group) through the BeachBoard DropBox at least 24 hour before the day of your presentation. [NOTE: 10% penalty for late submission per day.] The instructor will not provide copies nor will prepare the presentation for presentation so bring you own materials and media data.

e. Review the grading rubric posted on BeachBoard to see the grading criteria. This assignment is meant to prepare the student for giving a “professional” presentation and should represent how you would present information in a real working situation.

County Profile Data Exploration. Working with your team, you will demonstrate to the class on 9/24 and 9/26 in 10 minutes on how you will obtain data necessary for your individual county profile paper (explained below). Each team will use at least one team member’s county to illustrate that county’s health profile and discuss how data will inform the analysis of its healthcare issues.

Individual Assignments:

Quizzes. There will be 12 online quizzes available throughout the course on BeachBoard, each containing five (5) questions and worth 1 point each, for a total of 5 points each quiz, based on the assigned readings for the week. Each quiz will be available at the end of the class on Wednesdays and due before the start of the covered week (Quiz on Ch. 2 will be available on Aug 29 @ 12:15 and due by 11 AM on Wednesday, Sep 5; Quiz on Ch. 3 will be available on Wednesday, Sep 5 @ 12:15 and due by 11 AM on Monday, Sep 10; and so on).

In-Class Exercises (ICEs). There will be ICEs assigned in class at various times without a predetermined schedule. Eight (8) ICEs in total will be graded randomly for up to 5 points each.

County Profile Paper. Writing is a process. You will need to submit two (2) deliverables for this assignment: 1) draft paper due by midnight on 11/7, in addition please bring two (2) print out of your draft (where you will provide and receive peer feedback) to class on 11/7, and 2) final paper due by midnight on 12/10. The paper is a needs assessment and analysis of a selected California county. Each student will sign up for a specific county. You need to collect and synthesize all important information related to the assigned county. Use the recommended data sources listed on BeachBoard and add information from literature including scholarly journals and the policy web sites listed in the syllabus bibliography. In the paper, you will:

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HCA 300, Fall 2018, Instructor: Erlyanaa. Discuss county general information and develop a health-related profile; b. Identify one or two of the most crucial healthcare problems in the county (focusing on cost,

access and quality);c. Discuss the consequences of the problem(s);d. Discuss what have been done in the county to address the problem(s);e. Recommend actions to address the problem(s).

Whenever applicable, compare your county information with statewide average or trend data for context. Use tables and graphs to display your data if it is necessary. Use APA format consistently and correctly. [Note: It is essential that you understand and utilize APA format; non-APA formatted papers will be rejected for reformatting]. Infographics are encouraged. The report should not exceed 10 pages (double-spaced, 10–12 point font), not including the title page, executive summary, and references.

Submit all deliverables through the BeachBoard DropBox on the due date. The final paper will be scanned by Turnitin®, a plagiarism prevention service available on BeachBoard. Students submit their papers electronically, and Turnitin® compares the text of those papers to the text in millions of other documents on the Internet, in papers submitted by other students around the world, and in commercial databases of journal articles and periodicals. Whenever similarities between the text in a student's paper and the text in an existing document are found, Turnitin® highlights those similarities, providing an annotated document showing both the student's paper and the original source. The similarity index for your papers should be less than 33%.

Peer Feedback on Draft Paper. Peer feedback can be very helpful for perfecting papers by providing new/different perspective on your writing. A reader will also be able to raise important questions and/or catch mistakes that you might have overlooked. On the other hand, preparing a critique or feedback to someone else’s paper will also be beneficial in improving your own writing. Therefore, written peer feedback will be provided to draft reports. Each student is required to comment on 2 draft papers received on 11/7 that are not their own and will receive up to 10 points each. Peer feedback is due in class on 11/14. Please refer to the specific rubric for grading criteria.

Midterm and Final Exams. The midterm exam will be administered online on BeachBoard on Oct 15 and the final exam will be administered in the classroom on Dec 17. The exam questions will be based on the textbook, supplemental readings and lectures, and may also include information from guest speakers and student presentations. Disabled students requiring special accommodations for exams, please advise instructor at the beginning of the course.

Professional Development. The professional development points could be earned through involvement in campus and/or community educational events. Points could be earned until last day of class, i.e., 12/12, up to 20 points.

a. Join and attend student/professional associations such as the American College of Healthcare Executives; Health Care Executives Association; Women in Health Administration; and our very own HCA Student Forum. Other professional associations may be considered; ask instructor. 5 points for each association joined and 5 points for each meeting attended. Submit written proof

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HCA 300, Fall 2018, Instructor: Erlyanaof membership/attendance (receipt, sign-in sheet), and/or

b. Attend other campus/community health care related events/activities. 5 points per meeting; bring proof of attendance (event verification form, agenda/handout from event, business card of presenter, etc.).

E-portfolio. As part of your program experience you will be required to compile as electronic portfolio throughout your time in the HCA Department. The portfolio will include work products from each of the required HCA courses, to demonstrate to a prospective employer that you have relevant skills for the workplace. The e-portfolio work product for this particular course is the County Profile Paper. BE SURE TO SAVE AN ELECTRONIC COPY OF THIS ASSIGNMENT AND PLACE INTO YOUR E-PORTFOLIO WEBSITE. Instructions for how to build am E-Portfolio website and examples will be posted in the "content" area of the HCA Student BeachBoard Portal:

You will need to submit the link of your E-portfolio website through BeachBoard DropBox with your final paper posted on the website.

Extra Credit

CHHS Advising post assessment. On 9/19, CHHS Advising will visit our classroom for a presentation that aims to (1) introduce/reinforce CHHS Advising as a support and resource throughout the student’s academic career, (2) encourage students to better understand and utilize their tools such as Degree Planner, Academic Requirements Report, and the CHHS Advising Website, and (3) address some common misconceptions and FAQs we see and hear from students regarding advising, their majors, and their academic records. CHHS Advising will later sent out a post assessment survey. The survey itself is voluntary, but for anyone who completes it, they will receive 5 points of extra credit.

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HCA 300, Fall 2018, Instructor: Erlyana

Assignment Policies and Grading:

Assignment Submission Policy ALL assignments are due on the date specified. Late assignments lose 10% of points

for each day past the deadline unless otherwise specified. NO ASSIGNMENTS ACCEPTED AFTER LAST DAY OF CLASS.

Submit all assignments through BeachBoard unless otherwise specified. Submit in recommended file format: Microsoft Word or PDF file. Name it clearly: LastName.FirstInitial.AssignmentName, i.e: Jones.X.CountyProfilePaper; Mary.Y.PeerFeedback1

Students absent for midterm or final exam must provide written third party documentation of unforeseen and unavoidable circumstances in order to be eligible to take a make-up exam. Such documentation should be submitted in a timely manner. Disabled students who qualify for alternative testing arrangements, please advise the instructor at least 2 weeks prior to the exam.

Grading

Individual Assignments Due Date Points PercentClass participation Ongoing 15 3.75Quizzes (5 points * 12) Ongoing 60 15ICEs (5 points * 8) Varies 40 10County profile paper: Draft Nov 7 20 5 Peer feedback on draft Nov 14 20 5 Final paper Dec 10 50 12.5Midterm Exam (online) Oct 15 60 15Final Exam (in class) Dec 17 60 15Professional Development

(membership and activities)Dec 12 20 5

E-portfolio Dec 12 10 2.5Group Assignments

Data Exploration Presentation Sep 24 & 26 15 3.75Chapter Issue Presentation Ongoing 30 7.5

Total 400 100

Final Course Grade Computation:360+ = A 320-359 = B 280-319 = C 240-279 = D <240 = F

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HCA 300, Fall 2018, Instructor: Erlyana

Commitment to Inclusion

California State University, Long Beach is committed to maintaining an inclusive learning community that values diversity and fosters mutual respect. All students have the right to participate fully in university programs and activities free from discrimination, harassment, sexual violence, and retaliation. Students who believe they have been subjected to discrimination, harassment, sexual violence, or retaliation on the basis of a protected status such as age, disability, gender, gender identity/expression, sexual orientation, race, color, ethnicity, religion, national origin, veteran/veteran status or any other status protected by law, should contact the Office of Equity and Diversity at (562) 985-8256, University Student Union (USU) Suite 301, http://www.csulb.edu/depts/oed.

Other Policies

Accessibility

Students with a disability or medical restriction who are requesting a classroom accommodation should contact the Disabled Student Services at 562-985-5401 or visit Brotman Hall, Suite 270 during 8AM-5PM weekday hours. Disabled Student Services will work with the student to identify a reasonable accommodation in partnership with appropriate academic offices and medical providers. We encourage students to reach out to DSS as soon as possible.

Attendance

Our class attendance policy conforms to University policy: http://www.csulb.edu/divisions/aa/grad_undergrad/senate/documents/policy/2001/01/

Cheating and Plagiarism. Please be aware of and ensure that your behavior conforms to University Policy, as contained in the California State University, Long Beach Policy Statement 80-01: http://www.csulb.edu/divisions/aa/grad_undergrad/senate/documents/policy/2008/02. No form of cheating will be tolerated. Anyone found to be cheating will, at minimum, receive zero credit for the assignment or test involved. Stiffer penalties, including course failure, may be imposed at the instructor’s discretion.

Withdrawal Policy. Per University policy: http://www.csulb.edu/divisions/aa/grad_undergrad/senate/documents/policy/2002/02/. For withdrawals after 2nd week and before final 3 weeks “permissible for serious and compelling reasons,” the instructor will evaluate student withdrawal requests on a case by case basis.

COPYRIGHT NOTICE: Any copyrighted materials used in this class are used for education purposes only and in compliance with United States copyright law. Use of these materials is limited to students enrolled in the course, for the duration of the course. Students must refrain from saving, changing, or distributing any such copyrighted materials.

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HCA 300, Fall 2018, Instructor: Erlyana

Class Topic and Weekly Schedule

Week Dates Topic/ Activity Chapters Covered1

Tasks/ Deliverable(s)

1 8/27, 8/29 Course Overview; History of the U.S. Health Care System

Ch. 01 Introductions; group formation

2 9/5(no class on

9/3)

Impact of the Affordable Care Act on Healthcare Services

Ch. 02 Quiz; County signups

3 9/10, 9/12 Current Operations of the Healthcare System

Ch. 03 Quiz;

4 9/17, 9/19 Government’s Role in U.S. Health Care

9/19 Guest Speaker: Lisa Fish – CHHS Advising

Ch. 04 Quiz; Chapter issue presentation

5 9/24, 9/26 Public Health’s Role in Health Care

Ch. 05 Quiz; Chapter issue presentation; data exploration (group)

6 10/1, 10/3 Inpatient and Outpatient Services

Ch. 06 Quiz; Chapter issue presentation

7 10/8, 10/10

U.S. Healthcare Workforce

Ch. 07 Quiz; Chapter issue presentation

8 10/15, 10/17

Midterm Exam (Online) on 10/15

Ch. 01-07

No class this week

1 Additional reading assignments will be made available for certain chapters. In addition, review the websites for each topic listed in Additional Resources.

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HCA 300, Fall 2018, Instructor: Erlyana9 10/22,

10/24Health Care Financing

Ch. 08 Quiz; Chapter issue presentation

10 10/29, 10/31

Managed Care Impact on Healthcare Delivery

Ch. 09 Quiz; Chapter issue presentation

11 11/5, 11/7 Information Technology Impact on Health Care

Ch. 10 Quiz; Chapter issue presentation; draft paper due on 11/7

12 11/13 (Tue), 11/14

Healthcare Law Ch. 11 Quiz; Chapter issue presentation; peer feedback due on 11/14

13 11/19, 11/21

Fall Break Happy Thanksgiving!

14 11/26, 11/28

Healthcare Ethics Ch. 12 Quiz; Chapter issue presentation

15 12/3, 12/5 Mental Health Issues Ch.13 Quiz; Chapter issue presentation

16 12/10, 12/12

Analysis of U.S. Healthcare System; Review of Ch. 8-14

Ch. 14 Final paper due on 12/10, proof for professional development and E-Portfolio due on 12/12.

17 12/17 (Mon)

Final Exam (10:15 AM-12:15 PM)

Ch. 08-14

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HCA 300, Fall 2018, Instructor: Erlyana

Additional Resources

Pertinent Web Sites. Just a few of many web sites with information pertinent to this course, by topic:

Topic Web SitesHealth policy (national)

Department of Health and Human Services: www.hhs.gov/ Health care.gov: www.health care.gov/index.html Medicare: www.medicare.govOffice of Consumer Information and Insurance Oversight: www.hhs.gov/ociio/index.htmlh Policy: www.academyhealth.org/ Health Reform GPS: Navigating Implementation: http://www.healthreformgps.org/

Health policy (California)

California Health care Foundation: www.chcf.org Insure The Uninsured Project: www.itup.org Health Access: health-access.org/Public Policy Institute of CA: www.ppic.orghttp://healthconsumer.org

Information resources

National Library of Medicine: www.nlm.nih.govVirtual reference style manuals: www.csulb.edu/library/eref/vref/style.htmlitations: www.apastyle.org/apa-style-help.aspx.Health policy

formation, agenda setting

Robert Wood Johnson Foundation: www.rwjf.orgThe Urban Institute: www.urban.org; Families USA: www.familiesusa.orgCenter for Health Care Strategies: www.chcs.orgwww.hschange.comPolicy

implementation & modification

National Academy for State Health Policy: www.nashp.orgUCLA Center for Health Policy Research: www.healthpolicy.ucla.eduCalifornia Health care Foundation: www.chcf.orgKaiser Family Foundation: www.kff.org; Rand Corporation: www.rand.org

Financing health services

Center for Medicare & Medicaid Services: www.cms.goviorities: www.cbpp.org CA Legislative Analyst's Office: www.lao.ca.gov Health care Financial Management Assn: www.hfma.orgManaged care,

insurance & benefits

Employee Benefits Research Institute: www.ebri.orgAmerica’s Health Insurance Plans: www.ahip.orgCA Assn. Of Health Plans: www.calhealthplans.comCA Dept. of Managed Health Care: www.dmhc.ca.govCA Office of the Patient Advocate: www.opa.ca.gov/index.aspx National Governors Association: www.nga.org/www.naic.org/

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HCA 300, Fall 2018, Instructor: ErlyanaTopic Web SitesAmbulatory health services

American Academy of Urgent Care Medicine: www.aaumc.com National Association for Ambulatory Care: http://www.urgentcare.org/ Medical Group Management Association: www.mgma.com

Hospitals & health systems

American Hospital Assn.: www.aha.org;Blue Cross/Blue Shield Assn.: www.bluecares.com Association for Community Health Improvement: http://www.communityhlth.org/communityhlth_app/index.jsp

Long Term Care; Politics of Aging & Disability

American Association of Retired Persons: www.aarp.orgDisability Rights Education & Defense Fund: www.dredf.org

Mental health National Institute of Mental Health: www.nimh.nih.govBazelon Center for MH Law: www.bazelon.orgwww.nlm.nih.gov/medlineplus/mentalhealth.html

Pharmaceuticals Pharmaceutical Research & Manufacturers of America: www.phrma.orgwww.ashp.org/Public health Centers for Disease Control & Prevention: www.cdc.govAmerican Public Health Association: www.apha.org

Health professionals

Am. Medical Assn.: www.ama-assn.org; Am. Nurses Assn. www.ana.orgAm. Academy of Physician Assistants: www.aapa.orgAm. Pharmaceutical Assn.: www.pharmacist.comQuality of care Institute of Medicine: www.iom.eduNational Committee for Quality Assurance: www.ncqa.orgJoint Commission (accreditation): www.jointcommission.org California Health care Foundation Quality Initiative: www.chcf.org Robert Wood Johnson Foundation: National Quality Directory:http://www.rwjf.org/qualityequality/product.jsp?id=71857Ethical issues Alliance for Health Reform: www.allhealth.orgHastings Center: www.thehastingscenter.org

Journals. Most available online through COAST e-journal collections: http://coast.library.csulb.edu/.

American Journal of Managed Care American Journal of Medical Quality American Journal of Public Health Business and HealthHarvard Business Review Cambridge Quarterly of Health care Ethics Evaluation and the Health Professions Health Education & BehaviorHealth Affairs Health Care Financing ReviewHealth Policy Health Services ResearchHealth Technology Trends InquiryInternational Journal of Health Services J of the American Medical Assn. (JAMA)

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HCA 300, Fall 2018, Instructor: ErlyanaJ of Behavioral Health Svcs. & Research J of Health Services Research & Policy Journal of Community Health Journal of Health and Social Behavior Journal of Health, Politics, Policy and Law Medical Care Research & Review Medicine and Health Milbank Memorial Fund QuarterlyNew England Journal of Medicine Qualitative Health Research Journal of Health Care Finance Family & Community HealthFrontiers of Health Services Management Hospital & Health Services Administration Journal of Ambulatory Care Management J of Health Care for the Poor & Underserved Public Health Reports Journal of Public Health PolicyModern Health care2 J of the American Geriatric Society Hospitals & Health Networks

Bibliography

Burke, S. (2011, June). The U.S. Congress and Health Policy. Retrieved from: http://www.kaiseredu.org/Tutorials- and-Presentations/US-Congress-and-Health-Policy.aspx.

Campbell, C.G. & Zinner, D.E. (2010). Disclosing industry relationships - toward an improved federal research policy. New England Journal of Medicine, 363, 604-606. DOI: 10.1056/NEJMp1006973

Craig, R.L., Felix, H.C., Walker, J. F., & Phillips, M. M. (2010). Public health professionals as policy entrepreneurs: Arkansas’ childhood obesity experience. American Journal of Public Health, 100, 2047-2052. DOI: 10.2105/AJPH.2009.183939

Donabedian, A. (2003). An introduction to quality assurance in health care. Cary, NC: Oxford University Press. (Classic)

Gawande, A. (2009, 1 June). The cost conundrum: What a Texas town can teach us about health care. The New Yorker. Retrieved from: gawande.com/articles.

Hollingsworth, J.M., Ye, Z., Strope, S.A., Krein, S.L., Hollenbeck, A.T., & Hollenbeck, B.K. (2010). Physician ownership of ambulatory surgery centers linked to higher volume of surgeries. Health Affairs, 29, 683-689.

Hsu, R.Y., Kellerman, A.L., & Shen, Y. (2011). Factors associated with closures of emergency departments in the United States. Journal of the American Medical Association, 305, 1978-1985.

Illich, I. (1975). Medical Nemesis: The expropriation of health. New York: Pantheon. (Classic)

Joynt, K.E., Orav, E.J., & Jha, A.K. (2011). Thirty-day readmission rates for Medicare beneficiaries by race and site of care. Journal of the American Medical Association, 305, 675-681.

2 Free student subscription available at: http://www.aupha.org/i4a/forms/form.cfm?id=51&pageid=3829&showTitle=1 13/14

HCA 300, Fall 2018, Instructor: ErlyanaKaye, H.S., Harrington, C. & LaPlante, M.P. (2010). Long-term care: Who gets it, who provides it, who

pays and how much? Health Affairs, 29, 11-21. DOI: 10/13777/hlthaff.2009.0535.

Kongstvedt, P. (2009). Managed care: What it is and how it works. Sudbury, MA: Jones & Bartlett.

Long, P. & Gruber, J. (2011). Projecting the impact of the Affordable Care Act on California. Health Affairs, 30, 63-70. doi:10.1377/hlthaff.2010.0961

Metzl, J.M. (2010). The protest psychosis: How schizophrenia became a black disease. Boston:

Beacon Press.

Meyer, H. (2011). Coding complexity: U.S. health care gets ready for the coming of ICD-10. Health Affairs, 30, 968-974. DOI: 10/13777/hlthaff.2011.0319.

Neumann, P.J. (2005). Using cost-effectiveness analysis to improve health care: Opportunities and barriers. New York: Oxford University Press.

Picard, A. (2008). The making of the American mouth: Dentists and public health in the twentieth century.Piscataway, NJ: Rutgers University Press.

Pipes, S. (2011). The truth about Obamacare. Washington, DC: Regnery Press.

Saranson-Kahn, J. (2011, November). Primary care, everywhere: Connecting the dots across the emerging health landscape. Oakland, CA: California Health care Foundation. Retrieved from: http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/P/PDF%20PrimaryCareEverywhere.p df .

Sisko, A.M., Truffer, C.J, Keehan, S.P., Poisal, J.A, Clemens, M.K. & Madison, A.J. (2010). National health spending projections: The estimated impact of reform through 2019. Health Affairs, 29, 1933-1941. DOI: 10/13777/hlthaff.201.0788.

Starr, P (2011). Remedy and reaction: The peculiar American struggle over health care reform. New Haven: Yale University Press.

Warnock, M. & MacDonald, E. (2008). Easeful death: Is there a case for assisted dying? New York: Oxford University Press.

Wilson, K.B. (2011, May). Health Care Costs 101, 2011 Edition. California Health care Foundation. Retrieved from: http://www.chcf.org/publications/2011/05/health-care-costs-101.

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