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Health Studies Program HST211H1S – Health Policy in Canada COURSE SYLLABUS [Winter 2024] COURSE CONTACTS Instructor: Adalsteinn (Steini) Brown (
dean.dlsph@utoronto.ca
)
Office Hours: In-person every Thursday from 11:30am to 1pm in Health Science Building (155 College), Room 638 Teaching Assistants: Deika Mohamed (
deika.mohamed@mail.utoronto.ca
) Nousheen Pradhan (
nousheen.pradhan@mail.utoronto.ca
)
Lectures: Monday 2-4 pm Tutorials: Last day to Drop:
Location:
Monday 4-5 pm
March 11 , 2024
FE 230 (371 Bloor Street West)
HEALTH STUDIES PROGRAM CONTACTS Health Studies Director: Colleen Dockstader (
collen.dockstader@utoronto.ca
) Health Studies Program Assistant: Khamla Sengthavy (
khamla.sengthavy@utoronto.ca
) Website: http://www.uc.utoronto.ca/healthstudies
COURSE DESCRIPTION The Canadian healthcare system remains one of the most valued yet polarizing elements of the Canadian policy landscape. It is often the most important issue in an election yet continues to perform mediocrely against other health systems. This course provides an overview of the Canadian healthcare system with a particular focus on its structure and operations and specific policy directions such as expanding medicare to include drug coverage, integrating care around patients, and continuing problems in the equity of care and health outcomes. Students completing the course will be able to discuss critically major themes in Canadian health policy and understand the driving factors underlying these different themes. COURSE OBJECTIVES By the end of the course, students should be able to: •
Appreciate and participate in major debates about the value of healthcare in Canada and around the world 1
Health Studies Program HST211H1S – Health Policy in Canada COURSE SYLLABUS [Winter 2024] •
Understand the evolution and structure of the Canadian health system •
Be able to discuss critically key health policy issues in Canada •
Understand and be able to apply tools to advance health policy goals in the Canadian context LECTURE AND TUTORIALS Classes will be held Mondays in person. Tutorials will be held Mondays in person at the end of class for an hour. Classroom time will be a mix of lecture, discussions, in class exercises, videos, and guest speakers. Each session in the course is organized around one number that provides an
entry point into discussions about a particular aspect of health policy. Throughout the course, we will also work to integrate the policy cycle so that students are able to understand how ideas progress to proposals and then to policies. The preliminary schedule for lectures is below: Lecture Topic
Pre-readings and class materials
Jan
8
th
$344 Billion (Total Expected Canadian Healthcare Expenditure)
What is included in the Canadian Health System?
Who is responsible for different parts of the system?
What are the rights and responsibilitie
s of Canadians in the system?
Read before class
Canadian Institute of Health Information. Snapshot of Canada’s 4 Health Care Priorities. 2 August 2023. Available at.
https://www.cihi.ca/en/taking-the-pulse-a-snapshot-of-canadian-health-care-2023/snapshot-of-canadas-4-health-
care#:~:text=Canadians%20take%20pride%20in%20their,need%20for%20mental%20health%20services
. Gawande A. Is healthcare a right? The New Yorker, 2017 https://www.newyorker.com/magazine/2017/10/02/is-health-care-a-right
Martin D et al. Canada’s universal health-care system: Achieving its potential. Lancet, 2018;391:1718-1735. doi: 10.1016/S0140-6736(18)30181-8
In Class Ford Government allocating $21b less to fund health care, hospital capacity to shrink: FAO. https://toronto.citynews.ca/2023/03/08/ontario-health-care-spending-doug-ford-hospitals-long-term-care/
In Class
Helen Angus
2
Health Studies Program HST211H1S – Health Policy in Canada COURSE SYLLABUS [Winter 2024] Jan
15
th
20 (Deaths per day from opioids)
How have opoid deaths changed over time?
How does public health work? How does it work with healthcare?
Who is responsible for public health?
What can we learn from the
COVID-19 pandemic?
Read before class Bodenner C. Why shouldn’t we follow the path of Portugal. The Atlantic, 2016. Available at https://www.theatlantic.com/health/archive/2016/04/why-shouldnt-we-follow-the-path-of-portugal/624322/
Hatt L. The Opioid Crisis in Canada. Government of Canada Library of Parliament, June 1, 2022. Available at: https://lop.parl.ca/sites/PublicWebsite/default/en_CA/ResearchPublications/202123E#:~:text=Parliament%20of
%20Canada-,Executive%20Summary,medical%20emergencies%20or%20other%20harms
. Savard JF. The Policy Cycle. Available online from ENAP https://dictionnaire.enap.ca/dictionnaire/docs/definitions/definitions_anglais/policy_cycles.pdf
In Class
Carol Strike on innovations in safe supply
Jan
22
n
d
54 (Deaths per day from COVID)
What happens in a health emergency?
How do we cope with uncertainty?
What happens when public institutions fail?
Read before class Public Health Agency of Canada. Executive Summary: A Vision to Transform Canada’s Public Health System. April 2022. https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-
health-canada/state-public-health-canada-2021/summary.html
Scudellari M. How Iceland hammered COVID with science. Nature, 2020 https://www.nature.com/articles/d41586-020-
03284-3
Amberber N, Iveniuk J, McKenzie K. Inequities over time in COVID-19 infection and COIVD-19-related hospitalizations/deaths. The Wellesley Institute, 2021 https://www.wellesleyinstitute.com/wp-content/uploads/2021/07/Inequities-over-time-in-COVID19-infection-and-related-
hospitalizations-and-deaths.pdf
In class
Testimony from Miin Doan and Cameron MacDonald in Standing Committee
Low healthcare capacity cost Canada economically amid pandemic
https://globalnews.ca/news/8237837/canada-health-care-capacity-covid-19/
In Class
Fahad Razak
3
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Health Studies Program HST211H1S – Health Policy in Canada COURSE SYLLABUS [Winter 2024] Jan
29
th
408,000 (Extra hospital days to adverse events)
Why do we see some things as problems and others not
Who is engaged in the problem formulation
Why do policies fall short in retrospect
Read before class
Shiffman J. Agenda setting in public health policy. International Encyclopedia of Public Health.
https://www.sciencedirect.com/science/article/pii/B9780128036785000072?via%3Dihub
Sismondo C. The history of why Canada’s healthcare system falls short. MacLean’s, 23 May 2018. Available at: https://macleans.ca/opinion/the-history-of-why-canadas-healthcare-system-falls-short/
Baker R, MacIntosh-Murray A. Governance for quality and patient safety: The impact of the Excellent Care for All Act, 2010. Healthcare Quarterly, 2012,15:44-50. doi 10.12927/hcq.2012.23161
In class
Deb Matthews
Feb
5
th
10
th
(Canada’s rank out of 11 countries)
How can we understand health system
performance?
How is the Canadian health system
performing?
How does improvement fit into the policy cycle
Read before class Connoll A and Frakt A. The best healthcare system in the World: Which one would you pick?. New York Times, 2017. https://www.nytimes.com/interactive/2017/09/18/upshot/best-health-care-system-country-bracket.html (and play the ranking game yourself) Schneider E. et al. Mirror, Mirror, 2017: International comparison reflects flaws and opportunities for better US healthcare. (
https://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirror-mirror-2017-international-
comparison-reflects-flaws-and
)
(Just read sections entitled “Performance Varies Among Health Systems” and “Causes of Poor Performance”)
Brown A, Smith K. Why we need to bring back hospital report cards. The Toronto Star, 17 November 2023. Available at:
https://www.thestar.com/opinion/contributors/why-we-need-to-bring-back-hospital-report-cards/article_4b2648ec-14c0-
5a00-b78e-5d73d5e70bc7.html Bevan G. Evans A, Nuti S. Reputations count: Why benchmarking performance is improving health care across the world. Health Economics, Policy and Law, 2019;14:141-161 https://pubmed.ncbi.nlm.nih.gov/29547363/
In Class
Anna Greenberg Reflection Paper Due
Feb
12
th
57 (Number of approved Ontario Health Teams)
How is the Canadian health system
Read before class
Ovretveit J. Executive Summary. Does improving quality save money. The Health Foundation, 2009. Pp. xi-xvi available at: https://www.health.org.uk/publications/does-improving-quality-save-money
James BC and Poulsen GP. The case for capitation. Harvard Business Review, July-August 2016. Available at https://hbr.org/2016/07/the-case-for-capitation
4
Health Studies Program HST211H1S – Health Policy in Canada COURSE SYLLABUS [Winter 2024] structured?
Why is health system structure important?
How can you change structure?
Government of Ontario. Ontario Health Teams: Guidance for Health Care Providers and Organizations. Available at: https://health.gov.on.ca/en/pro/programs/connectedcare/oht/docs/guidance_doc_en.pdf
In Class
The King’s Fund. Sam’s Story. Available at: https://www.youtube.com/watch?v=3Fd-S66Nqio
Stephanie Lockert
Feb
19
th
Reading Week
No class this week
Feb
26
th
Mid-Term Exam
Mid-term exam available at the start of class and to be completed and submitted by 2pm, February 27
th
. Note the exam is intended to take no more than 2 hours of time to complete. The professor and TAs will be available from 2-4pm on Februrary 26
th
online to answer questions about the exam.
Mar
4
th
$4,037 (How much the Don Mills Surgical Unit
gets for moderate complexity surgery)
What is the role of financing in shaping care?
Does improvement change with financing?
Read before class
Batalden P and Davidoff F. What is quality improvement and how can it transform healthcare? Quality and Safety in Healthcare, 2007;16:2-3 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464920/)
Porter ME and Kaplan RS. How to pay for health care. Harvard Business Review. July-August 2016. Available at https://hbr.org/2016/07/how-to-pay-for-health-care
Crawley M. Doug Ford government will give for-profit clinics bigger role in surgeries. CBC News, 13 January 2023. Available at: https://www.cbc.ca/news/canada/toronto/ontario-doug-ford-private-clinics-health-care-1.6712444
In class
David Jacobs
Mar
11
th
$2.9 billion (Estimated cost of poverty-
induced healthcare)
What are the sources and impacts of inequity in healthcare and health?
Read before class
Timothy R. How racism impacts your health. Macleans, 2018 (
https://www.macleans.ca/society/how-racism-impacts-
your-health/
) Executive Summary. A Review of Jordan’s Principle. Government of Canada: https://www.sac-isc.gc.ca/eng/1565786653117/1565786690869
Health Quality Ontario. Health Equity Plan, 2016. (
http://www.hqontario.ca/portals/0/documents/health-quality/health_equity_plan_report_en.pdf
) Class led by Dr. Nakia Lee-Foon
5
Health Studies Program HST211H1S – Health Policy in Canada COURSE SYLLABUS [Winter 2024] What can we do to fix these
inequities?
How effective are current policies to improve equity?
In class
Corey Bernard
Mar
18
th
$298.1 billion
(Cost savings from
COVID-19 vaccination in Canada)
Why do we measure costs and benefits?
What is value in healthcare?
Read before class
CDC. Cost-effectiveness Analysis. (https://www.cdc.gov/policy/polaris/economics/cost-effectiveness.html) CDC, 2017.
Sutherland J. Value in healthcare and why it is needed in Canada. Healthcare Papers, 2019;18:4-7. Available at DOI: 10.12927/hcpap.2019.25932
Teja B et al. Ensuring adequate capital investment in Canadian heathcare. CMAJ, 2020;192:677-683. Available at: DOI: https://doi.org/10.1503/cmaj.191126
In Class
Warren Buffett Charlie Munger and Bill Gates discuss Haven. CNBC News, 2019. https://www.cnbc.com/video/2019/05/06/warren-buffett-discusses-the-berkshire-amazon-jp-morgan-health-care-
venture.html
David Klein
Group paper due
Mar
25
th
First set of group pres.
Read before class
No readings
Apr 1
st
Second set of group pres.
Concluding remarks on the course
Read before class Ivers N, Brown A, Detsky A. Lessons from the Canadian experience with single-payer health insurance: Just comfortable enough with the status quo. JAMA Internal Medicine, 2018;178:1250-1255. doi: 10.1001/jamainternmed.2018.3568.
Shearer J et al. Why do policies change? Institutions, interests, ideas, and networks in three cases of policy reform. Health Policy and Planning, 2016 (
https://academic.oup.com/heapol/article/31/9/1200/2452985
) Tutorials follow each class. Tutorials will be held in person. The tutorials serve two main functions in this course. First, the tutorials will give you an opportunity to discuss issues raised in the course in a smaller group setting. The TA leading the session will 6
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Health Studies Program HST211H1S – Health Policy in Canada COURSE SYLLABUS [Winter 2024] facilitate the discussion and/or lead a relevant activity/exercise. Second, the tutorials will be an opportunity to learn about what is expected of you in each assignment/test, obtain feedback, and ask any relevant questions. Please note that tutorials will commence a few minuts after the close of class to allow students time to move to the tutorial room.
Tutorials are meant to enhance your learning experience. REQUIRED READINGS Required readings are noted in the course outline above. QUERCUS INFORMATION Students will be required to make use of course website. All relevant information including the course outline, assignment details and marking rubric, and additional reading material will be posted to the course site. Assignments will be submitted via the course website. GRADING SCHEME Assignment/Test
Due Date
% of Final Grade
Reflection paper
February 5th
10%
Mid-term exam
February 26
th
20%
Group paper March 18
th
25%
Group presentations
March 25
th and April 1
st
Peer evaluations
15%
5%
Final exam
During examination period
25%
The first evaluation is the reflection paper due on February 5
th
. This short paper (maximum of 400 words) is meant to give students the chance to reflect critically on a major challenge faced by the Canadian health system because of how it is structured. The reflection paper should focus on describing an important issue and identifying where this issue is in the policy cycle at the municipal, provincial or federal level. This means that papers should focus on an issue that is under active consideration by at least one political party.
The mid-term exam will cover topics addressed during the first half of the course. It will be a short answer format and is open book. Students may refer to readings, course notes and other materials
when preparing their answers. The focus will be on critical thinking about key health policy topics to produce concise, clear and evidence-informed evaluations of Canadian progress on key health policy areas. For example, questions might include “What are the key barriers to inter-provincial 7
Health Studies Program HST211H1S – Health Policy in Canada COURSE SYLLABUS [Winter 2024] collaboration in health policy,” “Why has Canada not expanded universal health insurance coverage to include drugs,” or “Who is responsible for public health policy in Canada?” This mid-
term will be made available at class time on February 26
th
and to be completed and submitted by 2 p.m. February 27
th
The group paper (groups of 5 defined by the course instructor) will require students to select and provide a three-point plan to improve health policy in a critical area such as expansion of access to
drugs or long-term care), pandemic preparedness, Racism and its impacts on health, timely access to care, or the appropriate role of for-profit providers. The paper should be no more than 4 pages (1000 words), it should be appropriately referenced using any major referencing style. The paper should define the key elements of a major health policy challenge, present three changes to health policy that are key to making improvements, and discuss the political challenges around making these changes and ways to work around these challenges. The paper is due by the start of
class on March 18
th
. The group presentation – on the same topic as the group paper – is due on March 25
th
with presentations in class split between March 25
th
and April 1
st
. These presentations are very short. They should be no more than 4 minutes in length. There will be two minutes for questions from the course instructor and TAs. For the purpose of these presentations, imagine that you have stepped onto an elevator with the Ontario Minister of Health and she has asked you for your advice on the key health system challenge you wrote about in your paper. Each presentation should focus on one of the key policy responses (not all three). For advice on what a short and successful pitch can
include please see this helpful article in Harvard Business Review (
https://hbr.org/2018/10/the-art-
of-the-elevator-pitch
). At the end of the pitch and a couple of questions, you should have been able
to convince the Minister through a carefully constructed and compelling storyline of both the value and feasibility of your policy change. You do not need slides for this pitch. All three members of the
group do not need to speak for the presentation. Please feel free to use whatever format (1 person, 2 person, or 3 persons speaking) that you feel will be most compelling. Please note that you will also do a peer evaluation of the contributions from the other people in your group (confidentially) which will form part of the grade for the course.
The final exam will be the same format as the mid-term exam and will cover all of the material from
the course.
8
Health Studies Program HST211H1S – Health Policy in Canada COURSE SYLLABUS [Winter 2024] In all of the evaluations, students are expected to demonstrate critical thinking. In her dissertation at Georgia State University, Martha Alexander identified five elements of critical thinking that were important to both public health practitioners and public health instructors.
1
These were:
i.
Information seeking or gathering data on the issue from different sources to develop a more holistic view of the issue;
ii.
Analayzing or breaking an issue down into the different pieces;
iii.
Identifying/Assessing the problem or clearly describing the problem under consideration, including understanding the mechanisms underpinning the problem;
iv.
Questioning or asking questions about the issue or problem to surface assumptions in the way that you understand it; and
v.
Reflecting or taking time to consider an issue or problem from multiple perspectives
In a discussion of critical thinking methods for public policy, C. Harvey Williams noted that “hearing, assimilating, and recalling content of lectures and reading assignments are not adequare
bases for educational achievement.” He further wrote that students can:
… inferring the thesis and counter thesis; collecting and organizing facts to support the application of concepts; and inventing representative concepts and propostions that reflect
sets of particular facts…[they can also} associate factors that represent problems with factors that have explanatory power… [and] extrapolate and classify value criteria used by decision-makers in making choices.
2
Students are also able to earn extra credit in the class by submitting potential final exam questions
for consideration by the course instructor and TAs. These questions should provide an opportunity for students to display their critical thinking skills related to a key health policy topic covered in one of the course sessions in an essay style. The final exam will include the best questions submitted and students who submit a thoughtful credible question can earn up to one extra point (1%) towards their final mark regardless of whether the question is chosen for the exam.
COURSE POLICIES 1
Alexander ME. “Critical Thinking in Publci Health: An Exploration of Skills Used by Public Health Practitioners and Taught by Instructors.” Dissertation, Georgia State University, 2014. https://scholarworks.gsu.edu/epse_diss/101
2
Williams CH. Doing critical thiking together” Applications to government, politics, and public policy. PS: Political Science and Politics, 1991;24(3):510-516 https://www.jstor.prg/stable/420101
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Health Studies Program HST211H1S – Health Policy in Canada COURSE SYLLABUS [Winter 2024] Contacting the Instructor or TAs Dr. Brown can be reached virtually during his office hours (or at other times by appointment). He will be happy to answer any questions you have during these times. The TAs can also be reached
during tutorial sessions every Monday from 4pm - 5pm. Students will receive course communications through their utoronto.ca
email address - students should check their utoronto.ca email regularly. You may also contact TAs via Quercus and Dr. Brown directly through his email address; all communications should be brief and courteous. Please do not expect an immediate reply to your message, but every effort will be made to get back to you within 48 hours (weekends not included). Assignment Submission All written assignments should be submitted via Quercus. Late Penalties There is a penalty of 5% per day (including weekends) for late assignment submissions. Assignments must be submitted by 11:59 pm on the due date. Late assignments will not be accepted after one week without a valid medical certificate. Extensions and Accommodation Extensions will be granted in the case of illness or other emergencies, with appropriate documentation (see http://www.illnessverification.utoronto.ca/Frequently-Asked-Questions.htm
for more information). Please consult your college registrar if you have ongoing difficulties during term – health related or otherwise – that prevent you from completing your course work satisfactorily. If you require accommodation for a disability or long-term illness, or have any accessibility concerns about the course, the classroom or course materials, please contact Accessibility Services as soon as possible at disability.services@utoronto.ca
. Academic Integrity Academic integrity is fundamental to learning and scholarship at the University of Toronto. At the University of Toronto, the following things are considered academic offences in papers you write: 10
Health Studies Program HST211H1S – Health Policy in Canada COURSE SYLLABUS [Winter 2024] •
Using someone else’s ideas without appropriate acknowledgement (i.e., in-text citation) •
Copying material directly from a source and not placing the words within quotation marks
•
Submitting your own work in more than one course without the permission of the instructor •
Making up sources or facts or including references to sources that you did not use. •
Obtaining or providing unauthorized assistance on any assignment including: •
Having someone else complete part or all of an assignment for you •
Working in groups on assignments that are supposed to be individual work •
Having someone rewrite or add material to your work while editing (having someone read your work is a good idea, but they should tell you what is wrong, not fix it for you) •
Lending your work to a classmate who submits it as his/her own The University of Toronto treats cases of academic misconduct very seriously. All suspected cases
of academic dishonesty will be investigated following the procedures outlined in the Code. The consequences for academic misconduct can be severe, including a failure in the course and a notation on your transcript. If you have any questions about what is or is not permitted in this course, please do not hesitate to contact the course instructor, the TA, other available campus resources like the U of T Writing Website. More information is available at www.artsci.utoronto.ca/osai/students
. Normally, students will be required to submit their course papers to Turnitin.com
for review of textual similarity and detection of possible plagiarism. In doing so, students will allow their essays to be included as source documents in the Turnitin.com
reference database, where they will be used solely for the purpose of detecting plagiarism. The terms that apply to the University’s use of the Turnitin.com
service are described on the Turnitin.com
website.
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