Victor G. Rodwin

Professor of Health Policy and Management

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Victor Rodwin

Victor G. Rodwin is Professor of Health Policy and Management, at the Wagner School of Public Service, New York University and Co-Director (with Michael K. Gusmano) of the World Cities Project, a joint venture of Wagner/NYU, the Hastings Center, and the Butler Columbia Aging Center.

Professor Rodwin teaches courses on community health and medical care, comparative analysis of health care systems and international perspectives on health system performance and reform. He has lectured on these topics around the world: the Council for Social Development, New Delhi, Sun Yat Sen University, Gouangzhou, Fudan University, Shanghai, Renmin University, Beijing, London School of Economics and London School of Hygiene and Tropical Medicine, London, and the Institut d'Etudes Politiques, Paris.

Professor Rodwin was Visiting Professor at the Conservatoire National des Arts et Métiers, Ecole Pasteur/CNAM de Santé Publique during his sabbatical leave in 2012-2013. He was awarded the Fulbright-Tocqueville Distinguished Chair during the Spring semester of 2010 while he was based at the University of Paris–Orsay. In 2000, he was the recipient of a three-year Robert Wood Johnson Foundation Health Policy Investigator Award on "Megacities and Health: New York, London, Paris and Tokyo." His research on this theme led to the establishment of the World Cities Project (WCP)  which focuses on neighborhood aging, population health and the health care systems in New York, London, Paris, Tokyo and Hong Kong, and among neighborhoods within these world cities.

Professor Rodwin is the author of numerous articles and books, including The Health Planning Predicament: France, Quebec, England, and the United States (University of California Press, 1984); The End of an Illusion: The Future of Health Policy in Western Industrialized Nations (with J. de Kervasdoué and J. Kimberly, University of California Press, 1984); Public Hospitals in New York and Paris (with C. Brecher, D. Jolly, and R. Baxter), New York University Press, 1992); Japan's Universal and Affordable Health Care: Lessons for the U.S.? (Japan Society, 1994); Growing Older in World Cities: New York, London, Paris and Tokyo (edited with M. Gusmano), Vanderbilt University Press 2006; Universal Health Insurance in France: How Sustainable? Essays on the French Health Care System (Washington DC, Embassy of France, 2006); Health Care in World Cities: New York, London and Paris (with M. Gusmano and D. Weisz), Johns Hopkins University Press, 2010. A recent book (with D. Tabuteau) was published in France: A La Santé de l'Oncle Sam: Regards croisés sur les systèmes de santé Américains et Français (To the Health of Uncle Sam: Perspectives on the American and French health systems). Paris, Jacob-Duvernet, 2010. Also, a research monograph (with P. Chau, J. Woo, M. Gusmano, D. Weisz) on Growing Older in Hong Kong, New York and London (2012) was published in Hong Kong. Recent journal articles have appeared in Health Affairs, New England J. of Medicine, American J. of Public Health, J. of Urban Health, J. of Health Economics Policy and Law, J. of Health Policy, Politics and Law, J. of Health Services Research and Policy, International J. of Health Services, International J. of Health Policy and Management and Sèves: Tribunes de la Santé.

Before launching WCP, Professor Rodwin directed Wagner’s International Initiative (1992 to 1998), and its Advanced Management Program for Clinicians (1987-1992). From 1983 to 1985 he was Assistant Professor of Health Policy at the University of California–San Francisco. Professor Rodwin has been a member of the Academy for Social Insurance since 1998. He reviews articles for leading journals in the field on a regular basis and has consulted with the French National Health Insurance Fund, the Paris University Hospitals (AP-HP), the World Bank, the United Nations Development Program, the World Health Organization and Blue-Cross/Blue Shield of Vermont. Professor Rodwin earned his Ph.D. in city and regional planning, and his MPH in public health, at the University of California, Berkeley.

All health systems in the industrialized world are grappling with problems of cost, access, equity and quality of health care; and the trade offs between these objectives. Reforms based on promoting markets, managed competition, public contracting, improved management, and changing financial incentives are some important issues under discussion in most nations.  

This seminar relies on public policy analysis and political economy perspectives  to compare health systems in wealthy OECD nations and BRIC nations (Brazil, Russia, India and China) to analyze efforts at health care reform. The readings, lectures, and class discussions will make students more knowledgeable about policy options and policy changes in different countries. The instructor will also provide opportunities for students to pursue individual research projects and work with the instructor to submit papers for publication.

The seminar begins with an overview of how forces of “globalization” affect health system reform. Next, we focus on ideas, concepts and theories of health care reform. We then go beyond the OECD and controversial WHO approach to health system performance. We examine the politics of health system reform efforts and present case studies in selected nations depending on students’ specific interests. Finally, we will address the policy question of what the U.S. and BRIC nations may learn from the experience of these nations.

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This class focuses on the organization and financing of health systems in wealthy nations. We begin with a discussion of conventional health system models around the world and alternative perspectives for studying them and evaluating their performance. The class readings reflect how selective evidence is often marshaled to evaluate health care systems in the U.S. and abroad. Finally, and this is the heart of the class, we discuss a range of different approaches to the empirical analysis of health system performance in selected nations, and examine the extent to which the available evidence supports or refutes widely shared views of different health care systems. I will ask students to become "experts" about a health system of their choice outside the United States, preferably in a nation belonging to the Organization of Economic Cooperation and Development (OECD), but with an option to focus on a health system in one of the so-called BRIC nations (Brazil, Russia, India, China).

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Only open to Executive MPA students.

This course explores core topics in the study of health and health care delivery in the United States. We will discuss the distribution of health and disease in society, the organization of the U.S. health care system and roles and behaviors of its key actors, the historical context for developments in public health and medicine, the quality and accessibility of health care services, and current events in health care reform. We will examine major themes in health care policy and practice using an interdisciplinary approach that employs sociological, political, economic and ethical perspectives on health and disease, characteristics of health care in the U.S., and the complexity of achieving high quality and affordability given the varied (and sometimes conflicting) motivations of policy-makers, payers, providers and patients. Students will also consider the U.S. health care system in an international context to provide a comparative lens on its nature and performance versus those of other industrialized nations. The objective of this course is to build understanding of fundamental ideas and problems in the areas of health and medical care and thereby to provide a strong foundation for future studies and careers in the health care field.

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Required for M.P.A. (health) students.

This introductory course in the Health Policy and Management program explores core topics in the study of health and health care delivery in the United States. We will discuss the distribution of health and disease in society, the organization of the U.S. health care system
and roles and behaviors of its key actors, the historical context for developments in public health and medicine, the quality and accessibility of health care services, and current events in health care reform. We will examine major themes in health care policy and
practice using an interdisciplinary approach that employs sociological, political, economic and ethical perspectives on health and disease, characteristics of health care in the U.S., and the complexity of achieving high quality and affordability given the varied (and sometimes conflicting) motivations of policy-makers, payers, providers and patients. Students will also consider the U.S. health care system in an international context to provide a comparative lens on its nature and performance versus those of other industrialized nations. The objective of this course is to build understanding of fundamental ideas and problems in the areas of health and medical care and thereby to provide a strong foundation for future studies and careers in the health care field.

Download Syllabus

This course introduces undergraduates to the complex interplay of social factors that affect population health in any society. It focuses on the social determinants and distribution of health and disease, the organization and financing of the health care system, and the relationship of one to the other.  The first part of the class presents an international perspective on the U.S. health care system and examines  divergent perspectives for thinking about medical care and health systems. We begin by comparing clinical and epidemiological  perspectives, sociological and cultural perspectives, and introduce students to health services research and health economics. The second part of the class focuses on big issues in American health care: the role of government, cost containment strategies and managed care, the Affordable Care Act, health care disparities and public health. Finally, we consider the future of health systems in the U.S., Europe, Brazil, China and India and students will have an opportunity to conduct their own research on past and future trends likely to shape medical care and health systems over the next few decades.

Download Syllabus

Required for M.P.A. (health) students.

This introductory course in the Health Policy and Management program explores core topics in the study of health and health care delivery in the United States. We will discuss the distribution of health and disease in society, the organization of the U.S. health care system
and roles and behaviors of its key actors, the historical context for developments in public health and medicine, the quality and accessibility of health care services, and current events in health care reform. We will examine major themes in health care policy and
practice using an interdisciplinary approach that employs sociological, political, economic and ethical perspectives on health and disease, characteristics of health care in the U.S., and the complexity of achieving high quality and affordability given the varied (and sometimes conflicting) motivations of policy-makers, payers, providers and patients. Students will also consider the U.S. health care system in an international context to provide a comparative lens on its nature and performance versus those of other industrialized nations. The objective of this course is to build understanding of fundamental ideas and problems in the areas of health and medical care and thereby to provide a strong foundation for future studies and careers in the health care field.

Download Syllabus

All health systems in the industrialized world are grappling with problems of cost, access, equity and quality of health care; and the trade offs between these objectives. Reforms based on promoting markets, managed competition, public contracting, improved management, and changing financial incentives are some important issues under discussion in most nations.  

This seminar relies on public policy analysis and political economy perspectives  to compare health systems in wealthy OECD nations and BRIC nations (Brazil, Russia, India and China) to analyze efforts at health care reform. The readings, lectures, and class discussions will make students more knowledgeable about policy options and policy changes in different countries. The instructor will also provide opportunities for students to pursue individual research projects and work with the instructor to submit papers for publication.

The seminar begins with an overview of how forces of “globalization” affect health system reform. Next, we focus on ideas, concepts and theories of health care reform. We then go beyond the OECD and controversial WHO approach to health system performance. We examine the politics of health system reform efforts and present case studies in selected nations depending on students’ specific interests. Finally, we will address the policy question of what the U.S. and BRIC nations may learn from the experience of these nations.

Download Syllabus

Only open to Executive MPA students.

This course explores core topics in the study of health and health care delivery in the United States. We will discuss the distribution of health and disease in society, the organization of the U.S. health care system and roles and behaviors of its key actors, the historical context for developments in public health and medicine, the quality and accessibility of health care services, and current events in health care reform. We will examine major themes in health care policy and practice using an interdisciplinary approach that employs sociological, political, economic and ethical perspectives on health and disease, characteristics of health care in the U.S., and the complexity of achieving high quality and affordability given the varied (and sometimes conflicting) motivations of policy-makers, payers, providers and patients. Students will also consider the U.S. health care system in an international context to provide a comparative lens on its nature and performance versus those of other industrialized nations. The objective of this course is to build understanding of fundamental ideas and problems in the areas of health and medical care and thereby to provide a strong foundation for future studies and careers in the health care field.

Download Syllabus

Required for M.P.A. (health) students.

This introductory course in the Health Policy and Management program explores core topics in the study of health and health care delivery in the United States. We will discuss the distribution of health and disease in society, the organization of the U.S. health care system
and roles and behaviors of its key actors, the historical context for developments in public health and medicine, the quality and accessibility of health care services, and current events in health care reform. We will examine major themes in health care policy and
practice using an interdisciplinary approach that employs sociological, political, economic and ethical perspectives on health and disease, characteristics of health care in the U.S., and the complexity of achieving high quality and affordability given the varied (and sometimes conflicting) motivations of policy-makers, payers, providers and patients. Students will also consider the U.S. health care system in an international context to provide a comparative lens on its nature and performance versus those of other industrialized nations. The objective of this course is to build understanding of fundamental ideas and problems in the areas of health and medical care and thereby to provide a strong foundation for future studies and careers in the health care field.

Download Syllabus

2016

Abstract

We compare health improvements among three megacities in BRIC nations as measured by declines in amenable mortality (AM). Although there have been studies of AM in Brazil and the Russian Federation using different definitions and age cohorts, this indicator has never been used to compare these cities. During the period 2000–10, age-adjusted rates of all leading causes of AM fell in all three cities. In São Paulo, it dropped from 1.57 to 1.19 per 1,000 population. In Moscow, it fell from 2.10 to 1.40, and in Shanghai, from 0.72 to 0.54. The rate of decrease was highest in Moscow (33 percent), followed by Shanghai (30 percent), and São Paulo (24 percent). All three cities experienced large reductions in chronic cardiovascular diseases in the form of IHD and stroke, but they remain the leading causes of premature death. Our finding of the decline of AM deaths in São Paulo, Moscow, and Shanghai suggests that all three health systems made significant improvements over the 2000–10 period. It will be important to monitor this indicator as economic growth in these countries and cities has slowed considerably since 2010.

Abstract

Over half of the world’s population lives in cities and United Nations (UN) demographers project an increase of 2.5 billion more urban dwellers by 2050. Yet there is too little systematic comparative research on the practice of urban health policy and management (HPAM), particularly in the megacities of middle-income and developing nations. We make a case for creating a global database on cities, population health and healthcare systems. The expenses involved in data collection would be difficult to justify without some review of previous work, some agreement on indicators worth measuring, conceptual and methodological considerations to guide the construction of the global database, and a set of research questions and hypotheses to test. We, therefore, address these issues in a manner that we hope will stimulate further discussion and collaboration.

Rodwin, VG. and Chinitz, D. Health Policy and Management: Mind the Theory, Policy, Practice Gap 2016. In Politique de santé: Idées, innovations et illusions Economica

2015

Abstract

Policymakers in the US and France are struggling to improve coordination among
hospitals and other health care providers. A comparison of hospital readmission rates, and the factors that may explain them, can provide important insights about the French and US health care systems. In addition, it illustrates a methodological approach to comparative research: how an empirical inquiry along a single indicator can reveal broader issues about system-wide differences across health care systems and policy. Using data from three French regions, the article extends a
previous national-level comparison indicating that rates of hospital readmission for the population aged 65+ are lower in France than in the US. In addition, we extend the range of variables available in the national comparison by drawing on neighborhood-level income data available from a previous study of access to primary care among three French regions. Within France, the odds of surgical hospital readmission are significantly lower in private for-profit hospitals compared with public hospitals. Patients who live in lower income neighborhoods are also more likely to be readmitted for medical and surgical conditions than are patients living in higher income neighborhoods, but this income effect is weaker than in the US. The article concludes with a discussion of how these findings reflect broader system-wide differences between the US and French health systems and the ways in which policymakers attempt to coordinate hospitals and community based services.

Abstract

Obamacare is the most important reform in the American healthcare system since 1965. Its introduction provoked unprecedented controversy between republicans and democrats. Whilst much remains to be done, it has already helped extend health insurance coverage, change the way the healthcare system is funded, establish federal regulations for private insurance, and above all, promote innovation and experiments to modernize the healthcare delivery. Seen from France, it is interesting to follow the array of ongoing experiments in the United States intended to modernize the healthcare system: adaptations to the payment systems for hospitals and doctors and organizational innovations to improve healthcare delivery.

Abstract

Les hospitalisations potentiellement évitables (HPE), nécessaires au moment de l’admission à l’hôpital, pourraient être évitées par une prise en charge appropriée des soins de premier recours. Quel est l’apport de l’indicateur des HPE dans un diagnostic territorial et dans l’évaluation des parcours de soins?

Link to 2 page abstract

Rodwin, VG. 2015. Preface to Pineault, R. Understanding Health Care Systems for Improved Management Eska Publishing, Portland, OR.
Abstract

Available on SSRN database here.

The largest cities in the wealthy nations all face an unprecedented challenge: how to meet the needs of a population that lives longer, has a declining birth rate, is generally healthier, but also increasingly beset by the rise of chronic illness. The World Cities Project (WCP) has produced two books and numerous articles based on comparisons among, and within five of the world's most dynamic cities: New York, Paris, London, Tokyo and Hong Kong. These cities are centres of economic growth and finance, culture and media, sophisticated transportation systems and innovations of all kinds. They are renowned for their centres of excellence in medical care, top-ranking medical schools, institutes of bio-medical research, and public health infrastructure. Likewise, they attract some of the wealthiest, as well as the poorest populations of their nations, which forces their health care systems to confront the challenge of confronting glaring inequalities and redesigning their health care systems.

Abstract

Windows can sometimes be mirrors. A look at health systems abroad can enable us to develop a better understanding of our health system in the United States. An international perspective suggests that the United States has the most expensive health care system in the world, but unlike other wealthy countries, we fail to provide universal health insurance coverage and experience large inequities in access to primary and specialty care. Health care costs are often a source of financial strain, even bankruptcy, for people with serious illness (Hacker, 2006), and Americans suffer from high rates of mortality that could have been avoided with timely and appropriate access to a range of effective health care services (Nolte & McKee, 2012). There is also evidence that the U.S. health care system squanders resources and fails to address many of its population’s health care needs. Not surprisingly, public opinion polls regularly find that medical professionals and the public are dissatisfied with the system and believe major change is necessary (Blendon, Benson, & Brulé, 2012). 

Abstract

We argue that the field of health policy and management (HPAM) ought to confront the gap between theory, policy, and practice. Although there are perennial efforts to reform health care systems, the conceptual barriers are considerable and reflect the theory-policy-practice gap. We highlight four dimensions of the gap (1) the dominance of microeconomic thinking in health policy analysis and design; (2) the lack of learning from management theory and comparative case studies; (3) the separation of HPAM from the rank and file of health care; and (4) the failure to expose medical students to issues of HPAM. We conclude with suggestions for rethinking the field of HPAM by embracing broader perspectives, e.g. ethics, urban health, systems analysis and cross-national analyses of health care systems.

See two commentaries on the article

Hunter, D. J. (2015). Health Policy and Management: In praise of political science Comment on "On Health Policy and Management (HPAM): Mind the theory-policy-practice gap" International Journal of Health Policy and Management Int J Health Policy Manag, 4(6), 391-394.

Kervasdoué, J. D. (2015). An American plague: Pro-market believers in health policy Comment on "On Health Policy and Management (HPAM): Mind the theory-policy-practice gap" International Journal of Health Policy and Management Int J Health Policy Manag, 4(2), 107-109. doi:10.15171/ijhpm.2015.15

2014

Abstract

Over the past two decades, Shanghai, the largest megacity in China, has been coping with unprecedented growth of its economy and population while overcoming previous underinvestment in the health system by the central and local governments. We study the evolution of Shanghai’s healthcare system by analyzing “Avoidable Mortality” (AM) – deaths amenable to public health and healthcare interventions, as previously defined in the literature. Based on analysis of mortality data, by cause of death, from the Shanghai Municipal Center for Disease Control and Prevention, we analyze trends over the period 2000–10 and compare Shanghai’s experience to other mega-city regions – New York, London and Paris. Population health status attributable to public health and healthcare interventions improved dramatically for Shanghai’s population with permanent residency status. The age-adjusted rate of AM, per 1,000 population, dropped from 0.72 to 0.50. The rate of decrease in age-adjusted AM in Shanghai (30%) was comparable to New York City (30%) and Paris (25%), but lower than London (42%). Shanghai’s establishment of the Municipal Center for Disease Control and Prevention and its upgrading of public health and health services are likely to have contributed to the large decrease in the number and rate of avoidable deaths, which suggests that investments in public health infrastructure and increasing access to health services in megacities – both in China and worldwide – can produce significant mortality declines. Future analysis in Shanghai should investigate inequalities in avoidable deaths and the extent to which these gains have benefitted the significant population of urban migrants who do not have permanent residency status.

See five commentaries on the article

Abstract

Objective: To compare rates of 30-day all-cause rehospitalization in France and the US among patients aged 65 years and older and explain any difference between the countries.

Methods: To calculate rehospitalization rates in France, we use an individual identifying variable in the national hospital administrative dataset to track unique individuals aged 65 years or more hospitalized in France in 2010. To calculate the proportion of rehospitalized patients (65þ) who received outpatient visits between the time of initial discharge and rehospitalization, we linked the hospital database with a database that includes all medical and surgical admissions. We used step by step regression models to predict rehospitalization.

Results: Rates of rehospitalization in France (14.7%) are lower than among Medicare beneficiaries in the US (20%). We find that age, sex, patient morbidity and the ownership status of the hospital are all correlated with rehospitalization in France.

Conclusions: Lower rates of rehospitalization in France appear to be due to a combination of better access to primary care, better health among the older French population, longer lengths of stay in French hospitals and the fact that French nursing homes do not face the same financial incentive to rehospitalize residents.

Abstract

To learn from health care systems abroad, we must move beyond simplistic characterizations and compare different systems with respect to salient performance measures. Despite findings from recent cross-national studies suggesting that many health care systems outperform the United States, claims by U.S. public officials often fail to acknowledge the actual accomplishments of health care systems abroad. We document significant variation among the United States and France, Germany, and England, which provide universal coverage, albeit in different ways. As previously documented, the United States has the highest rate of mortality amenable to health care. We extend this work by adding two indicators: (a) access to timely and effective primary care as measured by hospital discharges for avoidable hospital conditions; and (b) use of specialty services as indicated by coronary revascularization (bypass surgery and angioplasty), adjusted for the burden of coronary artery disease. Our findings indicate that: (a) the United States suffers the gravest consequences of financial barriers to primary care; (b) in all four countries, older people (65+) receive fewer revascularizations than their younger counterparts once we account for disease burden; and (c) in France, patients receive the most revascularizations, after adjusting for the burden of disease.

Abstract

The field of health policy and management (HPAM) faces a gap between theory, policy and practice. Despite decades of efforts at reforming health policy and health care systems, prominent analysts state that the health system is ‘‘stuck’’ and that models for change remain ‘‘aspirational.’’ We discuss four reasons for the failure of current ideas and models for redesigning health care: (1) the dominance of microeconomic thinking; (2) the lack of comparative studies of health care organizations and the limits of health management theory in recognizing the importance of local contexts; (3) the separation of HPAM from the rank and file of health care, particularly physicians; and (4) the failure to expose medical students to issues of HPAM. We conclude with suggestions for rethinking how the field of HPAM might generate more promising policies for health care providers and managers by abandoning the illusion of context-free theories and, instead, seeking to facilitate the processes by which organizations can learn to improve their own performance.

2013

Abstract

This article presents an indicator used in the United States and other OECD nations (hospitalizations for ambulatory-care sensitive conditions – ACSC) to assess access to primary care services and their capacity to handle a set of medical conditions before they require acute hospital treatment. Based on a study of Ile de France, which relies on residence-based hospital discharge data on patient diagnoses and treatments, the indicator identifies areas where hospitalizations for ACSC appear particularly high. Such hospital stays are considered potentially avoidable. Based on data from the Programme de m.dicalisation des syst.mes d’information (PMSI), disparities are measured. We rely on logistic regression analysis to identify a range of individual factors and neighborhood-level factors that explain these disparities. Access to primary care appears to be worse among residents in areas with average household income in the lowest quartile and among those hospitalized in public hospitals. This raises an important question for the future of health policy. Should areas with higher hospital discharge rates of ACSC be understood as having populations with poor health-seeking behaviors or health care systems not well enough organized to target higher-risk populations?

Abstract

Based on the number of hospitalizations for ambulatory-care sensitive conditions in the Paris region (Ile-de-France), and the DRG-based rates for these hospital stays, we estimate the hospital expenditures that could be avoided if patients had access to primary care services that successfully manage their chronic conditions and avoid exacerbations that lead to necessary hospitalizations when they occur. In addition, we caution policymakers about what inferences can legitimately be drawn from such estimates for the expenditures averted on hospital care do not represent a net gain as there would likely be additional expenditures needed to upgrade ambulatory care to manage a host of complex chronic diseases.

Abstract

Objectives: This paper compares access to primary and specialty care in three metropolitan regions of France: Ile de France (IDF), Nord-Pas-de-Calais (NPC) and Provence-Alpes-Côte d’Azur (PACA); and identifies the factors that contribute to disparities in access to care within and among these regions.

Methods: To assess access to primary care, we compare variation among residence-based, age-adjusted hospital discharge rates for ambulatory care sensitive conditions (ASC). To assess access on one dimension of specialty care, we compare residence-based, age- adjusted hospital discharge rates for revascularization – bypass surgery and angioplasty – among patients diagnosed with ischemic heart disease (IHD). In addition, for each region we rely on a multilevel generalized linear mixed effect model to identify a range of individual and area-level factors that affect the discharge rates for ASC and revascularization. Results: In comparison with other large metropolitan regions, in France, access to primary care is greater in Paris and its surrounding region (IDF) than in NPC but worse than in PACA. With regard to revascularization, after controlling for the burden of IHD, use of services is highest in PACA followed by IDF and NPC. In all three regions, disparities in access are much greater for revascularization than for ASC. Residents of low-income areas and those who are treated in public hospitals have poorer access to primary care and revascularizations. In addition, the odds of hospitalization for ASC and revascularization are higher for men. Finally, people who are treated in public hospitals, have poorer access to primary care and revascularization services than those who are admitted for ASC and revascularization services in private hospitals.

Conclusions: Within each region, we find significant income disparities among geographic areas in access to primary care as well as revascularization. Even within a national health insurance system that minimizes the financial barriers to health care and has one of the highest rates of spending on health care in Europe, the challenge of minimizing these disparities remains.

Abstract

With population aging and increasing urbanization, it is important to examine the quality of life of older people living in cities, in particular world cities. However, few comparative studies of world cities examine their health, long-term care systems, or the characteristics of their older populations. To assess how well world cities are addressing the challenges associated with aging populations, it is helpful to review comparable data on the economic and health status of older persons, as well as the availability and use of health, social, and long-term care services. By extending the work of the “CADENZA: A Jockey Club Initiative for Seniors” Project and the World Cities Project, this chapter compares three world cities—Hong Kong, New York City, and London. The three world cities are similar in the size and proportion of their older populations, but the characteristics of older people and the health and long-term care systems available to them differ in significant ways. These comparisons reveal how Hong Kong, New York City, and London are responding to a rapidly aging population. They should be valuable to other cities that face the challenges of population aging.

Abstract

We investigate avoidable hospital conditions (AHC) in three world cities as a way to assess access to primary care. Residents of Hong Kong are healthier than their counterparts in Greater London or New York City. In contrast to their counterparts in New York City, residents of both Greater London and Hong Kong face no financial barriers to an extensive public hospital system. We compare residence-based hospital discharge rates for AHC, by age cohorts, in these cities and find that New York City has higher rates than Hong Kong and Greater London. Hong Kong has the lowest hospital discharge rates for AHC among the population 15–64, but its rates are nearly as high as those in New York City among the population 65 and over. Our findings suggest that in contrast to Greater London, older residents in Hong Kong and New York face significant barriers in accessing primary care. In all three cities, people living in lower socioeconomic status neighborhoods are more likely to be hospitalized for an AHC, but neighborhood inequalities are greater in Hong Kong and New York than in Greater London.

2012

Abstract

Declining birth rates, increasing longevity and urbanization have created a new challenge for cities: how to respond to an ageing population. Although population ageing and urbanization are not new concerns for national governments around the world, the consequences of these trends for quality of life in cities has only recently started to receive attention from policy makers and researchers. Few comparative studies of world cities examine their health or long-term care systems; nor have comparisons of national systems for the provision of long-term care focused on cities, let alone world cities.

By extending the work of the CADENZA and World Cities Projects , this report investigates how three world cities -- Hong Kong, New York and London -- are coping with this challenge. These world cities are centers of finance, information, media, arts, education, specialized legal services and advanced business services, and contribute disproportionate shares of GDP to their national economies. But are these influential centers prepared to meet the challenge posed by the “revolution of longevity?” How will these world cities accommodate this revolutionary demographic change? Are they prepared to implement the health and social policy innovations that may be required to serve their residents, both old and young? Will they be able to identify the new opportunities that increased longevity may offer? Can they learn from one another as they seek to develop creative solutions to the myriad issues that arise? Finally, can other cities learn from the experience of these three cities as they confront this challenge?

To address these questions, we examine comparable data on the economic and health status of older persons, as well as the availability and use of health, social and long-term care across and within these cities. In the report “How Well Are Seniors in Hong Kong Doing? An International Comparison”, a first attempt was made to compare the situation in Hong Kong with five economically developed countries. This report extends this study by comparing the situation in Hong Kong with two other world cities—New York City and London, which are more comparable in terms of population size and economic characteristics.

2011

Abstract

Cities are critical sites for enquiry and action in relation to health and well-being. With up to 70 per cent of the world’s population estimated to be living in urban areas by 2050 1 , global health will be determined increasingly in cities. As Africa and Asia become the locus of urbanisation, researchers and policy-makers are increasingly contextualising, questioning or even moving beyond the urban health knowledge and approaches we have developed over the past century mainly in Western Europe and North America. The existence of significant urban health inequalities even within rich cities, often stubbornly resisting the efforts of public policy to reduce them, also continue to demand our attentions. In response to these challenges, the 2011 Urban Age Hong Kong conference, organized by the London School of Economics and Political Science and the Alfred Herrhausen Society in partnership with the University of Hong Kong, brought together over 170 planners, architects, sociologists, medical doctors, public health experts and economists from 36 cities and 22 countries to help identify the routes through which new meanings, methods and interventions for health and well-being might be developed for greater effect in today’s cities.

Abstract

Hong Kong stands out among wealthy megacities as having some of the best indicators of population health. Infant mortality is 3.0 per 1,000 births in Hong Kong compared to 6.2 in New York City and 4.0 in Paris, while life expectancy at birth is 78.0 years compared to 77.7 years in Tokyo and 76.1 years in Greater London (Table 1). Such indicators are too broad, however, to draw useful inferences about the performance of Hong Kong’s health care system, let alone the effects of Hong Kong, as a city, on its population’s health. It is difficult to disentangle the relative importance of health systems and diverse city characteristics, such as population density, levels of environmental pollution or the nature of the built environment, from the multiple determinants of health, including the sociocultural factors and the neighbourhood context of the population whose health is measured.

Abstract

While the growth of urbanization, worldwide, has improved the lives of migrants from the hinterland, it also raises health risks related to population density, concentrated poverty and the transmission of infectious disease. Will megacity regions evolve into socially infected breeding grounds for the rapid transmission of disease, or can they become critical spatial entities for the protection and promotion of population health? We address this question for the Pearl River Delta Region (PRD) based on recent data from Chinese sources, and on the experience of how New York, Greater London, Tokyo and Paris have grappled with the challenges of protecting population health and providing their populations with access to health care services. In some respects, there are some important lessons from comparative experience for PRD, notably the importance of covering the entire population for health care services and targeting special programs for those at highest risk for disease. In other respects, PRD's growth rate and sheer scale make it a unique megacity region that already faces new challenges and will require new solutions.

Abstract

Patient safety, and more broadly the quality of care, is typically discussed with reference to the reduction of preventable adverse events within hospitals and adherence to practice guidelines on care processes. We call it the ‘care-centered approach’ and recognize that the United States is a leader in the field. Another face of patient safety and care quality may be defined as the ‘system-centered approach’. It focuses on access to a timely and effective continuum of health-care services – clinical prevention, primary care and appropriate referral to and receipt of specialty care. Although France's efforts to pursue a care-centered approach to patient safety are limited, its system-centered approach yields some benefits. Based on the evidence we have reviewed for access to primary care (hospital discharges for avoidable hospital conditions), mortality amenable to medical intervention and consumer satisfaction, in the United States and France, there appear to be good grounds for bolstering the system-centered approach in the United States.

2010

Rodwin, V.G. . Six Countries, Six Reform Models: The healthcare reform experience of Israel, The Netherlands, New Zealand, Singapore, Switzerland and Taiwan: Healthcare Reforms "Under the Radar Screen" JAMA. 2010; Vol. 304, No. 18: 2,070-2,071
Abstract

The article presents a review of an individual approach to emergency preparedness for socially isolated elderly city dwellers. It cites crisis instances highlighting older persons' vulnerability and the importance of neighborhood characteristics as the isolated elderly had reportedly higher mortality rates in poor neighborhoods and abandoned lots than in equally poor but more socially-connected neighborhoods. It suggests a population-based case management requiring information dissemination and outreach strategies for finding and assisting older persons.

Abstract

Victor Rodwin, professor of health policy and management at NYU Wagner, and his colleague Didier Tabuteau, counselor of state and professor of health policy at the Institut d'Etudes Politiques and the University of Paris Descartes, have published a new book (published by Editions Jacob Duvernet) in which they challenge the conventional wisdom that the French health care system is a government-managed, public and collective enterprise and the American system a private, market-oriented and individualist system. Based on six months of debates in Paris while Professor Rodwin held the Fulbright-Toqueville Chair (spring semester, 2010), this book compares public health, health insurance, the power of physicians, health care reform, and the silent revolution that is transforming health care organization in both France and the United States.

Abstract

New York. London. Paris. Although these cities have similar sociodemographic characteristics, including income inequalities and ethic diversity, they have vastly different health systems and services. This book compares the three and considers lessons that can be applied to current and future debates about urban health care.

Highlighting the importance of a national policy for city health systems, the authors use well-established indicators and comparable data sources to shed light on urban health policy and practice. Their detailed comparison of the three city health systems and the national policy regimes in which they function provides information about access to health care in the developed world's largest cities.

The authors first review the current literature on comparative analysis of health systems and offer a brief overview of the public health infrastructure in each city. Later chapters illustrate how timely and appropriate disease prevention, primary care, and specialty health care services can help cities control such problems as premature mortality and heart disease.

In providing empirical comparisons of access to care in these three health systems, the authors refute inaccurate claims about health care outside of the United States.

Click here for a brief excerpt of the content.

Book review in Journal of Health Politics, Policy and Law.

Abstract

A major effort to introduce new vaccines into poor nations of the world was initiated in recent years with the help of the GAVI alliance. The first vaccines introduced have been the Haemophilus influenzae type B (Hib) and the hepatitis B (Hep B) vaccines. The introduction of these vaccines during the first phase of GAVI's operations demonstrated considerable variability. We set out to study the factors affecting the introduction of these vaccines. The African Region (AFRO), where new vaccines were introduced to a substantial number of countries during the first phase of GAVI's funding, was selected for this study.

2009

Abstract

Victor G. Rodwin, qui tiendra une conférence à Marseille le 22 janvier prochain, explique en quoi la réforme
du système de santé est si difficile à mettre en oeuvre aux États-Unis. Si le Président Obama a surmonté
les premières difficultés, la course d'obstacles n'est pas pour autant terminée. Rodwin reconnaît l'excellence
du système médical français tout en contestant la première place attribuée par l'OMS à notre pays.

Abstract

The question posed in this paper is whether single-payer health care systems

are more likely to provide equal treatment for equal need (horizontal equity) than are multipayer systems. To address this question, we compare access to primary and specialty health care services across selected neighborhoods, grouped by average

household income, in a single-payer system (the English NHS), a multiple-payer system with universal coverage (French National Health Insurance), and the U.S. multiple-payer system characterized by large gaps in health insurance coverage. We find that Paris residents, including those with low incomes, have better access to health care than their counterparts in Inner London and Manhattan. This finding casts doubt on the notion that the number of payers influences the capacity of a health care system to provide equitable access to its residents. The lesson is to worry less about the number of payers and more about the system’s ability to assure access to primary and specialty care services.

Rodwing, V.G. . La Révolution Tranquille du Managed Care aux Etats Unis. (The Silent Revolution of Managed Care in the United States) Ch. 21 in Tabuteau, D. Bras, P.L. and de Pouvourville, G., eds. Traité d’Economie et de Gestion de la Santé. Paris. Presses de Sciences Politiques
Abstract

How do we understand and also assess the health care of America? Where is health care provided? What are the characteristics of those institutions which provide it? Over the short term, how are changes in health care provisions affecting the health of the population, the cost of care, and access to care? These core issues regarding our health policy are answered in this text.This is a textbook for course work in health care, the handbook for administrators and policy makers, and the standard for in-service training programs.

Rodwin, V.G., Gusmano, M.K., Suhrcke, M.K., Nolte, E., McKee, M. & Weisz, D. . Health Care as an Investment? Reframing the Health Policy Debates in Europe London: Alliance for Health & the Future, Policy Brief, June 2008, 1(2).
Rodwin, V.G. & Gusmano, M.K. & Weisz, D. . Health Care Inequities: Towards An Empirical Assessment Revue d'Epidémiologie et de Santé Publique  Vol 27, No. 6  56S S348-S355

2008

2007

Abstract

Background: Access to timely and effective medical services can reduce rates of premature mortality attributed to certain conditions. We investigate rates of total and avoidable mortality (AM) and the percentage of avoidable deaths in France, England and Wales and the United States, three wealthy nations with different health systems, and in the urban cores of their world cities, Paris, Inner London and Manhattan. We examine the association between AM and an income-related variable among neighbourhoods of the three cities. Methods: We obtained mortality data from vital statistics sources for each geographic area. For two time-periods, 1988–90 and 1998–2000, we assess the correlation between area of residence and age- and gender-adjusted total and AM rates. In our comparison of world cities, regression models are employed to analyse the association of a neighbourhood income-related variable with AM. Results: France has the lowest mortality rates. The US exhibits higher total, but similar AM rates compared to England and Wales. Rates of AM are lowest in Paris and highest in London. Avoidable mortality rates are higher in poor neighbourhoods of all three cities; only in Manhattan is there a correlation between the percentage of deaths that are avoidable and an income related variable. Conclusions: Beyond the well-known association of income and mortality, persistent disparities in AM exist, particularly in Manhattan and Inner London. These disparities are disturbing and should receive greater attention from policy makers.

Abstract

Climate change and human health are intertwined.  The heat waves in Chicago, in 1995, and in Paris, in 2003, followed by Hurricane Katrina_s destruction of New Orleans, raised awareness of the risks faced by vulnerable older people. Many cities have responded by announcing emergency preparedness plans; some of these plans have already been tested. Last summer, from July 27 to August 5, New York City suffered a mild heat wave with temperatures reaching 100-F. Paris, as well, was hit by another heat wave from July 17 to July 29, with maximum temperatures reaching 104-F, which was considerably milder than in 2003 when they often exceeded 110-F. In New York, there were 100 "excess deaths," an increase of 8% over past trends. In Paris, the number of excess deaths in 2006 (42), also an increase of 8%, was considerably lower than the 1,294 deaths registered in 2003-an increase of 190% compared to the preceding three-year average. Given existing surveillance capacity, it is impossible to know whether the reduction in excess deaths in Paris was due, partly, to its enhanced preparedness or whether it reflects no more than the effects of a far milder heat wave. Nevertheless, the milder heat wave of 2006 does provide an opportunity to examine the actual implementation of the heat wave preparedness plan. In light of ongoing efforts to develop such plans in cities worldwide and completed studies on the effects of the 2003 heat wave in Paris, what may be learned to promote urban health and improve understanding of the factors that put vulnerable older people at greatest risk?

Abstract

Cross-national comparisons that assess dimensions of health system performance indicate that the US provides higher rates of revascularization procedures than France and other developed nations, but we believe these findings are misleading. In this paper, we compare the use of these procedures in the US, France and their two world cities, Manhattan and Paris. In doing so, we address a number of limitations associated with existing cross-national comparisons of heart disease treatment. After adjusting for the prevalence of disease in these nations and cities, we found that residents of France aged 45�64 years receive more revascularization procedures than residents of the US and that Parisians receive more revascularizations than residents of Manhattan. Older residents 65 years and over (65 ) in the US receive more of these procedures than their French counterparts, but the differences are not nearly as great as previous studies suggest. Moreover, our data on Manhattan and Paris where the population and level of health resources are more comparable, indicate that older Parisians obtain more revascularization procedures than older Manhattanites. Finally, we found that the use of revascularization procedures is significantly lower in Manhattan among persons without private health insurance and among racial and ethnic minorities.

Abstract

An interdisciplinary examination of rates of avoidable hospitalizations in France and England to evaluate access to primary care and identify the extent to which these countries may be able to reduce hospital costs by investing in disease management and primary care. The policy brief was published under the Alliance for Health & the Future, a partnership between ILC-USA, ILC-UK and ILC-France.

2006

Abstract

Declining birthrates, increasing longevity and growing urbanization have created a new challenge for cities: how to respond to an aging population. The World Cities Project was designed to examine whether the four largest cities among the wealthiest nations of the world - New York, London, Paris and Tokyo - offer a model of what other cities will someday resemble as their populations grow older.

Perhaps the four world cities examined here will always be regarded as special cases; however, they share in common a host of important characteristics. Within them live the largest number of older people in their countries and in some neighborhoods the percent of elders 65 or older far exceeds what the census demographers project for their nations in 2030. Thus, these great cities may serve as laboratories to inquire about the implications of demographic change for health and quality of life, living arrangements and housing, and the provision of long-term care to older adults when they eventually become frail.

 

 

Abstract

Based on a comparison of discharges for avoidable hospital conditions (AHCs), we find that Paris provides greater access to primary care than Manhattan. Ageadjusted AHC rates are more than 2.5 times as high in Manhattan as in Paris. In contrast, the difference in rates of hospital discharge for "marker conditions" are only about 20 percent higher in Manhattan. Rates of discharges for AHCs are higher among residents of low-income neighborhoods in both cities, but the disparity among high- and low-income neighborhoods is more than twice as great in Manhattan. Our analysis highlights the consequences of access barriers to care in Manhattan, particularly among vulnerable residents.

Abstract

Population aging often provokes fears of impending social security deficits, uncontrollable medical expenditures, and transformations in living arrangements, but public policy could also stimulate social innovations. These issues are typically studied at the national level; yet they must be resolved where most people live—in diverse neighborhoods in cities. New York, London, Paris, and Tokyo are the four largest cities among the wealthiest, most developed nations of the world. The essays commissioned for this volume compare what it is like to grow older in these cities with respect to health care, quality of life, housing, and long-term care. The contributors look beyond aggregate national data to highlight the importance of how local authorities implement policies.

Abstract

In France, American nostrums of unleashing market forces under the banner of "consumer-directed health care," and selective contracting by private health insurers, have gained little ground. That should not, however, lead one to conclude that the French health care system is irrelevant to the United States. The organization and financing of health care, in France, resembles, in many respects, that of the United States - more so, in fact, than do Britain's National Health Service or Canadian and German national health insurance (NHI). The French reliance on a public-private mix that includes a significant proprietary hospital sector, private fee-for-service medical practice, and enormous patient choice among a pluralistic organization of health care providers makes French NHI a model for what Senator Ted Kennedy and Congressman Pete Stark have called "Medicare for all."

Abstract

How do we understand and also assess the health care of America? Where is health care provided? What are the characteristics of those institutions which provide it? Over the short term, how are changes in health care provisions affecting the health of the population, the cost of care, and access to care? These core issues regarding our health policy are answered in this text.This is a textbook for course work in health care, the handbook for administrators and policy makers, and the standard for in-service training programs.

2005

Abstract

Objective: We investigated the association between average income or deprivation and infant mortality rate across neighborhoods of four world cities.

Methods: Using a maximum likelihood negative binomial regression model that controls for births, we analyzed data for 1988-1992 and 1993-1997.

Results: In Manhattan, during both periods, we found a statistically significant association between income and infant mortality (.05 level) while in Tokyo there was none. In Paris and London, there was no association in period one. In period two, the association just misses statistical significance for Paris while in London association with a deprivation index is significant.

Conclusions: In contrast to Tokyo, Paris and London, the association of income and infant mortality rate is more strongly evident in Manhattan.

Abstract

Health services research is, by nature, multidisciplinary, for it draws on the methods,concepts and theories of social sciences, which are relevant to the study of how the organization and financing of health services can improve the delivery of health care services (Gray, et al., 2003). While medicine and public health, too, are multidisciplinary enterprises drawing on such disciplines as molecular biology, physiology, anatomy, genetics, epidemiology and more, health services research departs from these disciplines in focusing not on the nature of disease and health but rather on the financing and organization of health systems.

So it is with urban health services research albeit that this field is more narrowly focused on health services in cities. The city focus has resulted in a large body of research on vulnerable groups, barriers to service access, public health clinics and community health centers. Likewise, it has led to important investigations of safetynet institutions, e.g. public hospitals and health centers, which serve a disproportionate share of uninsured and low-income patients. In addition, urban health services research has focused on a host of specific services associated with subpopulations suffering from TB, HIV/AIDS, drug addiction and other social pathologies that are typically associated with the "inner city."

 

2004

Abstract

The World Health Organization recently ranked the French health care system the best in the world.1 Although the methods and data on which this assessment was based have been criticized, there are good grounds for being impressed by the French system. Yet in August 2004, with the national health insurance (NHI) system facing a severe financial crisis, France enacted Minister of Health Philippe Douste-Blazy's reform plan. Like previous efforts at health care reform, this one seeks to preserve a system of comprehensive benefits, which is supported by the major stakeholders.

Abstract

Background: Gender disparities in the treatment of coronary artery disease (CAD) have been extensively documented in studies from the United States. However, they have been less well studied in other countries and, to our knowledge, have not been investigated at the more disaggregated spatial level of cities.

Objective: This study tests the hypothesis that there is a common international pattern of gender disparity in the treatment of CAD in persons aged ≥65 years by analyzing data from the United States, France, and England and from their largest cities-New York City and its outer boroughs, Paris and its First Ring, and Greater London.

Methods: This was an ecological study based on a retrospective analysis of comparable administrative
data from government health databases for the 9 spatial units of analysis: the 3 countries, their 3 largest
cities, and the urban cores of these 3 cities. A simple index was used to assess the relationship between
treatment rates and a measure of CAD prevalence by gender among age-adjusted cohorts of patients.
Differences in rates were examined by univariate analysis using the Student t test for statistical differences
in mean values.

Results: Despite differences in health system characteristics, including health insurance coverage, availability
of medical resources, and medical culture, we found consistent gender differences in rates of percutaneous
transluminal coronary angioplasty and coronary artery bypass grafting across the 9 spatial units.
The rate of interventional treatment in women with CAD was less than half that in men. This difference
persisted after adjustment for the prevalence of heart disease.

Conclusions: A consistent pattern of gender disparity in the interventional treatment of CAD was seen
across 3 national health systems with known differences in patterns of medical practice. This finding is
consistent with the results of clinical studies suggesting that gender disparities in the treatment of CAD
are due at least in part to the underdiagnosis of CAD in women.

 

Abstract

Background: Gender disparities in the treatment of coronary artery disease (CAD) have been extensively documented in studies from the United States. However, they have been less well studied in other countries and, to our knowledge, have not been investigated at the more disaggregated spatial level of cities.

Objective: This study tests the hypothesis that there is a common international pattern of gender disparity in the treatment of CAD in persons aged > 65 years by analyzing data from the United States, France, England and from their largest cities - New York City and its outer boroughs, Paris and its First Right, and Great London.

Conclusions: A consistent pattern of gender disparity in the interventional treatment of CAD was seen across 3 national health systems with known differences in patterns of medical practice. This finding is consistent with the results of clinical studies suggesting that gender disparities in the treatment of CAD are due at least in part to the underdiagnosis of CAD in women.

Abstract

We examine, for residents in two nations (U.S. and France) and the hearts of two world cities (New York, and Paris), differences in rates of mortality and hospital discharge, by area of residence, for ischemic heart disease (IHD), acute myocardial infarction (AMI), and rates of revascularization. To assess the relationship between treatment rates and the prevalence of IHD, we introduce an index based on the ratio of procedure rates to AMI hospital discharge rates and mortality. After accounting for disease prevalence, we find that procedure rates are lower in Manhattan than in Paris for both age groups, and lower in the United States than France among the 45-64 year old cohort.

Rodwin, V.G. & Croce-Galis, M. . Population Health in Utah and Nevada: An Update on Victor Fuchs' Tale of Two Cities in Peter Conrad, Sociology of Health and Illness, New York, Worth-St. Martin's Press,
Abstract

A comparison of citywide infant mortality rates for Manhattan, Inner London, Paris, and Inner Tokyo during 1988–97 shows the Manhattan rate nearly always higher than those of the other cities. Differences in the neighborhood rate distributions of the four cities explain the citywide pattern. In contrast to the other cities, Manhattan has neighborhoods with rates substantially above its median neighborhood rate and these neighborhoods drag its citywide rate above those of the other cities.

Abstract

Les villes de New York, Londres, Paris et Tokyo concentrent une part majeure de l'activité et de la richesse de leurs nations. Elles connaissent une forte densité de population, et notamment de personnes âgées. Elles disposent en outre d'un potentiel en équipement, réseaux et infrastructures de soins médicaux très important par rapport aux autres agglomérations.

Examiner le vieillissement de leur population et comparer les systèmes de santé et de soins dans ces quatre mégapoles est l'objet d'un programme de recherche international, qui vise à s'interroger sur les adaptations des systèmes sanitaires et sociaux à la longévité croissante de la population.

C'est parmi les quatre villes Tokyo qui présente la densité la plus élevée de personnes âgées de 65 ans et plus, mais Paris celle de personnes très âgées (85 ans et plus).

À Tokyo, les personnes âgées vivent également moins souvent seules que dans les autres mégapoles, les centres urbains de Manhattan, Paris et Londres concentrant en particulier une forte proportion de femmes très âgées et vivant seules.

Si ces quatre villes ont un équipement médical et hospitalier plus important en centre urbain qu'en périphérie, la densité en lits médicalisés et de long séjour apparaît inférieure à Londres et à Tokyo.

Les services d'aide à domicile, plus denses dans les centres urbains, sont plus difficiles à comparer mais semblent légèrement mieux assurés dans le centre de Londres.

2003

Abstract

The French health system combines universal coverage with a public–private mix of hospital and ambulatory care and a higher volume of service provision than in the United States. Although the system is far from perfect, its indicators of health status and consumer satisfaction are high; its expenditures, as a share of gross domestic product, are far lower than in the United States; and patients have an extraordinary degree of choice among providers. Lessons for the United States include the importance of government’s role in providing a statutory framework for universal health insurance; recognition that piecemeal reform can broaden a partial program (like Medicare) to cover, eventually, the entire population; and understanding that universal coverage can be achieved without excluding private insurers from the supplementary insurance market.

2002

Abstract

This article provides an overview of the World Cities Project (WCP), our rationale for it, our framework for comparative analysis, and an overview of current studies in progress. The WCP uses New York, London, Paris, and Tokyo as a laboratory in which to study urban health, particularly the evolution and current organization of public health infrastructure, as well as the health status and quality of life in these cities. Comparing world cities in wealthier nations is important because of (1) global trends in urbanization, emerging health risks, and population aging; (2) the dominant influence of these cities on “megacities” of developing nations; and (3) the existence of data and scholarship about these world cities, which provides a foundation for comparing their health systems and health. We argue that, in contrast to nation-states, world cities provide opportunities for more refined comparisons and cross-national learning. To provide a framework for WCP, we define an urban core for each city and examine the similarities and differences among them. Our current studies shed light on inequalities in health care use and health status, the importance of neighborhoods in protecting population health, and quality of life in diverse urban communities.

Rodwin, V.G., with Montero, G. & Gusmano, M.K. . Vieillissement et Milieux Urbains: le World Cities Project Les Politiques Sociales, 61(1&2), pp. 115-121.

2001

Rodwin, V.G. . L'hôpital et les Réseaux de Médecins Proceedings from the June 20 colloquium En France au XXIe siècle: Quelle Perspectives? Paris: Editions Nucleon.
Abstract

The city is, at once, a center for disease and poor health and also a place for hope, cures and good health. From the earliest times, the city has attracted the poor and been the target of the plague, as well as war. Likewise, the health care industry has always been part of the economic base of cities - from Lourdes, in France, to Rochester, Minnesota, to megacities around the world. With its highly disproportionate share of health resources, e.g., hospitals, physicians, nurses and social services, the big city is a center of excellence in medicine. Yet, as Richard Horton, editor of The Lancet once noted, "For all of its rational efficiency and benevolent intent, the city is likely to be the death of us." Are cities socially infected breeding grounds for disease? Or do they represent critical spatial entities for promotion of population health? I propose to begin with a global view of urban health and disease and the challenge this poses for public health today. Next, I examine some evidence for the hypothesis that population health in cities is relatively poor. Finally, I suggest that the more pertinent question is not whether the city is unhealthy or healthy but rather the extent to which we can alleviate the problems posed by inequalities of income and wealth - in the city as well as outside of it.

Rodwin, V.G., Chambaretaud, S. & Lequet-Slama, D. . Couverture Maladie et Organization des Soins aux Etats-Unis Etudes et Resultats, 119, June,

2000

Abstract

How do we understand and also assess the health care of America? Where is health care provided? What are the characteristics of those institutions which provide it? Over the short term, how are changes in health care provisions affecting the health of the population, the cost of care, and access to care? These core issues regarding our health policy are answered in this text.This is a textbook for course work in health care, the handbook for administrators and policy makers, and the standard for in-service training programs.

Abstract

Improvements in health care and declining birth rates have combined to create rapidly aging populations throughout the industrialized world. By 2020, for example, nearly seventeen percent of the US population is expected to be over the age of sixty-five. In Japan that mark has already been passed, with more than one-quarter of the population expected to be over sixty-five by 2020. At the same time, the world's population is increasingly concentrated in urban areas: the United Nations estimates that by 2025, sixty-one percent of the world's population will live in cities. As both urbanization and population aging increase, we will need models of how to accommodate this population shift and examples to emulate in dealing with these phenomena.

Rodwin, V.G. . Health Care Reform in the Transitional Economies Poverty in Transition? New York: UNDP.

1998

Rodwin, V.G. . Adapter les Méthodes du "Managed Care" a Notre Système d'Assurance Maladie Le Monde.

1997

Rodwin, V.G. . The Rise of Managed Care in the United States: Lessons from French Health Policy in Health Policy Reform, National Schemes and Globalization, Ed. C. Altenstetter and J. Bjorkman, London: Macmillan; New York: St. Martin's Press.
Rodwin, V.G. . Les Maladies du Plan Juppé Le Monde, November 19.

1996

Rodwin, V.G. & Levy, E. . Vers Un Managed Care à la Française? Chroniques Economiques S.E.D.E.I.S., (45), September.
Rodwin, V.G. & Le Pen, C. . Le Plan Juppé Droit Social, September-October .
Rodwin, V.G. . Aux Bons Soins du l'Oncle Sam-Le Managed Care Aux Etats-Unis Pharmaceutiques, (29) .

1995

Rodwin, V.G. . Japan's Universal and Affordable Health Care: Lessons for the United States? With the assistance of Llyn Kawasaki and James Littlehales. New York: Japan Society.

1994

Rodwin, V.G. . La réforme du système de santé aux Etats Unis, Concours Médicale, Paris, France (three part series), September-October, 1994.
Rodwin, V.G. & Vladescu, C. . L'Etat et les systèmes de santé, Medecine et Hygiène (Geneva, Switzerland, Fall 1994).
Rodwin, V.G. . "Le rôle de l'assurance maladie dans la régulation du système de santé" Revue d'Economie Régionale et Urbaine, No. 1, 1994.
Rodwin, V.G. . "Health Insurance and Health Policy, American and Japanese Style: Lessons of Comparative Experience" Japan and the World Economy, (5)2, Summer 1993.

1993

Rodwin, V.G. & Saric, M. . "The Once and Future Health System in the Former Yugoslavia: Myths and Realities" Journal of Public Health Policy, Spring 1993.
Rodwin, V.G. & Sandier, S. . "Health Care under French National Health Insurance: A Public-Private Mix, Low Prices and High Volumes"

1992

Rodwin, V.G. . "Medical Care and the State" Review Essay, Journal of Health Politics, Policy and Law (17) 2, Summer, 1992.

1990

Rodwin, V.G., Grable, H. & Theil, G. . "Updating the Fee Schedule for Physician Reimbursement: A Comparative Analysis of France, Germany and Canada" Quality Assurance and Utilization Review, February 1990.
Rodwin, V.G. . "Physician Payment Reform: Lessons From Abroad" Health Affairs (9)1, Winter 1990.

1989

Abstract

The Advanced Management program for Clinicians (AMPC) was established in 1986 with the help of a grant from the W.K. Kellogg Foundation. It is designed for health care professionals who are currently in management positions and for those who seek career shifts in the direction of health care management and policy. The AMPC program represents New York University's response to some of the sweeping changes affecting the health sector: (1) the growth of large health care organizations; (2) pressures by payers to contain health care expenditures; (3) increasing intervention by government and corporations in the practice of medicine; and (4) disgruntlement among clinicians about their working environment. 

 

In this paper we briefly review these trends and discuss our goals in creating the AMPC program. Next, we describe the program's distinguishing characteristics. And we conclude with some reflections about the issues raised by two and a half years of experience training physicians in this program. 

Rodwin, VG . New Ideas for Health Policy in France, Canada and Britain Rodwin, VG. (1989). New Ideas for Health Policy in France, Canada and Britain. In Field, M. (Ed.), Success and Crisis in National Health Systems: A Comparative Approach. New York: Routledge.

1987

Rodwin, V.G. . Le Controle des Pouvoirs Publics et des Payeurs: Comparaisons Internationales Rodwin, V. G. (1987). Le Contrôle des Pouvoirs Publics et des Payeurs: Comparaisons Internationales. In M. Berthod-Wurmser & V. G. Rodwin (Eds.), Système de santé, pouvoirs publics et financeurs: Qui contrôle quoi? (pp. 55-68). France: Documentation Française.
Rodwin, V.G. . "American Exceptionalism in the Health Sector: The Advantages of `Backwardness' in Learning from Abroad" Medical Care Review, (44)1, 1987.

1985

Rodwin, V.G., Launois, R.J., Majnoni d'Intignano, B. & Stéphan, J.C. . "Les réseaux de soins coordonnés (RSC): propositions pour une réforme profonde du système de santé" Revue Française des Affaires Sociales (1) January/March, 1985.
Rodwin, V.G. . "The Public/Private Mix in the American Health Sector: A Misleading Dichotomy" Politiques et Management Publique (4)1985.

1982

Rodwin, VG. . Management Without Objectives: The French Health Policy Gamble In Maynard, A. and McLachlan, G. (Eds.), The Public/Private Mix for Health: The Relevance and Realities of Change. London: Nuffield Provincial Hospitals Trust.
Rodwin, V.G. . "The Marriage of NHI and la Médecine Libérale in France: A Costly Union" Milbank Memorial Fund Quarterly, (59)1, 1981. Reprinted in J. McKinlay, ed., Politics and Health Care. Cambridge: MIT Press, 1982.

1981

Rodwin, V.G. . "On the Separation of Health Planning and Provider Reimbursement: The U.S. and France" Inquiry, Blue Cross Association, Summer, 1981.