Victor G. Rodwin

Professor of Health Policy and Management

212.998.7459
Fax
212.995.4162
The Puck Building
295 Lafayette Street
2nd Fl.
New York, NY 10012
Tuesdays 2:00-3:30 PM, and by appointment
Victor G. 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.

This course focuses on selected issues of particular relevance to students in health policy and management (HPAM) interested in gaining an international perspective on key issues in the field. We begin by considering the challenges of globalization for population health and the field of HPAM. We consider the relationship among the global drug war and the opioid epidemic, the role of global cities in spreading infectious disease and protecting their population with public health infrastructure, and the globalization of the obesity epidemic. Next, we  turn our attention to the roles of state and non-state actors in  improving health care systems and population health. Finally, we examine selected national policies in China, India, Cuba and their impact on global health. We conclude by exploring the future of health systems: the implications of health systems growth in Brazil, Russia, India and China (BRIC nations) for Big Pharma and the globalization of the medical-industrial complex.

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All health systems, in the industrialized world, grapple with problems of cost, access, equity and quality of health care; and the trade-offs among 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 nations and analyze efforts at health care system reform. The readings, lectures, and class discussions will make students more knowledgeable about policy options and policy changes in different countries. I will also provide opportunities for students to pursue their individual research interests by comparing two relatively wealthy nations of their choice. The seminar begins with an introduction to health care system performance. Next, we focus on theories, concepts and fads in health care reform, including managed competition, primary health care reform, and universal health coverage. We review the controversial WHO approach to health system performance, the contributions of the Commonwealth Fund’s international health survey data, and the extent to which existing metrics are useful for monitoring the health care reform process. We then examine the politics of health system reform efforts in selected nations – France, Canada, the United Kingdom and China.
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Required for MPA Health students. This introductory course is designed to familiarize students with basic concepts and ideas concerning the distribution of health and illness in society, the organization of the health care system, and the relationship of one to the other. We begin by considering the evolution of the U.S. health care system and of health policy. We then present an international perspective on the U.S. health care system with an emphasis on the Affordable Care Act, alternative government roles, current challenges and the future of the health care system. In the second part of the course, we explore divergent perspectives for analyzing health and health care: clinical, epidemiological, economic, sociological/cultural and public health. In the third part, we focus on, selected issues in HPAM: the challenge of mental health, variations in medical practice and the quality of care, health care rationing and access to care. Finally, we conclude with a discussion of how practitioners in the field of HPAM should respond to the growing awareness of the social determinants of health and the growth of the medical-industrial complex for HPAM.

Class readings cover major topics in the study of health and health care delivery: the organization and financing of health care systems; cost and access to health care; health policy challenges and the Affordable Care Act; the roles of government in health systems and policy; the epidemiology of health and medical care, economic and ethical issues related to health care rationing, the social determinants of health. Along with covering these subjects, we emphasize the value of understanding diverse disciplinary perspectives, the challenges of meeting the varied (and often conflicting) needs and motivations of health care system stakeholders, and the ways in which the United States health care system differs from those of other wealthy nations.

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Only open to Executive MPA students. This introductory course is designed to familiarize nursing leaders with the broader context of the health care system within which they work. It emphasizes basic concepts and ideas concerning the distribution of health and illness in society, the organization of the health care system, and the relationship of one to the other. We begin by considering the evolution of the U.S. health care system and of health policy. We then present an international perspective on the U.S. health care system with an emphasis on the Affordable Care Act, alternative government roles, current challenges and the future of the health care system. In the second part of the course, we explore divergent perspectives for analyzing health and health care: clinical, epidemiological, economic, sociological/cultural and public health. In the third part, we focus on, selected issues in HPAM: the challenge of mental health, variations in medical practice and the quality of care, health care rationing and access to care, and the implications of growing attention to social determinants of health and the growth of the medical-industrial complex for HPAM.

Class readings cover major topics in the study of health and health care delivery: the organization and financing of health care systems; cost and access to health care; health policy challenges and the Affordable Care Act; the roles of government in health systems and policy; the epidemiology of health and medical care, economic and ethical issues related to health care rationing, the social determinants of health. Along with covering these subjects, we emphasize the value of understanding diverse disciplinary perspectives, the challenges of meeting the varied (and often conflicting) needs and motivations of health care system stakeholders, and the ways in which the United States health care system differs from those of other wealthy nations.

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Why are people in some countries so much healthier than others? Why are health systems around the world organized and financed in such different ways? What difference do health systems and universal health coverage (UHC) make in explaining differences in population health? Beyond such basic questions in the field of “global health,” this course focuses on selected issues of particular relevance to students in health policy and management (HPAM). We begin by considering the challenges for HPAM and why the field should be concerned with global cities, the spread of infectious disease and the design of public health infrastructure. We will then turn our attention to the roles of state and non-state actors in global policies aimed to improve health care systems and population health. Finally, we consider the meanings of universal health coverage (UHC) and how the globalization of the medical industrial complex is likely to affect the future of health care systems. All nations face challenges from the effects of globalization and international organizations (e.g. the World Health Organization, the Gates Foundation, and the General Agreement on Tariffs and Trade-GATT) that affect population health and national economies. Government leaders must address not only health problems within their borders, but those that cross their borders. Likewise, they must interact with international organizations that affect global health. The course draws on diverse disciplinary and professional perspectives (public health, economics, political science, management, sociology, anthropology). It has two objectives: to expose students to the burgeoning literature in global HPAM; and to prepare them to work in international organizations, consulting firms, and governments. As pre-requisites, it would be helpful, though not required, to have taken an introduction to HPAM and/or to public policy.
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We tend to be ethnocentric in our views of health care organization and policy. A look abroad, however, can provide insights about problems at home. In spite of differences in the organization and financing of their health care systems, most countries share a number of common problems with the United States. First, is the question of deciding - or not explicitly deciding - what proportion of GNP should be devoted to health and welfare. Second, is the problem of agreeing on appropriate criteria to allocate health and social service expenditures. Third, is the problem of how to implement established policies: through regulation, promotion of competition, budgeting, or reimbursement incentives directed at health care providers. The readings, lectures and class discussions will focus 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. We will discuss how so much of the literature draws on selective evidence to evaluate health care systems in the U.S. and abroad. Finally, we will study 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.
Download Syllabus

Required for MPA Health students. This introductory course is designed to familiarize students with basic concepts and ideas concerning the distribution of health and illness in society, the organization of the health care system, and the relationship of one to the other. We begin by considering the evolution of the U.S. health care system and of health policy. We then present an international perspective on the U.S. health care system with an emphasis on the Affordable Care Act, alternative government roles, current challenges and the future of the health care system. In the second part of the course, we explore divergent perspectives for analyzing health and health care: clinical, epidemiological, economic, sociological/cultural and public health. In the third part, we focus on, selected issues in HPAM: the challenge of mental health, variations in medical practice and the quality of care, health care rationing and access to care. Finally, we conclude with a discussion of how practitioners in the field of HPAM should respond to the growing awareness of the social determinants of health and the growth of the medical-industrial complex for HPAM.

Class readings cover major topics in the study of health and health care delivery: the organization and financing of health care systems; cost and access to health care; health policy challenges and the Affordable Care Act; the roles of government in health systems and policy; the epidemiology of health and medical care, economic and ethical issues related to health care rationing, the social determinants of health. Along with covering these subjects, we emphasize the value of understanding diverse disciplinary perspectives, the challenges of meeting the varied (and often conflicting) needs and motivations of health care system stakeholders, and the ways in which the United States health care system differs from those of other wealthy nations.

Download Syllabus

Only open to Executive MPA students. This introductory course is designed to familiarize nursing leaders with the broader context of the health care system within which they work. It emphasizes basic concepts and ideas concerning the distribution of health and illness in society, the organization of the health care system, and the relationship of one to the other. We begin by considering the evolution of the U.S. health care system and of health policy. We then present an international perspective on the U.S. health care system with an emphasis on the Affordable Care Act, alternative government roles, current challenges and the future of the health care system. In the second part of the course, we explore divergent perspectives for analyzing health and health care: clinical, epidemiological, economic, sociological/cultural and public health. In the third part, we focus on, selected issues in HPAM: the challenge of mental health, variations in medical practice and the quality of care, health care rationing and access to care, and the implications of growing attention to social determinants of health and the growth of the medical-industrial complex for HPAM.

Class readings cover major topics in the study of health and health care delivery: the organization and financing of health care systems; cost and access to health care; health policy challenges and the Affordable Care Act; the roles of government in health systems and policy; the epidemiology of health and medical care, economic and ethical issues related to health care rationing, the social determinants of health. Along with covering these subjects, we emphasize the value of understanding diverse disciplinary perspectives, the challenges of meeting the varied (and often conflicting) needs and motivations of health care system stakeholders, and the ways in which the United States health care system differs from those of other wealthy nations.

Download Syllabus
All health systems, in the industrialized world, grapple with problems of cost, access, equity and quality of health care; and the trade-offs among 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 nations and analyze efforts at health care system reform. The readings, lectures, and class discussions will make students more knowledgeable about policy options and policy changes in different countries. I will also provide opportunities for students to pursue their individual research interests by comparing two relatively wealthy nations of their choice. The seminar begins with an introduction to health care system performance. Next, we focus on theories, concepts and fads in health care reform, including managed competition, primary health care reform, and universal health coverage. We review the controversial WHO approach to health system performance, the contributions of the Commonwealth Fund’s international health survey data, and the extent to which existing metrics are useful for monitoring the health care reform process. We then examine the politics of health system reform efforts in selected nations – France, Canada, the United Kingdom and China.
Download Syllabus
We tend to be ethnocentric in our views of health care organization and policy. A look abroad, however, can provide insights about problems at home. In spite of differences in the organization and financing of their health care systems, most countries share a number of common problems with the United States. First, is the question of deciding - or not explicitly deciding - what proportion of GNP should be devoted to health and welfare. Second, is the problem of agreeing on appropriate criteria to allocate health and social service expenditures. Third, is the problem of how to implement established policies: through regulation, promotion of competition, budgeting, or reimbursement incentives directed at health care providers. The readings, lectures and class discussions will focus 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. We will discuss how so much of the literature draws on selective evidence to evaluate health care systems in the U.S. and abroad. Finally, we will study 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.
Download Syllabus

2018

Abstract

Rehospitalization after acute myocardial infarction (AMI) is common in elderly patients. It increases morbimortality and health care expenditures. The association between ambulatory care after discharge forAMI and rehospitalization has never been studied in France. We analyzed the impact of ambulatory care on rehospitalization of elderly patients (≥65 years) within 30 days after hospital discharge. 

We conducted a nationwide population-based study of elderly patients hospitalized with a main diagnosis of AMI in France between 2011 and 2013. We excluded patients hospitalized for AMI in the previous year and those who died during the index hospitalization or within 30 days after discharge. The primary outcome was the first all-cause 30-day rehospitalization in an acute care hospital. Individual and neighborhood-level variables were compared among rehospitalized and nonrehospitalized patients. Determinants of 30-day rehospitalization were identified using logistic regression models. 

Among the 624 eligible patients, 137 (22.0%) were rehospitalized within 30 days after discharge. In multivariate analyses, chronic kidney failure (odds ratio [OR] 1.88; 95% confidence interval [CI], 1.01–3.53) was an independent predictor of 30-day rehospitalization. We found no association among deprivation and spatial accessibility measures and 30-day rehospitalization. The purchase of lipid-lowering drugs prescription within 7 days after discharge was associated with a reduced risk of 30-day rehospitalization (OR 0.53; 95% CI, 0.36–0.79).

This study highlights the role of coordination among hospital and primary care physicians in post-AMI discharge and follow-up among elderly patients. Specifically, targeted interventions to reduce 30-day rehospitalizations should focus on patients with comorbidities and use of prescription drugs after hospital discharge.

Abstract

Although eliminating financial barriers to care is a necessary condition for improving access to health services, it is not sufficient. Given the contrasting health systems with regard to financing and organization of health insurance in the United States and Canada, there is a long history of comparing these countries. We extend the empirical studies on the Canadian and US health systems by comparing access to ambulatory care as measured by hospitalization rates for ambulatory care sensitive conditions (ACSC) in Montreal and New York City. We find that, in New York, ACSC rates were more than twice as high (12.6 per 1000 population) as in Montreal (4.8 per 1000 population). After controlling for age, sex, and number of diagnoses, significant differences in ACSC rates are present in both cities, but are more pronounced in New York. Our findings are consistent with the hypothesis that universal, first-dollar health insurance coverage has contributed to lower ACSC rates in Montreal than New York. However, Montreal’s surprisingly low ACSC rate calls for further research.

Abstract

The French health care system is a model of national health insurance (NHI) that provides health care coverage to all legal residents. It is an example of public social security and private health care financing, combined with a public-private mix in the provision of health care services. The French health care system reflects three underlying political values: liberalism, pluralism and solidarity. This article provides a brief overview of how French NHI evolved since World War II; its financing health care organization and coverage; and most importantly, its overall performance.

Abstract

OBJECTIVES:

To determine whether implementation of a case-based payment system changed all-cause readmission rates in the 30 days following discharge after surgery, we analysed all surgical procedures performed in all hospitals in France before (2002-2004), during (2005-2008) and after (2009-2012) its implementation.

SETTING:

Our study is based on claims data for all surgical procedures performed in all acute care hospitals with >300 surgical admissions per year (740 hospitals) in France over 11 years (2002-2012; n=51.6 million admissions).

INTERVENTIONS:

We analysed all-cause 30-day readmission rates after surgery using a logistic regression model and an interrupted time series analysis.

RESULTS:

The overall 30-day all-cause readmission rate following discharge after surgery increased from 8.8% to 10.0% (P<0.001) for the public sector and from 5.9% to 8.6% (P<0.001) for the private sector. Interrupted time series models revealed a significant linear increase in readmission rates over the study period in all types of hospitals. However, the implementation of case-based payment was only associated with a significant increase in rehospitalisation rates for private hospitals (P<0.001).

CONCLUSION:

In France, the increase in the readmission rate appears to be relatively steady in both the private and public sector but appears not to have been affected by the introduction of a case-based payment system after accounting for changes in care practices in the public sector.

Abstract

In Manhattan, the rate of hospital discharges for avoidable hospital conditions (AHC), a measure of access to timely and effective ambulatory care, fell by nearly 50 percent between 1999 and 2013. Despite this remarkable improvement, there has been virtually no change in racial, ethnic, or neighborhood-level differences in rates of AHC. This is surprising given New York City's emphasis on public health and its efforts to reduce health and health-care inequalities. We discuss the policy implications of these findings and argue that growing income and wealth inequalities have limited the ability of New York City to address inequalities in population health and health-care access. Unless there are substantial changes in federal and state policy, designed to reduce economic inequalities, it will be difficult to achieve the goal of eliminating health and health-care inequalities.

Abstract

Objectives: India has proclaimed commitment to the goal of Universal Health Coverage and Delhi, the National Capital Territory, has increased investment in public health and other health services over the past decade. The research investigates whether Delhi's increased investment in health over this period is associated with a reduction in premature deaths, after the age of 1 year, which could have been avoided with better access to effective health care interventions (amenable mortality).

Study design: A population-based study of changes in amenable mortality (AM) in Delhi over the 2003-2013 period.

Methods: To calculate AM, a list of International Classification of Disease (ICD) codes from the published literature was relied upon. In defining AM in India, an upper age limit of 69 years was adopted, rather than the more common limit of 74 years. Population estimates and vital statistics were downloaded from the Delhi Statistical Handbook. Deaths by cause and age, including medical certification, are from the Vital Statistics site of the Delhi Government. To age-adjust these data, the direct method was employed, using weights derived from the 2010 United Nations world standard population.

Results: The research found that, between 2004 and 2013, the age-adjusted rate of AM rose from 0.87 to 1.09. The leading causes of death in both years were septicemia and tuberculosis. Maternal mortality is well above the global level for middle-income countries. Conclusion: Recent investments in public health and health care and the capacity to leverage them to improve access to effective care have not been sufficient to overcome the crushing poverty and inequalities within Delhi. Large and growing numbers of residents die prematurely each year due to causes that are amenable to public health and health care interventions.

2016

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

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.

2015

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

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

We reflected on why the field of HPAM has had little impact on the basic arrangements within which most physicians practice. We argued that this failure reflects four dimensions of a theory-policy-practice gap: 1) The dominance of microeconomic thinking; 2) The lack of learning from comparative case studies in healthcare management; 3) The separation of HPAM from frontline medical providers; and 4) The failure to expose medical students to issues of HPAM with respect to the organizational and regulatory environments in which they will ultimately work.

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). 

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

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

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.

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.

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.

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

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.

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.

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."

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.

 

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.

2001

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

2000

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.

1996

VG. Rodwin, E. Lévy. Vers un managed care à la Française. Chroniques Economiques S.E.D.E.I.S, 45

1995

VG. Rodwin. Aux Bons Soins du l'Oncle Sam-Le Managed Care Aux Etats-Unis. Pharmaceutiques, (29) .

1994

VG. Rodwin. La réforme du système de santé aux Etats Unis. Concours Médicale, Paris, France (three part series), September-October, 1994.

1993

Abstract

This paper considers how American and Japanese policymakers might learn from
their mutual experience with health insurance and health policy. Each country views itself as a
health care leader in their respective areas of strength. Each country is characterized by
distinctive patterns of health care organization and financing. Yet, policy analysts on both sides
are intrigued and often envious of the other’s success. Americans can learn from the central
regulation of Japanese national health insurance and from Japan’s stellar health status and its
recent political commitment to long-term care. The Japanese can learn from the active role of
payers and other organizations in the United States in controlling volume, assuring quality of
care, and designing alternative health care delivery systems.

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. 

VG. Rodwin. Systèmes de Santé, Pouvoirs Publics et Financeurs: Qui Contrôle Quoi?. Contributor and editor (with M. Berthod-Wurmser, Y. Souteyrand, and J.C. Henrard) Paris: Documentation Française, 1987.

1984

Abstract
In Western industrialized nations, the health sector can no longer continue to grow in the future as it has in the past. The notion that the welfare state can provide an abundance of costly medical services for all its citizens is now widely recognized as an illusion. And policymakers are challenging traditional assumptions, criticizing existing structures, and initiating significant reforms in the health sector.
       What will the future bring? Can the Western tradition of individualism be reconciled with the principle of equity in health policy? Will it be possible to continue to remunerate the growing number of physicians at the level to which they have become accustomed? Will it be feasible to encourage new medical technologies, support the biomedical industry, and at the same time contain the growth of health care costs and achieve more equitable access to services? What are alternative roles for the state in coping with issues of public policy?
       In addressing these questions, Kervasdoue, Kimberly, and Rodwin have edited and contributed to an original collection of essays and case studies on the forces that are transforming health care systems in the West. They begin by identifying issues around which debates about health policy will focus in the 1980s and beyond. These are: (1) the contrasting perspectives on the role of the state in society; (2) the place of disease prevention and health promotion in health policy; (3) the development and consequences of new medical technology; and (4) the ethical challenge of health care rationing. These issues are reflected in the other essays in the book-all by knowledgeable scholars from different disciplines and of varying political persuasions-to provide a fascinating comparative view of health systems.
       At the heart of the book is its four case studies on the recent past and probable future of health policy in France, Britain, the United States, and the Canadian province of Quebec. And in the final chapter, John Kimberly and Victor Rodwin distinguish some common themes-as well as some variations-that emerge from the case studies and also speculate about the new constraints and choices that will characterize the future of health policy. Coming at a crucial time, The End of Illusion examines the forces that are transforming health care systems in the Western industrialized nations, and identifies the issues and themes on which debates about health policy will focus in the 1980s and beyond.

1981

VG. Rodwin. La Santé Rationnée? La Fin d'un Mirage. Contributor and editor (with Jean de Kervasdoué and John Kimberly) Paris: Economica, 1981.