Health Systems 2015

Welcome to the 2015 Health Systems Course. 

Health Systems is one of the three "core courses" of the Social Medicine Curriculum set up at the RPSM in the early 1980's.  For many years it was designed and taught by Dr. Hal Strelnick.  Beginning in 2011, Dan O'Connell and Matt Anderson became the course directors.  This is our sixth year teaching the course and every year we incorporate a good deal of new content.  One thing that has not changed is our commitment to listen carefully to you and to act on your feedback.  

Goals of the Course

1. Understand the US health care system(s)

One major focus of the course is the ongoing implementation of the Affordable Care Act (ACA). We will spend a good deal of time thinking and debating what the new environment means for health care in the US as well as for the goal of "health for all."

2. Explore physician activism as a tool for social change

In the course of this month we will meet with a broad variety of health care professionals engaged in different forms of advocacy.   We will meetwith physicians who work within the government to promote public health (Dr. Hillary Kunins and Dr. Celia Quinn at the New York City DOH). Others engage in political advocacy from the outside to change government policies (this is the focus of lobby day). Some involved in the course have joined unions (Dr. Roona Ray) or attempted to create alternative visions of health care (Dr. Diana Ramirez). We will hear from physicians who have partnered with communities (Dr. Lanny Smith) and others who have attempted to use the academic setting to promote change ( Dr. Marji Gold).  

Each of these forms of advocacy has its particular strengths and limitations.  We are offering you a chance to talk with those who are doing the work and learn from their experiences.

Structure of the Course

The organization of health systems is currently an area of intense public debate, not only in the US, but also internationally.  In this course we will look at local health systems (Montefiore Health System and NYCDOHMH), state and national health systems such as the ACA,  and some international systems. Interwoven throughout these specific topics is the theme of activism and advocacy.  Approaching health systems from the perspective of changing them will require us to consider questions of political power and how social change is made.  Friday mornings are devoted specifically to topics related to activism.

Structure of each day

The course will just run in the mornings (8:30-11:45) with a few exceptions.  Most mornings will be divided into two 90 minute sessions. The first will run from 8:30 to 10:00. The second will run from 10:15 to 11:45[RS1] .  On Thursday May 12 and 26th  DFSM Grand Rounds will be broadcast in the 3rd floor conference room at 8:00 AM (Dr. Alan Blum will speak on the 12th and Dr. Peter Arno on the 26th). Our first session will begin immediately afterwards. 

What we expect from you

 We expect you to come to class and to do the readings. We want you to listen critically and ask questions.

 Each resident will be responsible for preparing two 10 minute presentations during the course of the month:

1.     Week 2: A health system (or health innovation) undertaken at the state level

2.     Week 3: A public health activism campaign that was either successful or not.

3.     Week 4: The health care system of a foreign country (or) the health care system reforms promoted by international organization

 [RS1]We will meet in the third floor conference room every day with the exception of May 10 when we will be in the Residents Lounge.


Copies of Bodenheimer and Grumbach's Understanding Health Policy, 5th Edition will be available for borrowing. (Here is the Amazon link for those who are interested).  This book is not required reading but may be helpful to you in understanding the diverse systems that make up the US "non-system" as well as recent policy debates.

The Heart of Power by James Morone may also be useful in understanding how our health care system has evolved over the past half century.  Some copies of this book are also available. (Amazon Link)


We will be conducting evaluations at the end of each week and a summative evaluation on June 2nd, following the final session of the course.  This course is pass fail for all students.

Matt Anderson, MD
Dan O'Connell, MD