Minor Smarter Choices for Better Health: A multidisciplinary approach to improve health behaviour and healthcare systems
- Verbredende minor
- 20 weken
Good health care is essential for a long and healthy life. A lot of progress has been made in recent decades, but many countries still face huge challenges when it comes to funding and delivering high quality health care. On average, health and life expectancy have improved, but there are big differences between and also within demographic groups. Lifestyle and preventive measures play an important role in this context. Academics from the disciplines of health economics, behavioural economics, public health care and global health are joining forces to make health care systems fairer and more effective with the existing financial resources. The results of this research will be reflected in this minor.
This 30 EC minor comprises of four modules: one large introductory module of 15 EC, which can also be chosen as a 15 EC minor (course code GWMINOR321), and three advanced modules of 5 EC each: two elective courses of Erasmus School of Health Policy & Management and a research assignment (group project).
The introductory module Analysing and Changing Unhealthy Behaviour (ACUB) uses a micro perspective to show how healthy behaviour can be stimulated. One of the components of this introductory minor is to design a health interventionIn the second half of the minor, the students work in small groups on a research assignment (RA) that may be linked to this health intervention. In addition, the students select two modules out of the following three options to deepen their knowledge. The module Value Based Healthcare (VBHC) applies a hospital perspective, focusing on maximising the value and minimising the costs of care delivery. The elective module Rationing: economic insights in rationing healthcare (RHC) uses behavioural economics to study the allocation of healthcare resources from a country perspective, including examples from different countries. Finally, the elective module Global Challenges in Health Behaviour (GCHB) adapts a global health perspective, with a focus on strengthening health care systems in low- and middle-income countries.
After this minor, students:
1) Can explain the traditional economic approach to rational choice, and discuss the merits and limitations of this approach for understanding and changing behaviour using insights from behavioural and health economics.
2) Can apply behavioural insights into psychological heuristics and biases to understand and analyse health behaviour.
3) Can apply insights from behavioural and health economics to develop and evaluate an intervention aimed at promoting health and/or wellbeing.
4) Can design and implement their own survey, experiment or intervention on a behavioural health topic.
5) Are able to perform sound quantitative scientific research and report it in a paper.
6) Can explain the main concepts behind and criticisms on VBHC theory
7) Are familiar with some of the current initiatives to implement VBHC, in the Netherlands and internationally
8) Understand Integrated practice units - integrating care paths at level of medical condition and recognize how IPUs compare and contrast to other forms of integrated care
9) Understand the basic principles behind Shared Decision Making (SDM), and how SDM and decision aids are linked to VBHC
10) Can reproduce the main practical advantages and disadvantages of VBHC
11) Understand what are the (dis)advantages and main methodological issues when benchmarking outcomes between health care providers.
12) Explain the main drivers of provider payment reform in health care
13) Describe the key features of different value-based payment methods
14) Derive lessons from initiatives with value-based payment in practice, and formulate future challenges
15)Have obtained a thorough understanding of rationing health care from an economic perspective and can critically reflect on the advantages and disadvantages of demand and supply side rationing (in different countries);
16) Understand worldwide challenges related to health, health care systems and health behaviours as well as policy interventions to reduce these, especially in low- and middle-income countries.
17) Are able to evaluate and critically reflect on a quantitative research method as applied in a scientific study on health, unhealthy behaviour and/or a related policy intervention.
18) Can create, give and provide feedback on a presentation about a scientific study related to health, health care systems and/or behaviour to peers.
The lectures and working groups finish before the Christmas break. The students continue to work on their RA in January. No prior knowledge is required, although the minor is entirely taught in English and, hence, good command of English is beneficial. No formal entry requirements exist. Attendance is not mandatory, except for the elective module GCHB, where participation determines 10% of your grade.
Overview content per week
See the separate coursebooks of each course.
Module 1 Analysing and changing unhealthy behaviour (ACUB)
- Code: GWMINOR321: ACUB
- EC: 15
- Content: People generally attach great importance to their health and would name it as one of the key aspects for a happy life. Nonetheless, many people do not adhere to a healthy lifestyle and therefore seem to behave in conflict with their own life goals. Smoking, physical inactivity, rejecting vaccination and screening or not adhering to physicians’ recommendations are popular examples. This raises the question as to how we can change behaviour and improve health and wellbeing. This is a question of concern to individuals, schools, companies and governments, and is the central question in this minor. The past decades have seen many different approaches as to how behaviour change can potentially be realised. Traditionally in many fields, but economics especially, individuals are seen as ‘rational decision-makers’, i.e. they know what they want, and make reasoned choices to achieve their goal of a better health and happiness. In this view, policies or interventions to promote behaviour change are only necessary when individuals are misinformed, externalities are present, or choice is limited. In particular, two issues arise that are the focus of this minor:
- The approach to behaviour and what incentivises behaviour change employed in traditional economics often times does not apply successfully to health, as for most people health is very different from most other commodities. Questions of how to approach issues in health are the domain of health economics, which is one of the core components of this minor.
- We all know that often people do not behave rationally when it concerns their own health and wellbeing. Understanding such non-rational behaviour requires insights from for example psychology and sociology, which are both central to behavioural economics – the second core component of this minor.
You will be introduced to the key concepts from behavioural and health economics, with examples related to health and healthcare. We will apply these concepts to i) understand health behaviour, both rational and non-rational, and ii) explore what this means for individuals, organisations and governments aiming to promote healthier behaviour (e.g., through nudging, boosting, incentives and regulation). Using these insights, you will select an actual health issue of your interest (e.g., excessive drinking, smartphone use in traffic), design an intervention, and reflect on it critically.
- Teaching method: Each week will have several (in case of ongoing corona restrictions: video) lectures, interactive Q&As and working groups (on Zoom if needed), in which students will work individually and in groups on cases specific to the learning goal of that week. For example, by analysing a specific health behaviour using the new knowledge covered in the lectures, or by debating positions on different policies for health behaviour change. Throughout the minor, students develop a portfolio that includes their weekly reflection on the covered material in various forms (e.g., short essay, slides, or vlog), a case analysis (of a health issue of their own choice) and they present an intervention. The latter part of this portfolio is also presented to other students and teachers.
- Teaching materials: 1 handbook, scientific papers, lecture slides, assignments in Canvas
- Contact hours: 12 hours per week.
- Self study: 28 hours per week.
Module 2 Research assignment (RA)
- Code: GW306: RA
- EC: 5
- Content: In this module you will perform a quantitative research project in groups of 3 students, within the topic of behavioural health economics. You can collect your own data by means of an experiment, a nudging study or a survey, or analyse an existing dataset. The results have to be reported in a research paper. Examples include the empirical implementation of the intervention you proposed as part of the assignment in ACUB, measuring health-related preferences in a survey (e.g. as a preparation for a nudge), or testing particular hypotheses related to health behaviour (e.g. concerning the presence of specific biases and heuristics) in a lab, online or field experiment.
- Teaching method: Group project, mostly unsupervised
- Teaching materials: Course materials of the module the research assignment are linked to the materials provided in the other modules, accompanied by relevant books and scientific publications to be found in the library and internet (e.g. Google Scholar, PubMed, EconLit).
- Contact hours: 2 hours per week.
- Self study: 18 hours per week on average (most hours in January)
Module 3a Value Based Health Care (VBHC)
- Code: GW302: Value based health care (VBHC)
- EC: 5
- Content: As the population ages and treatment opportunities constantly increase, controlling costs while maintaining quality is one of the major challenges in the health care sector. Value-based Health Care (VBHC) was introduced by Harvard Professor Michael Porter as a way to address this challenge. VBHC focuses on maximizing the value and minimizing the costs of care delivery, amongst others by paying provides based on outcomes and inducing competition between providers to increase efficiency. Worldwide, the interest in VBHC as a way to increase value for money in health care has grown rapidly. Encouraging healthcare providers to deliver high-value care has become a focal point in health policy. Also, in the Netherlands, many hospitals are trying to implement VBHC, and like elsewhere, they face several challenges and there is also criticism. Different aspects that relate to VBHC (integrated care, shared decision making, outcome differences in outcomes between health care providers, value-based payment) will be introduced during this course. You will learn on the theory principles. This will be combined with guest lectures from practitioners (for example from the Erasmus University Medical Center and Zilveren Kruis) that have tried to implement (elements of) VBHC in practice.
For example, measuring outcomes plays a central role in VBHC, but when comparing outcomes between providers several methodological issues should be taken into account. You will learn on the validity of outcome measures as indicators of quality of care and which issues complicate between-provider comparisons. Moreover, various types of value-based payment models have been proposed to replace common volume-based payment methods. New models to how health care providers are paid come in many different flavors, stimulating different dimensions of value, such as quality of care, coordination of care across providers and settings, cost-consciousness, and health outcomes. You will learn about the main drivers of value-based payment reform.
- Teaching method: (Guest)lectures and working groups
- Teaching materials: Scientific papers
- Contact hours: 6 hours per week
- Self study: 14 hours per week
Module 3b Rationing: economic insights in rationing healthcare (RHC)
- Code: GW301: RHC
- EC: 5
- Content: If there is one problem that health care systems around the world face and share, it is making the best use of the available resources in health care. Despite growing health care expenditures, there are never sufficient resources to meet all health care needs and demands. This means that health care somehow needs to be rationed. Baily (2003) defined rationing as follows:
“To limit the beneficial health care an individual receives by any means – price or non-price, direct or indirect, explicit or implicit.”
Hence, policy makers somehow decide or organise that some care, that would likely benefit certain patients, is not provided (timely or freely). Although perhaps necessary and unavoidable, rationing (even the word itself) has been, is, and likely will remain a contentious topic in both politics and society.This course focuses on this important topic mainly from an economic perspective, making use of behavioural economic insights. The topics that are discussed are rationing in general, demand and supply side rationing, and principles of rationing. Moreover, you will gain insight into how different countries ration health care.
- Teaching method: (Guest) lectures and Q&A sessions
- Teaching materials: Selection of book chapters and journal articles
- Contact hours: 4hours per week
- Self study: 16 hours per week
Module 3c Global Challenges in Health & Behaviour (GCHB)
- Code: GW307: GCHB
- EC: 5
- Content: This course will introduce students to worldwide challenges in health and unhealthy behaviours, with a focus on low- and middle-income countries (LMICs). This will be combined with coaching to further improve students’ presentation skills. First we will set the scene by introducing students to the global burden of disease across LMICs. We will identify the relative importance of communicable and non-communicable diseases and the “double burden of disease” these countries are increasingly facing. Then we will explore the limited demand for health care in these countries and interventions to increase this demand including conditional cash transfers. This is followed by interventions to strengthen the supply side of health care systems including performance based financing. We will assess the progress of different countries towards the goal of “Universal Health Coverage”. Throughout the course, students will learn to interpret results of quantitative studies that relate to these different global health topics and will improve their presentation skills working with a presentation expert.
- Teaching method: (Guest)workgroups and training about presentation skills. In most workgroups, a small group of students will present a paper and receive feedback from another group of students, as well as the teacher(s).
- Teaching materials: Scientific papers
- Contact hours: 4 hours per week
- Self study: 16 hours per week
Method of examination
The examination of the different modules is as follows:
- ACUB: combination of a written exam, an intervention (including a poster and pitch), and weekly reflection exercises
- RA: report
- Elective modules: a. VBHC: written exam b. RHC: written exam c. GCHB: presentation, providing feedback and participation
Composition of final grade
ACUB: The written exam and portfolio both comprise 50% of the grade. The portfolio consists of a proposal for a behavioural health intervention (40%) and reflection exercises (10%). To pass this course, students need a weighted average grade of 5.5 or higher, and get at least a 5.0 for each part. The written exam can be retaken later in the academic year, but the portfolio cannot.
RA: 100% report
VBHC: 100% written exam
RHC: 100% written exam
GCHB: Presentation of a scientific quantitative paper (content of the presentation 25%; skills 25%), peer feedback (content 20%; style 20%), participation (10%)
ACUB: students receive written feedback from the teacher at different stages of their intervention. They get weekly feedback on their reflection exercises. Finally, oral feedback is given during the Q&A’s and workgroups.
RA: students provide peer feedback during their project and receive feedback from the teacher on intermediate products
VBHC: feedback is given in the (online) lectures. RHC: feedback is provided in the Q&A sessions.
GCHB: All students are required to prepare the paper that is discussed by their fellow three students and one specific group of three students is pre-selected to provide peer feedback on both content and execution of the presentation. This is followed by a detailed reflection on execution of the presentation in line with the advice provided in the first two lectures by the presentation expert. Students will also receive individual feedback during the meetings from peers and the lecturer