History and Evolution of Health Systems
A.Y. 2021/2022
Learning objectives
What were the driving (economic, social and institutional) forces that transformed healthcare systems from local services into fast-growing and largely globalised businesses during the last century? How did financial systems take shape in the long run, operating on a foundation of insurance providers and state interventionism, to support the growth of healtcare? How did the main models of hospital manegement originate and spread? Which companies and entrepreneurs engaged in building new kinds of businesses to improve the population's health and answer the needs of medical doctors and patients? What were their incentives, and what possible alternative choices and pathways were available to them during the modernisation of the healthcare business of the twentieth century? Which was the role of public and private initiative in designing the evolution of healthcare system?
Answering such questions, the course intends to achieve a proper understanding of the historical development of the western healthcare systems (intended as the whole of hospital structures, administrative institutions, management, organizational and funding paradigms). It envisages the period from the embryonic modernization in the first half od the XIX c. up to the current trend. The approach is that of economic history. It helps to grasp the complexity of the phenomena putting together istitutional, social and economic factors. Special attention is posed also to their interplay with biological and clinical aspects in order to determine the meaningful changes and path-dependences in the evolution of healthcare systems. The tone of the course is essentially interpretative and is aimed at providing students with the historical skills needed to comprehend the genealogy of the current healthcare systems, and to evaluate the ongoing health policy issues.
Answering such questions, the course intends to achieve a proper understanding of the historical development of the western healthcare systems (intended as the whole of hospital structures, administrative institutions, management, organizational and funding paradigms). It envisages the period from the embryonic modernization in the first half od the XIX c. up to the current trend. The approach is that of economic history. It helps to grasp the complexity of the phenomena putting together istitutional, social and economic factors. Special attention is posed also to their interplay with biological and clinical aspects in order to determine the meaningful changes and path-dependences in the evolution of healthcare systems. The tone of the course is essentially interpretative and is aimed at providing students with the historical skills needed to comprehend the genealogy of the current healthcare systems, and to evaluate the ongoing health policy issues.
Expected learning outcomes
At the end of the course, students are expected to be able:
- to understand and evaluate, through a comparative approach, the role of different institutional frameworks (national and international) in conditioning and determining, over the last two centuries, the main characteristics and types of healthcare systems, as well as their evolutionary dynamics;
- to carry on a critical analysis of the economic and financial choices in relation to inertia, traditions, and to biological factors (regarded both as social diseases and pandemic emergencies);
- to reflect on the role of different national contexts in providing opportunities and/or placing constraints on the action of entrepreneurs and corporations in the healthcare sector;
- to identify and evaluate the critical turning points in the pathway of development of a healthcare national system taking into account economic, social, political and bilogical factors;
- to argument along the space-time axis the taxonomy of healthcare systems and their funding;
- to have a sound dominance of the concepts and main interpretations of public and private healthcare history;
- to examine public health through its historical context and use all the aquired information in the evaluation of current public health issues.
- to understand and evaluate, through a comparative approach, the role of different institutional frameworks (national and international) in conditioning and determining, over the last two centuries, the main characteristics and types of healthcare systems, as well as their evolutionary dynamics;
- to carry on a critical analysis of the economic and financial choices in relation to inertia, traditions, and to biological factors (regarded both as social diseases and pandemic emergencies);
- to reflect on the role of different national contexts in providing opportunities and/or placing constraints on the action of entrepreneurs and corporations in the healthcare sector;
- to identify and evaluate the critical turning points in the pathway of development of a healthcare national system taking into account economic, social, political and bilogical factors;
- to argument along the space-time axis the taxonomy of healthcare systems and their funding;
- to have a sound dominance of the concepts and main interpretations of public and private healthcare history;
- to examine public health through its historical context and use all the aquired information in the evaluation of current public health issues.
Lesson period: Second trimester
Assessment methods: Esame
Assessment result: voto verbalizzato in trentesimi
Single course
This course cannot be attended as a single course. Please check our list of single courses to find the ones available for enrolment.
Course syllabus and organization
Single session
Responsible
More specific information on the delivery modes of training activities for academic year 2021/22 will be provided over the coming months, based on the evolution of the public health situation.
Course syllabus
At the origin of healthcare: the primacies of Italy between XIV and XVI c. The birth of the Lombard hospital system: the Milanese Ca' Granda di Milano as model for Europe.
Preindustrial era regressions and improvements: the Great urban plauges and the first healthcare reforms in the Enlightment Age.
Torn between philantropy and charitable effort: the taxonomy of healthcare institutions in Europe during the first half of XIX c.
The emergence of hospital centrism between 1880s and 1930s. Comparing Uk, Usa and Germany on the background of Bismark's health insurance policy and mutualism.
The transition to Welfare State and the inception of NHS (1948) between funding issues and resource allocation. Analysing the English, German, Spanish and Japanese systems during the western Golden Age. The creation, management, and financing of healthcare corporations and organizations at the sunset of State intervention era.
Healhcare in Italy from Unification to SSN (1978) and to reform's redesign. The corporatization and and regionalization of the national system in the 1990s. Innovations and growth in private healthcare.
Further info concerning the course content will be provided on https://ariel.unimi.it
Preindustrial era regressions and improvements: the Great urban plauges and the first healthcare reforms in the Enlightment Age.
Torn between philantropy and charitable effort: the taxonomy of healthcare institutions in Europe during the first half of XIX c.
The emergence of hospital centrism between 1880s and 1930s. Comparing Uk, Usa and Germany on the background of Bismark's health insurance policy and mutualism.
The transition to Welfare State and the inception of NHS (1948) between funding issues and resource allocation. Analysing the English, German, Spanish and Japanese systems during the western Golden Age. The creation, management, and financing of healthcare corporations and organizations at the sunset of State intervention era.
Healhcare in Italy from Unification to SSN (1978) and to reform's redesign. The corporatization and and regionalization of the national system in the 1990s. Innovations and growth in private healthcare.
Further info concerning the course content will be provided on https://ariel.unimi.it
Prerequisites for admission
Nothing
Teaching methods
Frontal lectures - accompanied by multimedia supports - combined with classroom works (flipped classrooms, buzz groups, cold calling, presentations by students on proposed themes and materials) in which students are required to actively participate.
Teaching Resources
Instructors will upload the slides and additional materials for both attending and non attending students on https://ariel.unimi.it
Assessment methods and Criteria
Attending Students
For the attending students 50% of the evaluation is carried out through classroom activities (flipped classrooms, buzz groups, cold calling, presentations ) and 50% through a written test, based on the teaching materials and notes used during lectures. The test comprises two sections; the former, made up of multiple-choice questions, is intended to ascertain the command of the ideas, events, dates, economic and financial dynamics related to the themes of the course; the latter, made up of two open-ended answers, is intended to verify the learnig outcomes of the course.
Non Attending students
For those who do not attend, the assessment is based on a written test, after which the study and knowledge of the material indicated for those who do not attend is strictly necessary. The test comprises two sections; the former, made up of multiple-choice questions, is intended to ascertain the command of the ideas, events, dates, economic and financial dynamics related to the themes of the course; the latter, made up of five open-ended answers, is intended to verify the learnig outcomes of the course.
For the attending students 50% of the evaluation is carried out through classroom activities (flipped classrooms, buzz groups, cold calling, presentations ) and 50% through a written test, based on the teaching materials and notes used during lectures. The test comprises two sections; the former, made up of multiple-choice questions, is intended to ascertain the command of the ideas, events, dates, economic and financial dynamics related to the themes of the course; the latter, made up of two open-ended answers, is intended to verify the learnig outcomes of the course.
Non Attending students
For those who do not attend, the assessment is based on a written test, after which the study and knowledge of the material indicated for those who do not attend is strictly necessary. The test comprises two sections; the former, made up of multiple-choice questions, is intended to ascertain the command of the ideas, events, dates, economic and financial dynamics related to the themes of the course; the latter, made up of five open-ended answers, is intended to verify the learnig outcomes of the course.
Professor(s)