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The PhD in health policy, awarded by the Faculty of Arts and Sciences, is administered by the Committee on Higher Degrees in Health Policy, representing six Harvard University faculties: Faculty of Arts and Sciences, Harvard Kennedy School, Harvard Medical School, Harvard School of Public Health, Harvard Business School, and Harvard Law School.
The First Two YearsProgram RequirementsThe PhD program has the following components: • Two years (generally) of coursework, including a full-year Core course. • Concentration in one academic discipline (decision sciences, economics, ethics, evaluative science and statistics, management, medical sociology, or political analysis) and specialization at the dissertation stage in one policy area (environmental health, health-care services, international health, mental health, or public health). • Three one-term courses, chosen from three concentrations outside a student’s field of concentration. The statistics requirement (noted below) may be used to satisfy one of the three requirements, except for students concentrating in evaluative science and statistics. • Two one-term courses in statistics. • One course in epidemiology. • A weekly research seminar starting in the third year. • Written general and concentration examinations following two years of coursework; the general examination may contain an oral component. • A dissertation prospectus and oral examination. • A dissertation based on original research and a dissertation defense.
Concentrations• PhD students in the Committee on Health Policy choose a concentration and meet specific curriculum requirements in one of seven disciplines:
Decision Sciences (Professor Milton C. Weinstein, chair). Decision sciences are the collection of quantitative techniques that are used for decision-making at the individual and collective level. They include decision analysis, risk analysis, cost-benefit and cost-effectiveness analysis, decision modeling, and behavioral decision theory, as well as parts of operations research, microeconomics, statistical inference, management control, cognitive and social psychology, and computer science. Examples of research topics in health decision sciences include: • cost-effectiveness analysis of medical technologies and pharmaceuticals • optimal screening policies for cancer and other chronic diseases • measurement and evaluation of health outcomes, including quality of life • policy simulation modeling of diseases such as AIDS, tuberculosis, cancer, and asthma • optimal resource allocation for biomedical research
Economics (Professor Joseph P. Newhouse, chair). The concentration in economics focuses on the economic behavior of individuals; providers; insurers; and international, federal, state, and local governments and actors as their actions affect health and medical care. In addition to examining the literature on health economics, the training emphasizes microeconomic theory, econometrics, and interactions with other disciplines, including clinical medicine.
Ethics (Professor Norman Daniels, chair). The ethics concentration integrates quantitative, qualitative, and normative approaches to the analysis of ethical issues in health policy and clinical practice. Increasingly, the investigation of ethical issues in medicine and health policy has not only drawn on normative ethics and political philosophy, but has included empirical research concerning attitudes and practices in clinical and broader institutional settings. A grasp of normative theories and tools is important because ethical principles and approaches underlie, explicitly or implicitly, the formulation of particular health policies at both the macro and micro level. Students in this track will focus on developing skills in a range of disciplines, with the goal of evaluating how ethical and socio-cultural values shape—and should shape—health policies as well as clinical and public health practices. Research in health policy and ethics would include such topics as: • policies for the allocation of scarce resources to individuals (e.g., human organs for transplantation, newly developed drugs, hospital beds) and across categories of patients (treatment vs prevention for HIV/AIDS, or for HIV/AIDS vs malaria) • policies for care at the beginning and end of life • evaluation of informed consent protocols and their effectiveness • issues of equity in the evaluation of policies determining access to health services and the reduction of risk factors • policies responding to cross-cultural variation in ethical norms • ways in which health professionals are educated • policies regarding the balance between the individual and the collective (e.g., in bioterrorism, epidemic control, etc.)
Evaluative Science and Statistics (Professors Stephen B. Soumerai and Alan M. Zaslavsky, co-chairs). Training in this concentration in health service and policy evaluation will enable students to evaluate the effects of a wide range of health services and policies (e.g., insurance, health-care quality improvement, and cost-containment) on behaviors, access, processes and quality of care, health outcomes, or costs. Students in this concentration will develop proficiency in experimental and quasi-experimental research design, statistics, other methodological approaches (e.g., epidemiology, program evaluation, qualitative methods, and survey design), and relevant social sciences. Previous students in this track have used innovative methodological and statistical approaches to study, for example: • the effects of drug coverage on access to essential medications in Medicare • the effects of employment on population health • international differences in outcomes of medical care for acute myocardial infarction • the health effects of HMO reductions and subsequent government increases in maternity lengths of stay • the effects of regulatory changes in legal drinking ages on health and mortality • the effectiveness of direct to consumer advertising of prescription drugs • methods for estimating racial/ethnic healthcare disparities and their effects on health
Management (Professors Amy C. Edmonson and Robert S. Huckman, co-chairs). The management concentration prepares students to do research on the organizational, managerial, and strategic issues facing health care providers, payers, and other players in the health care market. Students in this track will learn how theories and concepts from fields such as technology and operations management, organizational behavior, organizational economics, and competitive strategy can be applied to—and further developed for understanding—health care organizations. Students in this track should have a strong interest in pursing research on such issues as: • the design and improvement of health care delivery processes • approaches for improving health care quality and productivity • the development and adoption of new medical technologies • financial incentives in health care • the new role of patients as consumers in health care • the appropriate ownership and organizational structure of hospitals and other health care providers • the management of professional health care staffs
Medical Sociology (Professors Nicholas A. Christakis and Peter V. Marsden, cochairs). In this track, students will learn about, and contribute to knowledge in, several research areas that are extremely important to health policy, including the study of professions and professional behavior, the structure of health care organizations and systems, the impact of organizational and professional change on the structure of medical work, organizational improvement programs and their evaluation, the diffusion of innovations across providers and organizations, and the behavior of patients and consumers—including consumer evaluations of health care quality and patient perspectives on the process and outcomes of care. Research on these substantive topics will be necessarily interdisciplinary. In particular, students should develop a strong grounding in psychological and sociological theories of individual behavior and theories of institutions, organizations, and professions.
Political Analysis (Professor Robert J. Blendon, chair). This concentration is intended for students who wish to do research on the relationship between politics and health policy. Students will study theories of individual opinion formation, voting behavior, legislative organization, and interest group formation. In addition, students will examine the role of public opinion, interest groups, the media, and institutions in influencing health policy outcomes. The research methodologies most utilized in this track include survey research methods and quantitative statistical methods appropriate for large-scale databases.
Language Requirements• There is no language requirement.
Policy on Incompletes• No grade of Incomplete can be used to satisfy any departmental requirements.
Human Subjects• All PhD students in Health Policy must receive human subjects training during their first year in the program (before they embark on research during their first summer in the program)—in connection with the Core course. This training must be updated as required by the University.
Advising• Once a student has accepted an offer of admission to the PhD program in health policy, he or she is asked to specify an advisor. In cases in which there is no preference, the faculty chair of the program, the concentration chair, and the program director select an advisor. After the first year, all students select their own advisors. During the third year of the program, a student forms a dissertation committee, which replaces the student’s faculty advisor. (However, frequently the student invites the second-year advisor to serve on the dissertation committee.) In addition to convening the dissertation committee for the dissertation proposal orals and final defense, a student is encouraged to meet together with his or her entire committee several other times during the process as well as individually with members of the committee on a regular basis. Starting in the third year, all students take the research seminar where they are encouraged to present in their third year and are required to present at least once per year thereafter until graduation from the program. In addition, students are encouraged to invite their advisors to attend these presentations. • The director of the program keeps in touch with all students and requests an annual progress report that is shared with the advisor and the concentration head. The associate director monitors Incompletes. • Thus, at all times when enrolled in the program, a student has one or more faculty advisors. Generally speaking, in this program, students form strong bonds with their advisors.
Master of Arts (AM)• This program does not award an AM. However, it does award a terminal master’s degree in circumstances that warrant it, by vote of the Committee on Higher Degrees in Health Policy. If students leave the program or are withdrawn after passing the general and concentration examinations and completing all their course requirements with a grade of B- or better, they are eligible for a terminal master’s degree.
Teaching• Teaching is not a requirement in this program, but at least one Harvard teaching experience is strongly encouraged.
General and Concentration Examinations• Generally, students take a full load of classes (four courses per term) for each of their first two years in the program. At the end of the two years, usually in the second week of June, general examinations are administered over the course of a week. The week usually starts with a one-hour in-class examination followed by a two-day take-home examination in which students must demonstrate that they have a master’s level understanding of the concentrations. It is followed the next week by an oral examination. This examination is the same for all students (i.e., is not concentration specific). Students are strongly encouraged to take the general examination at the end of their second year in the program or at the completion of their coursework (excluding epidemiology). If students would like to take it at the end of their first year in the program, they must petition the program. Only students with prior relevant master’s degrees can petition. Once permission is granted, the student must declare by the end of first term that he/she will indeed take the generals at the end of his or her first year. If a student fails either part of the generals, the student is given one opportunity the following year to retake the part or parts that the student did not pass. Students also take a two-day examination in their concentration, usually at the end of their second year in the program. Students should complete all concentration course requirements, with the exception of epidemiology, prior to taking a concentration examination. Any exceptions must be approved by the student’s concentration chair.
Dissertation Proposal and Orals• The purpose of the dissertation proposal and its oral examination is to provide a formal occasion for the student to receive feedback on, and gain approval of, his or her dissertation topic(s). This should be done early enough to incorporate significant changes in direction based on faculty input, but it should reflect a fairly advanced stage of study design for at least part of the dissertation. Throughout this process, the student is expected to keep in close contact with his or her research committee.
Timing• Within one year of passing the qualifying examination, a student is expected to have formed a dissertation committee, submitted a written proposal, and passed an oral examination on his or her dissertation proposal. To monitor and spur progress on the dissertation, a weekly research seminar is required of all third-year students and above. At the seminar, the students present their dissertation work at all stages, starting with the proposal stage. Students are strongly discouraged from leaving the Boston area before they have passed their proposal defense. Those contemplating leaving must take up the matter with the executive committee. In addition, the program encourages students to remain in residence throughout the dissertation stage as well. A student living outside the Boston area must, like all students in the PhD program, meet with their research committee at least twice each academic year (preferably one meeting per term). • Ordinarily, the dissertation proposal orals must be passed by the end of the third year in the program. Failure to do so could affect financial aid decisions in subsequent years. Also, if students cannot pass their dissertation proposal orals by the end of their third year, they must meet together with their proposed committee by June 30 of that year to discuss their thoughts to date. The committee will then be asked to sign a form indicating that the student is making progress toward the dissertation proposal. If a student has not set a date for the dissertation proposal orals by January of the fourth year in the program, the program must notify the student and the chair of the student’s dissertation committee. In exceptional cases, and with special permission of the Committee on Higher Degrees in Health Policy, the dissertation proposal oral examination may be postponed, but in no case later than the end of the fourth year. There is no limit to the number of times a student may repeat a dissertation proposal oral examination, but ordinarily failure to obtain acceptance of a dissertation proposal by the end of the fourth year would be considered evidence of unsatisfactory progress. Students are strongly encouraged to present at the research seminar starting in their third year as an aid to dissertation progress.
What is Expected in a Dissertation Prospectus1) The student should identify three parts for the dissertation. Normally these will be three papers, or three chapters within a monograph. In assessing each of the three parts, the committee should judge that each, if successfully carried out, will lead to a publishable paper. 2) The Public Health Service (PHS) grant guidelines, available as instructions in Form 398, are a good beginning, and students should read them. The first paper should be described in some detail (approximately ten pages), the second in somewhat less detail (approximately eight to ten pages), and the third could be presented as a preliminary set of possible topics. The level of detail for the third paper might only be a few paragraphs on each option, including at least some indication of the importance of the topic, data availability, and general methodologic approach. There could be several possibilities presented for the third paper. 3) For each of the first two topics—and ideally the third as well—the student should present: a) What questions is the student answering? The PHS guidelines call this specific aims. The student will usually need a few paragraphs of introductory material to set up his or her questions. 4) In the case of the first paper, a draft manuscript, possibly of a preliminary or partially completed version, is often attached as an appendix. The student should give evidence that he or she has gotten his or her “hands dirty” and is immersed in the conduct of this study.
The Following Steps Must Occur Prior to the Dissertation Proposal Orals: 2) The student must ascertain from the members of the research committee that she or he is prepared to schedule the dissertation proposal oral examination. 3) The student must arrange with the research committee a mutually agreeable date, time, and location for the dissertation proposal orals, and make this information known to the program director at least two weeks prior to the scheduled dissertation proposal orals. Two hours should be allowed, including time for discussion, evaluation by the research committee, and feedback to the student after the faculty evaluation. 4) The student must submit to the research committee, at least two weeks prior to the scheduled dissertation proposal orals, a written dissertation proposal ordinarily consisting of twenty to thirty typed pages. The written proposal should include an overview of the dissertation, a detailed research plan (equivalent to the methods section of a manuscript or PHS-style grant proposal) of at least one of the papers; a preliminary research plan of at least a second paper, including evidence of feasibility of methodology and data availability; and an overview of a third paper. It is acceptable to present alternative possibilities for the third paper. If a paper has already been submitted for publication, the manuscript should be included with the proposal. For a monograph-type dissertation, the equivalent requirements apply to the separately publishable components of the dissertation research. 5) The written proposal submitted two to three weeks in advance of the dissertation orals should not be the first time the research committee has seen these ideas presented by the student. At least the research advisor, and preferably the entire research committee, should be consulted in advance to ensure approval in principle of the topic(s) and to ensure the suitability of the members of the research committee.
The Dissertation Proposal Oral Examination• The program office will maintain copies of proposals by some health policy PhD students, and these may be borrowed by students planning their proposal orals. It is the student’s responsibility to obtain a dissertation proposal form from the program director and to bring it to the chair of the research committee. The student will be responsible for getting the signed form and a copy of the dissertation proposal to the program director after the proposal orals, for inclusion in the student’s folder. • At the dissertation proposal orals, the student will present the proposal in a twenty-to thirty-minute oral presentation, leaving most of the time for discussion. Persons invited to the dissertation proposal orals are: 1) the research committee; 2) other faculty members from Harvard and elsewhere invited by the student to provide additional expertise in evaluating the research proposal; 3) members of the Committee on Higher Degrees in Health Policy; 4) the PhD program director; and 5) other students invited by the presenting student, possibly including one who has agreed to take notes. Discussion will be limited, however, to the presenting student, the research committee, and invited faculty in categories 2) and 3) above. • At the conclusion, the research committee meets in closed session to discuss the disposition of the proposal. No grade or ordinal evaluation is given. In evaluating the student’s performance at the orals, the research committee will take into account the quality of the student’s oral presentation, the quality of the student’s responses to questions from the research committee, and the written material prepared prior to the oral date. Possible results are: accept, accept conditionally, or reject the dissertation proposal. Conditional acceptance means that the student must meet certain specified conditions prior to obtaining unconditional approval of the dissertation proposal. Such conditions may include, for example: demonstration of the student’s knowledge or facility in a particular methodology, theory, or content area; demonstration of the availability of data needed to conduct the research; demonstration that the proposed research topic is original; or endorsement of the topic by an individual (e.g., a faculty member) with expertise in a related field but not present at the orals. The research committee may decide how these contingencies can be satisfied, either in writing, orally, by obtaining a course grade, or other means. In any event, at the time when a conditional acceptance is changed to an acceptance, it is the student’s responsibility to have all committee members sign off on the form and to submit it to the program office.
DissertationContent of the Dissertation • Dissertations may be applications of analytical tools to health policy issues, or they may be primarily theoretical. The dissertation should be written in a scholarly style, including thorough literature reviews, and it must include detailed descriptions of methods, data, and analyses. • The first format consists of three publishable papers relating to health policy. The papers are typically related, either by their substantive content or by methodology, but this is not a requirement. It is recommended that at least two of the three papers be related, either by content or methodology, but this is left to the discretion of the student’s research committee. • While publishability is a necessary condition for the acceptability of the dissertation, the fact that a paper has been published in a peer-reviewed publication does not necessarily make it acceptable for the dissertation. Material such as literature reviews, detailed description of analytic methods and data, which may be excluded from published versions due to page constraints, must be included in the dissertation, possibly as appendices or as separate background papers. • On occasion, one or more of the papers may have been published prior to submission of the dissertation, and the published version may be included in the dissertation in lieu of a typescript. However, none of the papers may have been published prior to the student’s matriculation into the program, and the majority of the work on the dissertation must be completed after matriculation. • The dissertation must include an overview summarizing the papers. It must also contain material that describes, in non-technical terms, the implications of the papers’ findings for the real world, as well as directions for future research that are suggested by the papers’ findings and/or limitations. This material may be incorporated into the individual papers (e.g., in discussion sections), or in a separate concluding section of the dissertation. • The second format alternative is a traditional monograph-style dissertation. Such a dissertation must either (a) contain at least three independently publishable units (which may be chapters) or (b) be suitable for subsequent publication in book form. The rules and recommendations described above for the three-paper format, regarding prior publication, dissertation summary, and concluding sections, apply to a traditional dissertation as well. • The dissertation must be innovative, in the sense that an existing method is being applied in a new way or to a new problem area, or in the sense that a methodology is extended or modified in a significant way. Primarily theoretical dissertations must still include a substantial demonstration of their applicability to a real-world, contemporary health-policy issue, and this application should be the major focus of one or more papers or chapters.
Co-authorship• Co-authored dissertation papers or chapters are permitted. Order of authorship should follow the • Co-authored dissertation papers or chapters are permitted. Order of authorship should follow the conventions of the field to which the paper is being submitted. The student should be first author for journals where first authorship indicates primary responsibility for the paper. Faculty members and students are cautioned that a faculty advisor should be a co-author only if he or she contributes substantially to the development of the database or analytical methodology for the paper or chapter. If, however, the faculty member is primarily responsible for both the data and method, then the paper probably does not qualify as independent work by the student. If the faculty member has developed the methodology in a previous research study, then it is expected that the student will apply the methodology independently to the problem under investigation.
Research Committee• The student is responsible for selecting a research advisor and a research committee consisting of at least two additional faculty members. The research advisor chairs the research committee and must be a full-time faculty member at Harvard University. The research committee must include at least one additional full-time Harvard faculty member and must include at least one member of the Committee on Higher Degrees in Health Policy, and it is preferred that the chair of the research committee be a member of that Committee. At least two of the three members must be faculty members of the Harvard University Faculty of Arts and Sciences. (All members of the Committee on Higher Degrees in Health Policy have FAS appointments.) If only one of the three members has a FAS appointment, then the chair of the Committee on Higher Degrees in Health Policy must also approve and sign the dissertation. The research committee may include a faculty member from another university, or an emeritus professor, or an adjunct professor at Harvard or elsewhere. (A member not on university faculties may be included only as a fourth member with the approval of the Committee on Higher Degrees in Health Policy.) The membership of the research committee must be approved by the executive committee of the Committee on Higher Degrees in Health Policy before the dissertation proposal oral examination is scheduled. • After passing the proposal oral examination, students are expected to meet with their research committee at least twice each academic year (preferably one meeting per term). This is the case whether or not a student is in residence. One of the meetings must be with all the members of their research committee physically present. The other meeting may be by teleconference if necessary. For documentation of these meetings, the program office will provide forms, which students will be expected to return to the program office.
Dissertation Defense• It is advisable to start arranging a tentative date for the defense well in advance to resolve possible scheduling conflicts between dissertation advisors. However, a dissertation defense may not be scheduled until at least a draft of all three papers has been submitted to all members of a student’s dissertation committee. All defenses will have as a component a public presentation. It is the option of the research committee to have the entire defense public or to close the examination part of it, followed by a public presentation open to faculty, students, and other interested parties—all of whom may ask questions. In both cases, a student must allow for time after the defense for working on revisions required by the committee. A draft copy of the dissertation must be submitted to each member of the research committee at least two weeks prior to the defense, and the program director must be notified of the time for the defense at least two weeks prior to the defense. At this point, anyone on the Committee on Higher Degrees in Health Policy has the right to ask for a draft copy of the dissertation. The student is responsible for providing the GSAS Dissertation Acceptance Certificate for the research committee members to sign at the defense. The program office will provide the program form for research committee members’ signatures at the defense.
Other• Except as specifically stated above, the rules of the Graduate School of Arts and Sciences regarding the format in which the dissertation will be printed, bound, and submitted will apply. The PhD Program in Health Policy strongly encourages submission of one bound copy of each dissertation to the program office, with a copy of the Dissertation Acceptance Certificate bound with it. In addition, the student will need to submit an electronic copy of the dissertation abstract to the program director for inclusion on the program’s website. • Most students complete the entire PhD within four to five years. All work for the PhD, including the dissertation, should be completed within eight years. Students whose work is not completed within this period will generally be asked to withdraw from the program, but will thereafter be allowed to apply for readmission so as to re-register for the purpose of receiving the degree, once the completed dissertation has been judged satisfactory by the research committee. Exceptions to this rule will be granted only under extraordinary circumstances. |