The cost of healthcare is one of the largest personal expenditures worldwide, with residents of the United States spending upwards of $10,000 each year1. Moreover, the cost of healthcare seems to be rising in most countries2. With real wages remaining relatively stagnant over the past several decades in the United States3 and other countries4, this presents growing concern for policy makers and citizens worldwide. A significant portion of healthcare costs in the United States and many other countries comes from paying for pharmaceuticals5. For students who represent the next generation of scientists, economists, politicians, and medical professionals it is imperative they have an intimate understanding of healthcare costs, healthcare technologies and the measures we can take to lower costs to the consumer.
With the new Next Generation Science Standards (NGSS) in Connecticut there is a push for instructional methods that encourage students to tackle real world problems. Under NGSS students are thought to develop deeper understanding of content and related issues via activities that promote inquiry, collaboration, and problem solving6. Lessons of this sort encourage use of so-called 21st century skills designed to prepare students to successfully navigate the modern world. Several of the NGSS standards for high school chemistry in Connecticut address evaluating a real-world issue from social and economic perspectives and designing a solution using concepts of engineering. Additionally, there is an NGSS standard in the chemistry curriculum that asks students to analyze a global challenge using qualitative and quantitative data that reflect societal wants and needs. Consequently, I believe a unit in which students study the economics of the healthcare system and then use chemistry concepts to design a technology to help make pharmaceuticals more affordable would beautifully hit upon several desired learning outcomes. The students will be provided with some foundational knowledge to give them ideas before they begin their own research and start the design process.
This unit will be designed for an 11th grade, high school chemistry class in New Haven, CT. According to data from 2017 on Census.gov, New Haven’s per capita income is about 79% of the national average and its median household income is only about 68% of the national median7-8. Many of the students I teach come from a low-income households, which means saving on the cost of their healthcare and prescription medications could be very meaningful and a topic they may find great interest in. Additionally, Connecticut consistently seems to have higher costs for healthcare procedures when compared to the national average. For instance, according to data from the Healthcare Cost Institute, cesarean childbirths and x-rays in Connecticut are on average 26% and greater than 33% more expensive than the national averages respectively9. Consequently, lowering healthcare costs may be especially important to my students. During the unit, an effort will be made to make such connections between the content and the community to encourage student investment.
In order for students to have a stake in the topic, apply their chemistry knowledge and put together a well thought out project, students will need to be exposed to some background on the healthcare and the pharmaceutical industries. Students will get a brief overview of the costs of healthcare and prescription medications as well as several ways costs of medications could potentially be decreased including the repurposing old drugs, improving stability, the design and use of biosimilars, or improving production efficiency. In order for students to research and/or design one of these cost reduction methods they will need a foundation of certain chemistry concepts which will likely include a combination of the following; the relationship between structure and function, pH, activation energy, the relationship between temperature and reaction rate, catalysts, inhibitors, among additional concepts. Students will also likely need to be able to use the periodic table to make predictions on the properties of various elements and how they may react with one another based on valence electrons. In their research, students will need to be able to access and analyze information they find including how to read and interpret charts and graphs. Depending upon the focus of their project, basic knowledge of other topics such as stoichiometry, electromagnetic radiation or cell culture may be necessary.
Students will be required to choose one method (repurposing old drugs, improving stability of current drugs, the design and use of biosimilars, or improving production efficiency) of reducing the cost of prescription drugs and research it. Students may choose a method not included in the list above but will be required to receive teacher approval before beginning. Students will both write a three-page research paper on their proposed method and will design a new strategy or technology. Teacher approval will be required once a focus for their research and design project has been decided upon. The research focus must be deemed reasonable and related to chemistry in some way. Students will present their research and designs in a 5 minute presentation in front of the class using a slideshow, poster board, video, demonstration, or other means of presentation. Regular teacher checks will be required along the way to ensure projects meet requirements and the students are on pace to finish.
The project along with the prerequisite material will be scaffolded over several weeks so that students are adequately prepared for the task and have enough time to complete what is asked of them. A significant part of the grade for this project will be determined by student’s ability to prove that their technology or strategy is viable. Students will need to provide references for their research and will spend one class in the library learning how to properly conduct research online and cite their sources. In the research paper students will need to provide calculations for their predictions on the cost savings to consumers of their proposed strategy or technology. If students would like to build a prototype or model of their technology they will need to submit a list of materials with their topic proposal and an approval decision will be made based on the availability of such materials.