APARC - AHPP Publications

A quarter century ago in a seminal paper, Hart, Shleifer and Vishny (NBER1996, QJE1997) developed a theory of the ‘Proper Scope of Government.’ Oliver Hart, 2016 Nobel Laureate, reflects on that framework and its place in economics, as well as the inspiration for his more recent work on norms, guiding principles, and contracts as reference points.

Health systems globally face increasing morbidity and mortality from chronic diseases, yet many - especially in low- and middle-income countries - lack strong chronic disease management in primary health care (PHC). We provide evidence on China’s efforts to promote PHC management using unique five-year panel data in a rural county, including health care utilization from medical claims and health outcomes from biomarkers.

In one of the first studies of service sector robotics using establishment-level data, we study the impact of robots on staffing in Japanese nursing homes, using geographic variation in robot subsidies as an instrumental variable. We find that robot adoption increases employment by augmenting the number of care workers and nurses on flexible employment contracts, and decreases difficulty in staff retention. Robot adoption also reduces the monthly wages of regular nurses, consistent with reduced burden of care.

Background. People with chronic conditions are disproportionately prone to be affected by the COVID-19 pandemic but there are limited data documenting this. We aimed to assess the health, psychosocial and economic impacts of the COVID-19 pandemic on people with chronic conditions in India.

India’s COVID-19 lockdown is widely believed to have disrupted critical health services, but its effect on non-COVID health outcomes is largely unknown. Comparing mortality trends among dialysis patients in the eight months around the lockdown with the previous year, we document a 64% increase in mortality between March and May 2020 and an estimated 22-25% total excess mortality through July 2020. The mortality increase is greater among females and disadvantaged groups.

Accurate future projections of population health are imperative to plan for the future healthcare needs of a rapidly aging population. Multistate‐transition microsimulation models, such as the U.S. Future Elderly Model, address this need but require high‐quality panel data for calibration. We develop an alternative method that relaxes this data requirement, using repeated cross‐sectional representative surveys to estimate multistate‐transition contingency tables applied to Japan's population.

Effective as of July 1, 2018, South Korea set a new cap on employees’ weekly working hours, decreasing the maximum number from 68 to 52. In this study, we comprehensively analyze the effectiveness of the law’s implementation by observing changes in work time, health status, health care utilization, health behavior, monthly expenses, and satisfaction between pre- and post-implementation periods (2014–2017 vs. 2019). We find evidence of both intended and unintended consequences—and, in this last category, some are beneficial and some not.

COVID-19 presents humanity with not just a health crisis but also a governance crisis as leaders around the globe confront the challenges of stemming the spread of the virus. Various governments have responded in various ways to slow the transmission of the virus. Ideally, the leaders of a country should approach the crisis with a two-pronged attack. The first is to flatten the epidemic curve (epi curve), which is simply a graphical representation of the number of cases and date of onset of the illness, and the second is to raise or strengthen the capacity of the health system. 

The intention to pay for human papillomavirus (HPV) vaccination among women of childbearing age in Vietnam, where cervical cancer remains a significant public health concern, has been mostly lacking. To examine this issue, we conducted a cross-sectional study of 807 pregnant women in an urban and a rural district (Dong Da and Ba Vi) of Hanoi, Vietnam. The vast percentage of our respondents expressed a firm intention to vaccinate, especially women in rural areas (over 90.0%).

The substantial social and economic burden attributable to smoking is well‐known, with heavy smokers at higher risk of chronic disease and premature mortality than light smokers and nonsmokers. In aging societies with high rates of male smoking such as in East Asia, smoking is a leading preventable risk factor for extending lives (including work‐lives) and healthy aging.

In the 2019 fourth quarter edition of the Milken Institute Review, Asia Health Policy Program director Karen Eggleston discusses the progress China has made since the 2009 reforms to its healthcare, which brought basic coverage to all and reduced patients' share of costs, and explains the many challenges that remain, including increasing the system's efficiency to ensure its sustainability and addressing the disparities in healthcare that echo the "yawning gap in living standards between China's rising middle class and its poorest citizens."

China’s national health reforms over the past two decades have brought the system closer to the modern, safe, reliable and accessible health system that is commensurate with China’s dramatic economic growth, improvement in living standards, and high hopes for the next generation.

In Live Long and Prosper?, a new eBook edited by David Bloom, AHPP director Karen Eggleston contributes the chapter "Understanding 'Value for Money' in Healthy Ageing," in which she advocates for and explains the concept of "net value of medical care," a metric that helps quantify the social value of spending on healthcare.

This special issue of The Journal of the Economics of Ageing, edited by Anita Mukherjee and APARC's Asia Health Policy Program Director Karen Eggleston, focuses on a key challenge around the world: financing the many needs that come with longer lives, lower fertility, and older population age structures. The triumph of longevity can pose a challenge to the fiscal integrity of public and private pension systems and other social support programs disproportionately used by older adults.

With an estimated 84 million people suffering from diabetes in South Asia, the disease imposes substantial economic burdens on individuals, families, and society. Furthermore, since the disease burden increasingly occurs in the most productive midlife period, it adversely affects workforce productivity and macroeconomic development. Diabetes-related complications lead to markedly higher treatment costs, causing catastrophic medical spending for many households, thus underscoring the importance of preventing diabetes-related complications.

This paper shows that, for mothers in Cebu, Philippines, access to electricity and the type of cooking fuel used at home affect both health outcomes and also how time is allocated, including for paid work. First, the use of fuelwood for cooking adversely affects the health of mothers, who are traditionally responsible for cooking and are often at home, taking care of their families. This result is consistent across different econometric specifications.

Cardiovascular diseases (CVDs), which are disorders of the heart and blood vessels, are the world’s leading cause of death (WHO, 2016). The transition from infectious diseases to non-communicable diseases (NCDs), primarily CVDs, as the primary cause of mortality and morbidity worldwide— combined with the economic burden associated with heart-related diseases—prompted the World Health Organization (WHO) and its regional offices to identify CVDs’ risk factors (WHO, 2016).

Background: Precise future projection of population health distribution is imperative for designing an efficient healthcare system in rapidly aging countries. Multistate-transition microsimulation models such as the US Future Elderly Model have been developed based on panel data collection, but these data may not be always available. We proposed a pseudopanel method using repeated cross-sectional representative surveys as a complementary approach, and specifically applied the model to Japan's population.

The growing literature on environmental migration presents conflicting results. While some find that natural disasters induce international migration, others discover a dampening effect. We aim to reconcile these differences by using a comprehensive list of weather shocks from the Philippines, a country prone to natural disasters and a major exporter of labor. We constructed a longitudinal provincial dataset (2005–2015) from an assemblage of administrative and survey datasets and tested linear, quadratic, and lagged models.

Risky health behaviors such as illicit drug use, smoking, overconsumption of alcohol, violence, and early sexual activity have contemporaneous and intertemporal adverse health and economic outcomes. The health-related and economic costs to individuals and to society overall are particularly pronounced when adolescents are the ones engaging in one or more of such behaviors.