In the 2019 fourth-quarter edition of the Milken Institute Review, AHPP director Karen Eggleston looks at China's healthcare system, exploring the inequalities that have opened up between rural and urban healthcare, and discussing what needs to be done to ensure that the system remains sustainable in the face of increasing aging and slower economic growth.

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.

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.

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).

China launched a new rural pension scheme (NRPS) for rural residents in 2009, now covering almost all counties with over 400 million people enrolled.

High costs of precision medicine raise concerns about exacerbating income-related disparities in healthcare utilization and health outcomes. One approach to expanding coverage in Asia has been to cover the precision therapy but require the pharmaceutical firm to cover the costs of the companion diagnostic test. Taiwan’s National Health Insurance (NHI) adopted this approach for lung cancer, colorectal cancer and leukemia, but not for the first target therapy covered by NHI, trastuzumab for the treatment of HER2-positive breast cancer.

Although many public hospital physicians in Vietnam offer private service on the side, little is known about the magnitude and nature of the phenomenon of so-called dual practice, let alone the dynamics between the public and private health sectors. This study investigates how and to what degree public hospital physicians engage in private practice. It also examines the commitment of dual practitioners to the public sector. The analysis is based on a hospital-based survey of 483 physicians at 10 public hospitals in four provinces of Vietnam.

We analyze the effects of early-life shocks with varying degrees of severity on mortality and human capital outcomes in the Philippines. We exploit variations in typhoon exposure and the introduction of a short-term post-disaster relief policy. Severe
typhoons are associated with increased mortality and adverse long-term outcomes. Before the disaster relief policy, mortality from in utero exposure to severe typhoons was 10 percent, and survivors exhibited similar levels of human capital as the unaffected.

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Substance abuse has been an important social and public health problem in Thailand for decades. The National Household Survey on Substance and Alcohol Use in Thailand, which has been conducted six times, shows that substance abuse has steadily increased.

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