Asia Health Policy Program Working Paper Series

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Asia Health Policy Program Working Paper Series

The Asia Health Policy Program working paper series disseminates high-quality social science research on health policy and demographic change in the Asia-Pacific region, drawing from the research of our affiliated faculty, postdoctoral fellows, visiting scholars, and select colleagues from Asia.

Publications

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Working Papers

The Impact of Centralized Drug Procurement on Drug Prices and Utilization in China

Jing Zhang, Wenjia Wang
2022 August 26, 2022

This study investigated the impact of China’s centralized drug procurement (CDP) on drug prices, utilization, and expenditure in China. Employing the event study method, we estimated the impacts for both contract-awarded (hereafter, “approved”) drug products and unawarded (hereafter, “unapproved”) products in the same molecule-dosage forms. The results show that the CDP decreased the prices of the approved drug products by 66.7% on average. Moreover, unintendedly, the CDP also pushed the prices of the unapproved products down by 25.9%. After the inception of the CDP, the quantities sold of the approved and unapproved products rose by four times and fell by 75.4%, respectively. With these estimates, we concluded that the CDP saves 252.2 billion yuan (equivalent to 38.8 billion US dollars) annually in drug expenditure.

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Working Papers

A Quarter Century of ‘The Proper Scope of Government’: Theory and Applications

Oliver Hart
Asia Health Policy Program working paper # 64, 2021 February 19, 2021

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.

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Working Papers

The Effects of Chronic Disease Management in Primary Health Care: Evidence from Rural China

Hui Ding, Yiwei Chen, Min Yu, Jieming Zhong, Ruying Hu, Xiangyu Chen, Chunmei Wang, Kaixu Xie, Karen Eggleston
Asia Health Policy Program working paper # 62, 2021 February 16, 2021

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.

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Working Papers

Robots and Labor in the Service Sector: Evidence from Nursing Homes

Karen Eggleston, Yong Suk Lee, Toshiaki Iizuka
Asia Health Policy Program working paper # 63, 2021 February 16, 2021

In one of the first studies of service sector robotics using establishment-level data, we study the relationship between robots and staffing in Japanese nursing homes. We utilize variation in robot subsidies across prefectures as an instrumental variable to explore the impact of robot adoption on nursing homes’ staffing decisions. We find that robot adoption appears to decrease difficulty in staff retention and to increase employment by augmenting the number of care workers and nurses on flexible employment contracts.

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Working Papers

Health, Psychosocial, and Economic Impacts of the COVID-19 Pandemic on People with Chronic Condition in India: A Mixed Methods Study

Kavita (Singh), Dimple Kondal, Sailesh Mohan, Suganthi Jaganathan, Deepa Mohan, Nikhil Srinivasapura Venkateshmurthy, Prashant Jarhyan, Anjana Ranjit Mohan, KM Venkat Narayan, Viswanathan Mohan, Nikhil Tandon, Mohammed K Ali, Dorairaj Prabhakaran, Karen Eggleston
Asia Health Policy Program working paper # 61, 2021 January 29, 2021

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.

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Working Papers

The Effects of India’s COVID-19 Lockdown on Critical Non-COVID Health Care and Outcomes

Radhika Jain, Pascaline Dupas
Asia Health Policy Program Working Paper Series working paper #60, 2020 September 23, 2020
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Working Papers

Intended and Unintended Consequences of a New Limit on Working Hours in South Korea: Implications for Precarious Employment

Sungchul Park, Hansoo Ko
Asia Health Policy Program working paper # 59, 2020 June 29, 2020

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.

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Working Papers

COVID-19 Incidence and the Timing of Quarantine Measures and Travel Restrictions: A Cross-country Analysis

Marjorie Pajaron
Asia Health Policy Program working paper # 58, 2020 June 22, 2020

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. 

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Working Papers

Intention to Pay for HPV Vaccination among Women of Childbearing Age in Vietnam

Xuan Thi Thanh Le, Phuong Thi Ngoc Nguyen, Toan Thi Thanh Do, Thang Huu Nguyen, Huong Thi Le, Cuong Tat Nguyen, Giang Hai Ha, Chi Linh Hoang, Bach Xuan Tran, Carl A. Latkin, Roger C.M. Ho, Cyrus S.H. Ho
Asia Health Policy Program working paper # 57, 2020 May 6, 2020

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%).

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Working Papers

Healing One-fifth of Humanity: Progress and Challenges for China’s Health System

Karen Eggleston, Karen Eggleston
Asia Health Policy Program working paper # 56, 2019 October 18, 2019

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.

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Working Papers

Weathering the Storm: Weather Shocks and International Migrants from the Philippines

Marjorie Pajaron
Asia Health Policy Program working paper # 51, 2019 January 17, 2019

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.

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Working Papers

The Impact of Adolescents’ Risky Health Behaviors on Their Later Economic Outcomes

Marjorie Pajaron
Asia Health Policy Program working paper # 52, 2019 January 17, 2019

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.

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Working Papers

The Impact of Energy Access on Mothers’ Health, Labor, and Time Allocation

Marjorie Pajaron
Asia Health Policy Program working paper # 53, 2019 January 17, 2019

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.

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Working Papers

How Individuals’ Birth Weight and Later Risk Factors Interact to Determine Their Risk of Cardiovascular Disease: A Longitudinal Study in the Philippines

Marjorie Pajaron
Asia Health Policy Program working paper # 54, 2019 January 17, 2019

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).

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Working Papers

Future Projection of the Health and Functional Status of Older People in Japan: A Pseudopanel Microsimulation Model*

Megumi Kasajima, Hideki Hashimoto, Sze-Chuan Suen, Brian Chen, Karen Eggleston, Jay Bhattacharya
Asia Health Policy Program working paper # 55, 2019 January 17, 2019

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.

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Working Papers

Economic Dimensions of Personalized and Precision Medicine in Asia: Evidence from Breast Cancer Treatment in Taiwan

Jui-fen Rachel Lu, Karen Eggleston
Asia Health Policy Program working paper # 48, 2018 April 20, 2018

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.

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Working Papers

Dual Practice of Public Hospital Physicians in Vietnam

Ngan Do, Young Kyung Do
Asia Health Policy Program working paper # 49, 2018 April 20, 2018

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.

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Working Papers

Selective Mortality and the Long-term Effects of Early-life Exposure to Natural Disasters

Margaret Triyana, Xing Xia
Asia Health Policy Program working paper # 50, 2018 April 20, 2018

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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Working Papers

Substance Abuse Policy in Thailand: Current Challenges and Future Strategies

Darika Saingam
Asia Health Policy Program working paper # 45, 2018 January 17, 2018

Abstract
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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Working Papers

Rural-Urban Disparities in the Utilization of Mental Health Inpatient Services in China: The Role of Health Insurance

Junfang Xu, Jian Wang, Madeleine King, Ruiyun Liu, Fenghua Yu, Jinshui Xing, Lei Su, Mingshan Lu
Asia Health Policy Program working paper # 46, 2018 January 17, 2018
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Working Papers

Boys, Girls, and Grandparents: The Impact of the Sex of Preschool-Age Children on Family Living Arrangements and Maternal Labour Supply

Ang Sun, Chuanchuan Zhang, Xiangting Hu
Asia Health Policy Program working paper # 44, 2017 October 20, 2017
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Working Papers

Personalized and Precision Medicine in Japan

Hokuto Asano
Asia Health Policy Program working paper # 43, 2017 July 11, 2017
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Working Papers

The Effect of Family-Friendly Policies on Fertility and Maternal Labor Supply

Nobuko Nagase
Asia Health Policy Program working paper # 42, 2017 May 4, 2017
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Working Papers

The Weaker Sex? Vulnerable Men, Resilient Women, and Variations in Sex Differences in Mortality since 1900

Mark R. Cullen, Michael Baiocchi, Karen Eggleston, Pooja Loftus, Victor Fuchs
Asia Health Policy Program working paper # 41, 2016 November 3, 2016

Abstract. Sex differences in mortality (SDIM) vary over time and place as a function of social, health, and medical circumstances. The magnitude of these variations, and their response to large socioeconomic changes, suggest that biological differences cannot fully account for sex differences in survival. We develop a set of empiric observations about SDIM with which any theory will have to contend.

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