Health policy
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Abstract

Background: Body mass index (BMI) and waist circumference (WC) are used in risk assessment for the development of noncommunicable diseases (NCDs) worldwide. Within a Cambodian population, this study aimed to identify an appropriate BMI and WC cutoff to capture those individuals that are overweight and have an elevated risk of vascular disease.

Methodology/Principal Findings: We used nationally representative cross-sectional data from the STEP survey conducted by the Department of Preventive Medicine, Ministry of Health, Cambodia in 2010. In total, 5,015 subjects between age 25 and 64 years were included in the analyses. Chi-square, Fisher’s Exact test and Student t-test, and multiple logistic regression were performed. Of total, 35.6% (n=1,786) were men, and 64.4% (n=3,229) were women. Mean age was 43.0 years (SD = 11.2 years) and 43.6 years (SD = 10.9 years) for men and women, respectively. Significant association of subjects with hypertension and hypercholesterolemia was found in those with BMI $23.0 kg/m2 and with WC .80.0 cm in both sexes. The Area Under the Curve (AUC) from Receiver Operating Characteristic curves was significantly greater in both sexes (all p-values, 0.001) when BMI of 23.0 kg/m2 was used as the cutoff point for overweight compared to that using WHO BMI classification for overweight (BMI $25.0 kg/m2) for detecting the three cardiovascular risk factors. Similarly, AUC was also significantly higher in men (p-value, 0.001) when using WC of 80.0 cm as the cutoff point for central obesity compared to that recommended by WHO (WC $94.0 cm in men).

Conclusion: Lower cutoffs for BMI and WC should be used to identify of risks of hypertension, diabetes, and hypercholesterolemia for Cambodian aged between 25 and 64 years.

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Journal Articles
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PLoS ONE
Authors
Siyan Yi
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How do demand- and supply-side incentives interact, when there are potentially large provider income effects? We develop a simple model and empirically test it with data from China’s Essential Medications List (EML) policy, which reduced patient copayments and changed provider incentives by removing a large source of revenue from primary care providers: drug dispensing revenues. Using a panel of patient-level spending and clinical data for Chinese patients with diabetes or hypertension over two and a half years, we find evidence of strategic provider response that dampened the impact of patient copayment reductions. Resource use and patient out-of-pocket spending did not change, when taking account of patient utilization outside primary care.

This paper has been published: Brian Chen, Y. Tony Yang, and Karen Eggleston, 2017.  Patient Copayments, Provider Incentives and Income Effects: Theory and Evidence from the Essential Medications List under China’s 2009 Healthcare Reform,” World Medical & Health Policy 9(1): 24–44."

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Working Papers
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Asia Health Policy Program working paper # 37
Authors
Karen Eggleston

Shorenstein APARC
Encina Hall E332
616 Serra Street
Stanford, CA 94305-6055

(650) 724-5710 (510) 705-2049 (650) 723-6530
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Developing Asia Health Policy Fellow
IMG_4537.jpg MD

Gendengarjaa Baigalimaa joins the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) during the 2013-2014 acedemic year as the Asia Health Policy Program Fellow. She joins APARC from the Mongolian National Cancer Center, where she serves as a Gynecological Oncologist.

During her appointment as Health Policy Fellow, she will conduct a comparative study of how knowledge of cervical cancer risk factors has influenced behavior changes in Mongolia before and after the introduction of the National Cervical Cancer Program.

Baigalimaa is the Executive Director of Mongolian Society of Gynecological Oncologists and is also a member of the International Gynecological Cancer Society (IGCS) in Mongolia, Russia, and France.

Baigalimaa holds a MD from Minsk Belarussia Medical University. She also received a Masters in Health Science from Mongolian Medical University. She is fluent in both Russian and English.

Shorenstein APARC
Encina Hall C331
616 Serra Street
Stanford, CA 94305-6055

(650) 724-5656 (650) 723-6530
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2013-2014 Asia Health Policy Postdoctoral Fellow
triyana_photo.jpg PhD

Margaret (Maggie) Triyana’s main research interests are inequality and human capital investments in developing countries. In particular, she is interested in the effects social policy changes on children’s health outcomes. As a Postdoctoral Fellow, she will analyze the effects of rural-urban migration in Indonesia and China, as well as the impact of health insurance expansion in Indonesia and Vietnam.

Triyana received a PhD in Public Policy from the University of Chicago in 2013.

 

Working Papers

“Do Health Care Providers Respond to Demand-Side Incentives? Evidence from Indonesia“

“The Effects of Community and Household Interventions on Birth Outcomes: Evidence from Indonesia”

“The Longer Term Effects of the ‘Midwife in the Village’ Program in Indonesia”

“The Sources of Wage Growth in a Developing Country” (with Ioana Marinescu)

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Co-sponsored by the Center of East Asian Studies, Stanford University

Prominent health policy expert—Rachel Lu from Taiwan—will share her view on recent health policy developments in the region, drawing on her extensive research and policy background.

Jui-fen Rachel Lu, Sc.D., is a Professor in the Department of Health Care Management, at Chang Gung University (CGU) in Taiwan, where she teaches comparative health systems, health economics, and health care financing and has served as department chair (2000-2004), Associate Dean (2009-2010) and Dean of College of Management (2010-2013).  She earned her B.S. from National Taiwan University, and her M.S. and Sc.D. from Harvard University, and she was also a Takemi Fellow at Harvard (2004-2005) and is an Honorary Professor at Hong Kong University (2007-2014), a guest professor at Huazhong University of Science and Technology (2010-2013), and an adjunct professor at Xi’an Jiaotong University (2011-2014) in China.  Her devotion to teaching driven by her firm belief in the value of education and investment in human minds was recognized by the Award of Excellence in Teaching conferred by CGU in both 2002 and 2013.

Her research focuses on 1) the equity issues of the health care system; 2) impact of the NHI program on health care market and household consumption patterns; 3) comparative health systems in Asia-Pacific region.  She is a long-time and active member of Equitap (Equity in Asia-Pacific Health Systems) research network and is currently the coordinator for the catastrophic payment component of Equitap II research project which involves 21 country teams and is jointly funded by IDRC, AusAID, and ADB.  Professor Lu has also been appointed to serve as a member on various government committees dealing with health care issues in Taiwan, such as National Health Insurance Supervisory Committee (DOH), Hospital Management Committee(DOH), and Hospital Global Budget Payment Committee (BNHI), etc.  Dr. Lu received the Minister Wang Jin Naw Memorial Award for Best Paper in Health Care Management presented by Kimma Chang Foundation in 2002 and was the recipient of IBM Faculty Award in 2009.  She has published papers in Health Affairs, Medical Care, Journal of Health Economics, Health Economics, Social Science and Medicine, Health Economics, Policy and Law, Osteoporosis International, Health and Quality of Life Outcomes, and Taiwan Economic Review etc, and is the author of “Health Economics”(a textbook in Chinese) and various book chapters.  

Philippines Conference Room
Encina Hall 3rd Floor Central
616 Serra Street, CA 94305

Jui-fen Rachel Lu Professor in the Department of Health Care Management Speaker Chang Gung University in Taiwan
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Homesickness, long hours, and demanding employers—many Filipinos who migrate to another country for temporary employment make personal sacrifices and face daunting working conditions.

To their family members receiving much-needed supplemental income and to the Philippine government bolstering its foreign reserves, they are the “new heroes.” Remittances from Overseas Filipino Workers (OFWs), as they are officially called, are now the country’s second largest source of foreign reserves, beating out foreign direct investment in terms of percentage of GDP. The government has even established an annual award to honor its most distinguished OFWs.

Marjorie Pajaron, the current Asia Health Policy Postdoctoral Fellow in Developing Asia, has been studying the significant economic benefit of OFW remittances to Philippine families and to the economy. She spoke recently with Shorenstein APARC about her research, which she will present at a seminar on May 9.

How many people from the Philippines are going abroad for temporary employment, and where are they finding work?

In 2008, OFWs numbered 2 million—representing 2 percent of the country’s total population. Fifty-one percent of these migrants were male, and 49 percent were female. Twenty percent went to Saudi Arabia; 14 percent to the Arab Emirates, Singapore, Hong Kong, Japan, Qatar, and Taiwan; 9 percent to Europe; and 8 percent to North and South America.

Where OFWs work depends on gender, education, and the type of employment. Many men go to the Middle East for construction-, mining-, and oil-related jobs. Women tend to go to Southeast and East Asia for caretaking and domestic jobs. In North America, most Filipino migrants work in professional jobs, including as nurses, doctors, and as other types of healthcare workers.

What is the “typical” profile of an Overseas Filipino Worker?

It often depends on the type of job. Healthcare professionals, for example, tend to be younger because they go abroad directly after graduation. Most of the nursing schools in the Philippines are linked to hospitals in the United States or Europe.

In general, overseas workers range from recent graduates to the median working age, from approximately 20 to 45 years old. Because of the large fixed cost associated with temporary overseas employment, families that are better off or who have the means to raise funds are those that are able to send family members abroad.

Most OFWs come from Manila or the surrounding urban areas. In the study I conducted, only 17 percent of rural households could afford to send a family member abroad. Usually several village families will pool together their resources, with the informal agreement that they will be repaid.

On average, male migrant remittances equal twice the amount sent by female migrants, who more frequently work in unskilled positions. For example, a well-educated man working in the Middle East in the construction and transportation industries earns higher than a woman working in a domestic position in Singapore. Some OFWs are overqualified in terms of education, but because of economic opportunity they decide to work abroad.

Do remittances provide short- or long-term economic benefits for families?

The benefits are both short and long term. Remittances can provide immediate assistance as needed, such as rebuilding after a natural disaster. From a longer-term perspective, many remittances in the Philippines go toward education, which is a form of human capital investment. Many families also invest in real estate, buying houses and land, and they also purchase durable goods, such as cars and appliances.

How do remittances benefit the country’s economy?

After exports, foreign remittances are actually the second largest source of foreign reserves in the Philippines. In 2006, remittances ranked even higher than foreign direct investment in terms of percentage of GDP. Some scholars have conjectured that OFWs have helped close the gap between the poor and the wealthy in the Philippines by contributing to a growing middle class. This is why migrant workers are called the “new heroes.” They sacrifice a lot by working in what are often unfavorable conditions. Because of the system of helping their families, they are also helping the entire country.

In your research, you have also looked at how rural farmers cope with natural disasters. What motivated you to study this issue, and what have you found based on recent years?

Farmers are the poorest of the poor in the Philippines, and since the country is in the Pacific Ring of Fire it is frequently hit by natural disasters, including earthquakes, typhoons, and drought. Filipino farmers are very vulnerable because most cannot afford to install irrigation. Instead, they have to depend on rain and their crops are continually susceptible to changes in the weather. There is limited government assistance available to them, and they do not have any formal insurance. In addition, they cannot take out loans because they do not have the collateral. So, I have been looking at how they survive after a natural disaster. The only possible explanation is that they depend on their networks of family and friends.

I had expected to find that they also depend on their family members abroad, but I have discovered that very few have been able to send relatives abroad in the first place. So this cannot be considered a reliable source of support. Instead, they seem to mainly rely on family members who have migrated to Manila and other cities.

There is much more work to be done on this issue. Studying how rural residents survive is important given they have limited access to formal credit, capital, and insurance markets; and government aid and transfers may also be limited or non-existent.

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Overseas workers from the Philippines line up to register as absentee voters in Hong Kong. East Asia is a major destination for temporary migrant workers from the Philippines.
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"Old while not affluent" situation, together with an unsustainable high investment rate and high dependency on foreign trade, spurs hot debates on the challenges of a fast-aging population and the exploitation of the second demographic dividend in today’s China. Literature related to elderly health in countries other than China often starts with medical concepts and then dwells on economic issues, mainly focusing on socioeconomic, behavioral, and environmental factors and their effects on the health of the elderly. This article reviews economic research on these topics and then discusses possible implications for the economic analysis of aging China.

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Asia Health Policy Program working paper # 34
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