FSI researchers work to understand continuity and change in societies as they confront their problems and opportunities. This includes the implications of migration and human trafficking. What happens to a society when young girls exit the sex trade? How do groups moving between locations impact societies, economies, self-identity and citizenship? What are the ethnic challenges faced by an increasingly diverse European Union? From a policy perspective, scholars also work to investigate the consequences of security-related measures for society and its values.
The Europe Center reflects much of FSI’s agenda of investigating societies, serving as a forum for experts to research the cultures, religions and people of Europe. The Center sponsors several seminars and lectures, as well as visiting scholars.
Societal research also addresses issues of demography and aging, such as the social and economic challenges of providing health care for an aging population. How do older adults make decisions, and what societal tools need to be in place to ensure the resulting decisions are well-informed? FSI regularly brings in international scholars to look at these issues. They discuss how adults care for their older parents in rural China as well as the economic aspects of aging populations in China and India.
Contracting with Private Providers for Primary Care Services: Evidence from Urban China
Controversy surrounds the role of the private sector in health service delivery, including primary care and population health services. China’s recent health reforms call for non-discrimination against private providers and emphasize strengthening primary care, but formal contracting-out initiatives remain few, and the associated empirical evidence is very limited. This paper presents a case study of contracting with private providers for urban primary and preventive health services in Shandong Province, China. The case study draws on three primary sources of data: administrative records; a household survey of over 1600 community residents in Weifang and City Y; and a provider survey of over 1000 staff at community health stations (CHS) in both Weifang and City Y. We supplement the quantitative data with one-on-one, in-depth interviews with key informants, including local officials in charge of public health and government finance.
We find significant differences in patient mix: Residents in the communities served by private community health stations are of lower socioeconomic status (more likely to be uninsured and to report poor health), compared to residents in communities served by a government-owned CHS. Analysis of a household survey of 1013 residents shows that they are more willing to do a routine health exam at their neighborhood CHS if they are of low socioeconomic status (as measured either by education or income). Government and private community health stations in Weifang did not statistically differ in their performance on contracted dimensions, after controlling for size and other CHS characteristics. In contrast, the comparison City Y had lower performance and a large gap between public and private providers. We discuss why these patterns arose and what policymakers and residents considered to be the main issues and concerns regarding primary care services.
Keywords:
Private providers; Contracting; Ownership; Primary care; Prevention; China
Shorenstein APARC Center Overview 2011-2012
Shorenstein APARC overviews provide detailed information about the Center's mission, history, faculty, financial support, organizational structure, projects, and programs.
Economic Aspects of Population Aging in China and India
China and India are, by far, the two most populous countries in the world. As a result of declining fertility, increasing life expectancy, and the progression of large cohorts to the older ages, both of them, like all other countries, have aging populations. However, China’s total fertility rate began to fall much earlier and faster than India’s, and its life expectancy began to rise much earlier. As a result, China is aging rapidly, with the ratio of working-age to dependent population set to decline. In India, the ratio is still rising.
For a variety of reasons that encompass but also extend beyond demographic factors, both countries have experienced rapid economic growth, though China’s rate has been much higher than India’s. With the two populations aging at different rates, the relative economic growth paths of the two countries may also change.
This conference features research papers addressing the economic determinants or consequences of population aging in China or India. Some focus on China or India; some compare the two. A lunchtime panel will feature roundtable discussion of invited researchers.
The conference is sponsored by the Program on the Global Demography of Aging, the South Asia Initiative, the Asia Center, the Harvard-Yenching Institute, the Harvard China Fund, and the Weatherhead Center for International Affairs (all at Harvard University), and the Walter H. Shorenstein Asia-Pacific Research Center (at Stanford University).
Bechtel Conference Center
The Impact of Water Quality on Health and Youth Education in Rural China
Providing people with safe drinking water is one of the most important health-related infrastructure programs in the world. The first part of our research investigates the effect of a major water quality improvement program in rural China on the health of adults and children. Using panel data covering about 4500 households from 1989 to 2006, we estimate the impact of introducing village-level access to water from water plants on various measures of health. The regression results imply that the illness incidence of adults decreased by 11 percent and their weight-for-height increased by 0.835 kg/m, and that children's weight-for-height and height itself both rose by 0.446 kg/m and 0.962 cm respectively, as a result of the program. And these estimates are quite stable across different robustness checks.
While the previous research has shown health benefit of safe drinking water program, we know little about the longer-term benefits such as education. The second part of our research examines the youth education benefits of this major drinking water infrastructure program. By employing a longitudinal dataset with around 12,000 individual observations aged between 16 and 25, we find that this health program has benefited their education substantially: increasing the grades of education completed by 0.9 years and their probabilities of graduating from a lower and upper middle schools by around 18 and 89 percent, respectively. These estimation results are robust to a host of robustness checks, such as controlling for educational policy and local resources (by including county-year fixed effects), village distance to schools, local labor market conditions, educational demand, instrumenting the water treatment dummy with topographic variables, among others. Our estimates suggest that this program is highly cost-effective.
Jing Zhang, an assistant professor, received her PhD from the University of Maryland in 2011, and joined Renmin University of China in the same year. Prior to that, she worked at the World Bank from 2010 to 2011. The focus of her research lies in health economics and public finance. Her publications include: “The Impact of Water Quality on Health: Evidence from the Drinking Water Infrastructure Program in Rural China,” Journal of Health Economics (2012) and “Soft Budget Constraints in China: Evidence from the Guangdong Hospital Industry,” International Journal of Healthcare Finance and Economics (2009).
Philippines Conference Room
Health and Aging in Japan
Professor Hidehiko Ichimura of the University of Tokyo will share recent results from his research on the health of older adults and the retirement process in Japan. His research draws upon a unique data source, the Japanese Study of Aging and Retirement (JSTAR). This rich dataset provides information on how middle-aged and elderly Japanese live in terms of economic, social, and health outcomes, and how these interact with their family status. The JSTAR project aims to provide longitudinal data enabling detailed policy-relevant comparisons to other industrialized countries (e.g. the Survey on Health, Aging and Retirement in Europe, the U.S. Health and Retirement Study, the English Longitudinal Study on Aging, and similar surveys now launched in Korea, China, and India).
Professor Ichimura received his BA in economics from Osaka University in 1981 and his PhD in economics for the Massachusetts Institute of Technology in 1988. He has taught at the University of Minnesota, the University of Pittsburgh, and University College London. He is currently a professor in the Graduate School of Public Policy and Graduate School of Economics at the University of Tokyo.
Philippines Conference Room