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Society

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.

Disease Control and Big Data Platforms for Health Policy in China: Experiences from Zhejiang Province

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Co-sponsored by the Center for East Asian Studies and the Asia Health Policy Program

With rapid economic development, changes in lifestyle, epidemiologic transition and the ageing of the population, China’s primary health challenge has become Non-Communicable Diseases (NCDs). Zhejiang province—one of the wealthiest and longest-lived—illustrates how China is responding to this challenge. In Zhejiang, NCDs account for 85% of deaths; the prevalence of hypertension and diabetes are 26.7 % and 7.4%, respectively; and the age of onset of diabetes is getting progressively younger. This seminar will focus on two inter-related strategies: strengthening primary care management of chronic disease, and leveraging newly created regional “big data” platforms to improve policy. Drawing on collaborative research with Stanford’s Asia Health Policy Program, Dr. Zhong will discuss management of hypertension and diabetes patients in community health centers, as well as how Ningbo City of Zhejiang exemplifies the experience of many local governments (municipalities or counties) in building their own regional health information platforms. By gradually collecting all administrative data and other health-related information for their residents from birth to death, including medical claims, vaccination records, lifestyle behaviors, environmental and meteorological factors, and so on, more and more local policymakers seek to analyze big data to explore potential risk factors, pilot targeted interventions, and support evidence-based health policies.

zhong jieming
Zhong, Jieming graduated from the school of public health of Zhejiang University and received his master's degree in public health (MPH) from the Chinese Center for Disease Control and Prevention. He is the director of the Department of Non-communicable Disease (NCD) Control and Prevention in the Zhejiang CDC. He served as deputy director of the Department of Tuberculosis Control and Prevention in Zhejiang CDC during 2008-2014. He is a member of the Zhejiang Preventive Medicine Association and has engaged in and chaired several international cooperation and local research projects. He has in-depth research on NCDs and TB control and prevention, and has published over 30 scientific papers in related fields.

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Zhong Jieming Director of the Department of NCD Control and Prevention, Zhejiang CDC, China.
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Call for applications: 2018-19 Postdoctoral fellowship in contemporary Asia

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The Shorenstein Asia-Pacific Research Center (APARC) at Stanford is now accepting applications for the Shorenstein Postdoctoral Fellowship in Contemporary Asia, an opportunity made available to two junior scholars for research and writing on Asia.

Fellows conduct research on contemporary political, economic or social change in the Asia-Pacific region, and contribute to Shorenstein APARC’s publications, conferences and related activities. To read about this year’s fellows, please click here.

The fellowship is a 10-mo. appointment during the 2018-19 academic year, and carries a salary rate of $52,000 plus $2,000 for research expenses.

For further information and to apply, please click here. The application deadline is Dec. 20, 2017.

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Mortality In Rural China Declined As Health Insurance Coverage Increased, But No Evidence The Two Are Linked

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Health insurance holds the promise of improving population health and survival and protecting people from catastrophic health spending. Yet evidence from lower- and middle-income countries on the impact of health insurance is limited. We investigated whether insurance expansion reduced adult mortality in rural China, taking advantage of differences across Chinese counties in the timing of the introduction of the New Cooperative Medical Scheme (NCMS). We assembled and analyzed newly collected data on NCMS implementation, linked to data from the Chinese Center for Disease Control and Prevention on cause-specific, age-standardized death rates and variables specific to county-year combinations for seventy-two counties in the period 2004–12. While mortality rates declined among rural residents during this period, we found little evidence that the expansion of health insurance through the NCMS contributed to this decline. However, our relatively large standard errors leave open the possibility that the NCMS had effects on mortality that we could not detect. Moreover, mortality benefits might arise only after many years of accumulated coverage.

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Karen Eggleston

Call for papers: Workshop on inequality and ageing

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The Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center, in conjunction with The Next World Program, is soliciting papers for a workshop, “Inequality & Aging,” held at the University of Hohenheim from May 4-5, 2018. The workshop will result in a special issue of the Journal of the Economics of Ageing, and aims to address topics such as:

  • Population dynamics and income distribution
  • The evolution of inequality over time and with respect to age
  • Health inequality in old age
  • The effects of social security systems and pension schemes on inequality
  • Policies to cope with demographic challenges and the challenges posed by inequality
  • Family backgrounds and equality of opportunities
  • Demographically induced poverty traps
  • Effects of automation and the digital economy in ageing societies
  • Flexible working time and careers, and their long-term implications
  • The dynamics of inheritances, etc.

Researchers who seek to attend the workshop are invited to submit a full paper or at least a 1-page extended abstract directly to Klaus Prettner and Alfonso Sousa-Poza by Sept. 30, 2017.

Authors of accepted papers will be notified by the end of October and completed draft papers will be expected by Jan. 31, 2018. Economy airfare and accommodation will be provided to one author associated with each accepted paper. A selection of the presented papers will be published in the special issue; the best paper by an author below the age of 35 will receive an award and be made available online as a working paper.

Researchers who do not seek to attend the workshop are also invited to submit papers for the special issue. Those papers can be submitted directly online under “SI Inequality & Ageing” by May 31, 2018.

For complete details, please click on the link below to view the PDF.

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The Third Annual Forum on China’s Primary Healthcare Reform and Community Medical Services

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The 2017 Forum will feature a luncheon keynote address on “Primary Care in the Netherlands: Lessons for China” by Jeroen N. Struijs, Senior Researcher in the Department of Quality of Care and Health Economics, National Institute of Public Health and the Environment, The Netherlands. Additional prominent speakers include Dr. Huncheol Bryant Kim, Cornell University, US, speaking on health policy in South Korea; Dr. Bei Lu, University of New South Wales, Australia, speaking on China’s efforts to integrate long-term care with primary care--Experiences of Qingdao’s Long-term Care Insurance program; Dr. Xiaoyun Liu, Peking University, on China’s primary care workforce; Dr. Jiayan Huang, Fudan University, on a model of integrated care from southern China; and Dr. Qiulin Chen, China Academy of Social Sciences, speaking on “Strengthening China’s primary care: A view from Inner Mongolia.” In addition, select policymakers and providers will introduce China's overall healthcare system reforms as well as discuss challenges to strengthening primary care in China.

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Stanford Center at Peking University

Jeroen N. Struijs Senior Researcher in the Department of Quality of Care and Health Economics, National Institute of Public Health and the Environment, The Netherlands
Huncheol Bryant Kim Cornell University, US
Bei Lu University of New South Wales, Australia
Xiaoyun Liu Peking University, China
Qiulin Chen China Academy of Social Sciences, China
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Asia Health Policy Program holds trans-Asian conference on diabetes in Beijing

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Emily Tuong-Vi Nguyen, a Stanford student studying human biology, writes about the Asia Health Policy Program’s international conference on diabetes

The Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center hosted the Net Value in Diabetes Management Workshop in March to discuss progress on an international research collaboration. Research teams from Hong Kong, Singapore, China, Taiwan, South Korea and the United States convened at the Stanford Center at Peking University (SCPKU) in Beijing to work on research that compares utilization and spending patterns on diabetes across different countries and to develop a method for measuring the net value of diabetes internationally, based on previous methods discussed in a Eggleston and Newhouse et al. 2009 study with Mayo Clinic Data for Type 2 diabetes.

The research teams from various Asian countries are attempting to calculate the net value of diabetes in those countries by observing the changes in diabetes value and spending. These calculations include monetizing the value of health benefits of new treatments and improvements in health, as well as avoided spending on treatments when prevention was effective, and associated mortality and probability of survival. Previous models used to measure diabetic values and risks, such as the United Kingdom Prospective Diabetes Study (UKPDS) risk engine that was created from U.K. data and populations, are not very relevant for Asian populations. The goal is to create separate risk models specifically suited for populations from Hong Kong, Singapore, China, Taiwan and South Korea.

During the workshop that spanned two days, the research teams had an opportunity to share updates on their individual projects and to discuss methods and ideas for future collaboration.

On the first day, each research team presented its work, describing data sets and explaining the risk models that were used or developed. Karen Eggleston, director of the Asia Health Policy Program, delivered introductory remarks and shared current progress by the Japan and Netherlands research teams on calculating value and risk for diabetes with data from the Netherlands and Japan. The data sets from those two countries were best estimated by the JJ Risk Engine for the Japan data and the UKPDS model for the Netherlands data.

Chao Quan of the University of Hong Kong presented the risk model used for Hong Kong populations. His work primarily looked at how the UKPDS risk engine predicted risk in Hong Kong populations as compared to a local Hong Kong risk engine and how to best calibrate the Hong Kong risk engine. His next step will be to monetize the value for improved survival in diabetes in Hong Kong. He offered to re-estimate the model using the risk factors available on others’ datasets so that the Hong Kong risk model could potentially be used by other teams as well.

Stefan Ma and Zheng Li Yau of the Ministry of Health of Singapore discussed the 5-year prediction model and statistical methods they used for all-cause mortality of Singaporean individuals with diabetes. Their work is based on Singapore’s extensive administrative and claims data as well as data provided by the national health surveys conducted every six years by the National Health Service of Singapore. The researchers plan to look into how their overall risk model compares with models for specific subpopulations, such as Chinese, Malay and Indian populations in Singapore.

Katherine Hastings from the Stanford University team, led by principal investigator Latha Palaniappan, presented preliminary ideas about measuring cardiovascular risk with the Atherosclerotic Cardiovascular Disease Risk Score in analyses of Stanford health system diabetic patients. The researchers are collaborating with a clinical bioinformatics team at Stanford to use machine learning to expedite the analysis.

Min Yu and Haibin Wu of the Zhejiang Center for Disease Control and Prevention shared results from their analysis of health data collected from community health centers for diabetes management, diabetes surveillance data, cause of death data and insurance claims data that showed relationships between different patient characteristics and insurance types. The researchers then estimated the annual cost of Type 2 diabetes and its complications in Tongxiang province, China.

Hai Fang and Huyang Zhang of Peking University worked with claims data of diabetic patients insured by the New Cooperative Medical Scheme in Beijing, and at the workshop, shared regression analyses on the relationship between outpatient visits and inpatient admissions.

Jianqun Dong of the People’s Republic of China Center for Disease Control and Prevention presented ongoing research about diabetes management in China, including preliminary results of a randomized control trial of diabetes self-management strategies.

Wankyo Chung of Seoul National University shared preliminary estimates of a risk model for mortality among diabetic patients in South Korea and discussed next steps for estimating net value of diabetes management using the detailed clinical and claims data available in South Korea.

On the second day, the workshop concluded with a videoconference between workshop participants in Beijing and collaborators at Stanford Graduate Business School, including Stanford professor Latha Palaniappan and Harvard visiting professor Joseph P. Newhouse, using the Highly Immersive Classroom.

The workshop was a good opportunity for the research teams to discuss preliminary models, to offer each other suggestions regarding research methods, and to discuss the future direction of the international collaboration on the net value of diabetes. All research teams are preparing comparative research papers that will be included in the working paper series of the Asia Health Policy Program. A follow-up event will be held at Stanford in November 2017 in recognition of World Diabetes Day.

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A group of participants from the workshop, “Net Value in Diabetes Management,” at Stanford Center at Peking University, March 24, 2017, from left to right: Zheng Yi Lau from the Ministry of Health of Singapore; Chao Quan (University of Hong Kong); Jui-fen Rachel Lu (Chang Gung University); Emily Nguyen, Karen Eggleston, and Katie Hastings (Stanford); and Stefan Ma (Ministry of Health of Singapore).
Courtesy of Emily Tuong-Vi Nyugen
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Dual Practice of Public Hospital Physicians: Implications for Universal Health Coverage in Vietnam

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Vietnam has adopted a public-private mixed health service delivery system for 30 years to mobilize more resources for the health sector. Public hospital physicians are allowed to practice for the private sector outside official working hours; therefore, physician dual practice is very common. This paper investigates the characteristics and dynamics of the phenomenon, focusing on the choices of physicians about whether to engage in dual practice, as well as their performance in their public practice. The analysis is based on a survey at 10 public hospitals in Vietnam with 510 physicians. Half of public hospital physicians reported participating in at least one type of private practice. Personal characteristics (gender, age, position), private practice income, and clinical autonomy are the reasons for dual practice involvement. Dual practitioners spend more time overall in clinical practice than their non-dual-practice counterparts, but reduce the time for public practice to have more time for private practice. They are also more likely to refer public patients to private practice. Nevertheless physicians appear to still be committed to the public sector to enlarge their professional networking, participate in training opportunities, and fulfill their sense of public responsibility.

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Ngan Do is currently a postdoctoral fellow at the Walter H. Shorenstein Asia-Pacific Research Center, Stanford University. Prior to that, she worked as a Health Leadership Development Initiative fellow at the World Health Organization Western Pacific Regional Office. Her research focuses on comparative healthcare systems and health reforms in Asia; payment incentives; physicians’ behaviors, human resources for health, and the public-private partnership in the health sector. She experienced field-work in Cambodia, Lao PDR, Philippines, Korea, and Vietnam. Ngan achieved her Ph.D. degree in health policy and management at Seoul National University College of Medicine. She earned her master degree on public policy at the KDI School of Public Policy and Management, and her bachelor degree on international relations at the Diplomacy Academy of Vietnam.

 

Ngan Do Kim 2016-2017 Developing Asia Health Policy Postdoctoral Fellow 2016-2017 Developing Asia Health Policy Postdoctoral Fellow
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FINANCING LONGEVITY: The Economics of Pensions, Health, Long-term Care and Disability Insurance

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The Asia Health Policy Program at Stanford’s Shorenstein Asia-Pacific Research Center (APARC), in collaboration with scholars from Stanford Health Policy's Center on Demography and Economics of Health and Aging, the Stanford Institute for Economic Policy Research, and the Next World Program, is holding its third annual conference on the economics of ageing. The conference is one of several activities planned in 2017 to mark the 10th anniversary of the Asia Health Policy Program.

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. High-income countries offer lessons – frequently cautionary tales – for low- and middle-income countries about how to design social protection programs to be sustainable in the face of population ageing. Technological change and income inequality interact with population ageing to threaten the sustainability and perceived fairness of conventional financing for many social programs. Promoting longer working lives and savings for retirement are obvious policy priorities; but in many cases the fiscal challenges are even more acute for other social programs, such as insurance systems for medical care, long-term care, and disability. Reform of entitlement programs is also often politically difficult, further highlighting how important it is for developing countries putting in place comprehensive social security systems to take account of the macroeconomic implications of population ageing.

The objective of the conference is to explore the economics of ageing from the perspective of sustainable financing for longer lives. The conference will bring together researchers to present recent empirical and theoretical research on a range of topics in this area.

The first full day of the conference – April 24 – is open to the public. The lunchtime keynote speech on the second day of the conference – April 25 – is also open to the public; the remaining portions of that day are reserved for panelists only to encourage candid conversation in a closed-door setting.

Conference Agenda

April 24

7:45                             Breakfast

8:25                             Welcome         Gi-Wook Shin, Stanford University

                                                           Karen Eggleston, Stanford University

 

Session I: Long-term Care and Intergenerational Support

Chair: Gopi Shah Goda, Stanford University

8:30 – 9:30                   “Housing Assets and Access to Long Term Care Services and Supports: Evidence from the Housing Bubble Burst”

                                                            Richard Frank, Harvard University

                                                            Discussant: Tom Davidoff, University of British Columbia

9:30 – 10:30               “The Demand for Long-Term Care Insurance in Canada”

                                                            Pierre-Carl Michaud, HEC Montréal and RAND

                                                            Discussant: Chris Tonetti, Stanford Graduate School of Business

10:30 – 10:45              Coffee break

10:45 – 11:45             “The Price of the East Asian Miracle: Generational Cultural Shift and Elderly Suicide”

                                                            Hyejin Ku, University College London

                                                            Discussant: Hongbin Li, Tsinghua University and Stanford University

Session II:

Co-Chairs: John Shoven and Karen Eggleston, Stanford University

11:45 – 13:45              Lunch

Keynote panel: "The policy challenges of financing longevity: Perspectives from Japan and the US"

Hirotaka Unami, Senior Director for Policy Planning and Research, Minister's Secretariat, Ministry of Finance, Japan

Olivia S. Mitchell, International Foundation of Employee Benefit Plans Professor, as well as Professor of Insurance/Risk Management and Business Economics/Policy, Wharton School, University of Pennsylvania

Session III: Financial Planning and Health

Chair: David Canning, Harvard University

14:00 – 15:00              “Cognitive Decline and Household Financial Outcomes at Older Ages”

                                                            Marco Angrisani, University of Southern California

                                                            Discussant: Kathleen McGarry, UCLA

15:00 – 15:15              Break

15:15 – 16:15             “From Compression to Expansion of Morbidity: Upcoming Challenges for Health Care and Long Term Care in China”

                                                            Bei Lu, University of New South Wales

                        Discussant: Wang Feng, Fudan University and UC Irvine

16:40                           Closing

 

Apri1 25

11:45 – 13:00              Lunch

                                    Policy challenges of financing longevity: Perspectives from Singapore

Kelvin Bryan Tan, Ministry of Health, Singapore

 

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Financial Protection in Health: Alternative Framework and Evidence from Vietnam

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The venue of this event has been moved to the Okimoto Conference room.

Dr. Ruger, a leading scholar of global and domestic health policy and public health, will speak about global and national health inequities, drawing from her research in Asia --including India, Indonesia, Malaysia, South Korea, Vietnam -- and Africa. With training in political economy, health policy, international relations, comparative social research and law, Dr. Ruger crosses disciplines to reexamine the principles and values that underlie health policy and public health and apply these principles empirically.  She created the health capability paradigm, challenging existing approaches and illuminating optimal health policies and she has developed an empirical approach to evaluate public health programs and health policies as they measure up to that paradigm.  Dr. Ruger’s scholarship has critically scrutinized the existing global health architecture in order to identify more effective global health policy responses linking public policy and law to global health theory at the global and national levels.  Dr. Ruger studies critical health policy and public health problems such as the equity and efficiency of health system access, financing, resource allocation, policy reform and the social determinants of health.  Her forthcoming book, Global Health Justice and Governance (OUP, in press), advances a theory of global health justice and governance called provincial globalism.

jennifer prah ruger
Dr. Ruger received a bachelor’s degree in the honors program in political economy from the University of California-Berkeley, master’s degrees from Oxford University, the Fletcher School of Law and Diplomacy and Yale University, a doctoral degree from Harvard University, and completed a post-doctoral fellowship at Harvard's Center for Population and Development. Dr. Ruger has authored over 100 publications and is internationally recognized for her leadership and work, which has been cited by the United Nations, World Bank, World Health Organization and United States Government.  She has been Principal Investigator and Co-Investigator on awards from the National Institutes of Health, Fogarty International Center, Hewlett Foundation, Henry J. Kaiser Family Foundation and she was awarded a Guggenheim Fellowship to complete Global Health Justice and Governance (OUP, in press).

Other papers:

1. Coping with Health Care Expenses Among Poor Households: Evidence from a Rural Commune in Vietnam: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1435832

2. Impact of Health Insurance on Health Care Treatment and Cost in Vietnam: A Health Capability Approach to Financial Protection: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1515733

3. Effect of Health Expenses on Household Capabilities and Resource Allocation in a Rural Commune in Vietnam: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1435820

4. The Changing Donor Landscape in Health Sector Aid to Vietnam: A Qualitative Case Study: http://www.sciencedirect.com/science/article/pii/S0277953615001719

5. An Alternative Framework for Analyzing Financial Protection in Health: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2139693

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Jennifer Prah Ruger Amartya Sen Professor of Health Equity, Economics, and Policy, School of Social Policy and Practice, University of Pennsylvania
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