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Co-sponsored by the Center for South Asia, Stanford University

Human life expectancy improved more in the last 50 years than in the preceding 5000 years. Much of this recent progress arose from declines in childhood mortality, and most of this decline was due to scientific knowledge and technologies (defined widely as drugs, diagnostics, policies, strategies, and epidemiological knowledge). The dominant challenge of the 21st century is to apply scientific knowledge to reduce premature adult mortality, in particular from vascular and neoplastic disease but also from persistent infectious disease such as malaria. Reliable quantification of the causes of death is a key starting point for control of adult diseases, as shown by the early results from India's Million Death Study. Specific global attention is required to tobacco, as on current patterns there will be 1 billion deaths from smoking in the 21st century, as opposed to "only" 100 million deaths from smoking in the 20th century. Scientific research on adult mortality, paired with specific action, might well halve premature adult mortality worldwide in the next few decades.

Professor Prabhat Jha has been a key figure in epidemiology and economics of global health for the past decade. He is the University of Toronto Endowed Professor in Disease Control and Canada Research Chair at the Dalla Lana School of Public Health, and the founding Director of the Centre for Global Health Research at St. Michael's Hospital in Toronto. Professor Jha is a lead investigator of the Million Death Study in India, which quantifies the causes of premature mortality in over 1 million homes from 1997-2014 and which examines the contribution of key risk factors such as tobacco, alcohol, diet and environmental exposures. He is the author of several influential books on tobacco control, including two that helped enable a global treaty on tobacco control, now signed by over 160 countries.

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Prabhat Jha University of Toronto Endowed Professor in Disease Control and Canada Research Chair Speaker the Dalla Lana School of Public Health
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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

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Health Economics Review
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Yan Wang (former)
Karen Eggleston
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Nutrition, physical activity, smoking, and alcohol consumption are major causes of morbidity and mortality related to noncommunicable diseases (NCDs). Hypertension, diabetes type II, cancer, and chronic pulmonary diseases cause 60 percent of deaths worldwide and will likely increase by 17 percent during the next 10 years. Eighty percent of deaths caused by NCDs are registered in low- and middle-income countries in the working-age population and contribute to the growth of poverty [1,2,3].

During the last 15 years in Mongolia the leading causes of mortality have been cardiovascular disease and cancer.

This qualitative survey is one part of the Facility-Based Impact Study (FBIS) and was funded by the MCA Health Project. The overall goal of the MCA Health Project is to reduce mortality and morbidity caused by NCD and traffic accidents. Over a period of five years, the project aims to provide the population with essential knowledge about health promotion, the prevention and early detection of NCDs, and the adoption of healthy lifestyles through capacity building for the health system and, more specifically, for the preventive facilities. One main activity of the project is to improve primary health services related to NCDs through interventions for capacity building on the level of health facilities. This FBIS focuses on assessing the current situation in the facilities to enable a later comparison of the results of this baseline study and a later follow-up study to evaluate the impact of the Health Project on the performance of health staff, their knowledge, attitudes, and practice in the facilities, and the preparedness of facilities in terms of equipment and staff. The survey was carried out by a joint team of local and international consultants from the MCA Health Project, EPOS Health Management and THL Finland, and researchers from the School of Public Health.  

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Asia Health Policy Program working paper # 31
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China and some other Asian countries have experienced a large surplus of men of marriageable age. The existing literature studies the impact of sex imbalance using aggregate sex ratios, such as at the county, city, or province level. However, these studies may miss important impacts on health and behavior because the relevance of surplus sons to family decisions mainly stems from pressure conveyed through social interactions with the local reference group.

This paper draws from unique social network data, collected from households' long-term spontaneous gift exchange records (li dan), combined with household panel data from 18 Chinese villages to explore the prevalence of men's localized pressure to get married. The surveyed villages are home to Chinese ethnic minorities, which largely circumvents endogenous fertility decisions on the first-born child due to the implementation of One Child Policy and its associated relaxations afterwards. To identify the effect of pressure to find wives for their sons on parental risky behavior, we focus on comparing families with a first-born boy versus a first-born girl and distinguish the network spillover effect from the direct effect.

The spatial econometric decompositions suggest that the pressure mainly originates from a few friends with unmarried sons and unbalanced sex ratios in the friendship networks, though own village sex ratio and having an unmarried son also affects parental risk-taking behavior. The results are consistent across specifications allowing for long-run and short-run effects. We also find similar patterns for parental working hours, their likelihood to engage in entrepreneurial activities and decision to migrate. In contrast, parents with a daughter do not demonstrate this pattern. Since the sex ratio imbalance in China will probably worsen in the next decade, disentangling the real sources of marriage market pressure may help design policies to improve parental well-being.

Dr. Xi Chen's main research interests involve health economics and development economics in the developing contexts. He recently completed his PhD in applied economics at Cornell. His research seeks to better understand how social interactions affect health behavior and outcomes, how socioeconomic status drives social competition. Most of his current work draws on primary data from China and secondary data from India and Indonesia.

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Xi Chen Assistant Professor Speaker Department of Health Policy and Management Yale School of Public Health
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This research aims to better understand the impact of the Matlab health interventions by using panel data to control for unobservables and understand the dynamics and long-term effects of these programs. Heterogeneity in the fertility response to the family planning program is analyzed, using sequential fertility to isolate the family planning program from other interventions and examine heterogeneity based on time-varying characteristics. The link between childhood measles vaccination and school enrollment is examined using instrumental variables, and is motivated by the hypothesis that by avoiding the long-term health effects of a disease, vaccinated children are higher-achieving. Both analyses generate interesting findings that are not captured using the traditional methodologies and outcomes of program evaluation.

Julia Driessen, PhD, is an assistant professor of health policy and management in the Graduate School of Public Health at the University of Pittsburgh. She has a secondary appointment in the Department of Economics. In 2011 Dr. Driessen received her PhD in Economics from Johns Hopkins University. Her research interests include program evaluation and the links between health interventions and socioeconomic status, with an emphasis on heterogeneity of program effects as well as long-term outcomes. Recent research has analyzed the schooling effects of childhood measles vaccination and variation in the fertility response to a family planning program in Bangladesh. Her primary new interest since arriving at Pitt is the clinical and financial effects of electronic medical records in developing countries.

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Julia R. Driessen Assistant Professor of Health Policy and Management in the Graduate School of Public Health Speaker the University of Pittsburgh
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