The Asia Health Policy Program is part of the Walter H. Shorenstein Asia-Pacific Research Center
FSI researchers strive to understand how countries relate to one another, and what policies are needed to achieve global stability and prosperity. International relations experts focus on the challenging U.S.-Russian relationship, the alliance between the U.S. and Japan and the limitations of America’s counterinsurgency strategy in Afghanistan.
Foreign aid is also examined by scholars trying to understand whether money earmarked for health improvements reaches those who need it most. And FSI’s Walter H. Shorenstein Asia-Pacific Research Center has published on the need for strong South Korean leadership in dealing with its northern neighbor.
FSI researchers also look at the citizens who drive international relations, studying the effects of migration and how borders shape people’s lives. Meanwhile FSI students are very much involved in this area, working with the United Nations in Ethiopia to rethink refugee communities.
Trade is also a key component of international relations, with FSI approaching the topic from a slew of angles and states. The economy of trade is rife for study, with an APARC event on the implications of more open trade policies in Japan, and FSI researchers making sense of who would benefit from a free trade zone between the European Union and the United States.
Launched in January 2011, Comparative Policy Responses to Demographic Change in East Asia is a three-year research initiative at the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC). It examines the rapid demographic changes that are profoundly shaping the political, economic, and social landscape of the Asia-Pacific region.
The results of my research [on HIV/AIDS intervention programs in China] have led to improvements in the…programs that were studied, and potentially will lead to broader change as I write up my research for publication. My research experience showed me the rewarding impact of public policy analysis on the quality and scope of health services. As a result, I decided to pursue a master’s in public policy at Stanford.
-Crystal Zheng, MA student, Public Policy Program
As an undergraduate student majoring in East Asian studies, Crystal Zheng spent two summers conducting extensive HIV/AIDS-related field research in China’s Yunnan province and Shenzhen special economic zone. Zheng worked closely with primary thesis advisor Karen Eggleston, director of the Asia Health Policy Program (AHPP) at the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC). In the end, the project shaped the direction of her future academic and professional interests as well as contributed to potentially far-reaching program improvements for a key health policy challenge in China.
In the short time since its 2007 founding, AHPP has empowered the research of numerous Stanford University students like Zheng—emerging scholars, researchers, and thought leaders—through its teaching and mentoring activities. The program promotes the comparative study of health and health policy across the Asia-Pacific region, and its work with students closely accords with Shorenstein APARC’s commitment to training the next generation of scholars. In keeping with the interdisciplinary nature of scholarship at Shorenstein APARC, students who tap into AHPP’s resources come from a wide variety of academic backgrounds.
The six undergraduate and graduate students profiled here have conducted or are in the process of carrying out timely, innovative research focusing on various aspects of healthcare and health policy in China. Depending on the context of their research, many students—such as Zheng, who received a Chappell Lougee Scholarship and a Major Grant through the Vice Provost for Undergraduate Education (VPUE)—have found Stanford-based funding in the form of research assistantships, grants, and scholarships. Several have also conducted substantial field research in China—even without prior Chinese-language training. In many cases, the research has proved life changing—one student was so inspired that she entirely switched the focus of her graduate studies.
It has been a true privilege to work with these students—their enthusiasm, quick learning, and productive research on their chosen topics make them a pleasure to mentor.”
-Karen Eggleston, Director, AHPP
Amy Chen, a human biology major and a 2011 Newman Civic Fellow Award recipient, will spend the summer surveying and conducting interviews with medical staff and students at Shandong Provincial Hospital to understand hospital worker attitudes about organ donation and transplantation in China. She received a Chappell Lougee Scholarship and a supplementary grant from the Center for East Asian Studies (CEAS) in support of her research activities. Eggleston, who is serving as Chen’s advisor for the project, helped connect Chen with colleagues at Shandong University who will work with her throughout the summer. “I came to her [Eggleston] with a passion and a genuine interest in learning more about organ transplantation,” says Chen, “but through her guidance I was really able to narrow down my interests...” Chen hopes to one day establish a workplace-based organ donation education program in China and has already started developing a future action plan for it.
Overcoming a potentially challenging language barrier, human biology major Monica Jeong successfully conducted diabetes-related research at Shandong Provincial Hospital. A recipient of a Major Grant, Jeong worked closely with her advisor Eggleston. She credits her honors research project with enriching her current work as a clinical research coordinator with the Department of Psychiatry and Behavioral Sciences. “I feel a lot more at ease interviewing patients,” she notes. “Furthermore, understanding the barriers that patients might face in seeking healthcare has made me a better-informed and more sensitive person when encountering patients at the Stanford Cancer Center.”
While studying the link between improved education enrollment and decreased mortality in Mao-era China as an AHPP research assistant, Jing Li, a former School of Education graduate student, developed a strong interest in health economics and policy analysis. “I am intrigued by the intuitiveness in quantifying relationships in health studies, as well as the crucial role of government in shaping health development using policy tools,” she says. This fall, Li will begin a doctoral program in health services and policy analysis at the University of California, Berkeley, where she plans to focus on health insurance policy, finance mechanisms, and payment systems in China. Li is particularly concerned with issues of inefficiency and inequality in healthcare policy.
Kelvin Bryan Tan, a doctoral student in the Department of Management Science and Engineering, gained a significant understanding of China’s healthcare system through the course “Healthcare in East Asia” taught by Eggleston. It led him to conduct a study to discover the optimal mix of different types of financing in medical savings-based healthcare financing systems, with a focus on Singapore and China. Eggleston worked closely with Tan, providing him with additional theoretical and background information. “This research project is likely to form a substantial part of my dissertation,” states Tan.
Anthony Vasquez, an East Asian studies master’s student, was inspired in a class taught by Eggleston to write a research paper about blindness prevention care in China, especially the role international non-governmental organizations (NGOs) play in providing this type of care in rural areas. In his research, Vasquez utilized a combination of academic literature and a study of NGOs currently operating in China. “By conducting this research,” he says, “I became more informed about the challenges that China faces in providing universal healthcare coverage, which is the government’s goal.” Although his MA thesis will focus on a different topic, Vasquez plans to stay closely connected to developments in China’s healthcare system.
Through her thesis research, Rachel Zimet Strick, a joint East Asian studies-business administration master’s student, examined the conditions for producing high-quality pharmaceuticals within China’s current market-based socialist economy. Eggleston served as her primary advisor, providing valuable guidance on her source materials and methodology, which combined economic modeling and theory, challenging field research, and primary and secondary source materials. Zimet, who now works for Abbott Laboratories as a member of its Management Development Program, credits her research with providing her with key skills that she utilizes in her work today. “[It] allowed me to demonstrate to Abbott…my ability to think deeply about the Chinese market…and to identify key market and non-market forces that would affect our business in any international environment,” she states.
AHPP welcomes inquiries from current and prospective students with an interest in issues surrounding healthcare and health policy in the Asia-Pacific region, and looks forward to continuing to help guide and inspire students for many years to come.
“Stanford attracts a diverse group of intellectually engaged students with a passion for research that can inform policy and improve lives,” says Eggleston. “AHPP strives to support those students interested in health and medical care across the Asia-Pacific, from freshmen to advanced grad students across a broad range of disciplines, to create a community of like-minded scholars and push boundaries. Our own research and policy outreach benefit tremendously from the synergies that result.”
More information about undergraduate and graduate research funding opportunities at Stanford is available at the AHPP, VPUE, CEAS, and Global Gateway websites.
The breadth of [Shorenstein] APARC's work is truly impressive... I look forward to making full use of the resources and opportunities afforded me through the visiting fellowship.
-Dr. Siyan Yi
How can Stanford University contribute to improved health policy in the low-income countries of Asia? In addition to our formal degree-granting and research programs, mentorship of young scholars can play a role in strengthening the evidence base and analytic skills undergirding health policy for the millions of Asians who live on only a few dollars a day.
The Asia Health Policy Program (AHPP) is delighted to announce the inauguration of a fellowship program for young health policy experts from developing countries in Asia. The first Developing Asia Health Policy Fellow will be Dr. Siyan Yi from Cambodia. He holds a medical doctor degree from the University of Health Sciences in Cambodia as well as a doctoral degree in international health sciences from the Graduate School of Medicine at the University of Tokyo. Dr. Karen Eggleston, director of AHPP, will be his primary sponsoring faculty member.
Dr. Yi's research has centered largely on epidemiological methods. This has included, for example, work on surveys in Cambodia on adolescent risky sexual behaviors, substance abuse, and depression; a health promotion project in primary schools; sexual behaviors among people living with HIV/AIDS; and HIV risk behaviors among tuberculosis patients. Currently, he is involved in hospital- and community-based research projects in several developing countries as well as in Japan.
Cambodia has recently created a School of Public Health and is facing an increasing burden of chronic disease, while the burden from infectious diseases such as tuberculosis remains significant. Since Dr. Yi's research interests lie in health promotion and risky behaviors, he could someday be instrumental in helping to set policies to address the public health challenges Cambodia will face.
Dr. Yi will join the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) in autumn 2011 for a nine-month fellowship to immerse in the academic environment and to develop additional skills to contribute to improved health policy in Cambodia. He notes that "the breadth of [Shorenstein] APARC's work is truly impressive... I look forward to making full use of the resources and opportunities afforded me through the visiting fellowship."
Dr. Brian Chen's research has examined the tradeoffs between moral hazard and efficiencies in the integration of physician and non-physician medical services in the presence of asymmetric information. He has looked at a policy intervention in Taiwan that prohibited self-referrals of patients to physician-owned pharmacies unless the physician group integrated pharmacy services into the clinic by hiring an onsite pharmacist. He found that the policy reduced drug expenditures by close to thirty percent among physicians that did not have an onsite pharmacist. However, these physicians responded by increasing the overprovision of diagnostic services not covered by the policy, thereby reducing the effectiveness of the policy. Forty-five percent of the clinics that did not have an onsite pharmacist prior to the policy hired one subsequent to the implementation of the policy. Overall, after integration, the policy applied to only seventeen percent of clinics, and only reduced average discretionary expenditures by about two-point-five percent. Chen's research also shows that despite the reduction in drug utilization, patients treated at clinics without an onsite pharmacist did not have greater observable adverse health events than patients treated at integrated clinics. His results show that moral hazard costs of self-referral incentives are large, that the “safe harbor” exemption severely reduces the effectiveness of the policy, and that the exemption explains much of the recent integration of ancillary services into physician offices.
Dr. Brian Chen recently completed his Ph.D. in business administration in the Business and Public Policy Group at the Haas School of Business, University of California at Berkeley. He received a Juris Doctor from Stanford Law School in 1997, and graduated summa cum laude from Harvard College in 1992.
Daniel and Nancy Okimoto Conference Room
Shorenstein APARC
Stanford University
Encina Hall, Room E-301
Stanford, CA 94305-6055
Dr. Brian Chen is currently a visiting scholar with the Asia Health Policy Program and Center for East Asian Studies at Stanford University. He was recently Shorenstein Asia-Pacific Research Center's 2009-2010 postdoctoral fellow in Comparative Health Policy. As a visiting scholar, Dr. Chen will conduct collaborative research about health of the elderly and chronic disease in China.
As an applied economist, Chen’s research focuses on the impact of incentives in health care organizations on provider and patient behavior. For his dissertation, Chen empirically examined how vertical integration and prohibition against self-referrals affected physician prescribing behavior. His job market paper was selected for presentation at the American Law and Economics Association’s Annual Meeting, the Academy of Management, the Canadian Law and Economics Association, the Conference on Empirical Legal Studies, and the First Annual Conference on Empirical Health Law and Policy at Georgetown Law Center in 2009. The paper was also nominated for best paper based on a dissertation at the Academy of Management.
Chen comes to the Shorenstein Asia-Pacific Research Center not only with a multidisciplinary law and economics background, but also with an international perspective from having lived and worked in Taiwan, Japan, and France. He has a particularly intimate knowledge of the Taiwanese health care system from his experience as an assistant to the hospital administrator at a medical college in Taiwan.
During his past residence as a postdoctoral fellow with the Asia Health Policy Program, Chen conducted empirical research on cost containment policies in Taiwan and Japan and how those policies impacted provider behavior. His work also contributed to the program’s research activities on comparative health systems and health service delivery in the Asia-Pacific, a theme that encompasses the historical evolution of health policies; the role of the private sector and public-private partnerships; payment incentives and their impact on patients and providers; organizational innovation, contracting, and soft budget constraints; and chronic disease management and service coordination for aging populations.
Dr. Brian Chen recently completed his Ph.D. in Business Administration in the Business and Public Policy Group at the Haas School of Business, University of California at Berkeley. He received a Juris Doctor from Stanford Law School in 1997, and graduated summa cum laude from Harvard College in 1992.
This colloquium will feature presentations by two visiting scholars from China. First, Dr. Huijun Liu will present research on health risks associated with gender imbalance in China. The problems of abnormal sex ratio at birth and high female infant mortality have plagued many Asian countries with a strong male preference and gender inequality. In China, these problems having lasted for more than twenty years and contributed to a serious gender imbalance in the population. As a direct consequence, “surplus men” or “forced bachelors,” are expected to increase to more than 30 million. Dr. Liu will discuss the potential health risks and other social problems likely to be exacerbated by this large-scale gender imbalance in China.
Second, Dr. Dahai Zhao will present “How Is Health Insurance Coverage Utilized among Migrant Workers in Shanghai, China?” According to the regulations of the Chinese national and Shanghai municipal governments, migrant workers employed in Shanghai should all be entitled to the Shanghai Migrant Worker Hospitalization Insurance (SMWHI) without premium and the vast majority should also have coverage through the New Rural Cooperative Medical System (NRCMS). Dr. Zhao will present results from research, conducted jointly with Dr. Wei Yu and Dr. Alan M. Garber, examining the status of the coverage and utilization of health insurance among migrant workers employed in Shanghai. Through their study, they found that a significant minority of migrant workers in Shanghai still had no health insurance, and that health insurance utilization among migrant workers was strongly limited by hospital location.
Huijun Liu is an associate professor in the Public Policy and Administration School at Xi'an Jiaotong University, China. She received her PhD in management science and engineering from the Management School of Xi'an Jiaotong University. Her main areas of research focus on gender imbalance, reproductive health, vulnerability, and social support. Her current research focuses on how gender imbalance and migration amplify the risk of HIV transmission in China. Liu has published over twenty papers in Chinese academic journals, including China Soft Science, Population and Economics, Psychological Science Advance, Collection of Women's Studies, and Modern Preventive Medicine.
Dr. Zhao is an assistant professor with the School of Public Economics and Administration at Shanghai University of Finance and Economics (SUFE), and a fellow with the Center for Health Policy at SUFE. He earned a master's degree in medicine in 2005 and a PhD in 2008, both from Fudan University, China.
Daniel and Nancy Okimoto Conference Room
Shorenstein APARC
Stanford University
Encina Hall, Room E301
Stanford, CA 94305-6055
Huijun Liu is an associate professor in the Public Policy and Administration School, Xi'an Jiaotong University, China. She received her PhD in management science and engineering from Management School of Xi'an Jiaotong University. Her main areas of research focuses on gender imbalance, reproductive health, vulnerability and social support. Her current research focuses on how gender imbalance and migration amplify the risk of HIV transmission in Chinese transformation society.
Liu has published over twenty papers in Chinese academic journals, which was featured in China Soft Science, Population & Economics, Psychological Science Advance, Collection of Women's Studies and Modern Preventive Medicine.
East Asia's demographic landscape is rapidly changing and comparative academic research is crucial to help guide well-informed decisions in the many policy areas that are affected, such as security, economics, and immigration. From January 20 to 21, the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) gathered subject experts from numerous fields for two days of lively and productive presentations and dialogue to help identify key research issues and questions for its new, three-year research initiative on this significant subject.
Shorenstein APARC held a public panel discussion on January 20, featuring eight scholars from across the United States and Asia. The issue of aging featured prominently in their presentations, as did fertility rates and immigration. A full audio recording of the panel discussion is available on the Shorenstein APARC website and summaries of the presentations follow below. A closed-session workshop took place the next day, the discussions from which will serve as the foundation for future programs and publications related to the research initiative.
January 20 Panel Discussion Presentations
The link between demography and security is more tenuous in East Asia than in other parts of the world, suggested Brian Nichiporuk, a political scientist with the RAND Corporation. Nichiporuk discussed possible policy responses to demographic change in Japan, North and South Korea, the Russian Federation, and China. He suggested, for example, that Japan's new maritime security focus is related to perceived economic and political competition from China, which is magnified by its domestic demographic concerns.
Michael Sutton, a visiting fellow with the East-West Center in Washington, DC, stated that Japan's aging population would remain a major policy issue for the next 20–30 years. He emphasized that the policy challenges posed by this phenomena are complicated by the role that the United States plays in the regional security structure, and also by the growing dominance of China and the history that it shares with Japan. Nonetheless, maintained Sutton, despite the obvious challenges, it is possible for Japan and the other countries facing this demographic issue to successfully adapt.
Social attitudes and policy in East Asia do not favor immigration, as they do in European countries such as Spain and Italy, suggested John Skrentny, director of the Center for Comparative Immigration Studies at the University of California, San Diego. Skrentny focused his talk on low-skill immigrant workers in South Korea and Japan, noting that these two countries, which began receiving workers in the 1970s and 1980s, commonly associate immigrants with social disruption. According to Skrentny, immigration policy is often tied to economics and tends to favor co-ethnic workers.
Chong-En Bai, chair of the Department of Economics at Tsinghua University, discussed numerous economic policy implications and responses related to demographic change in China. He noted areas where successful policies have been adopted but challenges still remain, including savings and investment, labor and urbanization, pension, healthcare, and long-term care. Bai described, for example, how the children of rural migrants now have access to urban schools, but that they still face the logistical challenge of having to travel back to their home provinces to take college entrance examinations.
Examining demographic change and health improvements is essential to understanding the significant economic growth in East Asia over the past several decades, emphasized David Bloom, chair of the Department of Global Health and Population at Harvard University. He noted the success of East Asian countries in lowering their infant mortality rates through investment in public health improvements, such as sanitation and vaccination. Bloom suggested that these and other past successful policy mechanisms have run their course, and that it is now imperative to find ways to address the region's key demographic issue of aging.
Naohiro Ogawa, director of the Population Research Institute at Nihon University, described findings from the National Transfer Accounts (NTA) project, an international effort to gauge economic flows across age groups. He discussed the pressure placed on Japan's working-age population by the increasing cost of caring for children and the elderly, as well as the challenges and possibilities related to having a large, healthy, aging population. Ogawa noted that institutional responses to demographic change, such as increasing the retirement age and adopting more open immigration policy, have moved slowly in Japan.
Andrew Mason, a professor of economics at the University of Hawai'i, Manoa, also utilized NTA data to make predictions about East Asia's economic future. He proposed that the amount of human capital, such as the money that parents spend on the education of their children, is likely to grow quite rapidly. He also suggested that financial wealth in East Asia is likely to increase significantly as the populations of its countries age. Finally, he suggested that the current trend of regional economic growth would continue, although at a somewhat steadier rate. Mason qualified his predictions with questions, such as whether the return on investment in education would be commensurate with what is spent.
James Raymo, a professor of sociology at the University of Wisconsin-Madison, described a wide array of findings about changes in fertility and family structure in Japan and their connections, as well as possible policy implications. Raymo discussed trends in marriage, childbearing, divorce, non-marital cohabitation, and the participation of women in the labor force. He pointed to gaps in current research, and suggested possible linkages to research on other demographic trends, such as Japan's aging population.
