The Republic of the Philippines began on the path to universal coverage with the passage of the National Health Insurance Act of 1995 (Republic Act 7875) which established the Philippine Health Insurance Corporation (PhilHealth) . Building on the Philippine Medicare program which began in 1971, PhilHealth has expanded coverage to more than 80% of the population with basic benefits, but accounts for only 10% of total health financing—wide population coverage with thin public benefits. An extensive system of private insurance provides additional benefits for high-income Filipino households. While the Philippines is pursuing a public insurance approach with private add-ons, Hawaii has mandated private employment-based coverage through the Pre-paid Health Care Act of 1974 and operates under a Congressionally granted ERISA exemption as well as an exemption from the Affordable Care Act of 2010. Combining the employer mandate with generous Medicaid and SCHIP programs, Hawaii has achieved a coverage rate exceeding 90% of the resident population with extensive benefit packages. The presenter will provide an overview of the two systems and present original research on the labor market effects and public insurance effects of the Hawaii system.

How will population aging impact the economies and social protection systems of Japan, South Korea, China, and India? This colloquium showcases research addressing that question by contributors to a new Shorenstein APARC book, Aging Asia, co-edited by Karen Eggleston and Shripad Tuljapurkar. Dr. Bloom discusses how aging of the baby boom generation, declines in fertility rates, and an increase in life expectancy imply several changes for the economies of the region. Notwithstanding the potential challenges, Bloom argues that population aging may have less of a negative effect on economic growth than some have predicted. Bloom will also discuss the longitudinal aging study in India.

David Bloom is Clarence James Gamble Professor of Economics and Demography at Harvard University, Chair of the Department of Global Health and Population at the Harvard School of Public Health, and Director of Harvard University’s Program on the Global Demography of Aging (funded by the National Institute of Aging). He is Research Associate at the National Bureau of Economic Research, where he serves as a member of three research programs: Labor Studies, Aging, and Health Economics. He co-chairs the Public Policy Committee of the American Foundation for AIDS Research. Bloom received a B.S. in Industrial and Labor Relations from Cornell University in 1976, an M.A. in Economics from Princeton University in 1978, and a Ph.D. in Economics and Demography from Princeton University in 1981.

The Chinese health care system has experienced profound changes like retrenchment of state financial support in the past decades. These changes have prompted the Chinese media and some academics to suggest that patients have a relatively low level of trust in physicians in today's China. In this colloquium, Dr. Tam reports the results of his survey of patient trust in physicians in Beijing's public hospitals. The survey was conducted by Horizon Research Group between November 2009 and January 2010, and 434 patients were interviewed.
 
The survey asked the respondents their degree of trust regarding the following three dimensions: physician agency, competence, and information provision. The survey finds a relatively high level of patient trust in physicians in Beijing public hospitals. Additionally, the survey data highlight three major determinants of patient trust in physicians, namely exposure to negative media reports about physicians and hospitals; the patient's self-assessed health status; and the patient’s level of education and income.
 
Waikeung Tam received his Ph.D. in political science at the University of Chicago in 2009. He is currently a Research Fellow at the LKY School of Public Policy at the National University of Singapore. His research focuses on public policy, political development, law and society, with special reference to China and Hong Kong. His research has been published in China Review, Asian Perspective, Journal of Contemporary Asia, and Law & Social Inquiry.

The talk will look at the short and longer-term implications of the tsunami for mortality and several other social and economic outcomes in Aceh and North Sumatra using data from the Study of the Tsunami Aftermath and Recovery.

Elizabeth Frankenberg is Professor of Public Policy, Director of Graduate Studies, MPP Program at Duke University. She earned her PhD in Demography and Sociology, University of Pennsylvania, Philadelphia, PA, 1992
M.P.A. Public Affairs, Woodrow Wilson School of Public and International Affairs, Princeton, NJ, 1989
BA with highest honors and distinction in Geography, University of North Carolina, Chapel Hill, NC, 1986.

The extent and existence of "defensive medicine" -- excessive medical care to defend a physician against malpractice claims -- is a perennial subject of both policy and academic debate.  For example, malpractice liability and associated defensive medicine are among the most-cited reasons for escalating health-care spending in the United States.

In this colloquium, Dr. Brian Chen will present results from his research investigating the extent of defensive medicine in Taiwan. He studies the impact of a series of court rulings in Taiwan that increased physicians’ liability risks, and a subsequent amendment to the law that reversed the courts’ rulings, on physicians’ test-ordering behavior and propensity to perform Caesarean sections.  He finds that physicians faced with higher malpractice pressure increased laboratory tests as expected, but unexpectedly reduced Caesarean sections.  (The reduction in Caesarean deliveries may be due to the fact that liability risks were more closely aligned with physicians’ standard of care after the court rulings.) After the law was amended to negate the court decisions, physicians reversed their previous behavior by reducing laboratory tests and increasing Caesarean deliveries.

This pattern of behavior is highly suggestive of the existence of defensive medicine among physicians in Taiwan. In other words, by studying physicians' response to legal changes in Taiwan, we find that greater malpractice liability may, under certain circumstances, prompt physicians to perform more services without necessarily improving patient health.

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.