International Development

FSI researchers consider international development from a variety of angles. They analyze ideas such as how public action and good governance are cornerstones of economic prosperity in Mexico and how investments in high school education will improve China’s economy.

They are looking at novel technological interventions to improve rural livelihoods, like the development implications of solar power-generated crop growing in Northern Benin.

FSI academics also assess which political processes yield better access to public services, particularly in developing countries. With a focus on health care, researchers have studied the political incentives to embrace UNICEF’s child survival efforts and how a well-run anti-alcohol policy in Russia affected mortality rates.

FSI’s work on international development also includes training the next generation of leaders through pre- and post-doctoral fellowships as well as the Draper Hills Summer Fellows Program.

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Using data from 276 general acute hospitals in the Pearl River Delta region of Guangdong Province from 2002 and 2004, we construct a preliminary metric of budget constraint softness. We find that, controlling for hospital size, ownership, and other factors, a Chinese hospital’s probability of receiving government financial support is inversely associated with the hospital’s previous net revenue, an association consistent with soft budget constraints.

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International Journal of Healthcare Finance and Economics
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Karen Eggleston
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When one can circle the globe in less than the time of incubation of most infectious pathogens, it is clear every country relies to some extent on the health systems of other countries to prevent and protect their citizens from global health threats. Therefore, creating and maintaining a good health system in one country requires attention to interregional and international cooperation. Domestic and international spheres of public health policies are becoming more intertwined and inseparable.

PUBLISHED: Qiong Zhang, Karen Eggleston (翁笙和), and Michele Barry, 2009. “Pandemic Influenza and the Globalization of Public Health” (流感大流行与公共卫生全球化), Comparative Studies 比较 (42):  (Beijing: China CITIC Press): 47-52.

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Asia Health Policy Program working paper #11
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Karen Eggleston
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China continues to face great challenges in meeting the health needs of its large population. The challenges are not just lack of resources, but also how to use existing resources more efficiently, more effectively, and more equitably. Now a major unaddressed challenge facing China is how to reform an inefficient, poorly organized health care delivery system. The objective of this study is to analyze the role of private health care provision in China and discuss the implications of increasing private-sector development for improving health system performance.

This study is based on an extensive literature review, the purpose of which was to identify, summarize, and evaluate ideas and information on private health care provision in China. In addition, the study uses secondary data analysis and the results of previous study by the authors to highlight the current situation of private health care provision in one province of China.

This study found that government-owned hospitals form the backbone of the health care system and also account for most health care service provision. However, even though the public health care system is constantly trying to adapt to population needs and improve its performance, there are many problems in the system, such as limited access, low efficiency, poor quality, cost inflation, and low patient satisfaction. Currently, private hospitals are relatively rare, and private health care as an important component of the health care system in China has received little policy attention. It is argued that policymakers in China should recognize the role of private health care provision for health system performance, and then define and achieve an appropriate role for private health care provision in helping to respond to the many challenges facing the health system in present-day China.

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Asia Health Policy Program working paper #10
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We examine the role that buyers in global supply chains play in helping vendors uncover productivity-enhancing labor management innovations. We report on a buyer-directed NGO-coordinated factory-based program targeting intestinal parasites and anemia in seven Bangalore apparel factories. Raw pre-post productivity comparisons were confounded by factory organizational changes that were implemented in anticipation of the termination of the Multi Fiber Arrangement (MFA). Using a difference-in-difference-in-difference (DDD) estimator, a full complement of medically appropriate treatment was found to increase individual productivity.

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World Development
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Karen Eggleston
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Using data from 276 general acute hospitals in the Pearl River Delta region of Guangdong Province from 2002 and 2004, we construct a preliminary metric of budget constraint softness. We find that, controlling for hospital size, ownership, and other factors, a Chinese hospital’s probability of receiving government financial support is inversely associated with the hospital’s previous net revenue, an association consistent with soft budget constraints.

Published inInternational Journal of Healthcare Finance and Economics special issue on provider payment incentivesKaren Eggleston, Yu-Chu Shen, Mingshan Lu, Congdong Li, Jian Wang, Zhe Yang, 2009. “Soft Budget Constraints in China: Evidence from the Guangdong Hospital Industry,” International Journal of Healthcare Finance and Economics 9(2): 233-42.

 

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Asia Health Policy Program working paper #8
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Karen Eggleston
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Karen Eggleston
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In December 2009, the Asia Health Policy Program celebrates the first anniversary of the launch of the AHPP working paper series on health and demographic change in the Asia-Pacific. The series showcases research by AHPP’s own affiliated faculty, postdoctoral fellows, and visiting scholars, as well as selected works by other scholars from the region.

To date AHPP has released eleven research papers in the series, by authors from China, South Korea, Thailand, Taiwan, Pakistan, and the US, with more on the way from Japan and Vietnam. Topics range from “The Effect of Informal Caregiving on Labor Market Outcomes in South Korea” and “Comparing Public and Private Hospitals in China,” to “Pandemic Influenza and the Globalization of Public Health.”  The working papers are available at the Asia Health Policy website.

AHPP considers quality research papers from leading research universities and think tanks across the Asia-Pacific region for inclusion in the working paper series. If interested, please contact Karen Eggleston.

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In the four years since a State Council think tank, the Development Research Center, bluntly declared the failure of three decades of healthcare reform, China has placed a high political priority on designing, building and financing a modern, equitable health delivery system that serves every last one of its 1.3 billion people. As publisher of practice-building trade magazines for medical specialists in China and India, Jeffrey Parker has developed unique and valuable perspectives on what's wrong with China's healthcare system -- and how Indian practitioners are able to deliver results despite a per-capita GDP that is roughly half of China's. Through an unprecedented China-India training exchange, Mr. Parker has begun testing whether Indian models of self-financed grassroots medical startup practices can help doctors shake free of China’s Stalinist paralysis without having to wait for sweeping programmatic reforms that are always on the horizon, but seem never to come. What's more, would such grassroots empowerment models not create unprecedented opportunities for participation by international investors who up to now have been largely marginalized in China's healthcare development?

In this lunchtime colloquium, Mr. Parker reviews his experiences in China and India over the past six years and looks at several exciting recent developments in China. These include:

  • An ambitious rural reimbursement scheme that already has begun to complete a nationwide healthcare safety net. The program is creating a vast pool of funds to finance rural medical services, but how will Beijing populate the countryside with sustainable grassroots practices?
  • The first domestic healthcare IPO, by which Aier Ophthalmology raised some $50 million as one of 28 debut listings in the Shenzhen's new "ChiNext" Growth Enterprise Market. New wind in the sails of healthcare privatization?
  • Licensing reforms that have begun delinking doctors' certification from their "work unit" hospitals under trials in Beijing and Yunnan, removing a vexing obstacle to hands-on surgical training of young practitioners. Will the breaking of senior doctors' "skills monopoly" create opportunities for private-sector training programs that will shake up China's Soviet-style residency programs?

Jeffrey Parker has lived in Greater China since 1990, first as a journalist and since 2003 as a publisher. His transition from chronicler of China's historic rise to active proponent of its economic development gives him a unique perspective on the opportunities still opening up in China -- and the challenges facing anyone keen to participate. With a twin B.A. in Asian Studies and Geography from U.C. Santa Barbara and Masters training in Journalism from Columbia University, Parker trimmed his sails for a China career from an early age. After early editorial jobs in New York and Washington, D.C., he was dispatched to Beijing by United Press International as senior correspondent in 1990. During the next 10 years with UPI and then Reuters, he covered a wide range of political, economic and social stories from postings in Hong Kong, Taiwan and the Peoples Republic. In his final two years at Reuters, Parker got his first taste of media development, launching local-language multimedia news and video feeds in China, Japan, Korea, India and Southeast Asia. Since 2003, Parker has built up a family of world-class doctors' magazines serving more than 50,000 specialists in China and India from the Shanghai base of ILX Media Group, where he is editorial director, chief operating officer, a corporate director and investor. Among his objectives is to help foster a badly needed transformation of medical practice across China by inspiring grassroots doctors to deliver high-quality, cost-effective services in rural and less-developed communities left behind by government health care.

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Jeffrey Parker Speaker ILX Media Group, Shanghai, PRC
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The principal-agent problem in health care asserts that providers, being imperfect agents for patients, will act to maximize their profits at the expense of the patients’ interests. This problem applies especially where professional regulations are lacking and incentives exist to directly link providers’ actions to their profits, such as a fee-for-service payment system. The current analysis tests for the existence of the principal-agent problem in the private health market in Vietnam by examining the prescribing patterns of the private providers. We show that

  1. private providers were able to induce demand by prescribing more drugs than public providers for a similar illness and patient profile;
  2. private providers were significantly more likely to prescribe injection drugs to gain trust among the patients; and
  3. patients’ education as a source of information and empowerment has enabled them to mitigate the demand inducement by the providers.

Our hypotheses were supported with evidence from Vietnam National Health Survey 2001 and 2002, the first and, so far, only comprehensive health survey in the country.

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Asia Health Policy Program working paper #12
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The health sector's successes in Vietnam have been described as "legendary" by international donors, but there is always the other side of the story. One can question the objectivity of reports from the government of Vietnam, the World Bank, and the World Health Organization. One can wonder in what areas the health sector has failed, who has paid for a "success story" and at what cost, and how much information is well documented and has been made public. Are there "stylized facts" regarding those aspects of health that have been successfully reformed compared with those where reform has lagged? Given these concerns, how can the research community contribute to improving health policy in Vietnam?

Dr. Truong will share his thought on recent socioeconomic development in Vietnam, discuss key health policy issues, and reflect upon his experiences including a research project in which the University of Queensland collaborated with Ministry of Health of Vietnam. Additional evidence will be drawn from a study of the cost-effectiveness of interventions to reduce tobacco use in Vietnam.

Khoa Truong was a visiting faculty member at the Hanoi School of Public Health and a research fellow at the Health Strategy and Policy Institute in 2008-2009.  Prior to that he spent six years as a doctoral fellow at the RAND Corporation.  His research interests include tobacco, alcohol, and illicit drug control policies; the impacts of built environments on health; international health issues; and economic development.

He received his doctorate and master of philosophy in policy analysis from the Pardee RAND Graduate School and earned a master's degree in development economics from Williams College. A native of Vietnam, he began his career working with NGOs in bilateral and multilateral development projects in Southeast Asia. He was awarded a Fulbright scholarship and wrote “most outstanding paper” submitted at an AcademyHealth's Annual Research Meeting (acknowledged as the premier forum for sharing the results of scholarship on health services).

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Dr. Khoa Truong Assistant Professor of Department of Public Health Sciences Speaker Clemson University
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