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Karen Eggleston
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How do countries in the vast and diverse Asia-Pacific region differ in “prescribing cultures”? How do health systems in the region balance access to pharmaceuticals with incentives for innovation? How do the forces of globalization shape, and in turn are shaped by, cultural legacies about health and health care? These are the key questions addressed by the new Asia Health Policy Program book, Prescribing Cultures and Pharmaceutical Policy in the Asia Pacific.

AHPP held a book launch event September 23rd with three authors of the book detailing how pharmaceutical policies are interlinked globally and at the same time deeply rooted in local culture. 

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Aims The prevalence of Type 2 diabetes mellitus (DM) has grown rapidly, but little is known about the drivers of inpatient spending in low- and middle-income countries. This study aims to compare the clinical presentation and expenditure on hospital admission for inpatients with a primary diagnosis of Type 2 DM in India, China, Thailand and Malaysia.

Methods We analysed data on adult, Type 2 DM patients admitted between 2005 and 2008 to five tertiary hospitals in the four countries, reporting expenditures relative to income per capita in 2007.

Results Hospital admission spending for diabetic inpatients with no complications ranged from 11 to 75% of per-capita income. Spending for patients with complications ranged from 6% to over 300% more than spending for patients without complications treated at the same hospital. Glycated haemoglobin was significantly higher for the uninsured patients, compared with insured patients, in India (8.6 vs. 8.1%), Hangzhou, China (9.0 vs. 8.1%), and Shandong, China (10.9 vs. 9.9%). When the hospital admission expenditures of the insured and uninsured patients were statistically different in India and China, the uninsured always spent less than the insured patients.

Conclusions With the rising prevalence of DM, households and health systems in these countries will face greater economic burdens. The returns to investment in preventing diabetic complications appear substantial. Countries with large out-of-pocket financing burdens such as India and China are associated with the widest gaps in resource use between insured and uninsured patients. This probably reflects both overuse by the insured and underuse by the uninsured.

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Diabetic Medicine
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Shorenstein APARC
Stanford University
Encina Hall, Room E-301
Stanford, CA 94305-6055

(650) 391-7164 (650) 723-6530
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AHPP Visiting Scholar, 2009-2010
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Dr. Yan Wang is a visiting scholar at Shorenstein Asia-Pacific Research Center for 2009-2010. Her research focuses on tobacco control, primary health care system, health education and health promotion, and health insurance. She is currently also the group manager of Division of Grass-Root Health Services, Shandong Provincial Health Department, P.R.China, and is in charge of urban community health services, health education and health promotion. She has an MA in public health from Shandong Medical University and PhD in Social Medicine and Health Management from Shandong University. Dr. Yan Wang has been an adjunct professor at Weifang Medical University since 2008. She also engaged in academic association and public organizations related to health affair.

Shorenstein APARC
Stanford University
Encina Hall, Room E-301
Stanford, CA 94305-6055

(650) 736-0771 (650) 723-6530
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2011 AHPP/CEAS Visiting Scholar
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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.

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PrescribingCultures front cover

Pharmaceutical policies are interlinked globally and at the same time deeply rooted in local culture. Prescribing Cultures examines how pharmaceuticals and their regulation play an important and often contentious role in the health systems of the Asia-Pacific.

The first section of this timely book analyzes pharmaceutical policy in China, Korea, Japan, Thailand, Taiwan, Australia, and India. The second section focuses on two cross-cutting themes: differences in "prescribing cultures" and physician dispensing; and the challenge of balancing access to drugs with incentives for innovation.

The book's contributors discuss important issues for U.S. policy. These include such hot-button topics as drug imports from Asia, regulation of global supply chains to assure drug safety and quality, new legislation to encourage development of drugs for neglected diseases, and the impact that decisions about pricing, regulation, and bilateral trade agreements have on access to medicines at home and abroad. In Prescribing Cultures, pharmaceutical policy reveals the economic trade-offs, political compromises, and historical trajectories that shape health systems.

Prescribing Cultures also illustrates how cultural legacies shape and are shaped by the forces of globalization, and thus will be of interest to students and scholars well beyond the confines of health policy.

Desk, examination, or review copies can be requested through Stanford University Press

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"The Role of the Private Sector in Health" was the topic of a full day symposium held July 11th at the Beijing International Convention Center. Convened one day before the World Congress of the International Health Economics Association, the private sector symposium attracted over a hundred participants from nations around the world. Aiming to foster dialogue between researchers interested in the private sector and policymakers, the event is one in a series with the long-term goal of promoting greater research interest and knowledge generation regarding the private sector to benefit health systems development. The program featured several scientific paper presentations and panels as well as keynote addresses by representatives from the Chinese Ministry of Health and the World Bank.

Karen Eggleston of the Asia Health Policy Program worked alongside several others on the organizing committee for this ongoing collaboration about the role of the private sector in health policy. Other committee members included Ruth Berg, PSP ONE, Abt Associates; Peter Berman, World Bank; Birger Forsberg, Karolinska Institutet; Gina Lagomarsino, Results for Development; Qingyue Meng, Shandong University; Dominic Montagu, University of California, San Francisco; Sara Bennett, Alliance for Health Systems and Policy Research; and Stefan Nachuk, Rockefeller Foundation.

Selected papers about the private health sector in Asia presented at the symposium will appear in the Asia Health Policy Program's working paper series on health and demographic change in the Asia-Pacific.

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Pharmaceutical policies are interlinked globally, yet deeply rooted in local culture. The newly published book Prescribing Cultures and Pharmaceutical Policy in the Asia-Pacific, edited by Karen Eggleston, examines how pharmaceuticals and their regulation play an important and often contentious role in the health systems of the Asia-Pacific.

In this colloquium, contributors to Prescribing Cultures discuss how the book analyzes pharmaceutical policy in China, Korea, Japan, Thailand, Taiwan, Australia, and India, focusing on two cross-cutting themes: differences in “prescribing cultures” and physician dispensing; and the challenge of balancing access to drugs with incentives for innovation.

As Michael Reich of Harvard University says in his Forward to Prescribing Cultures,

“The pharmaceutical sector…promises great benefits and also poses enormous risks.… Conflicts abound over public policies, industry strategies, payment mechanisms, professional associations, and dispensing practices—to name just a few of the regional controversies covered in this excellent book.

The tension between emphasizing innovation versus access -- a topic of hot debate on today’s global health policy agenda -- is examined in several chapters…

This book makes a special contribution to our understanding of the pharmaceutical sector in China… Globalization is galloping forward, with Chinese producers pushing the pace at breakneck speed. More and more, our safety depends on China’s ability to get its regulatory act together…”

The colloquium features presentations by Naoko Tomita (Keio University), Anita Wagner (Harvard University), and Karen Eggleston (Stanford FSI Shorenstein Asia-Pacific Research Center). They will give specific examples of how pharmaceutical policy serves as a window into the economic tradeoffs, political compromises, and historical trajectories that shape health systems, as well as how cultural legacies shape and are shaped by the forces of globalization.

Oksenberg Conference Room

Anita Wagner Speaker Harvard University
Naoko Tomita Speaker Keio University

Shorenstein APARC
Stanford University
Encina Hall E301
Stanford, CA 94305-6055

(650) 723-9072 (650) 723-6530
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Senior Fellow at the Freeman Spogli Institute for International Studies
Center Fellow at the Center for Health Policy and the Center for Primary Care and Outcomes Research
Faculty Research Fellow of the National Bureau of Economic Research
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
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Karen Eggleston is a Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford University and Director of the Stanford Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center at FSI. She is also a Fellow with the Center for Innovation in Global Health at Stanford University School of Medicine, and a Faculty Research Fellow of the National Bureau of Economic Research (NBER). Her research focuses on government and market roles in the health sector and Asia health policy, especially in China, India, Japan, and Korea; healthcare productivity; and the economics of the demographic transition.

Eggleston earned her PhD in public policy from Harvard University and has MA degrees in economics and Asian studies from the University of Hawaii and a BA in Asian studies summa cum laude (valedictorian) from Dartmouth College. Eggleston studied in China for two years and was a Fulbright scholar in Korea. She served on the Strategic Technical Advisory Committee for the Asia Pacific Observatory on Health Systems and Policies and has been a consultant to the World Bank, the Asian Development Bank, and the WHO regarding health system reforms in the PRC.

Director of the Asia Health Policy Program, Shorenstein Asia-Pacific Research Center
Stanford Health Policy Associate
Faculty Fellow at the Stanford Center at Peking University, June and August of 2016
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