International Development
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Emerging infectious diseases (EIDs) pose international security threats because of their potential to inflict harm upon humans, crops, livestock, health infrastructure, and economies. The following questions stimulated the research described in this paper: What infrastructure is necessary to enable EID surveillance in developing countries? What cultural, political, and economic challenges stand in the way of setting up such infrastructure? And are there general principles that might guide engagement with developing countries and support EID surveillance infrastructure?

Using the U.S. Naval Area Medical Research Unit No. 2 as a common denominator, this paper compares barriers to EID surveillance in Cambodia and Indonesia and presents key factors—uncovered through extensive interviews—that constrain disease surveillance systems. In Cambodia, the key factors that emerged were low salaries; poor staff and human resources management; the effect of patronage networks; a culture of donor dependence; contrasting priorities between the government and international donors; and a lack of compensation for animal culling. The Cambodian military has also played a part. The government ceased a merit-based salary supplement scheme for civil servants after the military is alleged to have demanded similar pay incentives that donors had no interest in funding.

In Indonesia the key issues emerging as barriers to effective surveillance include poor host-donor relationships, including differing host-donor priorities and a misunderstanding of NAMRU-2 by Indonesian authorities; low salaries; a decline in the qualifications of personnel in the Ministry of Health; poor compensation for animal culling; and difficulties incentivizing local-level reporting in an era of decentralization.

As the interviews with in-country practitioners revealed, low levels of development in general are the main impediments to building EID surveillance infrastructure and are perhaps beyond the scope of health and scientific agencies at this point. Nevertheless, promoting greater understanding of these issues is a critical first step in mitigating negative outcomes.

Published: Ear, Sophal. "Emerging Infectious Disease Surveillance in Southeast Asia: Cambodia, Indonesia, and the US Naval Area Medical Research Unit 2." Asian Security 8.2 (2012): 164-187.

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Working Papers
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Asia Health Policy Program working paper #27
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Sophal Ear
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Consistent with the property rights theory of ownership incorporating soft budget constraints (SBCs), we find that controlling for SBCs, for-profit hospitals drop safety-net services more often and exhibit higher mortality rates, suggesting aggressive cost control that damages non-contractible quality.

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Elsevier
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Karen Eggleston
Karen Eggleston
Yu-Chu Shen
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China has recently reformed its health care system with the intent of providing universal coverage for basic health care to every Chinese citizen. Three separate health insurance plans have recently been launched to achieve this objective: the rural newly cooperative medical scheme, urban resident health insurance, and urban employee-based health insurance. Each plan differs substantially in terms of insurers, insured population, premiums, and benefits packages. Using data from the 2009 China Health and Nutrition Survey, Hai Fang will discuss a study that investigates whether and to what extend different health insurance plans have created disparities in health care utilization and expenditure.

Hai Fang is an assistant professor in the Department of Health Systems, Management, and Policy at the University of Colorado Denver, and a research associate in the Kennedy School of Government at Harvard University. He earned his doctorate in economics and master of public health from the State University of New York at Stony Brook in 2006. Before joining the University of Colorado Denver, he taught at the University of California, Davis, and the University of Miami. His research interests include health economics, labor economics, and public health.

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Hai Fang Associate Professor, Department of Health Systems, Management, and Policy Speaker University of Colorado Denver
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This seminar explores whether and to what extent the relative circumstances of men and women following marital dissolution affect sex selection behavior within marriages. China's new divorce law, which was enacted in 2001, reduced divorce costs, especially for women, by granting the right to divorce and claim damages in the case of domestic violence and extra-marital relationships and by securing women's property rights upon divorce. Ang Sun has modeled the legal change as a decrease in women's divorce costs in a household in which all the marital surplus accrues to the husband. Sun shows: (1) that the new divorce law predicts an increase in divorce rates after the birth of a daughter; (2) that the new law results in fewer sex-selective abortions for the second birth if the first birth produced a daughter; and (3) that the effect of the new law on the sex ratio should have diminishing returns to divorce cost reduction for women. All the predictions are supported by the empirical evidence. Most importantly, she finds that most of the decline occurred in historically high divorce-cost regions, which is consistent with the predictions of the model and helps rule out concomitant changes in household income and relative returns to male and female children.

Ang Sun received her PhD from Brown University’s Department of Economics. Sun’s research interests encompass development economics, labor and demographic economics, and health economics. She focuses on intra-household allocations, gender differences, and household formation. In particular, she studies how a combination of different forces in China—including traditional values, rapid growth, and the population structure—is affecting Chinese families.

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Walter H. Shorenstein
Asia-Pacific Research Center
616 Serra St C335
Stanford University
Stanford, CA 94305-6055

(650) 724-5668 (650) 723-6530
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2011-12 Asia Health Policy Fellow
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MA, PhD

Ang Sun joins the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) from Brown University’s department of economics where she recently received her PhD.

Sun’s research interests encompass development economics, labor and demographic economics, and health economics. She focuses on intra-household allocations, gender differences, and household formation. In particular, she studies how a combination of different forces in China—including traditional values, rapid growth, and the population structure—is affecting Chinese families. During her time at Shorenstein APARC, Sun will participate in an interdisciplinary study of the impact of the aging process in Asia on economic growth.

Sun holds a PhD and an MA in economics from Brown University, and an MA from the China Center of Economic Research. She also received a BA in economics and a BS in information and computer science from Beijing University.

Ang Sun 2011-12 Asia Health Policy Fellow Speaker Stanford University
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Health systems provide a rich field for testing hypotheses of institutional economics. The incentive structure of current healthcare delivery systems have deep historical and cultural roots, yet must cope with rapid technological change as well as market and government failures. This paper applies the economic approach of comparative and historical institutional analysis (Aoki, 2001; Greif, 2006) to health care systems by conceptualizing physician control over dispensing revenues as a social institution. The theory developed—emphasizing the interplay between cultural beliefs, interest groups, technological change, insurance expansion and government financing—offers a plausible explanation of reforms since the 1960s separating prescribing from dispensing in societies such as Japan, South Korea, Taiwan and China. Technological change and adoption of universal coverage trigger reforms by greatly increasing the social opportunity costs of physician over-prescribing and reshaping the political economy of forces impinging on the doctor–patient relationship.

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Journal of Institutional Economics, FirstView Article
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Karen Eggleston
Karen Eggleston
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This colloquium will discuss the state of evidence, challenges, and research agenda regarding the growth of private hospitals and public-private hospital partnerships in developing Asia.

Dominic Montagu is an assistant professor of epidemiology and biostatistics and lead of the Health Systems Initiative at the Global Health Group of the University of California, San Francisco (UCSF). His work is focused on private delivery of health services in developing countries and on market function for health services and health commodities. He has active field research projects ongoing in Nigeria and Myanmar. Montagu holds masters degrees in business administration and public health, as well as a doctorate in public health, from the University of California, Berkeley (UC Berkeley). He has worked extensively in Africa and Asia, and teaches on the private sector in developing countries, and on the regulation of private hospitals and public-private-partnerships at UCSF, UC Berkeley, and on behalf of the World Bank Institute.

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Dominic Montagu Speaker University of California, San Francisco
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