Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

Dual Practice of Public Hospital Physicians: Implications for Universal Health Coverage in Vietnam

Thursday, May 18, 2017 | 12:00 PM -Thursday, May 18, 2017 | 1:30 PM

Vietnam has adopted a public-private mixed health service delivery system for 30 years to mobilize more resources for the health sector. Public hospital physicians are allowed to practice for the private sector outside official working hours; therefore, physician dual practice is very common. This paper investigates the characteristics and dynamics of the phenomenon, focusing on the choices of physicians about whether to engage in dual practice, as well as their performance in their public practice. The analysis is based on a survey at 10 public hospitals in Vietnam with 510 physicians. Half of public hospital physicians reported participating in at least one type of private practice. Personal characteristics (gender, age, position), private practice income, and clinical autonomy are the reasons for dual practice involvement. Dual practitioners spend more time overall in clinical practice than their non-dual-practice counterparts, but reduce the time for public practice to have more time for private practice. They are also more likely to refer public patients to private practice. Nevertheless physicians appear to still be committed to the public sector to enlarge their professional networking, participate in training opportunities, and fulfill their sense of public responsibility.

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Ngan Do is currently a postdoctoral fellow at the Walter H. Shorenstein Asia-Pacific Research Center, Stanford University. Prior to that, she worked as a Health Leadership Development Initiative fellow at the World Health Organization Western Pacific Regional Office. Her research focuses on comparative healthcare systems and health reforms in Asia; payment incentives; physicians’ behaviors, human resources for health, and the public-private partnership in the health sector. She experienced field-work in Cambodia, Lao PDR, Philippines, Korea, and Vietnam. Ngan achieved her Ph.D. degree in health policy and management at Seoul National University College of Medicine. She earned her master degree on public policy at the KDI School of Public Policy and Management, and her bachelor degree on international relations at the Diplomacy Academy of Vietnam.

Ngan Do Kim 2016-2017 Developing Asia Health Policy Postdoctoral Fellow 2016-2017 Developing Asia Health Policy Postdoctoral Fellow

Seminars

FINANCING LONGEVITY: The Economics of Pensions, Health, Long-term Care and Disability Insurance

Monday, April 24, 2017 | 8:30 AM -Monday, April 24, 2017 | 4:30 PM

The Asia Health Policy Program at Stanford’s Shorenstein Asia-Pacific Research Center (APARC), in collaboration with scholars from Stanford Health Policy's Center on Demography and Economics of Health and Aging, the Stanford Institute for Economic Policy Research, and the Next World Program, is holding its third annual conference on the economics of ageing. The conference is one of several activities planned in 2017 to mark the 10^th anniversary of the Asia Health Policy Program.

The triumph of longevity can pose a challenge to the fiscal integrity of public and private pension systems and other social support programs disproportionately used by older adults. High-income countries offer lessons – frequently cautionary tales – for low- and middle-income countries about how to design social protection programs to be sustainable in the face of population ageing. Technological change and income inequality interact with population ageing to threaten the sustainability and perceived fairness of conventional financing for many social programs. Promoting longer working lives and savings for retirement are obvious policy priorities; but in many cases the fiscal challenges are even more acute for other social programs, such as insurance systems for medical care, long-term care, and disability. Reform of entitlement programs is also often politically difficult, further highlighting how important it is for developing countries putting in place comprehensive social security systems to take account of the macroeconomic implications of population ageing.

The objective of the conference is to explore the economics of ageing from the perspective of sustainable financing for longer lives. The conference will bring together researchers to present recent empirical and theoretical research on a range of topics in this area.

The first full day of the conference – April 24 – is open to the public. The lunchtime keynote speech on the second day of the conference – April 25 – is also open to the public; the remaining portions of that day are reserved for panelists only to encourage candid conversation in a closed-door setting.

Conference Agenda

April 24

7:45 Breakfast

8:25 Welcome Gi-Wook Shin, Stanford University

Karen Eggleston, Stanford University

Session I: Long-term Care and Intergenerational Support

Chair: Gopi Shah Goda, Stanford University

8:30 – 9:30 “Housing Assets and Access to Long Term Care Services and Supports: Evidence from the Housing Bubble Burst”

Richard Frank, Harvard University

Discussant: Tom Davidoff, University of British Columbia

9:30 – 10:30 “The Demand for Long-Term Care Insurance in Canada”

Pierre-Carl Michaud, HEC Montréal and RAND

Discussant: Chris Tonetti, Stanford Graduate School of Business

10:30 – 10:45 Coffee break

10:45 – 11:45 “The Price of the East Asian Miracle: Generational Cultural Shift and Elderly Suicide”

Hyejin Ku, University College London

Discussant: Hongbin Li, Tsinghua University and Stanford University

Session II:

Co-Chairs: John Shoven and Karen Eggleston, Stanford University

11:45 – 13:45 Lunch

Keynote panel: "The policy challenges of financing longevity: Perspectives from Japan and the US"

Hirotaka Unami, Senior Director for Policy Planning and Research, Minister's Secretariat, Ministry of Finance, Japan

Olivia S. Mitchell, International Foundation of Employee Benefit Plans Professor, as well as Professor of Insurance/Risk Management and Business Economics/Policy, Wharton School, University of Pennsylvania

Session III: Financial Planning and Health

Chair: David Canning, Harvard University

14:00 – 15:00 “Cognitive Decline and Household Financial Outcomes at Older Ages”

Marco Angrisani, University of Southern California

Discussant: Kathleen McGarry, UCLA

15:00 – 15:15 Break

15:15 – 16:15 “From Compression to Expansion of Morbidity: Upcoming Challenges for Health Care and Long Term Care in China”

Bei Lu, University of New South Wales

Discussant: Wang Feng, Fudan University and UC Irvine

16:40 Closing

Apri1 25

11:45 – 13:00 Lunch

Policy challenges of financing longevity: Perspectives from Singapore

Kelvin Bryan Tan, Ministry of Health, Singapore

Agenda

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Conferences

Financial Protection in Health: Alternative Framework and Evidence from Vietnam

Monday, April 3, 2017 | 12:00 PM -Monday, April 3, 2017 | 1:30 PM

The venue of this event has been moved to the Okimoto Conference room.

Dr. Ruger, a leading scholar of global and domestic health policy and public health, will speak about global and national health inequities, drawing from her research in Asia --including India, Indonesia, Malaysia, South Korea, Vietnam -- and Africa. With training in political economy, health policy, international relations, comparative social research and law, Dr. Ruger crosses disciplines to reexamine the principles and values that underlie health policy and public health and apply these principles empirically. She created the health capability paradigm, challenging existing approaches and illuminating optimal health policies and she has developed an empirical approach to evaluate public health programs and health policies as they measure up to that paradigm. Dr. Ruger’s scholarship has critically scrutinized the existing global health architecture in order to identify more effective global health policy responses linking public policy and law to global health theory at the global and national levels. Dr. Ruger studies critical health policy and public health problems such as the equity and efficiency of health system access, financing, resource allocation, policy reform and the social determinants of health. Her forthcoming book, Global Health Justice and Governance (OUP, in press), advances a theory of global health justice and governance called provincial globalism.

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Dr. Ruger received a bachelor’s degree in the honors program in political economy from the University of California-Berkeley, master’s degrees from Oxford University, the Fletcher School of Law and Diplomacy and Yale University, a doctoral degree from Harvard University, and completed a post-doctoral fellowship at Harvard's Center for Population and Development. Dr. Ruger has authored over 100 publications and is internationally recognized for her leadership and work, which has been cited by the United Nations, World Bank, World Health Organization and United States Government. She has been Principal Investigator and Co-Investigator on awards from the National Institutes of Health, Fogarty International Center, Hewlett Foundation, Henry J. Kaiser Family Foundation and she was awarded a Guggenheim Fellowship to complete Global Health Justice and Governance (OUP, in press).

Other papers:

1. Coping with Health Care Expenses Among Poor Households: Evidence from a Rural Commune in Vietnam: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1435832

2. Impact of Health Insurance on Health Care Treatment and Cost in Vietnam: A Health Capability Approach to Financial Protection: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1515733

3. Effect of Health Expenses on Household Capabilities and Resource Allocation in a Rural Commune in Vietnam: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1435820

4. The Changing Donor Landscape in Health Sector Aid to Vietnam: A Qualitative Case Study: http://www.sciencedirect.com/science/article/pii/S0277953615001719

5. An Alternative Framework for Analyzing Financial Protection in Health: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2139693

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Jennifer Prah Ruger Amartya Sen Professor of Health Equity, Economics, and Policy, School of Social Policy and Practice, University of Pennsylvania

Seminars

Shorenstein APARC selects two postdoctoral fellows for 2017-18 academic year

Read more about Shorenstein APARC selects two postdoctoral fellows for 2017-18 academic year

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News

Date

Thu, 02/09/2017 - 12:00

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The Shorenstein Asia-Pacific Research Center (APARC), in pursuit of training the next generation of scholars on contemporary Asia, has selected two postdoctoral fellows for the 2017-18 academic year. The fellows will begin their year of academic study and research at Stanford this fall.

Shorenstein APARC has for more than a decade sponsored numerous junior scholars who come to the university to work closely with Stanford faculty, develop their dissertations for publication, participate in workshops and seminars, and present their research to the broader community.

The 2017-18 cohort includes two Shorenstein Postdoctoral Fellows; they carry a broad range of interests from labor migration policy in China to regional institutions in East Asia. Their bios and research plans are listed below:

H. Seung Cho is completing his doctorate at Columbia University’s Department of Political Science. He researches U.S. and Chinese foreign policy toward East Asia’s regional institutions with a broader interest in U.S.-China relations, the political economy of East Asia and qualitative research methods. His dissertation probes the popular narrative that United States and China are competing over East Asia’s regional architecture, arguing that mutual misperception and security dilemma dynamics also play out in the politics of regional institution building. To explore this phenomenon, Seung has conducted extensive fieldwork in Beijing, Jakarta, Seoul and Washington, D.C. At Shorenstein APARC, Seung will be developing his dissertation into a book manuscript while looking to further examine the relationship between the politics of East Asia’s multilateral security institutions and their perceived lack of effectiveness. Previously, Seung was a predoctoral fellow at Peking University’s School of International Studies from 2014-16. Prior to starting his doctoral studies, he also served in South Korean military intelligence as part of the two-year national service. Seung holds a Bachelor of Science in government and economics and Master of Science in international relations from the London School of Economics and Political Science (LSE).

Samantha Vortherms is a doctoral candidate in the University of Wisconsin – Madison Department of Political Science. Her research focuses on comparative political economy, development, social welfare and research methodology. Her dissertation examines subnational variation in access to citizenship rights in China through the household registration system. Her research has been supported by the National Science Foundation, the U.S. Department of Education through the Fulbright-Hays Doctoral Dissertation Research Abroad and the Social Science Research Council's Dissertation Proposal Development Fellowship, among others. At Shorenstein APARC, Sam will work on converting her dissertation to a book manuscript and advance her post-dissertation project on the role of the firm in labor migration policies. Before going to Wisconsin, Sam received her Master of Arts in international relations at the University of Chicago, Artium Magister in public policy from University of Chicago's Harris School of Public Policy, and a Bachelor of Arts from the University of Richmond. From 2014-16, she was a visiting research fellow at the National School of Development's China Center for Health Economics Research at Peking University.

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Is Knowing Half the Battle? Behavioral Responses to Risk Information from the National Health Screening Program in Korea

Thursday, February 9, 2017 | 12:00 PM -Thursday, February 9, 2017 | 1:30 PM

The benefits of screening depend on whether information changes individual behaviors. We study the National Health Screening Program in Korea which provides free general health screening to individuals aged over 40. We apply a regression discontinuity design to estimate behavioral responses to information about one’s risk classifications for diabetes, obesity, and high cholesterol. We find evidence of weight loss around the high risk threshold for diabetes, where risk information is combined with prompting for a secondary examination and medical treatment. However, we find no differences around other risk classification thresholds, where risk information is not combined with such prompting.

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Hyuncheol Bryant Kim is an applied micro-economist with broad interests in health economics, development economics, public economics, education economics, and labor economics. The main goal of Prof.Kim's research is to understand the impact and behavioral responses to the public intervention programs in both developed and developing countries. Prof.Kim has been investigating various public intervention programs such as cancer screening, general health screening, long-term care insurance, girls' education support program, HIV/AIDS prevention programs such as male circumcision and HIV testing, mother and child health program as well as job opportunity and internship program on employment.

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Hyuncheol Bryant Kim Lois and Mel Tukman Assistant Professor, Department of Policy Analysis and Management (PAM), Cornell University

Seminars

Universal Long-term Care Insurance Program: South Korea’s Experience

Tuesday, January 31, 2017 | 12:00 PM -Tuesday, January 31, 2017 | 1:30 PM

South Korea, the most rapidly aging society in the world, introduced a public long-term care insurance (LTCI) program with universal coverage in 2008. This presentation will begin with the socioeconomic and political context of the introduction of the LTCI and explain the finance and provision of LTCI in Korea, compared to the LTCIs of Germany and Japan. It will provide recent evidence on the performance of the LTCI along with its prospects and lessons for other countries.

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Hongsoo Kim is an associate professor at the Graduate School of Public Health at Seoul National University (SNU), South Korea, and a 2016-2017 Fulbright Visiting Scholar & Takemi Fellow in International Health at Harvard School of Public Health, United States. Her research areas include aging and health policy, long-term care systems, and health system performance assessment. She is currently involved the Comparative Diabetes Net Value Project led by Dr. Karen Eggleston at Stanford University. She was formerly the scientific committee chair of the Korean Academy of Long-term Care, the Korean Gerontological Society, and the Korean Society of Health Policy and Administration. She received her PhD from New York University, where she worked as assistant professor before she joined SNU.

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Hongsoo Kim Fulbright Scholar & Takemi Fellow at Harvard School of Public Health, U.S.; Associate Professor at Seoul National University Graduate School of Public Health, South Korea

Seminars

One-Child Policy, Marriage Distortion, and Welfare Loss

Tuesday, January 17, 2017 | 12:00 PM -Tuesday, January 17, 2017 | 1:30 PM

This seminar will discuss the marriage distortion and the associated welfare loss caused by the One-Child Policy (OCP) in China. Using the variation in the ethnicity-specific assigned birth quotas and different fertility penalties across provinces over time, we first show that the OCP induced a significantly higher unmarried rate and more interethnic marriages. Using sufficient statistics approach, we then derive a formula for the social welfare loss caused by the OCPinduced lower fertility and marriage distortion, and it only depends on the estimated reducedform elasticities. Our estimates suggest that the associated welfare loss is around 3.7 percent of annual household income, with marriage distortion contributing 30 percent of this. These findings highlight the unintended behavioral responses to public policies and corresponding social consequences.

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Yi Zhou is a PhD candidate in Demography at University of California – Berkeley. His research interests include Economic Demography, Formal Demography and Health Economics. He received a M.A. in Economics and a B.B.A. in Accounting from Peking University."

Presentation

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Yi Zhou Department of Demography, University of California, Berkeley

Seminars

Asia Health Policy Program hosts primary care conference in Beijing

Read more about Asia Health Policy Program hosts primary care conference in Beijing

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Karen Eggleston

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News

Date

Fri, 10/21/2016 - 12:00

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China’s recent initiatives to deepen health reform, control antimicrobial resistance, and strengthen primary health services are the topics of ongoing collaborative research by the Asia Health Policy Program (AHPP) at Stanford’s Shorenstein Asia-Pacific Research Center and Chinese counterparts. For example, with generous support from ACON Biotechnology and in partnership with the ACON Biotech Primary Care Research Center in Hangzhou, China, AHPP hosts an annual conference on community health services and primary health care reform in China.

The conference, titled Forum on Community Health Services and Primary Health Care Reform, was held in June at the Stanford Center at Peking University (SCPKU) in Beijing. It featured distinguished policymakers, providers and researchers who discussed a wide-range of topics from China’s emerging “hierarchical medical system” for referring patients to the appropriate level of care (fenji zhenliao), as well as the practice and challenges of innovative approaches to primary care and integrated medical care systems. Yongquan Chen, director of Yong’an City Hospital and representative for the mayor’s office of Sanming, talked about health reforms in Sanming City, Fujian Province, a famous example within China. He discussed the incentives and reasoning behind the reforms, which focus on removing incentives for over-prescription of medications, demonstrating government leadership for comprehensive reforms, consolidating three agencies into one, monitoring implementation and easing tensions between doctors and patients. He pointed out the feasibility and early successes of reform by comparing public hospitals in the city in terms of their revenues and costs, reduced reliance on net revenue from medication sales, and other dimensions of performance. Finally, he addressed reform implementation and future plans on both the hospital's and the government's part.

Xiaofang Han, former director of the Beijing Municipal Development and Reform Commission, shared her personal views on the challenges patients face in navigating China’s health system (kan bing nan) and the need to improve the structure of the delivery system, including a revision to the incentives driving over-prescription in China’s fee-for-service payment system. She emphasized that patients’ distrust of primary care providers can only be overcome by demonstrating improved quality (e.g. with a systematic training program for general practitioners, GPs), and that referral systems should be based on the actual capabilities of the clinicians, not their formal labels. To reach China’s goal of over 80 percent of patients receiving management and first-contact care within their local communities will require improved training and incentive programs for newly-minted MDs, a more flexible physician labor market, and innovations in e-health and patient choice regarding gatekeeping or “contract physician services” (qianyue fuwu).

Guangde County People's Hospital Director Mingliang Xu spoke about practices and exploration of healthcare alliances and initiatives to provide transparent incentives linking medical staff bonuses to metrics of quality. Ping Zhu from Community Healthcare Service Development and Research Center in Ningbo addressed building solid relationships between doctors and residents and providing more patient-centered services.

Professor Yingyao Chen from Fudan University School of Public Health discussed performance assessment of community health service agencies based on his research in Shanghai. He introduced the strengths and weaknesses of the incentives embedded in the assessment system for China’s primary care providers, and concluded with suggestions for future research. Dr. Linlin Hu, associate professor at Peking Union Medical College, discussed China's progress and challenges of providing universal coverage of national essential public health services.

Professor Hufeng Wang of Renmin University of China discussed China’s vision for a “hierarchical medical system”– bearing resemblance to “integrated care,” “managed care,” or NHS-like coordination of primary and specialized care – with examples of pilot reforms from Xiamen, Zhenjiang and Dalian cities. Dr. Zuxun Lu, professor of Tongji Medical College of Huazhong University of Science and Technology, also discussed hierarchical medical systems and declared that China currently had a “discounted gatekeeper system.”

Dr. Yaping Du of Zhejiang University presented his research on mobile technology for management of lipid levels and with the help of a volunteer, demonstrated “Dyslipidemia Manager,” a mobile app-based product for both patients and doctors. Innovative strategies for primary prevention of cardiovascular diseases in low- and middle-income countries were the focus of remarks by Dr. Guanyang Zou from the Institute for Global Health and Development at Queen Margaret University, including its connections to international experiences with China’s current efforts in that area.

In sum, the 2016 Forum elicited lively, evidence-based discussions about the opportunities and challenges in improving primary care and sustaining universal coverage for China. Plans are underway for convening the third annual ACON Biotech-Stanford AHPP Forum on Community Health Services and Primary Health Care Reform in June 2017 at SCPKU. Anyone with original research or innovative experiences with primary care in China may contact Karen Eggleston regarding participation in next year’s Forum.

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