Toward Healthier Outcomes: Examining Health Policies and Their Effects on Patient Behavior

While access to essential health services has expanded in the 21st century for a significant segment of the world’s population, progress is uneven. Low- and middle-income economies continue to grapple with healthcare access challenges due to factors such as shortage of trained health workers, equipment and medicines, poverty, insufficient health insurance, and information gaps. That’s why Jianan Yang, APARC's 2022-23 Asia Health Policy Postdoctoral Fellow, studies the characteristics and potential inefficiencies of the pharmaceutical market in developing countries. Yang's research, situated at the intersection of development and health economics, focuses on understanding drivers of suboptimal healthcare-seeking behaviors in developing nations and exploring how price and non-price mechanisms can drive improvement.

APARC’s Asia Health Policy Program awards the Asia Health Policy postdoctoral fellowship annually to support a recent PhD undertaking original research on contemporary health or healthcare policy of high relevance to countries in the Asia-Pacific region, especially developing countries.

Yang earned her Ph.D. in Economics at the University of California San Diego. In Yang’s dissertation, she studied how drug price reductions in China affected drug utilization by patients with chronic conditions. The study documented a significant increase in utilization and a meaningful reduction in underuse among the uninsured, suggesting there are higher price elasticities in developing countries. The findings indicate that reducing drug prices, which squeeze out the price markups imposed by pharmaceutical companies due to their market power, can lead to substantial  welfare benefits.

We caught up with Yang to hear more about her fellowship experience this academic year and what’s next. The conversation has been slightly edited for length and clarity.

First off, can you briefly describe your research?

My research aims to improve population health in developing countries by focusing on two main areas. Firstly, I study patient behavior and how it can be influenced by public policies and social events. For example, I investigate whether providing patients with information on antibiotics resistance can reduce overuse and examine the impact of price reductions on medication utilization and adherence for chronic conditions. While my previous research primarily focused on China, I am currently engaged in an ongoing project in the Philippines. This project assesses the effects of the 2017 Dengvaxia controversy on childhood vaccination and maternal healthcare utilization.

Secondly, I explore the pharmaceutical industry in developing countries, which plays a critical role in supplying novel drugs and ensuring the quality of existing ones. I assess the effects of public policies on drug quality and on the quantity and quality of pharmaceutical innovation.

Through my work, I strive to contribute valuable insights that can inform evidence-based policies for improving healthcare outcomes in developing countries.

How did you come to be interested in your current research?

What drew me to this topic was the profound significance of health in human development. Health is not only essential for productive human capital but also serves as a fundamental aspect of our overall well-being. Personally, like many others, I have experienced illness firsthand and witnessed the challenges that loved ones faced during periods of illness. These personal experiences have deepened my understanding of the critical role that good health plays in our lives.

Furthermore, the field of healthcare presents numerous challenges and uncertainties. These challenges are even more prominent in developing countries. Inspired by these complexities, I chose to focus on my familiar context of China and approached the issue from an economics perspective to explore ways of enhancing population health.

Congratulations on your recent publication in the Journal of Development Economics! How did you develop this study?

Thank you! The journey of developing this study began in the summer of 2018, when I returned to China during a break in my graduate school studies. At that time, having completed my coursework, I was eager to apply the research methodologies I had learned and explore meaningful projects. It was fortuitous that I connected with my coauthors, who introduced me to the possibility of conducting an experiment at a primary care facility in Beijing, focusing on the pressing issue of antibiotics resistance.

Antibiotics resistance is a significant concern, particularly in developing countries like China, where the misuse and overuse of antibiotics contribute to its exacerbation. In this project, we investigated whether providing individuals with information about the threat of antibiotics resistance to public health could lead to changes in their antibiotics purchasing behavior.

To our surprise, we discovered that a simple message conveying the potential social impact of antibiotics resistance had a substantial effect. This finding highlighted the potential of informational interventions in shaping behavior and addressing critical public health challenges. This study aimed to contribute to the broader understanding of behavioral responses to health-related information and provide insights into effective strategies for tackling antibiotics resistance.

How has your time at APARC as the Asia Health Policy Postdoctoral Fellow aided your research?

The Asia Health Policy Postdoctoral Fellowship has been immensely beneficial to my research in several ways. Firstly, it provided me with invaluable flexibility to conduct my own research. This freedom allowed me to dedicate time and effort to revising my work, ultimately resulting in the successful publication of the paper we just mentioned.

Additionally, the funding support associated with the fellowship enabled me to attend numerous conferences relevant to my research area. These conferences served as excellent platforms for presenting my work and establishing valuable connections with fellow researchers in the field. These connections have been instrumental in expanding my professional network and fostering collaborations.

Moreover, as part of my responsibilities, I had the privilege of organizing the Peking University – AHPP joint webinar series this year. This opportunity not only sharpened my skills in organizing and moderating webinars but also provided a unique chance to engage with senior scholars in the field, whose work I have long admired. The interactions and insights gained from these scholars have been tremendously enriching for my research journey.

Overall, my time as an Asia Health Policy Postdoctoral Fellow at APARC has provided me with the necessary resources, flexibility, and networking opportunities to advance my research, strengthen my skills, and cultivate meaningful connections within the academic community.

What other aspects of your time at APARC have you benefited from?

During my time at APARC, I have benefited from various aspects beyond the Asia Health Policy Postdoctoral Fellowship itself. One notable advantage has been the vibrant and diverse Stanford community focused on health-related topics. This academic environment has allowed me to engage with health economists from the Economics Department and collaborate with public health scholars from the Health Policy Department. This interdisciplinary exposure has broadened my perspectives and enriched my understanding of the complex intersection between health and policy.

Additionally, I have had the opportunity to establish connections with fellow postdoctoral fellows and early-career scholars who share similar research interests. Through small group seminars and research presentations, we have formed a supportive network, providing valuable feedback and insights to one another. These interactions have fostered an environment of intellectual exchange and growth, further enhancing the quality and impact of our research endeavors.

Are there any people at APARC that you particularly benefited from working with?

Working at APARC has provided me with valuable opportunities to collaborate and learn from various scholars. One individual with whom I have particularly enjoyed collaborating with is Global Affiliate Visiting Fellow Jitukrushna Swain, of Reliance Life Sciences in India. Despite our different academic backgrounds, we share a common interest in the field. Through auditing classes together and engaging in insightful conversations, Jitu has provided invaluable insights into the innovation incentives within the pharmaceutical industry and other intricate aspects of the field. This collaboration has greatly enhanced my understanding of the industry and enriched my research.

Furthermore, being a part of APARC has allowed me to interact with scholars from diverse fields within the social sciences. Communicating my own research to them has provided valuable perspectives and allowed for interdisciplinary exchanges that have broadened my understanding of the social, economic, and political implications of my work.

What is on the horizon for you? What's next?

I am excited to share that my next step will be joining the Peking University Institute of Global Health and Development as an assistant professor this fall. This new opportunity will allow me to continue my research and contribute to the field of global health and development from an academic position. I am looking forward to further exploring critical issues, conducting impactful research, and collaborating with colleagues at Peking University and beyond. I am eager to embark on this new chapter in my career, and I am excited about the possibilities and contributions that lie ahead.

Do you have any advice for students interested in your field?

For students interested in pursuing a career in this area, firstly, I would encourage you to immerse yourself in the field by gaining practical experience and exposure to the realities of the issues you wish to address. Direct engagement will provide valuable insights and help you better understand the nuances and complexities of the field.

Secondly, invest time in building a solid foundation of knowledge by delving deep into the existing literature. Familiarize yourself with key theories, methodologies, and empirical findings in your area of interest. This will equip you with a strong understanding of the field and enable you to identify gaps in knowledge that can serve as potential research avenues.

Lastly, be bold and passionate in your pursuit of questions and topics that you genuinely believe are valuable for enhancing human well-being. The field you are interested in is filled with open questions and challenges waiting to be addressed. Trust your instincts and follow your interests. Undertake research that aligns with your values and has the potential to make a meaningful impact.

Stay curious, collaborate with peers and experts in the field, and be open to new perspectives and approaches. By actively engaging in the field, expanding your knowledge, and pursuing questions that resonate with you, you can contribute to meaningful advancements in your chosen area and make a positive difference in the lives of individuals and communities.