Health Care
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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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**Due to space restrictions, this event has reached capacity and we will no longer be taking RSVPs. Everyone is still welcome to attend but please plan to arrive early as seating is on a first come, first serve basis.**

Under the Hu-Wen leadership, China announced a shift in its development policy from a policy program that mainly emphasizes economic growth to one that pursues a “harmonious society.” The harmonious society program was a response to rapid increases in inequality during the 1990s, and its aim has been to ensure that the benefits from growth are widely shared.    

In recent years have the benefits from growth been widely shared? Has income inequality increased or decreased during the Hu-Wen era?

Drawing on recent findings from the China Household Income Project, a collaborative survey research project monitoring changes in incomes and inequality, Professor Terry Sicular will discuss recent trends in inequality and poverty in China. 

Terry Sicular is professor of economics at the University of Western Ontario. She received her doctorate at Yale and has taught at Stanford and Harvard. She is a specialist on the Chinese economy, speaks Mandarin, and has been studying and travelling to China for more than 30 years. Her recent research examines incomes and inequality in China, as well as related topics such as educational attainment and its intergenerational transmission, and the impact of housing reforms on household income and wealth. She has published widely in scholarly journals and books, and is as a contributor to and co-editor of Inequality and Public Policy, published by Cambridge University Press (2008). She has served as a consultant to international donor organizations, and is a leader in the ongoing, China Household Income Project, a collaborative research project that conducts a nationwide household survey and monitors trends in China’s incomes and inequality.

This event is part of the China's Looming Challenges series

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Terry Sicular Professor Speaker Department of Economics, University of Western Ontario
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The global health community has been aiming at ensuring health coverage for all. To achieve universal health care coverage, the German Social Health Insurance model is one solution. However, one major disadvantage of Social Health Insurance is the fragmented insurance plans, exemplified by 3,500 insurance plans in Japan’s public universal health insurance system. To improve the financial sustainability of Japan’s public universal health insurance, policy options include consolidating fragmented plans as already implemented in Germany and South Korea.

This presentation has two major goals. One is to evaluate the optimal health insurance size in consolidating 3,500 insurance plans in Japan through a simulation analysis using the best available micro data in Japan. The other goal is to discuss the global policy implications based on the experiences of Japan's public universal health insurance.

Dr. Byung-Kwang Yoo is an associate professor in health policy in the Department of Public Health Sciences at the UC Davis School of Medicine. Yoo’s unique career includes clinical medicine (MD) in Japan and research experience as a health services researcher/health economist in the United States. He obtained an MS in health policy and management from Harvard University, and a PhD in health policy and management (concentration on health economics) from Johns Hopkins University. Yoo used to work as a research associate at the Center for Health Policy at Stanford University, as a health economist at the Centers for Disease Control and Prevention in Atlanta, and as an assistant professor in the Division of Health Policy at the University of Rochester School of Medicine in New York State. He has published his work in leading journals such as Lancet, Health Economics, Health Services Research, the American Journal of Public Health, and the American Journal of Preventive Medicine.

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Byung Kwang Yoo Associate Professor in Health Policy in the Department of Public Health Sciences, School of Medicine Speaker UC Davis
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The team of leaders who will take the helm in China beginning next year—the so-called “Fifth Generation”—will be better educated, have greater exposure to the outside world, and extensive experience implementing policies that have facilitated sustained economic growth and growing international influence. They may view issues somewhat differently than their predecessors but have risen to the top by going along to get ahead and are unlikely to propose radical policy initiatives.  But they must confront a growing number of challenges fueled by China’s past success and recent behavior and will be constrained by structural features of the Chinese system and integration into the global market.

Thomas Fingar is the Oksenberg-Rohlen Distinguished Fellow at the Freeman Spogli Institute for International Studies (FSI). In 2009, he was the Payne Distinguished Lecturer at FSI. From May 2005 through December 2008, he served as the first deputy director of national intelligence for analysis and, concurrently, as chairman of the National Intelligence Council.

This event is part of the China's Looming Challenges series

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Freeman Spogli Institute for International Studies
Stanford University
Encina Hall, C-327
Stanford, CA 94305-6055

(650) 723-9149 (650) 723-6530
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Shorenstein APARC Fellow
Affiliated Scholar at the Stanford Center on China's Economy and Institutions
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Thomas Fingar is a Shorenstein APARC Fellow in the Freeman Spogli Institute for International Studies at Stanford University. He was the inaugural Oksenberg-Rohlen Distinguished Fellow from 2010 through 2015 and the Payne Distinguished Lecturer at Stanford in 2009.

From 2005 through 2008, he served as the first deputy director of national intelligence for analysis and, concurrently, as chairman of the National Intelligence Council. Fingar served previously as assistant secretary of the State Department’s Bureau of Intelligence and Research (2000-01 and 2004-05), principal deputy assistant secretary (2001-03), deputy assistant secretary for analysis (1994-2000), director of the Office of Analysis for East Asia and the Pacific (1989-94), and chief of the China Division (1986-89). Between 1975 and 1986 he held a number of positions at Stanford University, including senior research associate in the Center for International Security and Arms Control.

Fingar is a graduate of Cornell University (A.B. in Government and History, 1968), and Stanford University (M.A., 1969 and Ph.D., 1977 both in political science). His most recent books are From Mandate to Blueprint: Lessons from Intelligence Reform (Stanford University Press, 2021), Reducing Uncertainty: Intelligence Analysis and National Security (Stanford University Press, 2011), The New Great Game: China and South and Central Asia in the Era of Reform, editor (Stanford University Press, 2016), Uneasy Partnerships: China and Japan, the Koreas, and Russia in the Era of Reform (Stanford, 2017), and Fateful Decisions: Choices that will Shape China’s Future, co-edited with Jean Oi (Stanford, 2020). His most recent article is, "The Role of Intelligence in Countering Illicit Nuclear-Related Procurement,” in Matthew Bunn, Martin B. Malin, William C. Potter, and Leonard S Spector, eds., Preventing Black Market Trade in Nuclear Technology (Cambridge, 2018)."

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Thomas Fingar Oksenberg/Rohlen Distinguished Fellow Speaker FSI
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A condensed version of this paper is published in the Journal of Institutional Economics (2012) 8(2): 247-270.

Abstract: 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 overprescribing and reshaping the political economy of forces impinging on the doctor-patient relationship.

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Asia Health Policy Program working paper #24
Authors
Karen Eggleston
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**Due to space restrictions, this event has reached capacity and we will no longer be taking RSVPs. Please plan to arrive early as seating is on a first come, first serve basis.**

Since 2008 China's banks have made loans that approach 30% of GDP each year. The central bank has used a broader measure of credit, total societal financing, that suggests credit extended in 2011 may exceed 40% of the country's GDP. It is inevitable that such profligate lending will result in significant amounts of problem loans.  The international market is well aware of this and Chinese bank shares have been hit hard for most of this year. How will these bad loans be managed? More importantly, why has the government once again used China's ostensibly commercial banks as if they were policy banks and what are the implications of this for China's economy going forward?

Carl E. Walter worked in China and its financial sector for the past 20 years and actively participated in many of the country’s financial reform efforts. While at Credit Suisse First Boston he played a major role in China’s groundbreaking first overseas IPO in 1992, as well as the first primary listing of a state-owned enterprise on the New York Stock Exchange in 1994. He was a member of senior management at China International Capital Corporation, China’s first and most successful joint venture investment bank where he supported a number of significant domestic and international stock and bond underwritings for major Chinese corporations. More recently at JPMorgan he was China Chief Operating Officer and Chief Executive Officer of its banking subsidiary. During this time Carl helped build a pioneering domestic security, risk and currency trading operation.

A long time resident of Beijing before his recent return to the United States, Carl is fluent in Mandarin and holds a PhD from Stanford University and a graduate certificate from Peking University. He is the co-author of Red Capitalism: the fragile financial foundations of China’s extraordinary rise as well as Privatizing China: inside China’s stock markets

This event is part of the China's Looming Challenges series

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Shorenstein APARC Encina Hall Stanford University
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Visiting Scholar at APARC, 2021-2022
Visiting Scholar at APARC, 2012-2013
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Carl Walter joined the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) as visiting scholar with the China Program for the 2021-2022 academic year. Prior to coming to APARC, he served as independent, non-executive Director at the China Construction Bank. He was also previously a visiting scholar with APARC during the winter and spring terms of the 2012–13 academic year after a career in banking spent largely in China. 

His research interests focus on China's financial system and its impact on financial and political organizations. During his time at Shorenstein APARC Walter will continue his book project on how fiscal reforms in China have impacted the banking system, the overall economy and the prospect for financial reform going forward.

Walter has contributed articles to publications including Caijing, the Wall Street Journal and the China Quarterly. He is also the co-author of Red Capitalism: The Fragile Financial Foundations of China's Extraordinary Rise (2012) and Privatizing China: Inside China's Stock Markets (2005).

Walter lived and worked in Beijing from 1991 to 2011, first as an investment banker involved in the earliest SOE restructurings and overseas public listings, then as chief operation officer of China's first joint venture investment bank, China International Capital Corporation. Over the last ten years he was JPMorgan's China chief operating officer as well as chief executive officer of its China banking subsidiary.

Walter holds a PhD in political science from Stanford University, a certificate of advanced study from Peking University and a BA in Russian Studies from Princeton University.

Carl Walter Former CEO Speaker JPMorgan Chase Bank China Co Ltd.
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The economic reforms of the past two decades have initiated a major social transition in China, characterized by unprecedented social mobility and stratification.  Meanwhile, the privatization of health care has increased costs to the consumer and further changed familial and social norms. While such changes would logically affect individuals’ psychological well-being, little attention has been paid to their impact in this regard. Using data from the Chinese General Social Survey (CGSS 2005), this paper looks at the relationships between social change, social support and the psychological well-being of individuals in both urban and rural areas, as well as the role of marital status in Chinese society. We find that an increasing health care burden is significantly reducing individuals’ psychological well-being. Perceptions of social status, especially as it changes over time and when compared against peers, also have an effect. Social support has protective function for psychological well-being, and also compensates for the negative effect of increasing health-care burden and relative deprivation during social change on psychological well-being. Marital status is also significantly correlated with psychological well-being, and moderates the relationships between social change, other social support and psychological health, especially in rural cases.

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Asia Health Policy Program working paper #23
Authors
Huijun Liu
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The Asia Pacific Observatory (APO) on Health Systems and Policies was established in June 2011. It is a collaborative partnership of interested governments, international agencies, foundations, civil society, and the research community. Modeled on the European Observatory of the same name, the APO has as its main function the collection and analysis of information and research evidence on health care systems, policies, and reforms, with the aim of making this knowledge widely available and easily accessible throughout the Asia Pacific Region; it will also draw cross-country lessons and disseminate these in formats that can be directly used for policymaking.

This presentation will trace the history underlying the creation of the Observatory and indicate its objectives, organizational structure, and proposed modes of operation. It will describe the challenges of attempting to bring a wide range of stakeholders together in support of a regional collaborative research effort. It will also touch on ways that research entities located outside the Asia Pacific region might interact with the APO.

L. Richard Meyers was employed by the World Bank for two decades managing teams that carried out World Bank health sector projects and analytical work in a number of countries in East Asia. He directed a team that produced the first comprehensive health sector review for Vietnam, as well as the first Vietnam National Health Survey.  He also led a team that produced the most comprehensive and empirically-based external analysis to date of the rural health sector in China. More recently he has worked with the European Health Observatory, the Asian Development Bank, the World Bank, the WHO Western Pacific and South Asia regional offices, and other stakeholders to facilitate the creation of the Asia Pacific Observatory.

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L. Richard Meyers Consultant Speaker World Bank
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Objective To investigate educational disparities in the care process and health outcomes among patients with diabetes in the context of South Korea's universal health insurance system.

Design Bivariate and multiple regression analyses of data from a cross-sectional health survey.

Setting A nationally representative and population-based survey, the 2005 Korea National Health and Nutrition Examination Survey.

Participants Respondents aged 40 or older who self-reported prior diagnosis with diabetes (n= 1418).

Main Outcome Measures Seven measures of the care process and health outcomes, namely (i) receiving medical treatment for diabetes, (ii) ever received diabetes education, (iii) received dilated eye examination in the past year, (iv) received microalbuminuria test in the past year, (v) having activity limitation due to diabetes, (vi) poor self-rated health and (vii) self-rated health on a visual analog scale.

Results Except for receiving medical care for diabetes, overall process quality was low, with only 25% having ever received diabetes education, 39% having received a dilated eye examination in the past year and 51% having received a microalbuminuria test in the past year. Lower education level was associated with both poorer care processes and poorer health outcomes, whereas lower income level was only associated with poorer health outcomes.

Conclusion While South Korea's universal health insurance system may have succeeded in substantially reducing financial barriers related to diabetes care, the quality of diabetes care is low overall and varies by education level. System-level quality improvement efforts are required to address the weaknesses of the health system, thereby mitigating educational disparities in diabetes care quality.

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International Journal for Quality in Health Care
Authors
Young Kyung Do
Karen Eggleston
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