**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. 

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.

The new health reform started in 2009 has shown the determination of the Chinese government, especially the central government, to increase its responsibility in the health sector. The most obvious manifestation of this commitment would be to increase government health expenditure (GHE). But there is still a hot debate about whether the government should allocate more public finds to health or just deepen the marketization of the health sector. Moreover, commitments at the central and local levels are not the same: local government responsibility for GHE is high, and commitments by the central government to increase GHE have not translated into increases in local government GHE as much as proposed in the national health reform.

Our research seeks to answer two questions: What was the actual pattern of GHE? And why did China’s local governments respond as they did? We first discuss the necessity of public financing for health care, and then analyze how intergovernmental economic competition affects local governments’ behavior under “Chinese-style decentralization” (known as fiscal decentralization with political centralization). Empirically, we apply a dynamic panel data model to provincial panel data from 1991 to 2007 to identify the effect of GHE on health performance in each province over time, using infant mortality and some morbidity metrics as health performance variables. We also examine differences across regions, as well as before and after the Severe Acute Respiratory Syndrome (SARS) epidemic of 2003.

Our analysis provides evidence that Chinese-style decentralization negatively impacted GHE. The main findings are as follows:

1. Increasing GHE did improve health performance, and this improvement was mainly driven by the GHE through the health department directly, not through spending by other governmental departments that also impact health. However, pursuit of economic performance lowered local governments’ GHE, mainly by decreasing GHE through local health departments.
   
2. Compared with in the eastern and western regions, this health improvement was not significant in China’s middle regions, where the intergovernmental economic competition leads to much less GHE through health departments.
   
3. The outburst of SARS in 2003 further increased the positive effect from GHE through local health departments, while the effect from GHE through other departments was not equally significant.
   

All these results suggest that adjusting the structure of public health financing, reforming the fiscal system, and improving the performance evaluation system for local governments are critical for the success of China’s on-going health reform.