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Fast Forward: Uncertainties, Risks and Opportunities of Rapid Aging in China, Japan, and Korea will be an innovative, invitation-only scenario planning exercise. Our goal is to develop a broader understanding of how population aging could affect the social, cultural, economic, and security futures of Asia over the next ten to twenty years. We’ve invited a select group of leaders from business, government, and academia with an interest in various aspects of Asia’s growth to identify key uncertainties and assess possible outcomes. This highly interactive session will be moderated by the Global Business Network, the world’s leading scenario consultancy.

This scenario planning workshop is part of a two-day conference at Stanford, Aging Asia: Economic and Social Implications of Rapid Demographic Change in China, Japan, and Korea. The first day, Aging in Asia Today: What the Experts Know, will feature keynote presentations and academic panels on the impacts of rapid aging in these countries, focused on four topics: economic growth, social insurance programs, long-term care, and health care.

Bechtel Conference Center

Conferences
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This conference, sponsored by the Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center and the Global Aging Program of Stanford Center on Longevity, explored the impact of rapid aging on economic growth, labor markets, social insurance financing, long term care, and health care in China, Japan, and Korea.

Bechtel Conference Center

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Former Shorenstein APARC Fellow
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Michael Armacost (April 15, 1937 – March 8, 2025) was a Shorenstein APARC Fellow at the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) from 2002 through 2021. In the interval between 1995 and 2002, Armacost served as president of Washington, D.C.'s Brookings Institution, the nation's oldest think tank and a leader in research on politics, government, international affairs, economics, and public policy. Previously, during his twenty-four-year government career, Armacost served, among other positions, as undersecretary of state for political affairs and as ambassador to Japan and the Philippines.

Armacost began his career in academia, as a professor of government at Pomona College. In 1969, he was awarded a White House Fellowship and was assigned to the Secretary and Deputy Secretary of State. Following a stint on the State Department's policy planning and coordination staff, he became a special assistant to the U.S. ambassador in Tokyo from 1972 to 74, his first foreign diplomatic post. Thereafter, he held senior Asian affairs and international security posts in the State Department, the Defense Department, and the National Security Council. From 1982 to 1984, he served as U.S. ambassador to the Philippines and was a key force in helping the country undergo a nonviolent transition to democracy. In 1989, President George Bush tapped him to become ambassador to Japan, considered one of the most important and sensitive U.S. diplomatic posts abroad.

Armacost authored four books, including, Friends or Rivals? The Insider's Account of U.S.–Japan Relations (1996), which draws on his tenure as ambassador, and Ballots, Bullets, and Bargains: American Foreign Policy and Presidential Elections (2015). He also co-edited, with Daniel Okimoto, the Future of America's Alliances in Northeast Asia, published in 2004 by Shorenstein APARC. Armacost served on numerous corporate and nonprofit boards, including TRW, AFLAC, Applied Materials, USEC, Inc., Cargill, Inc., and Carleton College, and he currently chairs the board of The Asia Foundation.  

A native of Ohio, Armacost graduated from Carleton College and earned his master's and doctorate degrees in public law and government from Columbia University. He received the President's Distinguished Service Award, the Defense Department's Distinguished Civilian Service Award, the Secretary of State's Distinguished Services Award, and the Japanese government’s Grand Cordon of the Order of the Rising Sun.

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Michael H. Armacost Speaker
David Bloom Speaker Harvard University
Judith Banister Speaker The Conference Board
Naoki Ikegami Speaker Keio University
Soonman Kwon Speaker Seoul National University
Shripad Tuljapurkar Speaker Stanford University
Marcus W. Feldman Speaker Stanford University
Naohiro Ogawa Speaker Nihon University
Andrew Mason Speaker University of Hawaii
Shanlian Hu Speaker Fudan University
Edward Norton Speaker University of Michigan
Shuzhuo Li Speaker Xi'an Jiaotong University
Maria Porter Speaker University of Chicago
Meng Kin Lim Speaker National University of Singapore National University of Singapore
Kai Hong Phua Kai Hong Phua Speaker National University of Singapore National University of Singapore
John C. Campbell Speaker University of Michigan Emeritus
Byongho Tchoe Speaker Korea Institute for Health and Social Affairs
Young Kyung Do Speaker Asia Health Policy Program
Jian Wang Speaker Shandong University
Dolores Gallagher-Thompson Speaker Stanford School of Medicine
Conferences
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Dr. Forsberg will present findings from studies in China and Vietnam and put those findings into a broader comparative perspective regarding the future role of the private sector in improving health service delivery and population health.

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Birger Carl Forsberg is a public health specialist and lecturer in International Health at the Karolinska Institute in Stockholm, Sweden from where he holds an MD and a PhD. He is also trained in economics and has health economics as one of his areas of work. Dr Forsberg has more than 20 years experience from international health from around 25 low- and middle-income countries as an adviser to bilateral donors and international organisations. Since 2002 he has been a consultant to the World Bank on public private sector collaboration in health. He is also coordinator since 2002 of a joint Harvard-Karolinska research programme called Private Sector Programme in Health (PSP). The programme has coordinated studies of the private health sector in five countries in Asia and Africa. In his talk Dr Forsberg will present findings from PSP studies in China and Vietnam and put those findings into a broader perspective on the future role of the private sector in health service delivery for increased access to health services and improved health.

Philippines Conference Room

Birger Carl Forsberg, MD Private Sector Program in Health Coordinator Speaker Karolinska Institutet, Sweden
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Karen Eggleston
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Clear evidence suggests the importance of health service provider payment incentives for achieving efficiency, equal access, and quality, including attention to primary, secondary, and tertiary prevention. “Pay for performance” may be on the cusp of significant expansion in Asia, and reform away from fee-for-service has been underway for several years in several economies. Yet despite the policy relevance, the evidence base for evaluating payment reforms in Asia is still very limited.

China in particular has been undertaking significant reforms to its health care system in both rural and urban areas. With the expansion of insurance coverage and need to resolve incentive problems like “supporting medical care through drug sales,” there is an urgent need for evaluating alternative ways of paying health service providers. Evidence from policy reforms in specific regions of China, as well as other economies of the Asia-Pacific, can provide valuable evidence to help inform policy decisions about how to align provider incentives with policy goals of quality care at reasonable cost.

To illuminate these questions, the Asia Health Policy Program and several collaborating institutions are planning to convene a conference on health care provider payment incentives on November 7-8, 2008 in Beijing. The conference will highlight and seek to distill “best-practice” lessons from rigorous and policy-relevant evaluations of recent reforms in China and elsewhere in the Asia Pacific.

The organizing committee – including health economists from Shorenstein APARC, Peking University, Tsinghua University, and Seoul National University – reviewed submissions in June 2008 and accepted sixteen. The conference papers cover payment issues in Korea, Japan, China, Taiwan, Thailand, Tajikistan, the Philippines, and the US, and the disciplines of economics, health services research/health policy, public health, medicine, and ethics. Topics include institutionalized informal payments; the impact of global budget policies on high-cost patients; public-private partnerships; public-sector physicians owning private pharmacies; evidence-informed case payment rates; payment and hospital quality; bonuses and physician satisfaction; physician prescription choice between brand-name and generic drugs; and differences in pharmaceutical utilization across insurance plans that pay providers differently (fee-for-service versus capitation).

Policymakers from China’s National Development and Reform Commission and Ministry of Health will also speak at the conference. Selected research papers will be published through the Shorenstein Asia-Pacific Research Center either in a special volume or in a special issue of an English-language health policy journal.

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Contradictory goals plague China’s pharmaceutical policy. The government wants to develop the domestic pharmaceutical industry and has used drug pricing to cross-subsidize public hospitals. Yet the government also aims to control pharmaceutical spending through price caps and profit-margin regulations to guarantee access even for poor patients. The resulting system has distorted market incentives, increased consumer cost, and financially rewarded inappropriate prescribing, thus undermining public health. Though pharmaceuticals account for about half of total healthcare expenditures in China, representing 43% of expenditure per inpatient episode and 51% of expenditure per outpatient visit, some essential medicines are unavailable or of questionable quality.

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Karen Eggleston
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Postdoctoral Fellow in Asia Health Policy Program, 2008-09
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Young Kyung Do is the inaugural Postdoctoral Fellow in the Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center. He completed his Ph.D. in health policy and administration at the University of North Carolina at Chapel Hill School of Public Health in August 2008. He has also earned M.D. and Master of Public Health degrees from Seoul National University (in 1997 and 2003, respectively). He earned board certification in preventive medicine from the Korean Medical Association in 2004. His research interests include population aging and health care, comparative health policy, health and development, quality of care, program evaluation, and quantitative methods in health research.

He received the First Prize Award in the Graduate Student Paper Competition in the Korea Labor and Income Panel Study Conference in 2007. He also is the recipient of the Harry T. Phillips Award for Outstanding Teaching by a Doctoral Student from the UNC Department of Health Policy and Administration in 2007. In May 2008, he was selected as a New Investigator in Global Health by the Global Health Council.

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We report the results of a review of the Chinese- and English-language literatures on service delivery in China, asking how well China's health-care providers perform and what determines their performance. Although data and methodological limitations suggest caution in drawing conclusions, a critical reading of the available evidence suggests that current health service delivery in China leaves room for improvement, in terms of quality, responsiveness to patients, efficiency, cost escalation, and equity. The literature suggests that these problems will not be solved by simply shifting ownership to the private sector or by simply encouraging providers - public and private - to compete with one another for individual patients. By contrast, substantial improvements could be (and in some places have already been) made by changing the way providers are paid - shifting away from fee-for-service and the distorted price schedule. Other elements of active purchasing by insurers could further improve outcomes. Rigorous evaluations, based on richer micro-level data, could considerably strengthen the evidence base for service delivery policy in China.

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Karen Eggleston
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China's Harmonious Society colloquium series is co-sponsored by the Stanford China Program and the Center for East Asian Studies

Since 2006, the official doctrine of China's Communist Party calls for the creation of a "harmonious society" (HeXieSheHui). This policy, identified with the Hu Jintao leadership, acknowledges the new problems that have emerged as China continues its amazing economic growth. The economy is booming but so are tensions from rising inequality, environmental damage, health problems, diverse ethnicities, and attempts to break the "iron rice bowl." In this series of colloquia, leading authorities will discuss the causes of these tensions, their seriousness, and China's ability to solve these challenges.

Depending on where one stands, China's state-owned enterprises have reformed too slowly or too fast. Some lament the incompleteness of China's efforts to break the "iron rice bowl," to free firms from inefficient industrial practices, to rid firms of non-production expenses. Yet, as incomplete and slow as the reforms seem to some, New Left critics charge that China's reforms have gone too far, that SOEs have been subject to asset stripping, that firms have been "given away," and that the privileged few, particularly factory managers, have become rich capitalists overnight, through corruption and collusion with local officials. The losers in this view are the workers, who have been left unemployed, subject to layoffs, without health care, and sometimes without even their promised pensions-the very problems that prompted Hu Jintao's call for fixes to create a new "harmonious society." These two views of SOE reform, while seeming to convey different realities, reflect the political cross currents that have shaped China's corporate restructuring. Based on recent research in China, Jean Oi will discuss how those charged with reforming SOEs have tried to walk the tightrope between too slow and too fast reform, and the consequences.

Philippines Conference Room

Department of Political Science
Stanford University
616 Serra Street
Stanford, CA 94305-26044

(650) 723-2843 (650) 725-9401
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Senior Fellow at the Freeman Spogli Institute for International Studies
William Haas Professor in Chinese Politics
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Jean C. Oi is the William Haas Professor of Chinese Politics in the department of political science and a Senior Fellow of the Freeman Spogli Institute for International Studies at Stanford University. She is the founding director of the Stanford China Program at the Walter H. Shorenstein Asia-Pacific Research Center. Professor Oi is also the founding Lee Shau Kee Director of the Stanford Center at Peking University.

A PhD in political science from the University of Michigan, Oi first taught at Lehigh University and later in the Department of Government at Harvard University before joining the Stanford faculty in 1997.

Her work focuses on comparative politics, with special expertise on political economy and the process of reform in transitional systems. Oi has written extensively on China's rural politics and political economy. Her State and Peasant in Contemporary China (University of California Press, 1989) examined the core of rural politics in the Mao period—the struggle over the distribution of the grain harvest—and the clientelistic politics that ensued. Her Rural China Takes Off (University of California Press, 1999 and Choice Outstanding Academic Title, 1999) examines the property rights necessary for growth and coined the term “local state corporatism" to describe local-state-led growth that has been the cornerstone of China’s development model. 

She has edited a number of conference volumes on key issues in China’s reforms. The first was Growing Pains: Tensions and Opportunity in China's Transformation (Brookings Institution Press, 2010), co-edited with Scott Rozelle and Xueguang Zhou, which examined the earlier phases of reform. Most recently, she co-edited with Thomas Fingar, Fateful Decisions: Choices That Will Shape China’s Future (Stanford University Press, 2020). The volume examines the difficult choices and tradeoffs that China leaders face after forty years of reform, when the economy has slowed and the population is aging, and with increasing demand for and costs of education, healthcare, elder care, and other social benefits.

Oi also works on the politics of corporate restructuring, with a focus on the incentives and institutional constraints of state actors. She has published three edited volumes related to this topic: one on China, Going Private in China: The Politics of Corporate Restructuring and System Reform (Shorenstein APARC, 2011); one on Korea, co-edited with Byung-Kook Kim and Eun Mee Kim, Adapt, Fragment, Transform: Corporate Restructuring and System Reform in Korea (Shorenstein APARC, 2012); and a third on Japan, Syncretism: The Politics of Economic Restructuring and System Reform in Japan, co-edited with Kenji E. Kushida and Kay Shimizu (Brookings Institution, 2013). Other more recent articles include “Creating Corporate Groups to Strengthen China’s State-Owned Enterprises,” with Zhang Xiaowen, in Kjeld Erik Brodsgard, ed., Globalization and Public Sector Reform in China (Routledge, 2014) and "Unpacking the Patterns of Corporate Restructuring during China's SOE Reform," co-authored with Xiaojun Li, Economic and Political Studies, Vol. 6, No. 2, 2018.

Oi continues her research on rural finance and local governance in China. She has done collaborative work with scholars in China, including conducting fieldwork on the organization of rural communities, the provision of public goods, and the fiscal pressures of rapid urbanization. This research is brought together in a co-edited volume, Challenges in the Process of China’s Urbanization (Brookings Institution Shorenstein APARC Series, 2017), with Karen Eggleston and Wang Yiming. Included in this volume is her “Institutional Challenges in Providing Affordable Housing in the People’s Republic of China,” with Niny Khor. 

As a member of the research team who began studying in the late 1980s one county in China, Oi with Steven Goldstein provides a window on China’s dramatic change over the decades in Zouping Revisited: Adaptive Governance in a Chinese County (Stanford University Press, 2018). This volume assesses the later phases of reform and asks how this rural county has been able to manage governance with seemingly unchanged political institutions when the economy and society have transformed beyond recognition. The findings reveal a process of adaptive governance and institutional agility in the way that institutions actually operate, even as their outward appearances remain seemingly unchanged.

Selected Multimedia

Director of the China Program
Lee Shau Kee Director of the Stanford Center at Peking University
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
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Jean C. Oi William Haas Professor in Chinese Politics, Professor of Political Science, Senior Fellow at FSI, and Director, Stanford China Program Speaker Stanford University
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China's Harmonious Society colloquium series

co-sponsored by the Stanford China Program and the Center for East Asian Studies

Since 2006, the official doctrine of China's Communist Party calls for the creation of a "harmonious society" (HeXieSheHui). This policy, identified with the Hu Jintao leadership, acknowledges the new problems that have emerged as China continues its amazing economic growth. The economy is booming but so are tensions from rising inequality, environmental damage, health problems, diverse ethnicities, and attempts to break the "iron rice bowl." In this series of colloquia, leading authorities will discuss the causes of these tensions, their seriousness, and China's ability to solve these challenges.


Nancy Shulman's talk topic will be posted soon.

Nancy Shulman conducts laboratory and clinical research in the area of HIV therapeutics, with focus on antiretroviral resistance and treatment strategies of experienced patients, the impact of antiretroviral treatment on HIV co-receptor utilization, and HIV in China. she received her MD from Kansas University Medical School and holds a BA in biochemistry from University of Texas, Austin. She is a doctor specializing in internal medicine, pediatrics, and infectious diseases.

"Healthcare Coverage for 1.3 Billion: China's Odyssey"

Karen Eggleston

Media coverage as well as the academic literature give conflicting appraisals of China's reality: Is China's healthcare system on the verge of collapse? Why is healthcare so expensive and difficult to access in contemporary China? Have reforms 'marketizing' healthcare drastically undermined progress in assuring affordable access for all? Or do hospitals and other providers constitute a last bastion of state control and bureaucratized monopoly in the name of equal access? Chinese analysts and policy advisers have engaged in a sometimes acrimonious debate; some champion a government-led, National Health Service-like model, while others passionately argue that market forces should play a greater role. In this talk, Karen Eggleston will present a brief overview of China's health system reforms and current developments.

Karen Eggleston focuses her research on comparative healthcare systems during economic development and transition from central planning to market-based economies. Her interests include the impact of payment incentives on healthcare insurer and provider behavior; chronic disease management; and incentives surrounding health behaviors such as the spread of HIV/AIDS and tuberculosis, overuse of antibiotics, and smoking. She earned her PhD in public policy from Harvard University and has MA degrees in economics and Asian studies from the University of Hawaii.

Philippines Conference Room

Shorenstein APARC
Stanford University
Encina Hall E301
Stanford, CA 94305-6055

(650) 723-9072 (650) 723-6530
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Senior Fellow at the Freeman Spogli Institute for International Studies
Center Fellow at the Center for Health Policy and the Center for Primary Care and Outcomes Research
Faculty Research Fellow of the National Bureau of Economic Research
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
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Karen Eggleston is a Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford University and Director of the Stanford Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center at FSI. She is also a Fellow with the Center for Innovation in Global Health at Stanford University School of Medicine, and a Faculty Research Fellow of the National Bureau of Economic Research (NBER). Her research focuses on government and market roles in the health sector and Asia health policy, especially in China, India, Japan, and Korea; healthcare productivity; and the economics of the demographic transition.

Eggleston earned her PhD in public policy from Harvard University and has MA degrees in economics and Asian studies from the University of Hawaii and a BA in Asian studies summa cum laude (valedictorian) from Dartmouth College. Eggleston studied in China for two years and was a Fulbright scholar in Korea. She served on the Strategic Technical Advisory Committee for the Asia Pacific Observatory on Health Systems and Policies and has been a consultant to the World Bank, the Asian Development Bank, and the WHO regarding health system reforms in the PRC.

Director of the Asia Health Policy Program, Shorenstein Asia-Pacific Research Center
Stanford Health Policy Associate
Faculty Fellow at the Stanford Center at Peking University, June and August of 2016
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Karen Eggleston Shorenstein Asia-Pacific Research Center Fellow Speaker Stanford University
Nancy Shulman Assistant Professor of Medicine (Infectious Diseases) Speaker School of Medicine, Stanford University
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Dr. Karen Eggleston will join the Shorenstein Asia-Pacific Research Center as a center fellow on July 1, 2007. Dr. Eggleston will lead the center's program on comparative health care in East Asia.

Dr. Eggleston's research focuses on comparative healthcare systems and their link to broader social protection policies during economic development and transition from central planning to market-based economies; payment incentives and their impact on healthcare insurer and provider behavior; the market structure of healthcare, including competition, integration, ownership, and healthcare productivity; and incentives surrounding health behaviors such as the spread of HIV/AIDS, overuse of antibiotics, and smoking. She studied in China for two years and was a Fulbright scholar in Korea.

Eggleston earned her Ph.D. in public policy from Harvard University in 1999. She has an M.A. in economics and another in Asian studies from the University of Hawaii, Economics (August 1995 and May 1992, respectively.) She is currently an assistant professor of economics at Tufts University in Boston. Dr. Eggleston joined the faculty at Tufts in 1999.

Currently, Dr. Eggleston is a research associate at the Kennedy School of Government at Harvard University and an academic program coordinator at the Kennedy School Health Care Delivery Policy Program also at Harvard. Dr. Eggleson has been a research associate at the China Academy of Health Policy (CAHP) at Peking University, Beijing, China since 2003 and in the summer of 2004 she was a consultant to the World Bank on their project on health service delivery and the rural health sector.

"Karen will be a great addition to the center," says director of the center, Gi-Wook Shin.

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