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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
Do.JPG MD, PhD

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.

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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
jean_oi_headshot.jpg PhD

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.

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Director, China Program at the Walter H. Shorenstein Asia-Pacific Research Center
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
Professor, by courtesy, Health Policy
Faculty Research Fellow of the National Bureau of Economic Research
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
karen-0320_cropprd.jpg PhD

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, Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center
Stanford Health Policy Associate
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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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Dr. Linton was born in Philadelphia in 1950 and grew up in Korea, where his father was a third generation Presbyterian missionary. He is a visiting associate of the Korea Institute, Harvard University, for 2006-07. Linton is currently Chairman of The Eugene Bell Foundation, a not-for-profit organization that provides humanitarian aid to North Korea.

Dr. Linton's talk will focus on the Eugene Bell Foundation and its programs. Named for Rev. Eugene Bell, Lintonn's great-grandfather and a missionary who arrived in Korea in 1895, the Foundation serves as a conduit for a wide spectrum of business, governmental, religious and social organizations as well as individuals who are interested in promoting programs that benefit the sick and suffering of North Korea.

Since 1995, the Foundation strives primarily to bring medical treatment facilities in North Korea together with donors as partners in a combined effort to fight deadly diseases such as tuberculosis (TB). In 2005, the North Korean ministry of Public Health officially asked the Foundation to expand its work to include support programs for local hospitals. The Foundation currently coordinates the delivery of TB medication, diagnostic equipment, and supplies to one third of the North Korean population and approximately forty North Korean treatment facilities (hospitals and care centers).

Dr. Linton's credentials include: thirty years of teaching and research on Korea, twenty years of travel to North Korea (over fifty trips since 1979), and ten years of humanitarian aid work in North Korea. Dr. Linton received a Bachelor of Arts degree from Yonsei University in Seoul, Korea, a Masters of Divinity from Korea Theological Seminary, and a Masters of Philosophy and a Ph.D. in Korean Studies from Columbia University.

This public lecture is part of the conference "Public Diplomacy, Counterpublics, and the Asia Pacific." This conference is co-sponsored by The Asia Society Northern California; The Japan Society of Northern California; Business for Diplomatic Action; Center for International Security and Cooperation at Stanford University; and the Taiwan Democracy Program in the Center on Democracy Development, and the Rule of Law at Stanford University.

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Stephen Linton Chairman Speaker The Eugene Bell Foundation
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Despite successful economic reforms over the past two decades, China's health care system for the nearly one billion people that live and work in rural areas is broken. Having admitted that there is a crisis, the government is now committed to looking for solutions. In this proposal, we have two overall goals to help provide insights on part of the solution. Our first objective is to collect an updated wave of highly informative data in Year 1 to build on an existing set of data already collected by our study team (from 2004) to analyze the effects of key health policies and institutions that have emerged over the past several years, including the government's rural health insurance system, the privatization of rural clinics, and new investments into township hospitals. Our second, more forward-looking goal for Years 2 and 3 is to set up and introduce an initial experiment on incentives to study one of the most serious flaws in China's health system: the practice in which doctors both prescribe and derive significant profit from drugs. The main hypothesis to be tested is whether realigning doctors' financial incentives embedded in the current organization of China's rural health system influence: a) the way doctors treat and manage their patients; b) the time and effort doctors put into patient care; and c) patient satisfaction.

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Scott Rozelle
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