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The Walter H. Shorenstein Asia-Pacific Research Center (APARC) is pleased to invite applications for a suite of fellowships in contemporary Asia studies to begin in fall quarter 2026.

The Center offers postdoctoral fellowships that promote multidisciplinary research on Asia health policy, contemporary Japan, and contemporary Asia broadly defined, as well as postdoctoral fellowships and visiting scholar positions with the Stanford Next Asia Policy Lab and a visiting fellow position on contemporary Taiwan. Learn more about each opportunity and its specific application requirements:

2026-27 Asia Health Policy Program Postdoctoral Fellowship


Hosted by the Asia Health Policy Program at APARC, the fellowship is awarded to one recent PhD recipient undertaking original research on contemporary health or healthcare policy of high relevance to countries in the Asia-Pacific region, especially developing countries. Appointments are for one year beginning in fall quarter 2026. The application deadline is December 1, 2025.

2026-27 Japan Program Postdoctoral Fellowship


Hosted by the Japan Program at APARC, the fellowship supports research on contemporary Japan in a broad range of disciplines, including political science, economics, sociology, law, policy studies, and international relations. Appointments are for one year beginning in fall quarter 2026. The application deadline is December 1, 2025.  

2026-27 Shorenstein Postdoctoral Fellowship on Contemporary Asia


APARC offers two postdoctoral fellowship positions to junior scholars for research and writing on contemporary Asia. The primary research areas focus on political, economic, or social change in the Asia-Pacific region (including Northeast, Southeast, and South Asia), or international relations and international political economy in the region. Appointments are for one year beginning in fall quarter 2026. The application deadline is December 1, 2025. 
 

2026-27 Taiwan Program Visiting Fellowship


Hosted by the Taiwan Program at APARC, the fellowship is awarded to one mid-career to senior-level expert with extensive experience studying contemporary Taiwan. The fellowship research focus is on issues related to how Taiwan can meet the challenges and opportunities of economic, social, technological, environmental, and institutional adaptation in the coming decades, using a variety of disciplines, including the social sciences, public policy, and business. The application deadline is March 1, 2026.  
 

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The center offers multiple fellowships in Asian studies to begin in fall quarter 2026. These include a postdoctoral fellowship on political, economic, or social change in the Asia-Pacific region, postdoctoral fellowships focused on Asia health policy and contemporary Japan, postdoctoral fellowships and visiting fellow positions with the Stanford Next Asia Policy Lab, and a visiting fellow position on contemporary Taiwan.

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As countries confront rising health care spending, policymakers everywhere face a key question: Who benefits from these spending increases?

Consider South Korea, a nation that has sharply increased its per capita health care spending over the past decade, delivering reasonable value in improving health outcomes as measured by rising life expectancy and a reduced overall disease burden. Yet, not all South Koreans reap equal rewards from the country’s health investments, according to a new study. Rather, adults in the lowest-income quintile receive the least health gains for every dollar spent on their care.

Published in the journal Health Affairs Scholar, the study reveals stark income-based disparities in the value of health care — defined as health gains relative to spending — among South Korean adults. The research systematically quantifies how efficiently health spending translates into longer, healthier lives across income groups in South Korea, providing insights into the distribution of health gains relative to health care spending.

“While earlier research often examined disparities in access, utilization, or outcomes separately, our analysis provides a more integrated assessment by jointly examining health care costs and health gains,” explains the research team, including Stanford health economist Karen Eggleston, the director of the Asia Health Policy Program (AHPP) at APARC. Eggleston’s co-authors are Sungchul Park, an associate professor in Korea University’s Department of Health Policy and Management; Young Kyung Do, a professor in Seoul National University’s Department of Health Policy and Management and AHPP’s inaugural postdoctoral fellow; and David Cutler, the Otto Eckstein Professor of Applied Economics at Harvard University. 

Their findings are sobering: between 2010 and 2018, South Korean adults in the lowest income quintile derived the least value from increased health spending compared to those in the middle- and higher income quintiles, suggesting a system that underserves the poorest population.


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These findings highlight structural inequities in the South Korean health system and emphasize the need for targeted policies to promote equitable health care value.
Eggleston et al.

Poorer Health, Smaller Gains


Between 2010 and 2019, per capita health care spending in Korea increased from $1,211 to $1,903, growing nearly 6 percent annually. During that decade, life expectancy climbed from 80.5 to 83.7 years, while disability-adjusted life years – expressed as the number of years lost due to ill-health – declined significantly. These measures seemingly suggest health spending has yielded solid returns in terms of improved health outcomes.

Yet stark income inequality persists in Korea. The country has both the highest old-age poverty rate and the largest share of out-of-pocket medical expenses among OECD countries. Does rising health spending benefit all segments of society equally?

To answer this question, the researchers analyzed trends in health spending and outcomes across income quintiles (excluding the bottom 10 percent of the household income distribution) from 2010 to 2018.

They measured health care spending as total medical expenditures, including costs for inpatient and outpatient services, emergency services, and prescription medications. All spending measures were adjusted for inflation and are reported in 2021 US dollars. To asses health outcomes, they used three indicators: (1) health-related quality of life, which relies on standard questionnaires to measure individuals’ perceived physical and mental health over time; (2) life expectancy, calculated using life table methods based on enrollment data from the national health insurance system; and (3) quality-adjusted life expectancy (QALE) at age 25, a measure that reflects both longevity and the quality of life during those years – an essential consideration when evaluating the effectiveness and equity of health care systems. To quantify the value of health care across income groups, the researchers applied statistical methods.

They found that adults in the lowest-income quintile experienced the smallest relative improvement in QALE over time: an increase of 0.7 years, compared with 1.4 years in the second and third quintiles, 1.3 years in the fourth, and 1.2 years in the highest quintile. Translated into a value estimate, adults in the lowest income quintile incurred $78,209 per QALE; in contrast, adults in the second through highest income quintiles achieved greater value estimates of $47,831, $46,905, $31,757, and $53,889, respectively. Thus, the most efficient gains in both longevity and quality of life were in the middle-income groups.

“We found that per capita spending was similar across income groups, but the lowest-income quintile experienced much smaller gains in QALE,” Eggleston and her collaborators write. 

Reflecting the principle of diminishing returns, “these findings highlight structural inequities in the South Korean health system and emphasize the need for targeted policies to promote equitable health care value.” 

Adults in the lowest-income quintile derived the least value, largely due to poorer baseline health and limited access to care.
Eggleston et al.

Why Spending Does Not Equal Value


While the study did not identify causal pathways, secondary data suggest two plausible explanations for the results: poorer baseline health and greater unmet needs.

The data indicate that adults in the lowest-income quintile had significantly higher rates of chronic disease, disability, behavioral risk factors such as smoking and obesity rates, and mental health issues. These factors make it more difficult to achieve health gains.

Moreover, adults in the lowest-income quintile were less likely to receive preventive services, with markedly lower rates of medical checkups and cancer screenings. “Despite greater health needs, these adults faced persistent barriers to accessing care, particularly financial constraints,” the researchers say.

Notably, the highest value of health spending was not observed among adults in the highest-income group. One explanation is that this group may consume more low-value or marginally beneficial health services.

Policy Implications: Efficiency with Equity


Eggleston and her co-authors emphasize “the need for health policy in South Korea to prioritize both equity and value.” They highlight the following targeted strategies to improve efficiency and fairness:

  • Invest in high-value services that link spending to meaningful health outcomes:
    • Improve access to high-value preventive and primary care services by expanding financial protections, particularly for lower-income groups.
    • Improve overall system efficiency by reducing the overuse of low-value health care services.
  • Pair health care reform with broader social policies: Coordinate efforts to address upstream factors tied to health disparities, such as income inequality.
  • Aim for improvements across the entire population: Implement evidence-based clinical appropriateness guidelines to ensure health care spending yields meaningful and equitable results.

While focused on South Korea, the study’s findings illuminate how income inequality interacts with health system designs and carry lessons for other countries.

“In countries with greater income inequality and fragmented health systems, such as the United States, disparities in health care value may be even more pronounced,” the co-authors write.

As South Korea and other countries continue to invest heavily in health care, the study highlights the urgency of improving the distribution and impact of that increased spending. Without focused reforms, it risks entrenching existing inequities rather than alleviating them.

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China’s Unified Health Insurance System Improved Mental Well-Being Among Rural Residents, Study Finds

New research by a team including Stanford health economist Karen Eggleston provides evidence about the positive impact of China’s urban-rural health insurance integration on mental well-being among rural seniors, offering insights for policymakers worldwide.
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Despite rising health care spending, adults in South Korea’s lowest-income quintile experience the smallest relative improvement in life expectancy and well-being, according to a new study. The co-authors, including Stanford health economist Karen Eggleston, call for the country’s health policy to prioritize both equity and value, and highlight lessons for other health systems.

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(Former) Visiting Scholar at APARC, 2025-2026
eunkyeong_lee.jpg PhD

Eunkyeong Lee joined the Walter H. Shorenstein Asia-Pacific Research Center (APARC) as a visiting scholar for the 2025-2026 academic year. She currently serves as Research Fellow at the Korea Institute of Public Finance. While at APARC, she conducted research on healthcare systems and utilization among the elderly in South Korea.

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Asia Health Policy Postdoctoral Fellow, 2025-2026
yuli_xu.jpg PhD

Yuli Xu joined the Walter H. Shorenstein Asia-Pacific Research Center (APARC) as Asia Health Policy Postdoctoral Fellow for the 2025-2026 academic year. She recently obtained her PhD in Economics at the University of California, San Diego. Her research focuses on Labor and Health Economics, with particular interests in how female labor force participation and fertility decisions are influenced by labor market institutions and past birth experiences.

In her thesis, "Gendered Impacts of Privatization: A Life Cycle Perspective from China," she demonstrates that the reduction in public sector employment has widened the gender gap in the labor market while narrowing the gender gap in educational attainment. She also finds that this structural shift has delayed marriage among younger generations.

In another line of research, Yuli examines the effects of maternity ward overcrowding. She finds that overcrowding reduces the use of medical procedures during childbirth without negatively impacting maternal or infant health. While it has no direct effect on subsequent fertility, she shows that mothers, especially those with a college degree, are more likely to switch to another hospital for subsequent births after experiencing overcrowding.

During her time at APARC, Yuli further investigated patient-physician relationships in the Chinese healthcare system, where patients have considerable flexibility in choosing their doctors at each visit. She explored the persistence of these relationships and examine how patients respond when their regular doctors are temporarily unavailable.

Yuli also holds a BA in Economics from the University of International Business and Economics in China.

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Abstract

 

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Introduction

Health care spending in South Korea is associated with improvements in health. However, it remains unclear whether the value of this spending is equally distributed across income groups.

 

Methods

We analyzed lifetime health care spending and quality-adjusted life expectancy (QALE) by income quintile among South Korean adults from 2010 to 2018. We then calculated the ratio of changes in health care spending to changes in QALE to estimate the value of health care spending across income groups. Additionally, we investigated mechanisms underlying income-related differences in the value of health care.

 

Results

Assuming 80% of QALE gains are attributable to health care, adults in the lowest income quintile received the least value, incurring $78,209 per QALE gained. However, middle- and higher-income quintiles achieved greater value ($47,831, $46,905, $31,757, and $53,889 from the second to highest quintile), although the highest value did not occur in the highest-income quintile. The higher spending per QALE gained in the lowest income quintile reflects smaller improvements in QALE, likely driven by poorer baseline health and greater unmet needs.

 

Conclusion

These findings highlight structural inequities in the South Korea health system and emphasize the need for targeted policies to promote equitable health care value.

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Over the past two decades, China has pursued an ambitious plan to establish an accessible and affordable health system that meets the needs of its population. As part of this journey, China’s leadership implemented comprehensive health system reforms and achieved near-universal health insurance coverage at a relatively low per capita income level. Key to this process was the integration of rural and urban resident health insurance programs, which has proven to yield positive outcomes in health care utilization, physical health, and related equity issues. Thus far, however, the integration’s potential psychological effects have been understudied.

New research, published in the journal Health & Social Care in the Community, addresses this gap in the literature. The researchers – Stanford health economist Karen Eggleston, the director of APARC’s Asia Health Policy Program (AHPP); Peking University’s Gordon Liu; and Renmin University of China’s Yue-Hui Yu and Qin Zhou, the latter a former visiting scholar with AHPP – find that the urban-rural health insurance integration has been beneficial for improving mental health among China’s rural adults.

Their study underscores the potential of policy-driven health system reforms to address longstanding disparities, promote mental well-being in vulnerable communities, and enhance quality of life among aging populations. This is the researchers’ final installment in a series of studies on China’s urban-rural health insurance integration.



Tracking Mental Health Over Eight Years


For decades, China had a fragmented health insurance system, which led to disparities between different populations and hindered the implementation of the Healthy China 2030 blueprint, a bold national strategy to make public health a precondition for all future economic and social development. Responding to this challenge, in 2016, China announced plans to unify its rural and urban health insurance programs. The unified health insurance system, called Urban and Rural Residents’ Basic Medical Insurance (URRBMI), offered equal health service packages and insurance benefits to rural and urban residents. Studies have shown that the integrated system improved healthcare access for nearly 800 million rural residents and helped reduce coverage gaps and inequality. Yet evidence about the integration’s potential psychological impacts has been limited.

Eggleston and her co-authors hypothesized that this reform might also benefit rural adults’ psychological well-being. To test this hypothesis, the researchers conducted a comprehensive analysis using data from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey that tracks health, economic, and social variables among Chinese adults aged 45 and older. The study focused specifically on rural residents, examining changes in mental health, particularly depressive symptoms, before and after the insurance integration. Data from four waves of CHARLS, spanning from 2011 to 2018, allowed the team to analyze trends over a substantial period.

The researchers used an event study combined with a time-varying difference-in-differences (DID) approach, capturing the effect of the health insurance integration on depressive symptoms and comparing changes over time between those affected by the reform and a control group not yet impacted (since local governments introduced the integration reforms in different years, samples in the control group had constantly entered the treatment group during the survey period). This method helps isolate the effect of the policy from other confounding factors, providing a clearer picture of causality. The researchers further examined the heterogeneity of the integration effect across subgroups by gender, age, health status, and family economic status. They also analyzed possible mechanisms through which the reform produced psychological effects

Based on our analysis, the integration reform has improved the overall mental health of rural adults, as both their scores of depressive symptoms and the likelihood of becoming depressed decreased.
Eggleston et al.

Key Findings: A Significant Drop in Depression


The researchers find that the health insurance integration was associated with a measurable reduction in depressive symptoms among rural seniors. Specifically:

  • CES-D scores – a standard measure of depression severity (using a version of the Centre for Epidemiological Studies Depression Scale) – decreased by an average of 0.441 points among those covered by the reform.
  • The likelihood of experiencing depression dropped by approximately 3.5% in the post-reform period.
  • The decline in depression scores following the integration was continuous, suggesting cumulative effects of the reform. Notably, some psychological benefits appeared up to two years before the reform took effect, likely due to public awareness and positive expectations generated by advance announcements from local authorities.


The results were statistically significant, indicating that the health insurance integration reform has significantly improved the mental health of rural adults and reduced their risk of becoming depressed.

The findings also indicate that a key driver that produced continuous positive psychological effects was the integration’s reduction of health care costs for rural residents, particularly for hospital care. By lowering financial barriers to treatment, the integration improved access to healthcare and made its use more equitable. This, in turn, boosted rural adults’ satisfaction with their health and overall sense of well-being. The improvement may have set off a positive cycle, encouraging more social engagement and physical activity, which helped further ease symptoms of depression.

While the reform reduced depressive symptoms for both male and female older adults, the findings revealed differences across subgroups. It appears the reform did not significantly reduce depressive symptoms for those aged 40-49 and over 70, individuals in poor health, or those in the lowest economic bracket. The researchers attribute this to ongoing financial barriers and limited insurance financing, which may blunt the perceived benefits for high-need groups.

Policy design should pay more attention to rural adults aged over 70, those with chronic disease or disability, and those with low income and little wealth.
Eggleston et al.

Policy Implications: A Path Toward Health Equity


The study’s co-authors highlight several policy implications for China:

  • Expand and standardize coverage: Build on the success of the URRBMI by moving from local-level integration to broader provincial or national coverage, and encourage enrollment among vulnerable populations through subsidies.
  • Improve equity for high-need groups: Design more targeted insurance policies for older adults, those with chronic illnesses or disabilities, and low-income groups, especially by covering outpatient treatments for high-cost conditions.
  • Increase funding for the URRBMI: Despite progress, reimbursement rates remain low, highlighting the need for greater investment in the program.
  • Strengthen rural health infrastructure: Insurance reforms must be paired with improvements in rural healthcare facilities and services to ensure quality care is both accessible and effective.


China’s experience offers valuable lessons for countries aiming to achieve universal health coverage and those grappling with health disparities and aging populations. The positive association between insurance integration and mental health among rural adults in China underscores the importance of comprehensive, inclusive policies addressing financial and social determinants of health.

The study’s findings highlight the need to ensure that the most vulnerable populations benefit equally from health reforms. They also serve as a compelling reminder that thoughtfully designed and implemented reforms can improve physical health and increase mental resilience and social cohesion.

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New research by a team including Stanford health economist Karen Eggleston provides evidence about the positive impact of China’s urban-rural health insurance integration on mental well-being among rural seniors, offering insights for policymakers worldwide.

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Abstract

 

Introduction

Like many other countries, China had a fragmented health insurance system; in China's case, there were two separate schemes covering rural and urban residents. This study focused on the policy implications of integrating the schemes, particularly on the psychological effects.

 

Methods

The study used four waves of data from the China Health and Retirement Longitudinal Study (CHARLS) collected in 2011, 2013, 2015, and 2018, adopting a time-varying DID approach to capture the effect of integration on depressive symptoms among rural residents.

 

Results

The average CES-D score of rural adults decreased by 0.424, and the likelihood of depressive symptoms decreased by 3.5% after the implementation of the urban–rural health insurance integration policy. The positive effects may be due to the reduced cost-sharing rates as well as improvements in health satisfaction, social interactions, and physical activity. The integration reform had a limited impact on improving the mental health of those with the lowest economic status, the worst health status, and those aged 40–49 or over 70.

 

Discussion

This health insurance integration helped to improve mental health among rural adults. There are several policy implications:

  1. The positive policy effects suggest that further improvements could result from the Chinese government expanding coverage of the rural program, moving up to provincial- or national-level pooling, and encouraging more to enroll.
  2. More targeted solutions to decrease inequity should be considered, like focusing on rural adults over 70 with low income/low wealth
  3. Reimbursement rates under the rural insurance program remain low, so increased funding for the program is warranted.
  4. Strengthening healthcare facilities and resources in rural areas is an important next step

 

Highlights
 

  • CES-D scores for rural adults decreased by 0.424
  • Likelihood of depressive symptoms decreased by 3.5%
  • Benefits began appearing two years before integration, perhaps indicating positive expectations
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Evidence From a Quasiexperimental Study

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Alzheimer’s disease and related dementias (ADRD) are putting a significant strain on families and healthcare systems worldwide, and with increasing life expectancies, they pose an escalating global challenge. As one of the world’s fastest aging economies, South Korea’s efforts to address the burden of care for people living with ADRD offer valuable lessons for other nations grappling with the social and economic pressures of the demographic transition.

A new comprehensive review of Korea’s programs and policies to promote healthy aging and diagnose, treat, and care for people living with ADRD sheds light on progress and ongoing challenges. Published in the May 2025 issue of Alzheimer's & Dementia: The Journal of the Alzheimer's Association, the review offers insights from Korea’s strategies that resonate far beyond its borders.

The co-authors – Stanford health economist Karen Eggleston, the director of APARC’s Asia Health Policy Program (AHPP), and Daejung Kim, an associate research fellow at the Korea Institute for Health and Social Affairs – focus on recent policies supporting “aging in place” for independent seniors and palliative care for those needing greater support.

Eggleston and Kim used a mixed-methods review of dementia care in Korea over the past 25 years, combining a critical analysis of peer-reviewed social science and health policy studies in both English and Korean, quantitative analysis of Korean statistical agency data compared with other OECD countries, and interviews with local policymakers and welfare administrators in a region with a high proportion of elderly population.



Social and Policy Pressures in a Rapidly Aging Economy


Korea is aging fast, and the prevalence of ADRD among older adults is expected to surge, as is the projected social and economic toll of dementia care. Demographic and economic projections suggest that the annual cost of ADRD in Korea would increase from 0.9 percent to almost four percent of GDP from 2019 to 2050.

“Korea’s demographic transition, like its economic development, has been compressed into just a few generations,” Eggleston and Kim explain. “As a result, its triumph of longevity and current extra-low fertility engender social strains and policy pressures to address the burgeoning needs for long-term services and support – including prevention of ADRD, investing in early detection, and providing appropriate care for people with ADRD, which often involves addressing the broader social issue of financial support for older adults and detecting cognitive decline in those still engaged in the labor force.”

A Foundation for Dementia Care Service Delivery


Korea has taken decisive steps to build a comprehensive system for dementia care, leveraging its national health insurance and long-term care insurance (LTCI). This dual insurance framework aims to reduce unnecessary hospitalizations and shift social care away from medical settings.

Research shows that “the adoption of LTCI in 2008 helped to address regional disparities by providing nationwide risk pooling for long-term care services,” but the system still faces hurdles. Within Korea’s private-dominated service delivery system, the public-private balance varies significantly across different services, coordination between healthcare and long-term care services remains fragmented, and there is a need for better integration of community-based support.

Furthermore, “social insurance is no panacea for mitigating disparities and securing financial support for the most vulnerable citizens, such as people with ADRD and their families,” Eggleston and Kim note. Out-of-pocket payments for medical care still constitute a substantial portion of Korean household consumption.

The economic and social costs of dementia will impose an even greater burden if population aging further slows GDP growth in Korea beyond current projections (for example, because of labor shortages and lower productivity growth in specific sectors of the economy).
Eggleston & Kim

Livelihood and Workforce Challenges


In light of Korea’s limited sources of financial support for its older citizens, the country has relatively high labor force participation, especially among older men. This high level of employment of older Koreans may bode ill in an economy where many of the “senior employment” positions – primarily low-paying roles in the service sector – are not age-friendly.

Giving elderly persons a reason to get up in the morning has its benefits, Eggleston and Kim note, but having them perform service jobs is not a sustainable way to support livelihoods and healthy aging. “How decision-making by cognitively impaired individuals affects health and financial well-being can be considered the defining feature of the economics perspective on ADRD and its social impacts,” the co-authors say.

The growing demand for professional dementia care strains Korea’s caregiving workforce in other ways. Amid the shortage and aging of caregivers, much of dementia care falls on unpaid family members, often women in their 50s, lowering their rates of labor force participation in prime age. The burden on these informal caregivers is profound.

The authors note that “Korea needs more strategies to recruit, retain, and empower a knowledgeable and resilient caregiving workforce.”

Prevention and Early Diagnosis: A Mixed Picture


Early detection is critical for planning care and support for people with ADRD, and Korea is taking steps to design programs and incentives for healthy aging habits and early ADRD detection. These efforts, however, require stronger staffing and funding to offer more personalized and coordinated care.

Another set of challenges stems from the underuse of existing long-term services and support programs and the need to diversify them. Currently, providers have weak incentives to offer palliative care, while families and patients often struggle to choose comfort care over ongoing medical treatments.

Policymakers must also expand the target group of beneficiaries and diversify long-term services and support for daily life, including promoting a reduction in risk factors associated with dementia, such as low educational attainment, smoking, physical inactivity, uncontrolled chronic diseases, and depression. Eggleston and Kim call for developing “additional care service types such as hospital companion and nutrition support services” and integrating new technologies as part of a diversified, long-term aging-in-place care system.

Better care support for daily life would involve the development of additional care service types, such as hospital companion services and nutrition support services. Aging-in-place also relies on effective housing support.
Eggleston & Kim

Expanding Care Options 


The demographic transition has been accompanied by shifting social norms regarding responsibilities and caregiving, meaning significantly fewer Koreans believe care for older parents is the sole responsibility of family members. Accordingly, Korean policies aim to strengthen home- and community-based services (HCBS). Yet, the country’s share of at-home care recipients remains lower than in many peer economies.

“Making the vision of quality HCBS a reality involves multiple dimensions of financing and service delivery, tailored to local and individual circumstances while supporting equitable access nationally for those in need,” write Eggleston and Kim.

Institutional care in residential facilities remains a necessity for frail older people with ADRD and multiple comorbidities. While the supply of such service providers has greatly improved and long-term care insurance coverage has enhanced their affordability for families, wide disparities in quality of care for those in residential facilities persist. Meanwhile, hospice and palliative care remain largely an underdeveloped care option for people with ADRD in Korea.

Lessons for Aging Economies


South Korea’s dementia care journey illustrates the complex balancing act of addressing the multiple dimensions of a rapid demographic transition. The country’s efforts to promote healthy aging and diagnose, treat, and care for people with ADRD offer valuable insights for other economies that must prepare to provide long-term support for their aging populations.

One major imperative in Korea and elsewhere is ensuring that dementia care policies and programs are based on robust evidence. “To utilize limited resources most effectively, it will be critical to design and collect policy-relevant evidence about what works for people with ADRD and their care partners,” Eggleston and Kim write.

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Rethinking Health and Innovation in Aging Societies: Mai Nguyen and Jinseok Kim Explore Asia’s Health Policy Crossroads

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A comprehensive review of rapidly aging South Korea’s efforts to mitigate the social and economic costs of Alzheimer’s disease and related dementias, co-authored by Stanford health economist Karen Eggleston, provides insights for nations facing policy pressures of the demographic transition.

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Abstract

 

 

Cover of Vol. 21, Issue 5, of "Alzheimer's & Dementia: The Journal of the Alzheimer's Association"

Introduction

As one of the most rapidly aging societies globally, Korea's efforts to mitigate the social burden of Alzheimer's disease and related dementias (ADRD) may provide valuable insights.

 

Methods

We conducted a mixed-methods review of studies and policies related to dementia care in Korea over the past 25 years, including quantitative analysis of administrative and comparative data.

 

Results

Estimates suggest a high social burden from ADRD, with annual costs increasing from 0.9% to 3.8% of gross domestic product between 2019 and 2050. Pilot programs for integrated community care and hospice palliative care reveal the advantages of innovating from a foundation of national health insurance and long-term care insurance, as well as the continuing challenges of appropriately designing programs and incentives for early detection, integrated care, and late-life palliative care.

 

Discussion

A rigorous analysis of programs addressing uneven quality and a study of the impact of integrated care models for home- and community-based services would be valuable.

 

Highlights
 

  • A mixed-method review highlights the challenges of rapid aging in Korea.
  • Universal health and long-term care systems support innovation for dementia care.
  • Dementia costs are projected to increase from 0.9% to 3.8% of gross domestic product in 2019–2050.
  • Pilots of integrated community care and hospice palliative care show promise.
  • Rigorous analysis of programs to address uneven quality would be valuable.
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Alzheimer's & Dementia: The Journal of the Alzheimer's Association
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Karen Eggleston
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5
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Michael Breger
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How do aging populations reshape health and innovation policies in Asian economies? What role can the private sector play in public health service delivery, and how do individual preferences affect the development of emerging technologies? Mai Nguyen and Jinseok Kim, the 2024-25 Asia health policy postdoctoral fellows at APARC, focus on these questions as part of their research into health care service adaptation and behavioral economics.

At a recent joint seminar, “Health, Aging, Innovation, and the Private Sector: Evidence from Vietnam and Korea,” they offered a comparative look at how Vietnam and South Korea navigate aging populations, rising healthcare demands, and rapid technological change. While Nguyen focuses on health system design in Vietnam and Kim explores innovation diffusion in Korea, they both use discrete choice modeling to understand how individuals make decisions within systems influenced by age, infrastructure, and policy.

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Nguyen and Kim’s work is supported by APARC’s Asia Health Policy Program (AHPP), which offers a postdoctoral fellowship each year to an early-career scholar conducting original research on health policy in the Asia-Pacific, particularly in low- and middle-income economies across the region. The fellowship demonstrates the program’s commitment to fostering the next generation of Asia-focused health policy researchers.

Vietnam’s Mixed Health System and the Role of Patient Choice


Mai Nguyen’s research centers around the role of private healthcare providers in Vietnam, especially for patients managing chronic diseases such as diabetes. She studies how patients choose between public and private healthcare providers, and what attributes of care they value most.

To analyze these preferences, she uses a method known as the Discrete Choice Experiment, which allows her to quantify the relative importance of various service attributes — such as appointment flexibility, doctor choice, quality of care, drug diversity, and cost coverage — in influencing patients’ decisions.

Despite potential downsides, such as increased costs, equity concerns, and profit-driven service delivery, my study finds that private healthcare helps relieve pressure on the public system and meets diverse patient needs.
Mai Nguyen

Nguyen’s interest in this topic began while she worked at Vietnam’s Ministry of Health. “That earlier work highlighted the growing contribution of the private sector in filling service delivery gaps, particularly in urban areas and for non-communicable diseases such as diabetes,” she says.

Her findings suggest that Vietnam’s private sector has become a necessary complement to public healthcare. “Despite potential downsides, such as increased costs, equity concerns, and profit-driven service delivery, my study finds that private healthcare helps relieve pressure on the public system and meets diverse patient needs.”

At APARC, Nguyen has sharpened the focus of her research under the mentorship of AHPP Director Dr. Karen Eggleston, a leading expert on public and private roles in Asian health systems. Nguyen also values her collaboration with Jinseok Kim. “Dr. Kim’s expertise provides valuable insights into how Korea is addressing the challenges of a rapidly aging population through innovative policy and service delivery models,” she notes.

Her time at Stanford has also broadened Nguyen’s horizons beyond traditional health economics. “I have developed a strong interest in the application of artificial intelligence to enhance the delivery of medical services,” she says. Looking forward, she plans to expand her research to Asian American populations in the United States, exploring how AI and digital health can improve diabetes care while also addressing barriers related to equity and access.

Innovation Adoption and the Aging Consumer in South Korea


Jinseok Kim investigates how aging affects new technology adoption and consumer behavior in South Korea, a country facing one of the fastest demographic shifts in the world.

“My current research involves looking at population aging and innovation diffusion, specifically in the context of the rapid aging trend in Korea,” Kim says. He studies how age influences consumer preferences in choosing new technologies such as electric vehicles, telemedicine, and generative AI platforms like ChatGPT.

By working out the relationship between consumer choice and population aging, I forecast the effect of the population aging trend on the diffusion of innovative products and provide the potential policy and marketing implications for government policy and corporate management.
Jinseok Kim

Understanding these preferences, Kim argues, is critical for both policy and market strategy. “By working out the relationship between consumer choice and population aging, I forecast the effect of the population aging trend on the diffusion of innovative products and provide the potential policy and marketing implications for government policy and corporate management.”

The challenge, he says, lies in making sense of a wide range of behaviors across age groups and product types. “The biggest challenge I had in my studies was finding the overarching trend in the relationship between consumer choice for particular innovative products and population aging and then translating this finding into meaningful implications for society and the economy.”

Kim credits his time at APARC, especially participating in the Stanford Next Asia Policy Lab (SNAPL) meetings, with broadening his perspective. “Working as a member of SNAPL gave me insights and perspectives I didn’t have before,” he says.

SNAPL, directed by Professor Gi-Wook Shin, is an interdisciplinary research initiative housed within APARC addressing pressing social, cultural, economic, and political challenges in Asia through comparative, policy-relevant studies. The lab cultivates the next generation of researchers and policy leaders by offering mentorships and fellowship opportunities for students and emerging scholars.

Kim sees APARC’s model as effectively bridging academia and policy. “There are so many opportunities to interact with other scholars, policymakers, and practitioners,” Kim says. “Scholars here not only research and write, but they also get to share their voice and research findings in real-world policy.”

His advice to early-career researchers is straightforward. “Be more down-to-earth with your studies and thinking,” Kim says. “Sometimes scholars tend to get caught up in their way of thinking and perspective, but it may not be practical in real life. That is why I think it is important to just get outside and observe real consumer choice and behavior.”

Kim plans to continue researching questions related to innovation and demographic change to help governments and businesses adapt to aging populations and shifting consumer needs.

Ground-Level Data, Big-Picture Impact


Mai Nguyen and Jinseok Kim approach shared societal challenges through distinct yet complementary lenses. Nguyen’s research reveals how patient preferences can guide more effective public-private collaboration in healthcare, ultimately shaping systems that are more responsive to real-world needs. Meanwhile, Kim examines how patterns of technology adoption — especially among older adults — can influence the trajectory of innovation in aging societies.

Both scholars emphasize the value of ground-level data in addressing large-scale issues. By centering real behaviors and preferences, their work helps inform smarter, more adaptive policy, whether in designing patient-centered care or planning for technology's role in future societies. At APARC, their research bridges theory and practice, offering fresh insight into how Asian countries can navigate the twin forces of demographic change and rapid innovation.

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As Asian economies grapple with aging populations, rising healthcare demands, and rapid technological change, APARC’s 2024-25 Asia Health Policy Program Postdoctoral Fellows Mai Nguyen and Jinseok Kim study large-scale health care structural and policy challenges from the lens of individual decision-making.

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