Hospitals in Thailand operate in a multiple insurance payment environment. This paper examines 1) access to medicines and other medical technologies, 2) treatment outcomes, and 3) efficiency in resource use, among beneficiaries of the three government health insurance schemes in Thailand. Using 2003-2005 inpatient data for patients with three tracer diseases from three government hospitals, we find that utilization of more expensive items differs between patients whose insurers pay on a closed- or open-ended basis. Where new vs. conventional drugs are both available, patients whose insurer pays on a fee-for-service basis tend to have greater access to new drugs, compared to patients whose insurer pays on a capitated or case basis. Similar patterns were found where there are options between originator vs. generic drugs, drugs in different dosage forms, and more vs. less advanced diagnostic technologies. Effects of insurance payment are more pronounced where price gaps among the medical technologies are significant. Efficiency results are mixed, depending on nature of the disease conditions and type of resources required for treatment.

Published: Hirunrassamee, Sanita, and Sauwakon Ratanawijitrasin. "Does your health care depend on how your insurer pays providers? Variation in utilization and outcomes in Thailand." International journal of health care finance and economics 9.2 (2009): 153-168.

Hard Choices offers a most rewarding perspective on how Southeast Asian states straddle the ongoing tensions among three rarely compatible goals—security, democracy, and regionalism. Empirically rich and topically diverse, [the book] is broad in scope and full of deep analytic insights. It will be appreciated well beyond Southeast Asia." — T. J. PEMPEL, University of California, Berkeley

Southeast Asia faces hard choices. The region’s most powerful organization, ASEAN, is being challenged to ensure security and encourage democracy while simultaneously reinventing itself as a model of Asian regionalism.

Should ASEAN’s leaders defend a member country’s citizens against state predation for the sake of justice—and risk splitting ASEAN itself? Or should regional leaders privilege state security over human security for the sake of order—and risk being known as a dictators’ club? Should ASEAN isolate or tolerate the junta in Myanmar? Is democracy a requisite to security, or is it the other way around? How can democratization become a regional project without first transforming the Association into a “people centered” organization? But how can ASEAN reinvent itself along such lines if its member states are not already democratic?

How will its new Charter affect ASEAN’s ability to make these hard choices? How is regionalism being challenged by transnational crime, infectious disease, and other border-jumping threats to human security in Southeast Asia? Why have regional leaders failed to stop the perennial regional “haze” from brush fires in democratic Indonesia? Does democracy help or hinder nuclear energy security in the region?

In this timely book—the second of a three-book series focused on Asian regionalism—ten analysts from six countries address these and other pressing questions that Southeast Asia faces in the twenty-first century.

Recent Praise for Hard Choices

“In this delightful volume, a diverse, fresh, and talented group of authors shed new light on Southeast Asia and speak engagingly to wider scholarly questions.  Emmerson's introduction sets the tone for an unusually creative edited collection.”
 —Andrew MacIntyre, Australian National University
“In Hard Choices, Donald Emmerson has brought together a remarkable group of leading young scholars to write on Southeast Asian regionalism from political-security, economic, and sociological perspectives. His introductory chapter defines the dimensions of regionalism on which the other contributors elaborate in a series of fine essays examining ASEAN’s past, present, and alternative futures. Hard Choices is a landmark study that will be consulted for years to come by scholars and practitioners. Highly recommended.”
—Sheldon Simon, Arizona State University

Examination copies: Desk, examination, or review copies can be requested through Stanford University Press.

Biotechnology (or biotech) has impacted almost every aspect of human life. It has reorganized industries, drastically changed healthcare, helped to improve the environment, and led to important changes in laws and ethical norms.

Among the various biotech fields, medical biotech has been by far the most influential, beneficial, and controversial. It has generated not only superlative discoveries to improve the lifespan and quality of human life, but also the greatest amount of wealth for all the players involved, and the greatest volume of public debate.

Several important trends are shaping the future of the pharmaceutical (or pharma) and biotech industries. The biotech industry is characterized by the presence of strong clusters in all countries. The pharma and biotech industries are experiencing an outsourcing phenomenon, mainly due to a lack of in-house expertise and efficiencies. Diagnostics and therapeutics are increasingly converging, a trend that will lead to predictive and precise diagnostics and personalized and preventive medicine. The first few years of the twenty-first century have witnessed significant changes in the pharma/biotech alliance landscape. Today we are seeing the “omic”-ization of the biotech industry: most of the emerging technologies are genomics, proteomics, cellomics, and pharmacogenomics. In addition, the biotech industry faces uphill ethical issues, including excessive marketing, third-world drug availability, genetic engineering, stem cells, and cloning.

The medical biotech industry faces several challenges. First, science, the human body, and disease are, essentially, complex. Second, unlike other high-technology industries, the biotech product development cycle is very long, even after proof of concept. Biotech projects take between ten and twenty years to become successful and cost over $200–300 million before a product reaches the market. Third, delivery of most biotech products and therapies is complex and can be painful, often involving intravenous delivery. Fourth, the preceding three factors pose significant challenges for research and development (R&D) financing. In addition, there are certain outside determinants that influence the biotech industry, including regulation, demography, reimbursement climate, and big pharma companies.

Stem cell research is one of the most fascinating areas of biology, but it raises questions as rapidly as it generates new discoveries. The greatest potential application of this research is the generation of cells and tissues that can be used for cell-based therapies. A stem cell is a special kind of cell that has a unique capacity to renew itself and to give rise to specialized cell types. Through the process of differentiation, stem cells form various tissues and organs, and the combination of these differentiated materials develops into the whole human body. This class of human stem cell holds the promise of being able to repair or replace cells or tissues that are damaged or destroyed by many of our most devastating diseases.

Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Diabetes mellitus is a type I diabetes—also called juvenile-onset diabetes or insulin-dependent diabetes—and develops when the body’s immune system destroys pancreatic beta cells, the only cells in the body that make the insulin that regulates blood glucose. Type II diabetes, also called adult-onset diabetes or noninsulin-dependent diabetes, may account for 90–95 percent of all diagnosed cases of diabetes. There are more than 194 million diabetics worldwide, with this number expected to exceed 333 million by 2025.

Insulin is currently the most effective drug for controlling hyperglycemia and is widely accepted as the gold standard for treating type I diabetes and even late-stage type II diabetes. However, physicians and patients are reluctant to use insulin until other less effective drugs have been attempted. This is mainly because insulin therapy is invasive and painful: patients must take insulin intravenously.

One of the most promising ways to cure diabetes is to restore the function of islet cells biologically, either through islet cell transplantation or by engineering cells to restore the insulin secreting function. Islet transplantation, a procedure that can restore insulin production in patients, is a highly promising area of research.

Based on analysis of stem cell research, diabetes market opportunities, and the development of stem cell therapies, it is possible to place a value on a company in the early (preclinical) development stage of a stem cell therapy for diabetes. Such an exercise involves valuing a company based on three different approaches—(1) the discounted cashflow model, (2) the royalty or licensing model, and (3) the comparables valuation model. Sensitivity analysis based on market, pricing, costing, R&D, and development stage can further lead to precise valuation range for a given company.

For biotechnology companies, various drivers play a critical role in company valuation, including people (management team), alliances and partnerships, intellectual property rights, R&D and technology, funding and financing, market opportunity, and therapeutic area.

Throughout history, nations have waged war against epidemics, from bubonic plague to pulmonary tuberculosis. Today, we confront HIV/AIDS, SARS, and avian influenza, among other major infectious diseases. The failure to contain HIV/AIDS, the longest contemporary pandemic, and the difficulties in dealing with the threat posed by avian influenza, show that the world is not well prepared for the next health crises. Because preventing and controlling these infectious diseases is a race against time, scientists around the world scrutinize viruses and bacteria more intently than ever. Yet while scientific advances are crucial, they are insufficient.

This timely book addresses the urgent need to study the governance of infectious disease epidemics, and argues that the battle must be fought on two fronts, simultaneously. The first is within the laboratory; the second is located in a wider social context that involves ordinary individuals, groups, communities, legislators, and the state. Research by medical sociologists and other social scientists indicates that many factors influence people's behavior and, in turn, the level of success in preventing and containing an infectious disease epidemic.

Using Asia as a case study, Crisis Preparedness discusses the inadequacies of current preventive and management approaches to deal with epidemics. The distinguished international contributors to this volume present perspectives from the fields of social science, epidemiology, and public health, and collectively seek to answer the pressing question: How can we prepare for the next global epidemic?

About the Editor: Stella R. Quah is professor of sociology at the National University of Singapore. She is on the advisory boards of the British Journal of Sociology, Health Sociology Review, and Asian Population Studies. She also serves as editor of the Health Systems Section, Encyclopedia of Public Health (Elsevier).

This title is now out of print. You may download individual chapters below:

Front matter and preface (includes chapter 1) 

1. Governance of Epidemics: Is There a Reason for Concern? (Stella R. Quah)
2. The Global Governance of Epidemics: Possibilities and Limitations (Jim Whitman)
3. Responding to Epidemic Disease Threats in Burma and Lessons for China: Why Good Governance Matters (Chris Beyrer)
4. Global and Local Strategies against HIV/AIDS in South and Southeast Asia: The Cases of India and Thailand (Graham Scambler)
5. Taming the Tiger: The Success and Failure of HIV/AIDS Policies in Thailand, Cambodia, Vietnam, and China (Kari Hartwig)
6. On Trust and Health Consensus-building in the Governance of Epidemics (Stella R. Quah)
7. Global Public Health Research Preparedness against Emerging and Reemerging Infectious Diseases (Gabriel M. Leung)