The intention to pay for human papillomavirus (HPV) vaccination among women of childbearing age in Vietnam, where cervical cancer remains a significant public health concern, has been mostly lacking. To examine this issue, we conducted a cross-sectional study of 807 pregnant women in an urban and a rural district (Dong Da and Ba Vi) of Hanoi, Vietnam. The vast percentage of our respondents expressed a firm intention to vaccinate, especially women in rural areas (over 90.0%). However, on being informed of the current price of the HPV vaccine, their intention to vaccinate dropped to about one-fifth of overall respondents, i.e., only 4.4% of women in rural areas. It was also observed that the initial intention to get the HPV vaccination among women in the rural district was
about ten times higher than that of women living in the metropolitan district. Those participants who had greater knowledge of cervical cancer andHPV vaccinations also had a significantly higher intention to vaccinate. Our findings underscore the need to develop a well-designed vaccination program in Vietnam and other countries in a similar situation to increase the adoption of HPV vaccination.

Keywords: HPV vaccination; cervical cancer; intention; women; Vietnam

Published: Intention to Pay for HPV Vaccination among Women of Childbearing Age in Vietnam

China’s national health reforms over the past two decades have brought the system closer to the modern, safe, reliable and accessible health system that is commensurate with China’s dramatic economic growth, improvement in living standards, and high hopes for the next generation. Celebrating a decade this year, China’s national health reforms of 2009 consolidated a system of social health insurance covering the entire population for basic health services, contributing to a surge in healthcare utilization while reducing out-of-pocket costs to patients – which declined from 56% to 28% of total health expenditures between 2003 and 2017. An expanded basic public health service package, funded by per capita government budget allocations that include a higher central government subsidy for lower income provinces, provides basic population health services to all Chinese. A higher percentage of Chinese accessed hospital admissions in 2017 than in the average high-income (OECD) country – a large increase from the turn of the 21st century.i A recent re-shuffle of the governance structure consolidates the purchaser role for social health insurance schemes under the newly created National Healthcare Security Administration, with most other health sector functions under the re-christened National Health Commission, among other changes. China’s world-leading technological prowess in multiple fields spanning digital commerce to artificial intelligence—and accompanying innovative business models such as WeDoctor that have not yet been fully integrated into the health system—hold promise for supporting higher quality and more convenient healthcare for China’s 1.4 billion.

Keywords: China; Health System

Published:   Healing-one-fifth-of-humanity

Background: Precise future projection of population health distribution is imperative for designing an efficient healthcare system in rapidly aging countries. Multistate-transition microsimulation models such as the US Future Elderly Model have been developed based on panel data collection, but these data may not be always available. We proposed a pseudopanel method using repeated cross-sectional representative surveys as a complementary approach, and specifically applied the model to Japan's population.

Methods: We calculated birth-cohort and sex-specific prevalence for all combinations of 14 health statuses using microdata from five waves of the Comprehensive Survey of People's Living Conditions. Combining obtained prevalences with vital statistics data, we determined transition probabilities of statuses over time using contingency tables. Assuming that state transition and mortality-exit follow the first-order Markov process, we then designed a virtual Japanese population aged older than 60 years as of 2013 and performed a microsimulation to project disease distributions to 2046 with forward, backward, and external validation tests. Following validation, we compared our projection results with those based on traditional stativ models.

Results: Our calculated morbidity and mortality rates successfully replicated governmental projections of population pyramids and matched cardiovascular and cancer incidences reported in existing epidemiological studies, supporting the validity of our estimation. Our future projection of stroke and heart disease indicated lower prevalences than expected from static models, presumably because of recent declining trends in disease incidence and fatality.

Conclusions: Our pseudopanel approach provides a valid alternative microsimulation frame for future health projection in aging societies.

Keywords: Pseudopanel approach; microsimulation; forecasting; aging; comorbidities; Japan

JEL No. C53, I1, I12, J11, J14

Cardiovascular diseases (CVDs), which are disorders of the heart and blood vessels, are the world’s leading cause of death (WHO, 2016). The transition from infectious diseases to non-communicable diseases (NCDs), primarily CVDs, as the primary cause of mortality and morbidity worldwide— combined with the economic burden associated with heart-related diseases—prompted the World Health Organization (WHO) and its regional offices to identify CVDs’ risk factors (WHO, 2016). This paper examines these risk factors with a focus on the fetal environment and its interaction with adult body mass index (BMI), using longitudinal data from the Cebu Longitudinal Health and Nutrition Survey (CLHNS).

Using a Cox proportional hazards model to estimate hazard ratios adjusted for age and risk factors in adulthood, such as cigarette smoking, the results suggest that there is a positive association between birth weight and heart disease. In addition, when birth weight is interacted with BMI, raised blood pressure is found to be higher among those who were bigger infants at birth and grew to be lighter adults, suggesting centile crossing. Probit models are also used for sensitivity analysis, and the results are consistent with those of the hazards model. Other factors such as adult obesity and a smoking habit are also positively associated with hypertension and CVD.

Keywords: Fetal origins hypothesis, CLHNS, hazards model, CVD, adult risk factors

This paper shows that, for mothers in Cebu, Philippines, access to electricity and the type of cooking fuel used at home affect both health outcomes and also how time is allocated, including for paid work. First, the use of fuelwood for cooking adversely affects the health of mothers, who are traditionally responsible for cooking and are often at home, taking care of their families. This result is consistent across different econometric specifications. Second, shifting to a more efficient source of energy allows women more time to be engaged in the labor force, including in micro enterprises. It also enables them to reallocate their time and efforts away from household chores (cooking, tending animals, and childcare) toward caring for themselves (improved personal hygiene and rest). Drafting and strengthening existing gender-sensitive energy policies and programs can, therefore, help the welfare of mothers in the Philippines, where 54% of households rely on fuelwood, and where the resulting indoor air pollution has a particularly adverse impact on women. The analysis relies on a longitudinal data set (CLHNS 1994-2005).

Keywords: Energy access; time allocation; health of mothers; labor participation of mothers; Philippines; CLHNS

Risky health behaviors such as illicit drug use, smoking, overconsumption of alcohol, violence, and early sexual activity have contemporaneous and intertemporal adverse health and economic outcomes. The health-related and economic costs to individuals and to society overall are particularly pronounced when adolescents are the ones engaging in one or more of such behaviors.

This paper uses longitudinal data from the Philippines (from the Cebu Longitudinal Health and Nutrition Survey) to examine the long-term impact of adolescents’ risky behaviors in 2002 (related to sex, tobacco, alcohol, and violence, but not drugs) on their economic outcomes in 2009 (related to participation in the labor force, educational attainment, and family formation). The results reveal that risky behaviors are most likely to affect educational outcomes. Teenagers who smoked at least one cigarette a day were 21% less likely to be in college several years later, and this difference was 17% for those who had an early sexual initiation, and 7% for those who consumed alcohol at least once a week. Labor outcomes were also adversely affected.

The growing literature on environmental migration presents conflicting results. While some find that natural disasters induce international migration, others discover a dampening effect. We aim to reconcile these differences by using a comprehensive list of weather shocks from the Philippines, a country prone to natural disasters and a major exporter of labor. We constructed a longitudinal provincial dataset (2005–2015) from an assemblage of administrative and survey datasets and tested linear, quadratic, and lagged models.

Our fixed-effects results are consistent with both strands in the literature with caveats. First, Filipinos are more likely to work abroad when they experience less-intense tropical cyclones and storm warning signal but are more likely to stay with a more damaging storm warning signal. Second, differential effects of weather shocks on international migration contingent on agriculture exists. Third, non-environmental factors such as economic (unemployment rate) and infrastructure (number of high schools) also push Filipinos abroad.

Keywords: Migration, Natural Disaster, Panel Dataset, Agriculture, OFWs

JEL classification: C33, C36, F22

Forthcoming, Journal of Population Economics.

We analyze the effects of early-life shocks with varying degrees of severity on mortality and human capital outcomes in the Philippines. We exploit variations in typhoon exposure and the introduction of a short-term post-disaster relief policy. Severe
typhoons are associated with increased mortality and adverse long-term outcomes. Before the disaster relief policy, mortality from in utero exposure to severe typhoons was 10 percent, and survivors exhibited similar levels of human capital as the unaffected.
Once implemented, the policy appears to have mitigated the mortality effect of severe typhoons, and survivors have lower human capital in the long term.

Keywords: fetal origins hypothesis, selective mortality, long-term outcomes, Philippines, natural disasters, disaster relief

JEL codes: I12, I15, O15

Although many public hospital physicians in Vietnam offer private service on the side, little is known about the magnitude and nature of the phenomenon of so-called dual practice, let alone the dynamics between the public and private health sectors. This study investigates how and to what degree public hospital physicians engage in private practice. It also examines the commitment of dual practitioners to the public sector. The analysis is based on a hospital-based survey of 483 physicians at 10 public hospitals in four provinces of Vietnam. Nearly half of the participants in the study sample reported themselves as dual practitioners. Various types of private practice were mentioned. Private practice at health facilities owned by the private sector was the most prevalent, followed by private practice delivered at health facilities owned by the dual practitioners themselves. Private practice inside public hospitals was also noted. Dual practitioners were likely to be senior and hold management positions inside their public hospitals. Substantial income differences were found between dual practitioners and those physicians practicing in only the public sector. The majority of dual practitioners, however, reported the willingness to give up private practice if certain conditions were met, such as a basic salary increase or non-pecuniary benefits. The main reasons dual practitioners gave for not leaving the public sector included a sense of public responsibility and opportunities to gain a broader professional network and more training. This study reiterates the significant challenges associated with dual practice, including its financial implications and possible effects on health care quality and access. The need for a high-quality workforce committed to the public sector is particularly critical, given the
possibility of universal insurance coverage. Future research should address the need to improve data collection on physicians’ dual practice and incorporate the topic in policy debates on health reform.

Keywords: physician dual practice, public-private mix, Vietnam, human resources for health, hospital reform, health system research, low- and middle-income countries, universal health coverage.

Published: https://academic.oup.com/heapol/article/33/8/898/5078580

High costs of precision medicine raise concerns about exacerbating income-related disparities in healthcare utilization and health outcomes. One approach to expanding coverage in Asia has been to cover the precision therapy but require the pharmaceutical firm to cover the costs of the companion diagnostic test. Taiwan’s National Health Insurance (NHI) adopted this approach for lung cancer, colorectal cancer and leukemia, but not for the first target therapy covered by NHI, trastuzumab for the treatment of HER2-positive breast cancer. Analyzing a unique dataset linking medical claims, cancer registry data and proxies for income between 2004 and 2015, we find that lower-income patients are more likely to be diagnosed with later stages of breast cancer, and this pattern renders NHI coverage of anti-HER2 therapy pro-poor even before full coverage of the diagnostic tests.

Moreover, the expansion of NHI coverage—including the FISH diagnostic test and trastuzumab for early-stage breast cancer—strengthened the pro-poor distribution of genetic testing and target treatment, albeit only marginally. The extent of pharmaceutical company coverage of testing and its impact on patient access are topics of our ongoing research, contrasting breast cancer with colorectal cancer.

Keywords: disparities, personalized medicine, income-related inequality, breast cancer, genetic testing, Taiwan, Asia