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Objective: To show the pattern of patient satisfaction with top-level delivery organizations (Level 2 and Level 3 hospitals), and using neo-institutionalism approach to explain the relatively low satisfaction and to explore the limitations with top providers, focusing on how to improve the competence of Level 2 and Level 3 hospitals at both the individual hospital level and the whole delivery system level.

Data Sources/Study Setting: The household survey by the National Bureau of Statistics in China in 2008; China Health Statistics Yearbooks.

Data Collection/Extraction Methods: The analysis uses a 2008 sample medical experiences of 5,036 residents from 17 provinces collected in a household survey by the National Bureau of Statistics in China. The linear regression model, the structural difference regression model, and the ordered probit model are used in our framework.

Principal Findings: The imbalance between the needs of patients and the limited competence of top-level providers, and the conflict between the business expansion and the limited competence of those providers are deeply and widely influenced by patterns of patient needs, the top providers’ expansion, and the institutional environment.

Conclusions: In order to effectively respond to patient needs, top and lower level providers need to set their own individual priorities. The government needs to improve institutional arrangements to respond to patient needs with the development of a fair and appropriate reimbursement and compensation pricing mechanism, and with further evaluation of top level providers’ advanced and limited health services.

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Qunhong Shen
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Beyond his childhood ties to Hawai'i and Indonesia and his self-styled designation as "America's first Pacific President," President Barack Obama has demonstrated significant and genuine interest in Asia and in developing trans-Pacific ties. He embarked on November 5 for the second presidential visit to Asia during his term, and while there he will visit India, Indonesia, South Korea to attend the summit of the Group of 20 (G20), and finally to Japan to attend the annual heads of state meeting of the Asia-Pacific Economic Cooperation (APEC) conference. Secretary of State Hillary Clinton will travel a week ahead of Obama to attend the Association of Southeast Asian Nations (ASEAN) gathering and the East Asia Summit (EAS) in Vietnam, followed by visits to Malaysia, Papua New Guinea, New Zealand and Australia. Her trip will include an added-in stop to China's Hainan Island. To address major issues surrounding the President's trip to Asia--including the "China question" and historic U.S. bilateral alliances--four scholars from the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) gathered for a public panel discussion on October 27.

Thomas Fingar, Oksenberg/Rohlen Distinguished Fellow of the Freeman Spogli Institute for International Studies, spoke about the symbolic aspects of Obama's visit, noting the importance of a presidential visit for showing a sense of real commitment to the region and an acknowledgement of the "rise" of countries like China and India. On a more pragmatic side, he also suggested that meeting in person with other leaders is crucial in order to "bring about deliverables." The omission of a visit to China should not be weighed too heavily, Fingar said, pointing out that the President visited China last year. The stops in Japan and South Korea are tied to important multilateral meetings, though they will also reaffirm longstanding ties with those allies, while the visit to India is an indication of growing relations between the two countries. Of particular importance is Obama's participation in the G20 Summit in South Korea and the APEC meeting in Japan because, Fingar stated, a major purpose of the visit is about the "United States having a role in building new multilateral institutions." Finally, while much of the success of the Asia trip rests on how well Obama conducts himself, Fingar expressed confidence that the President would skillfully manage the visit.

During his visit to Indonesia, Obama will meet with Indonesia's President Susilo Bambang Yudhoyono for a bilateral discussion of such issues as economics, security, and higher education. Donald K. Emmerson, director of the Southeast Asia Forum, said that the postponement of earlier-planned visits to Indonesia has lessened some of the enthusiasm for Obama's "homecoming" to Jakarta. China's omission on the trip agenda is noteworthy, he suggested, and Clinton's addition of a stop in Hainan is due, in part, to help alleviate recent tension between the United States and China regarding China's claim of sovereignty over the South China Sea. Clinton's involvement in the EAS is an "important multilateral engagement" for the United States because of the presence of its ally Japan and the fact that the United States and China both have a voice there, unlike the ASEAN Plus Three meetings that do not include the United States. While in recent months the U.S.-China relationship has become more strained, Emmerson asserted that the "United States is not going to get into a cold war with China."

Obama will travel from Indonesia to South Korea for the G20 Summit, another major multilateral engagement during his travels. David Straub, associate director of the Korean Studies Program, described several significant aspects of this time in South Korea. While not technically an organization, Straub said, the Summit is an important forum for the discussion of economic stability and growth. Similar to Fingar, Straub noted the efficacy and significance of in-person meetings. The Summit provides an opportunity for world leaders to have face-to-face discussions on non-economic issues, such as North Korea's political situation. Straub suggested that President Lee Myung-bak's investment in the Summit is based, in part, on raising South Korea's global prestige, which is tied also to increasing the status of the G20 to become the premiere global financial organization. Finally, Straub stated that alongside the G20 meeting, Obama and Lee are expected discuss bilateral relations, which are at an all-time high, including the stalled U.S.-South Korea free trade agreement (Korus FTA). The FTA, which would be the most significant free trade agreement for the United States since NAFTA, has faced opposition and mixed support on both sides.

Obama's visit to India will be the third U.S. presidential visit there in the past decade, which is indicative of changing U.S. perceptions of India brought about through the IT boom and growing economic ties, suggested Daniel C. Sneider, associate director of research for Shorenstein APARC. Sneider pointed to a broader shared agenda despite a lack of clarity on some issues, such as Pakistan, and a focus on India as Asia's "other" growing economy. He stated that he would be watching for the United States and India to work together to emphasize India's role in East Asia, highlighted by India's participation in the EAS. India's Prime Minister Manmohan Singh has championed a "look east" policy and expressed stronger interest in East Asia, especially China. In terms of Obama's visit to the APEC heads of state conference in Japan, Sneider noted the importance of this trip also for the U.S.-Japan alliance. The newly formed government of Prime Minister Naoto Kan has worked to ease tensions in the alliance and both countries hope to use the visit to bolster a more positive image of the alliance. Certain points of contention, like the move of the U.S. military base on Okinawa, have been put aside for the time being. Sneider stated that recent China-Japan tensions have also served to reinforce the importance of the relationship.

Events during Obama's Asia visit in the next two weeks will help to solidify or possibly call into question his image as the "Pacific President," and undoubtedly influence the role of the United States in Asia for the future.

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President Barack Obama and Secretary of State Hillary Clinton talk with Prime Minister Singh of India in the Cross Hall of the White House. November 24, 2009. | Official White House Photo by Pete Souza
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After the Sichuan 5.12 earthquake, many people in the disaster area suffered from mental health problems. To decrease morbidity from mental disease, the Sichuan authorities worked with diverse hospitals to establish a “three-level network of psychiatric prevention and treatment.” The goal was to disseminate knowledge about prevention and treatment for psychiatric conditions from doctors to recipients, especially regarding symptoms. How to disseminate such knowledge effectively and efficiently deserves study. Based on a sample of 146 doctor-recipient pairs from 52 hospitals in diverse areas of China (including Sichuan, Beijing, and Guangzhou), this study examines the impact of knowledge characteristics, the network status of the doctor, the network status of the hospital with which the doctor is affiliated, and the relationship quality between doctor and recipient on the effectiveness and efficiency of knowledge transfer from the doctor to patient. Findings indicate that high-status doctors are more effective in knowledge transfer. In addition, low-status hospitals were found to have a positive effect on knowledge transfer efficiency. In particular, results highlight the strong positive impact that the quality of the relationship between the doctor and patient has on both the efficiency and effectiveness of knowledge transfer. Finally, findings suggest that the relationship between knowledge characteristics and knowledge transfer is partially mediated by the relationship quality between the doctor and the recipient.

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Zhe Zhang is an assistant professor of organization management at the School of Management, Xi'an Jiaotong University, China, where she also received her PhD. Her research focuses on public-private partnerships, corporate governance, and corporate social responsibility. She has published in the Journal of High Technology Management Research, International Journal of Health Care Finance & Economics, Management and Organization Review, and the International Journal of Networking and Virtual Organizations.

(Amy) Zhe Zhang Visiting Scholar, 2009-2011 Speaker Shorenstein APARC
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Joyce Lee
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An international forum on North Korea was held in Palo Alto on October 26, 2010, in an effort to educate the public on reunifying the two Koreas. The San Francisco Chapter of the National Unification Advisory Council organized the forum. Approximately 150 audience members heard panelists speak about the economic, social, and political challenges that face South Korea today in its preparation for a peaceful reunification, as well as about their visions for the future of North Korea.

Gi-Wook Shin, the director of the Walter H. Shorenstein Asia-Pacific Research Center (APARC), moderated the presentations and the panel discussion. The panel of four experts included John Everard, 2010-2011 Pantech Fellow at APARC and a former British ambassador to North Korea, speaking about diplomacy and security; Greg Scarlatoiu, director of public affairs and business issues at the Korea Economic Institute, on economic issues; Sang-Hun Choe, 2010-2011 Fellow in Korean Studies at APARC and a reporter at the International Herald Tribune, on factionalism; and Jung Kwan Lee, the South Korean Consul General in San Francisco, on South Korea's policy toward North Korea.

Everad analyzed North Korea's development during the Cold War of a diplomatic technique by which it repeatedly attempted to play one ally off against another in its relationships with the Soviet Union and China. While arguing that North Korea continues to make effective use of this technique against South Korea, the United States, and the European Union, Everad noted that North Korea's current political uncertainty, following the succession, and its ongoing economic concerns will together create a situation in which it may be very difficult for North Korea to maintain political solidarity.

Scarlatoiu, meanwhile, contended that North Korea's is a post-Stalinist, neo-patrimonial economy. Thus, with recent efforts such as the 2002 market reforms and the 2009 currency reform, the North Korean regime has found itself confronted with a major dilemma. According to Scarlatoiu, while economic reforms are necessary to the long-term survival of the regime, they could also lead to the regime's collapse. This predicament, he added, must be considered as the regime undergoes a leadership transition in the succession to Kim Jong-un.

Choe spoke on the process of succession to Kim Jong-un as well, pointing out that while Kim Jong-un is indisputably the heir to the leadership of North Korea, he has yet to prove his competency as North Korea's future leader. In addition, Choe emphasized that difficulties judging North Korea's intentions and anticipating its behavior stem from the outside world's inability to understand the North Korean leadership and the goals that it truly has in mind.

Finally, Lee stressed that the basic objectives of South Korea's policy on North Korea are to promote a common prosperity and to peacefully resolve North Korean nuclear issues. However, he also made it clear that the South Korean government is seeking to keep North Korean nuclear issues distinct from the issue of inter-Korean relations.

 

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I promise that this program could change your mind and future.

-Daisuke Maeda



Daisuke Maeda
, 2008-2009 Corporate Affiliates fellow, embraced the opportunity of being at Stanford University in order to actively engage with students, scholars, and Silicon Valley entrepreneurs. Connecting in person in an environment of innovation and entrepreneurship informed Maeda's thinking about his work with the Sumitomo Corporation, both retrospectively and for the future.

Established in 1919 but with business roots extending back into the 17th century, Sumitomo Corporation is a Tokyo-based general trading company with approximately 200 offices and 800 subsidiaries worldwide, including such major global cities as Beijing, London, Madrid, Istanbul, Casablanca, Sao Paulo, and New York City. Sumitomo is divided into seven business units based on its wide diversification: metal products; transportation and construction systems; infrastructure; media, network, and lifestyle; mineral resources, energy, chemical, and electronics; general product and real estate; and financial and logistics. Some of its subsidiary companies include Discovery Japan, Inc.; Barneys Japan; and Pacific Summit Energy, LLC. The corporation's mission statement expresses a strong focus on social responsibility.

Before coming to Stanford, Maeda had the responsibility for overseeing the marketing strategy of one of Sumitomo's e-commerce companies and while at Stanford he then conducted research about the "long tail" statistical theory which emphasizes the strength of a vendor, such as Amazon, selling a wide array of specialty goods. Maeda looked at arguments for and against this theory and spoke with Stanford students and Silicon Valley entrepreneurs on this subject.  In addition to his research, Maeda met with local startup companies and offered advice on marketing their products in Japan.

Maeda is now a director in the mobile and internet department of Sumitomo's media, network, and lifestyle business unit, which is home to Japan's largest cable television provider, the biggest home shopping television channel, and a major households goods e-commerce website. His current work involves developing a Japan-focused online marketing strategy for Sumitomo's healthcare business offerings.

Maeda urges current fellows to seize the opportunity of being at Stanford, saying, "Don't hesitate. Time is limited." He explains that he actively sought out opportunities to enrich his own knowledge and potential, including meeting and talking with people. "I promise that this program could change your mind and future," he concludes.

 

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In September 2009, President Barack Obama's administration announced a new U.S. policy direction for relations with Burma/Myanmar. Over the past year, this new course has moved the United States away from previous efforts to isolate Burma's ruling generals, balancing economic sanctions with "pragmatic engagement." Against this backdrop, the Asia Society established a task force on U.S. Policy toward Burma/Myanmar to provide concrete recommendations for how the United States could best approach this new path of engagement. The task force released its policy recommendation report in March 2010. With elections set to be held in Burma on November 7 for the first time in 20 years, the Asia Society has released a task force report update, which provides an overview of key developments that have unfolded during recent months. Donald K. Emmerson, director of SEAF, is a member of the task force.
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On Monday, an undersea earthquake shook Indonesia's remote Mentawai Islands and triggered a 10-foot tsunami: It has killed at least 272 people, and left 412 missing. The first cargo plane with humanitarian supplies arrived today. Hundreds of miles away in eastern Java, the volcanic Mount Merapi erupted Tuesday and killed at least 30 people.

That's two disasters in less than 24 hours.

 Indonesia is no stranger to catastrophe. It is located along the Pacific Ring of Fire, which is one of the most seismically and volcanically volatile areas in the world. Its last sizeable earthquake and tsunami duo struck in December of 2004, killing more than 225,000 people in 14 countries.

But despite the death and destruction of the last 48 hours, Indonesian Foreign Minister Marty Natalegawa said today that he doesn't yet see a need for foreign aid or rescue assistance.
So far, only the Philippines and the United States have offered to help Indonesia. But Natalegawa's behavior seems counter-intuitive. In the face of disaster, why would any country preemptively say no to aid?

A look into Indonesia's history reveals latent political sensitivities that may have influenced Natalegawa's decision. Indonesia's first president, Sukarno, was a founding member of the Non-Aligned Movement, an organization of countries who are not aligned with or against any major world power.

Indonesia prides itself on its "independent and active" foreign policy, which was first developed by then Vice President Mohammad Hatta on September 2, 1948 in Central Java. "Do we, Indonesians, in the struggle for the freedom of our people and our country, only have to choose between Russia and America?" he asked. "Is not there any other stand that we can take in the pursuit of our ideals?"

The "other stand" became known as "mendayung antara dua karang" or "rowing between two reefs."

Indonesia doesn't want to appear incompetent, or weak, to outside governments, and may also be wary to accept aid for fear of undermining its national legitimacy.
 
In 2004, Indonesia's acceptance of aid had an arguably negative effect on its citizens. "Though the post-tsunami reconstruction efforts in Aceh were generally successful, the amount of aid did engender some resentment in Jakarta over whether the national government had lost control of the reconstruction, and also potentially altered the economy in Aceh," explains Josh Kurlantzick a fellow for southeast Asia at the Council on Foreign Relations. "So people remember that."

Donald Emmerson, the director of the Southeast Asia Forum at Stanford University's Shorenstein Asia-Pacific Research Center, cites several reasons for Natalegawa's response. First, he says, if the Indonesian government solicited foreign aid, it would be inundated with offers. Coordinating offers of assistance right now would be a severe burden on the government.
 
Then there's the question of scale: so far, the destruction seems manageable in comparison to the 2004 disaster. Still, it's unclear whether Indonesia will be able to adequately respond on its own. "Indonesia is a large country, and its infrastructure is overstretched," Emmerson says. "Its capacity to respond effectively to domestic disasters is not as good as it might be."

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Dr. Robert R. King became the Special Envoy for North Korean Human Rights Issues in November 2009 following confirmation by the United States Senate.

Prior to his appointment, Ambassador King worked on Capitol Hill for 25 years – 24 of those years as Chief of Staff to Congressman Tom Lantos (D-California). Ambassador King was heavily involved in the planning and conduct of Lantos’ human rights agenda, including the establishment and supervision of the Congressional Human Rights Caucus, (which recently became the Tom Lantos Congressional Human Rights Commission). Dr. King traveled with Congressman Lantos to North Korea and played a key role in the passage of the 2004 North Korean Human Rights Act. He was concurrently Staff Director of the Foreign Affairs Committee of the U. S. House of Representatives (2007-2008), Democratic Staff Director of the Committee (2001-2007) and held various professional staff positions on the Committee since 1993.

Prior to his service on Capitol Hill, Ambassador King served on the National Security Council Staff as a White House Fellow during the Carter Administration. He was Assistant Director of Research and Analysis at Radio Free Europe in Munich, Germany. Ambassador King holds a Ph.D. in International Relations from the Fletcher School of Law and Diplomacy and has authored five books and some 40 articles on international relations.

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Ambassador Robert R. King Special Envoy for North Korean Human Rights Issues Speaker
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