When one can circle the globe in less than the time of incubation of most infectious pathogens, it is clear every country relies to some extent on the health systems of other countries to prevent and protect their citizens from global health threats. Therefore, creating and maintaining a good health system in one country requires attention to interregional and international cooperation. Domestic and international spheres of public health policies are becoming more intertwined and inseparable.

PUBLISHED: Qiong Zhang, Karen Eggleston (翁笙和), and Michele Barry, 2009. “Pandemic Influenza and the Globalization of Public Health” (流感大流行与公共卫生全球化), Comparative Studies 比较 (42):  (Beijing: China CITIC Press): 47-52.

The relationship between economic concentration and governance remains controversial. While some studies find that high economic concentration strengthens collective action and reform cooperation, others stress dangers of rent-seeking and state capture. In this paper I argue that effects are neither strictly positive nor negative: they are best described as an inverted-u-shaped relationship, where better governance performance emerges with moderate economic concentration. Decentralization reforms in Indonesia and the Philippines – unprecedented in scope and scale – provide a unique opportunity to test this hypothesis. Subnational case studies and cross-sections, from both countries, indicate that moderately concentrated polities are accompanied by better service and lower corruption. The presence of ‘contested oligarchies’ – small circles of multi-sectoral interest groups – creates a situation where economic elites are strong enough to influence policymakers and, at the same time, diverse enough to keep each other in check. The results of this paper suggest that contested oligarchies compensate for weakly-developed societal and juridical forces and can become a stepping stone to good governance.

China continues to face great challenges in meeting the health needs of its large population. The challenges are not just lack of resources, but also how to use existing resources more efficiently, more effectively, and more equitably. Now a major unaddressed challenge facing China is how to reform an inefficient, poorly organized health care delivery system. The objective of this study is to analyze the role of private health care provision in China and discuss the implications of increasing private-sector development for improving health system performance.

This study is based on an extensive literature review, the purpose of which was to identify, summarize, and evaluate ideas and information on private health care provision in China. In addition, the study uses secondary data analysis and the results of previous study by the authors to highlight the current situation of private health care provision in one province of China.

This study found that government-owned hospitals form the backbone of the health care system and also account for most health care service provision. However, even though the public health care system is constantly trying to adapt to population needs and improve its performance, there are many problems in the system, such as limited access, low efficiency, poor quality, cost inflation, and low patient satisfaction. Currently, private hospitals are relatively rare, and private health care as an important component of the health care system in China has received little policy attention. It is argued that policymakers in China should recognize the role of private health care provision for health system performance, and then define and achieve an appropriate role for private health care provision in helping to respond to the many challenges facing the health system in present-day China.

We examine the role that buyers in global supply chains play in helping vendors uncover productivity-enhancing labor management innovations. We report on a buyer-directed NGO-coordinated factory-based program targeting intestinal parasites and anemia in seven Bangalore apparel factories. Raw pre-post productivity comparisons were confounded by factory organizational changes that were implemented in anticipation of the termination of the Multi Fiber Arrangement (MFA). Using a difference-in-difference-in-difference (DDD) estimator, a full complement of medically appropriate treatment was found to increase individual productivity.

After North Korea’s nuclear test on 9 October 2006, the fate of South Korea’s engagement policy with North Korea seemed to hang in the balance. To many, the nuclear test stood as a clear indictment of the Sunshine Policy and its successor, President Roh Moo-hyun’s Peace and Prosperity Policy. After years of investment and aid to the North under these policies, South Korea appeared to have received little in return. Conservative lawmakers charged that the nuclear test amounted to the “death penalty” for the Sunshine Policy, and former president Kim Young-sam proclaimed that the policy “should be thrown into a trash can.” Roh’s unification minister apologized to the National Assembly.

But others did not see the nuclear test as a verdict on South Korean engagement of the North. To more progressive forces, including the Roh administration, this is not a story of inter-Korean cause and effect; engagement represents a much larger inter- Korean effort, while the nuclear issue is rooted in problematic U.S.-DPRK relations. In their view, the nuclear test occurred because the Bush administration has taken a hard line with North Korea, creating an environment—featuring “regime change” rhetoric and the preemptive-strike doctrine—that spurred the North to pursue weapons considered the ultimate guarantee of security. The Sunshine Policy cannot be held to account for ruinous U.S.-DPRK relations, though such a circumstance can hinder inter-Korean engagement. While Roh offered a careful, politically calibrated suggestion to the public in the wake of the nuclear test, saying he “would like to suggest that we take time to figure out the causal relationship between the engagement policy and the nuclear test,” former president Kim Dae-jung pressed the progressive perspective in no uncertain terms, offering a direct, clamant answer: “North Korea has never said it would develop nuclear weapons because of South Korea’s Sunshine Policy. It said that it was developing nuclear weapons as a last resort to survive, because the United States was hard on the country.”

Using data from 276 general acute hospitals in the Pearl River Delta region of Guangdong Province from 2002 and 2004, we construct a preliminary metric of budget constraint softness. We find that, controlling for hospital size, ownership, and other factors, a Chinese hospital’s probability of receiving government financial support is inversely associated with the hospital’s previous net revenue, an association consistent with soft budget constraints.

Published inInternational Journal of Healthcare Finance and Economics special issue on provider payment incentivesKaren Eggleston, Yu-Chu Shen, Mingshan Lu, Congdong Li, Jian Wang, Zhe Yang, 2009. “Soft Budget Constraints in China: Evidence from the Guangdong Hospital Industry,” International Journal of Healthcare Finance and Economics 9(2): 233-42.

Government and private roles in health service delivery remain controversial in China, as in many countries.  Using 2004 data from over 360 government-owned and private hospitals in Guangdong Province, we find that non-government hospitals serve an overlapping but distinct market.  They are smaller, newer market entrants, more likely to specialize, and less likely to be included in urban social insurance networks. We also document differences in staffing and financial performance, but no systematic ownership differences in simple measures of quality, controlling for size, location, case-mix and other confounding factors.

UPDATED VERSION PUBLISHED:
BMC Health Services Research 2010, 10:76doi:10.1186/1472-6963-10-76
http://www.biomedcentral.com/1472-6963/10/76

Background

The literature comparing private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from high-income and established market economies. Studies from developing and transitional economies remain scarce, especially regarding patient case-mix and quality of care in public and private hospitals, even though countries such as China have expanded a mixed-ownership approach to service delivery. The purpose of this study is to compare the operations and performance of public and private hospitals in Guangdong Province, China, focusing on differences in patient case-mix and quality of care.

Methods

We analyze survey data collected from 362 government-owned and private hospitals in Guangdong Province in 2005, combining mandatorily reported administrative data with a survey instrument designed for this study. We use univariate and multi-variate regression analyses to compare hospital characteristics and to identify factors associated with simple measures of structural quality and patient outcomes.

Results

Compared to private hospitals, government hospitals have a higher average value of total assets, more pieces of expensive medical equipment, more employees, and more physicians (controlling for hospital beds, urban location, insurance network, and university affiliation). Government and for-profit private hospitals do not statistically differ in total staffing, although for-profits have proportionally more support staff and fewer medical professionals. Mortality rates for non-government non-profit and for-profit hospitals do not statistically differ from those of government hospitals of similar size, accreditation level, and patient mix.

Conclusions

In combination with other evidence on health service delivery in China, our results suggest that changes in ownership type alone are unlikely to dramatically improve or harm overall quality. System incentives need to be designed to reward desired hospital performance and protect vulnerable patients, regardless of hospital ownership type.

Published: Eggleston, Karen, et al. "Comparing public and private hospitals in China: evidence from Guangdong." BMC Health Services Research 10.1 (2010): 1.

When both physicians and pharmacists in Taiwan prescribed and dispensed drugs, many elderly people considered the two types of health care providers more or less synonymous (i.e., close substitutes). Two policies mandated in the 1990s changed this perception: National Health Insurance (NHI), which provides insurance coverage to all citizens, and a separation policy (SP) that forbids physicians from dispensing and pharmacists from prescribing drugs. The author finds that by providing an economic incentive to the previously uninsured elderly, NHI raised the probability that they would visit physicians, relative to their continuously insured counterparts. In particular, some previously uninsured elderly who once only visited pharmacists were more likely to also visit physicians after NHI was implemented. Following this, the SP made it more likely that all elderly patients would only visit physicians and buy drugs from on-site pharmacists hired by physicians—a result different than its policy goal.

Published: Chang, Kang-Hung. "The healer or the druggist: effects of two health care policies in Taiwan on elderly patients’ choice between physician and pharmacist services." International journal of health care finance and economics 9.2 (2009): 137-152.

No crisis is uniformly global.  The suffering and the opportunity that a "global" crisis entails are always unevenly distributed across countries, and unevenly across the population inside any one country.  That said, one can nevertheless argue that we-not the old royal "we" but, more presumptuously, the new global "we"-are in January 2009 experiencing the latest of four dramatic changes that major parts of the world have undergone over the last twenty years.

Revised and updated as of late January 2009, this paper was originally presented at a conference on "Refreshing Thai-U.S. Relations" held in Thailand on 8-9 January 2009.