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This issue of Value in Health presents selected articles from the ISPOR Second Asia Pacific Conference held in Shanghai, March 2006. Under the leadership of ISPOR and the ISPOR Asian Consortium, the ISPOR AsiaPacific Conference is held every two years in Asia with a twofold mission: to help develop knowledge and capacity for health economics and outcomes research (HE/OR) in Asia; and to promote the use of HE/OR in policymaking processes in Asia, with the goal of improving efficiency in the allocation of resources. With "Improving Evidence and Outcomes in Health Care Decision-Making" as the theme, the Second ISPOR Asia-Pacific Conference was well received, achieving an unprecedented level of participation from the Asian communities. All articles included in this issue underwent the usual anonymous process of peer review.

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Karen Eggleston
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At first sight, political turmoil in Thailand and the Philippines—repeated violent protests, impeachment battles, and military coups—gives the impression that democracy in Southeast Asia is on a downward spiral. One country in the region, however, has sustained a stable pluralistic democracy: the Republic of Indonesia.

In 1999, after thirty years of Suharto’s centralistic, authoritarian rule, Indonesia embraced far-reaching decentralization and election reforms. Within a brief period of two years, the Indonesian government reshaped its administrative architecture, including the devolution of local tax and service responsibilities to more than 400 district governments. In view of its deep-seated authoritarian traditions, beginning with Javanese kingdoms and sultanates, moving through Dutch colonialism (1619–1942), and ending with Suharto’s New Order (1965–98), Indonesia’s rapid shift toward democratic decentralization stands out as one of the most remarkable political transitions in recent history.

Particularly notable is the peaceful and competitive conduct of Indonesian elections. Over the last decade, local citizens have elected more than 30,000 local councilors and over 400 mayors, regents, and governors, with little violence or intimidation. High voter turnouts (around 70 percent) and high replacement rates of incumbent executives (roughly 40 percent) bear witness to rising electoral competition in local polities. While subnational elections display considerable flux, the upcoming presidential elections in July 2009 suggest continuity. The latest national polls, for example, predict a comfortable lead for President Susilo Bambang Yudhoyono (49 percent) over his main competitor, Megawati Soekarnoputri (36 percent).

The institutionalization of democracy and decentralization, however, has yet to translate into substantive public sector reforms. Indonesia continues to score low in global governance assessments. According to Transparency International and the World Bank, Indonesia’s government ranks 126th (out of 180) in terms of corruption, and 129th (out of 181) in terms of administrative efficiency for business start-ups. With the introduction of regional autonomy, these governance problems have, to a considerable extent, been decentralized to hundreds of districts. Yet, despite formally uniform institutional settings, local governments exhibit vast differences in regulatory quality, administrative efficiency, and anticorruption measures.

What motivates some local governments to perform better than others? Implicit in this question, which stands at the center of my research, is the idea that local democracy is not only an end in itself, but also a means for improving government outcomes. The pronounced policy differences that arise in Indonesia’s district polities provide a good opportunity to examine the workings of Indonesian local democracy or, to use a different terminology, the political economy of local decision-making.

The findings from controlled case comparisons and subnational datasets suggest that policy variations are best explained by differences in government leadership. Good policy environments emerge primarily in cases where local regents and mayors, whose career aspirations are tested by direct elections, skillfully use their office powers to forge reform coalitions and supervise bureaucratic practices. Societal reform pressures that arise from local parliaments, business chambers, and nongovernmental organizations, in comparison, tend to be less significant drivers of good governance. While broad-based interest groups continue to struggle with collective-action problems, district council members seem more concerned with provincial/national party elites (and their party list positions) than with representing local constituencies. Thus, in Indonesia’s early stage of democratic transition, where societal pressures are yet to fully unfold, much seems to depend on leadership efforts to initiate, facilitate, and oversee government improvements.

Under what conditions, then, are local leaders likely to act in the public interest, rather for private gain? While direct elections provide basic incentives, the direction and strength of these incentives also hinge upon existing socioeconomic structures. Government leaders need to accommodate interests of powerful economic groups in order to secure support for campaign funding and co-investments in public goods. Whether these interest alignments result in unproductive rent-seeking and corruption, or in constructive government reforms, depends on the constellation and transparency of economic powers.  The more economic powers become concentrated in specific sectors, groups, and firms, and the less public-private interactions are monitored by local media, the greater the likelihood that leaders will pursue self-preferential and collusive strategies.

As a result, it is plausible to assume that a moderate economic concentration and strong media presence are conducive to better governance. At this point, only some districts fall into this category. But as globalization and communication technologies progress, local polities are bound to become more economically diverse and politically informed. With growing political awareness and increased incentives for better leadership, it is likely that Indonesia, over time, will see more public-private symbioses for reform and, thus, bridge the gap between well-functioning elections on the one hand and poor governance
on the other.

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North Korean leader Kim Jong-il’s apparent stroke in mid-August raises the possibility of near-term political succession in the Democratic People’s Republic of Korea (DPRK, or North Korea). This has prompted U.S. and Republic of Korea (ROK, or South Korea) planners—concerned with command and control of North Korea’s fissile material under conditions of regime disarray, internecine conflict, or collapse—to examine afresh the alliance’s assumptions, contingency plans, and political strategies.

The Korean Peninsula occupies a central place in the Chinese national security calculus. Chinese policy above all aims to avert military conflict on the Peninsula and regime collapse in the North. Conflict and collapse scenarios could embroil China in unwanted military action, imperil its long-term economic development program, jeopardize its crucial ties with the United States and South Korea, open the floodgates to North Korean refugees, and alter the Northeast Asian strategic landscape to China’s disadvantage.

For these and other reasons, China has emphasized the need for a peaceful, negotiated resolution of the problem posed by North Korea’s nuclear ambitions. It has encouraged North Korea to emulate, to the extent feasible, China’s own post-1978 economic reforms. At the same time, China has deepened political and commercial ties with South Korea, and sustained the North Korean regime through generous economic and military assistance.

China’s core interests—plus its special ties with North Korea’s military, party, security, and economic elite—have persuaded many outside observers that Beijing possesses not only unique insights into the Pyongyang regime’s internal dynamics but also potential leverage. Further, many assume that China, having both the need and ability to influence North Korea’s political succession, will do precisely that—shape, or if necessary impose, a North Korean succession that accords with China’s policy interests.
China has consistently denied having superior knowledge and usable leverage, and has adamantly rebuffed speculation regarding its national ambitions and potential actions.

Such disclaimers notwithstanding, some in the ROK and the United States postulate that national and alliance interests might best be served by “coordinating” with China on North Korean regime change/collapse scenarios. A few even argue that the alliance should “subcontract” this issue to China, thereby tacitly acquiescing in its intervention to ensure a peaceful, stable transition.

Despite the high stakes, crucial U.S.-ROK contingency planning seemingly has been approached in an environment that is rich in conjecture and hope, and poor in hard intelligence and agreed assessments.
Yet it is possible—indeed imperative—to do better than this. With respect to one small part of the complex whole—China’s interests, potential leverage, and likely actions—a starting point for rigorous
analysis might include the following issues and questions:

Knowledge : Does China in fact enjoy superior knowledge of internal DPRK decision-making? What are the sources of and limits upon such knowledge? How have the North Koreans approachedspecial bilateral ties with the Chinese in the realms of party-to-party affairs and military cooperation?
Are there reasons to believe that China contributed to North Korea’s nuclear program? If not, are there reasons to believe that North Korea shared any knowledge whatsoever of its activities with China? Has China sought to cultivate North Korean officials and, if so, when, and how successfully?  How has North Korea reacted to any such Chinese activities?

Leverage: How much leverage does China enjoy over North Korean political, military, and economic decisions? What are the sources of such leverage? What are the constraints? How should one assess North Korea’s likely response to Chinese pressure? What options does North Korea enjoy in deflecting such pressure?

A Proactive Approach by China to North Korean Political Succession : What posture is China likely to adopt toward political succession in North Korea? What are its policy options? What assets does it hold? How does the issue of North Korean succession—including the possibility of regime chaos or collapse—fit into China’s broad strategic posture? What external considerations (especially those involving the ROK, the United States, Japan, and Russia) must China take into account?

ROK and U.S. Policy Considerations Regarding China’s Potential Involvement in a North Korean • Political Succession: What essential posture should the ROK and the United States adopt? On the one hand, should they enlist China’s cooperation in “managing” political succession in North Korea, or endeavor to minimize that involvement, instead addressing North Korean succession scenarios as primarily a task for the U.S.-ROK alliance? On the other hand, should they accept (and even tacitly encourage) China’s superior ability to effect a stable succession that preserves peace and stability? Should they broaden the scope of the current six-party talks to include formal discussion among “the five” (excepting North Korea)? Or should some other approach be adopted?

On one level, U.S. and ROK planners must urgently address these issues in order to have confidence that the two allies can deal smoothly with any North Korean political succession scenario. On a deeper level, a rigorous bilateral analysis of this type can serve to strengthen the U.S.-ROK alliance itself by fully illuminating a broader set of underlying national attitudes, interests, and priorities.

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Asia’s economies have been hard hit by the current global financial crisis, despite in most cases enjoying strong macroeconomic fundamentals and stable financial systems.  Early hopes were that the region might be “decoupled” from the Western world’s financial woes and even able to lend the West a hand through high growth and the investment of large foreign exchange reserves.  But that optimism has been dashed by slumping exports, plunging commodity prices, and capital outflows.  The region’s most open, advanced and globally-integrated economies—Hong Kong, Singapore, and Taiwan—are already in severe recession, with Japan, Korea and Malaysia not far behind, and dramatic slowdowns are underway in China, India, Indonesia, Thailand and Vietnam.  What role did Asian countries play in the genesis of the global crisis, and why have they been so severely impacted?  How is their recovery likely to be shaped by market developments and institutional changes in the West, and in Asia itself in response to the crisis?  Will the region’s embrace of accelerated globalization and marketization following the 1997-98 Asian financial crisis now be retarded or reversed?

Linda Lim is a leading authority on Asian economies, Asian business, and the impacts of the current global financial crisis on Asia, and she has published widely on these topics. Her current research is on the ASEAN countries’ growing economic linkages with China.

Forthcoming in 2009 are Globalizing State, Disappearing Nation: The Impact of Foreign Participation in the Singapore Economy (with Lee Soo Ann) and Rethinking Singapore’s Economic Growth Model. She serves on the executive committees of the Center for Chinese Studies and the Center for International Business Education at the University of Michigan, where formerly she headed the Center for Southeast Asian Studies. Before coming to Michigan, she taught economic development and political economy at Swarthmore. A native of Singapore, she obtained her degrees in economics from Cambridge (BA), Yale (MA), and Michigan (PhD).

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Linda Yuen-Ching Lim Professor of Strategy, Stephen M. Ross School of Business Speaker University of Michigan
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The U.S. financial crisis has spread around the globe. Financial globalization means that most countries and regions are not immune to the contagious effects of a financial crisis that originates in one country.

East Asian countries had already experienced the contagious effects of a financial crisis in 1997. That year, a financial crisis that broke out in Thailand and Indonesia reached Malaysia and then South Korea. Each of these countries reacted differently to the crisis. South Korea, Indonesia, and Thailand accepted International Monetary Fund (IMF) conditionalities that required neoliberal economic restructuring in return for emergency loans, while Malaysia rejected the IMF offer and instead encouraged the inflow of speculative financial capital, while reforming the banking and financial system. In the aftermath of the East Asian financial crisis, regional economic, financial and security cooperation were discussed among East Asian countries. These efforts resulted in the Chiang Mai Initiative, the Bond Initiative, the East Asian Summit, the Shanghai Cooperation Organization, and the Six Party Talks.

Thus, regionalism in East Asia was revived in response to external shocks, such as global financial volatility, endogenous opportunities such as East Asian market compatibility (Pempel, 2008), endogenous security threats such as the North Korean nuclear development, and exogenous opportunities such as "bringing in the U.S." (Pempel, 2008).

Nonetheless, East Asian regionalism is still at a low level of institutionalization compared to Europe. East Asian regionalism is still basically "bottom-up, corporate (market)-driven regionalism" (Pempel, 2005). 

I will discuss the obstacles and the opportunities that Northeast Asian countries are facing since the end of the Cold War and the advent of globalization.

Hyug Baeg Im is Professor at the Department of Political Science and International Relations, Korea University, Seoul, South Korea. He is Dean at the Graduate School of Policy Studies and Director at Institute for Peace Studies. He received B.A. in political science from Seoul National University, M.A. and Ph.D. in political science from the University of Chicago. He was visiting professor at Georgetown University (1995-1996), Duke University (1997), Stanford University (2002-2003) and visiting fellow at International Forum for Democratic Studies, National Endowment for Democracy, Washington DC (1995-1996). He served as a presidential adviser of both Kim Dae Jung and Roh Moo Hyun presidency. His current research focuses on the impact of IT revolution and globalization on Korean democracy. His publications include “The Rise of Bureaucratic Authoritarianism in South Korea,” World Politics, Vol. 34, No. 2 (1987), “South Korean Democratic Consolidation in Comparative Perspective” in Consolidating Democracy in South Korea (Lynne Rienner, 2000) and “’Crony Capitalism’ in South Korea, Thailand, and Taiwan: Myth and Reality,” (co-authored with Kim, Byung Kook) Journal of East Asian Studies, Vol. 1, No. 1 (2001), “Faltering Democratic Consolidation in South Korea: Democracy at the End of Three Kims Era” Democratization, Vol. 11, No. 5(2004), “Christian Churches and Democratization in South Korea” in Tun-jen Cheng and Deborah A. Brown (eds.), Religious Organizations and Democratization: Comparative Case Studies in Contemporary Asia (M.E. Sharpe, 2006) and “The US Role in Korean Democracy and Security since Cold War Era,” International Relations of the Asia Pacific, Vol. 6, No.2 (2006).

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HYUG BAEG IM Department of Political Science and International Relations Speaker Korea University
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Recent analyses of U.S.-Korea relations have tended to focus on rising anti-American sentiments in South Korea and the changing nature of the overall alliance relationship. Either attributed to a case of Korean exceptionalism or U.S. exceptionalism, the current trend of anti-Americanism in Korea is treated as a unique watershed moment that portends the transformation of bilateral relations. Park argues that mobilization of anti-Americanism in Korea, however, is also a manifestation of anti-Great Power-ism, which is not new in the history of Korean politics. In fact, President Roh’s election platform of finding autonomy and self-reliance demonstrates close parallels with the anti-Qing mobilization in turn-of-the-century Korea. Anti-Great Power-ism (anti-sadae) emerged as a potent tool of political mobilization in the late 19th century, when the newly created Reform/Enlightenment Party made their criticism of the existing policy of “revering Great Powers” (sadae) the centerpiece of their attack against the conservative establishment. Even though sadae was originally a pragmatic policy of accommodating the powerful Qing, marking a departure from a cultural-ideological emulation of Ming China, it was stigmatized during 19th century politics as subservient and Great Power-dependent.

By comparing the progressives’ political mobilization processes in the late 19th century and in 2002-2006, the speaker argues that today’s anti-Americanism is actually a continuation of anti-China-ism seen from a broader historical perspective. At the same time, such anti-Great-Power mobilizations demonstrate the importance attached to relations with the “Great Powers” in Korean politics. Korean leaders have historically sought to generate political legitimacy by achieving different types of status in relations with the region’s dominant power in the context of regional hierarchy. A key implication of this study is that the social context of hierarchy continues to play an important role in alliance politics as well as East Asian security.

Seo-Hyun Park is an acting instructor in the Korean Studies Program at APARC and a PhD candidate in the Government Department at Cornell University. Her dissertation project explores enduring patterns of strategic thinking and behavior in East Asia, examining how the hierarchical regional order has conditioned conceptions of state sovereignty and domestic security politics through comparative case studies of Japanese and Korean relations with China in the traditional East Asian order and with the United States in the post-1945 regional alliance system.

Park received a B.A. in Communications from Yonsei Universitiy in Korea and an M.A. in Government from Cornell University.

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Seo-Hyun Park is an acting instructor in the Korean Studies Program at APARC and a PhD candidate in the Government Department at Cornell University. Her dissertation project explores enduring patterns of strategic thinking and behavior in East Asia, examining how the hierarchical regional order has conditioned conceptions of state sovereignty and domestic security politics through comparative case studies of Japanese and Korean relations with China in the traditional East Asian order and with the United States in the post-1945 regional alliance system.

Park has been a recipient of the Japan Foundation Dissertation Fellowship, the Mellon Fellowship, and the Cornell University Einaudi Center’s Carpenter Fellowship, and most recently, the Predoctoral Fellowship at the Center for International Security and Cooperation (CISAC) at Stanford University. She has also conducted research in Japan and Korea as a visiting researcher at the University of Tokyo and the Graduate School of International Studies at Yonsei University.  She received a B.A. in Communications from Yonsei Universitiy and an M.A. in Government from Cornell University.

Seo-Hyun Park Acting Instructor, Shorenstein Asia Pacific Research Center, Stanford University Speaker
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As the new year begins, the administration of ROK President Lee Myung-bak faces an unusually complex and rapidly evolving regional security landscape as he seeks to craft a strategy that simultaneously deepens ties with the U.S., protects South Korean equities in North Korea, continues to reduce tensions with neighboring countries and promotes economic objectives in Northeast Asia (including eastern Siberia). What are his options, considerations and prospects for success?

The past year witnessed an accelerated pace and apparent deepening in substance of the nascent security ties between and among the nations of Northeast Asia. A veritable whirlwind of diplomatic activity featured “upgraded” dialogue and symbolic steps. Meanwhile, as token of warming relations and impetus for even closer regional cooperation, China, Japan and the ROK met trilaterally on an array of issues. Ambitious proposals – and cutthroat bargaining – attended competition for a stake in Russian energy resources and potential infrastructure projects in the conjunction of eastern Siberia, Korea and China. Through the year all involved parties – the ROK, China, Russia, Japan, and the U.S. – met in the Six-Party talks context. Each party, excepting North Korea, paid public obeisance to the goal of “transforming” the talks into a new regional security mechanism.

But the year 2009 dawns against the backdrop of uncertainties that cast a cloud over the promise suggested by these developments: the global economic and financial crisis; battered, untested or unpopular political leaderships; competing nationalisms – and national interests; and the import and implications of China’s “rise.”

Mr. Keyser retired from the U.S. Department of State in September 2004 after a 32-year career. He had been a member of the Senior Foreign Service since 1990, and held Washington-based ambassadorial-level assignments 1998-2004. Throughout his career he focused on U.S. policy toward East Asia, particularly China, Taiwan, Hong Kong, Japan and the Korean Peninsula. Fluent in Chinese and professionally conversant in Japanese, Russian and French, he served three tours at the American Embassy in Beijing, two tours at the American Embassy in Tokyo, and almost a dozen years in relevant domestic assignments. In the course of his career, Keyser logged extensive domestic and foreign experience in senior management operations, conflict resolution, intelligence operations and analysis, and law enforcement programs and operations.

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Donald W. Keyser retired from the U.S. Department of State in September 2004 after a 32-year career.  He had been a member of the Senior Foreign Service since 1990, and held Washington-based ambassadorial-level assignments 1998-2004.  Throughout his career he focused on U.S. policy toward East Asia, particularly China, Taiwan, Hong Kong, Japan and the Korean Peninsula. Fluent in Chinese and professionally conversant in Japanese, Russian and French, he served three tours at the American Embassy in Beijing, two tours at the American Embassy in Tokyo, and almost a dozen years in relevant domestic assignments.  In the course of his career, Keyser logged extensive domestic and foreign experience in senior management operations, conflict resolution, intelligence operations and analysis, and law enforcement programs and operations.  A Russian language major in college and a Soviet/Russian area studies specialist through M.A. work, Keyser served 1998-99 as Special Negotiator and Ambassador for Regional Conflicts in the Former USSR.   He sought to develop policy initiatives and strategies to resolve three principal conflicts, leading the U.S. delegation in negotiations with four national leaders and three separatist leaders in the Caucasus region.

Keyser earned his B.A. degree, Summa Cum Laude, with a dual major in Political Science and Russian Area Studies, from the University of Maryland.  He pursued graduate studies at The George Washington University, Washington, D.C., from 1965-67 (Russian area and language focus) and 1970-72 (Chinese area and language focus).   He attended the National War College, Fort McNair, Washington (1988-89), earning a certificate equivalent to an M.S., Military Science; and the National Defense University Capstone Program (summer 1995) for flag-rank military officers and civilians.

Don Keyser Pantech Fellow, Shorenstein Asia Pacific Research Center, Stanford University Speaker
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In Southeast Asia, and particularly for for the Association of Southeast Asian Nations (ASEAN), security has long trumped democracy as a priority. But the brutal dictatorship in Burma/Myanmar, political pluralism in Indonesia, and the global growth of democratic norms have led some Southeast Asians to question ASEAN’s habit of turning a blind eye to domestic abuses by member states. The concept of regional security, meanwhile, is being reoriented from military threats toward new dangers to health and the environment, and from state security toward human security.

Will promoting democracy cause local autocrats to hunker down, and split ASEAN into hostile camps? Will ignoring demands for democracy allow domestic pressures to rise to dangerous levels? Should Burma/Myanmar be expelled or engaged? How should ASEAN respond to nontraditional threats to security in which member states are themselves implicated? In Hard Choices, expert authors—including a foreword by Surin Pitsuwan, the current secretary-general of ASEAN—grapple with these and other key and controversial questions for Southeast Asia today—and tomorrow.

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Marcus Mietzner is currently Lecturer in Indonesian Studies at the Faculty of Asian Studies, Australian National University. Between 1998 and 2008, he lived, worked and researched in Indonesia. He has published extensively on Indonesian politics, among others in Journal of Southeast Asian Studies, Southeast Asian Research and Contemporary Southeast Asia. His most recent book is Military Politics, Islam, and the State in Indonesia: From Turbulent Transition to Democratic Consolidation, published by ISEAS in Singapore in December 2008.

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Marcus Mietzner Lecturer in Indonesian Studies and Faculty of Asian Studies Speaker Australian National University
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Yoshiki Kaneko is a professor at Dokkyo University in Saitama, Japan.  SEAF hosted him as a visiting scholar at Stanford for part of 2007 to continue or complete the research and writing of several Japanese-language manuscripts on Southeast Asia that are now in print or awaiting publication.  They include three chapters  in edited volumes: two forthcoming in 2009, "Ethnicity and Politics in Malaysia and Singapore," in Beyond Ethnic Politics in South and Southeast Asia (Keiso Shobo), and "The Collapse of Judicial Independence under the Mahathir Administration in Malaysia," in Rethinking Southeast Asia Politics (Keio University Press); and one published in 2007, "The Function of the Judiciary in the Democratization Process in Southeast Asia," in New Political and Economic Order in Southeast Asia: Changes and Challenges aft the Asian Currency Crisis in 1997 (Daito-Bunka University, 2007).

Kaneko Yoshiki is a professor at Dokkyo University in Saitama, Japan.  SEAF hosted him as a visiting scholar at Stanford for part of 2007 to continue or complete the research and writing of several Japanese-language manuscripts on Southeast Asia that are now in print or awaiting publication.  They include three chapters  in edited volumes: two forthcoming in 2009, "Ethnicity and Politics in Malaysia and Singapore," in Beyond Ethnic Politics in South and Southeast Asia (Keiso Shobo), and "The Collapse of Judicial Independence under the Mahathir Administration in Malaysia," in Rethinking Southeast Asia Politics (Keio University Press); and one published in 2007, "The Function of the Judiciary in the Democratization Process in Southeast Asia," in New Political and Economic Order in Southeast Asia: Changes and Challenges aft the Asian Currency Crisis in 1997 (Daito-Bunka University, 2007).

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