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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.

 

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Asia Health Policy Program working paper #8
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Karen Eggleston
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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.

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Asia Health Policy Program working paper #7
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Karen Eggleston
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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.

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Asia Heath Policy Program working paper #5
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On December 18, tobacco control was the theme of the 2009 Kunming Health and Development Conference, co-convened by the Yunnan Health and Development Research Association, Pioneers for Health, and ThinkTank Research Center for Health Development. “Pioneers for Health” is a health policy non-governmental organization (NGO) founded in China a year ago with help from AHPP faculty affiliate Matthew Kohrman, Associate Professor of Anthropology. Pioneers for Health also received the good news that Tobacco-Free Kids/Bloomberg Initiative to Reduce Tobacco Use has renewed it for another two-year grant to cover all operational and health advocacy costs.

Article in Translation (Source:  The Economic Daily 经济日报):

More than sixty specialists and academicians from the fields of medicine, economy and sociology convened in Kunming (YunnanProvince) on December 18 for the 2009 Kunming Health and Development Conference, jointly hosted by the Yunnan Health and Development Research Association, Pioneers for Health, and ThinkTank Research Center for Health Development. The theme of the conference was "Tobacco Control for the Creation of a Healthy Lifestyle".  The conference was divided into three parts. For the first part a short film was shown. Titled "Tobacco: From Global Epidemic to Global Control", the film detailed the history of the global tobacco epidemic and its development up to the current day. It looked at the background and significance of the Framework Convention on Tobacco Control. The specialists and academicians present all agreed that a global consensus has been reached regarding the need for tobacco control. As a signatory of the FCTC and as a large nation, China is now responsible for carrying out a huge task. Tobacco control in Yunnan Province will be especially arduous. The second part -- Tobacco Control in Yunnan; Taking the First Step -- focused on the tobacco control effort in Yunnan Province. Topics for discussion included an analysis of ideas and methods to prevent youth from smoking. In the third part -- The Challenges and Opportunities for Tobacco Control in Yunnan Province; a Multi-disciplinary Perspective -- economists, sociologists and health experts engaged in a discussion of issues regarding tobacco control. During the discussion the participants stressed that tobacco control concerns not only public health, but also community development, the domestic economy, the people's livelihood, and the government's image. The most popular topics in this segment were "Tobacco and the Economy", "Tobacco and Health", and "The Influence of Popular Culture on the Behavior of Smoking". A multi-disciplinary approach was used when delving into the issues surrounding tobacco control.

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More than six decades after the end of World War II, the Japanese government has yet to release an estimated ¥200 billion worth of unpaid wages owed to Korean forced laborers who were brought to wartime Japan. Nor has the government disbursed an additional ¥200 billion worth of financial benefits owed to Korean and Taiwanese military servicemen. During the Allied Occupation of Japan, American authorities directed Japanese officials to compensate these Asian victims of the war effort, setting up a custody account for labor conscripts in 1946 and a foreign creditor's account for military conscripts in 1949. However, the outbreak of the Korean War destroyed any chance of monetary compensation, as the U.S. preoccupation over the new cold-war conflict effectively froze up bank accounts relating to Japan's former colonial subjects. Clarifying the historical record of American involvement in this unresolved issue of war compensation can contribute towards resurrecting efforts to reach regional reconciliation between Japan and its neighbors in Northeast Asia.

Matthew Augustine is the 2009-2010 Northeast Asia History Fellow at Shorenstein APARC, Stanford University. He received his Ph.D. from the History Department at Columbia University and his B.A. from the Politics Department at Princeton University. His research interests include military occupations, especially the U.S. occupations in Japan, Korea, and Okinawa after World War II; transnational migrations and border controls; Japan's colonial empire in the Asia-Pacific; and the history and politics of war reparations in Northeast Asia.

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Shorenstein APARC
Stanford University
Encina Hall, Room E-301
Stanford, CA 94305-6055

(650) 725--093 (650) 723-6530
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NE Asian History Fellow, 2009-2010
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After two years of research at the University of Tokyo, Dr. Matt Augustine recently received his Ph.D. in History from Columbia University. Augustine also received a M.A. in History from Columbia and received a B.A. from the Politics Department at Princeton University. He specializes in the history of modern Japan and Korea.

Augustine’s research focuses on international and comparative history of military occupations, especially U.S. occupations in Japan, Korea, and Okinawa; Japan’s colonial empire in the Asia-Pacific; and the history of race, migration, and border controls.

He recently published an article that explores the interaction between the cross-border smuggling and reversion movement with Japan as acts of resistance by Okinawans against U.S. military rule in the Ryukyu Islands after World War II. Augustine’s dissertation, “Crossing from Empire to Nation: Repatriation, Illegal Immigration, and the Allied Occupation of Japan, 1945-1952,” examines the relationship between migration and border controls, as well as the redefinition of nationality and ethnicity in post-imperial Japan.

While at Shorenstein APARC, Augustine will research and write on the history of war reparations that continue to affect relations between Japan and its neighbors in Northeast Asia. He will also teach a course that covers such issues as war, empire, postcolonialism, and U.S. military occupations in the region.

Matthew Augustine 2009-2010 Northeast Asia History Fellow Speaker Stanford University
Seminars
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Just how easy (or difficult) is it for North Koreans to watch banned American movies or listen to Korean-language news broadcasts that Pyongyang spends a great deal of time condemning and resources trying to block?  The North Korean border has become increasingly porous, with news reports suggesting that American and South Korean films have become so popular that the North Korean authorities have been forced to issue edicts on the length of men’s hair, for example.  At the same time, several American, South Korean and Japanese radio stations are targeting North Korea through short and medium-wave broadcasts.  A growing number of defectors report having tasted such forbidden fruit before leaving North Korea.  To what extent is banned media undermining the regime’s control of the flow of information?  Do such broadcasts encourage North Koreans to defect?

Peter M. Beck is the 2009-10 Pantech Fellow at Stanford University’s Asia Pacific Research Center.  He also teaches at American University in Washington, D.C. and Ewha Woman's University in Seoul.  He also writes a monthly column for Weekly Chosun and The Korea Herald.  Previously, he was the executive director of the U.S. Committee for Human Rights in North Korea and directed the International Crisis Group’s Northeast Asia Project in Seoul.  He was also the Director of Research and Academic Affairs at the Korea Economic Institute in Washington.  He has published over 100 academic and short articles and testified before Congress.

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Peter M. Beck teaches at American University in Washington, D.C. and Ewha University in Seoul.  He also writes a monthly column for Weekly Chosun and The Korea Herald. Previously, he was the executive director of the U.S. Committee for Human Rights in North Korea and directed the International Crisis Group's Northeast Asia Project in Seoul.  He was also the Director of Research and Academic Affairs at the Korea Economic Institute in Washington. He has served as a member of the Ministry of Unification's Policy Advisory Committee and as an adjunct faculty member at Georgetown and Yonsei universities.

He also has been a columnist for the Korean daily Donga Ilbo, an instructor at the University of California at San Diego, a translator for the Korea Foundation, and a staff assistant at Korea's National Assembly and Ministry of Foreign Affairs. He has published over 100 academic and short articles, testified before Congress, and conducted interviews with the world's leading media outlets. He received his B.A. from the University of California at Berkeley, completed the Korean language program at Seoul National University, and conducted his graduate studies at U.C. San Diego's Graduate School of International Relations and Pacific Studies.

2009-10 Pantech Fellow
Peter M. Beck Pantech Fellow, Asia-Pacific Research Center Speaker
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Two major unresolved issues from World War II in the Pacific are the use of the atomic bomb by the United States, which destroyed the cities of Hiroshima and Nagasaki, and the use of foreign slave labor for war-related production by Japan. Koreans and Allied POWs were among those who were victims of both atrocities. While limited compensation for non-Japanese hibakusha have been won in Japanese courts in recent years, no compensation has been forthcoming for their labor under armed confinement. The American government was responsible for the use of these atomic bombs, but company contractors such as Du Pont profited from their development as well. Just as Japanese companies such as Mitsubishi that profited from foreign forced labor should contribute to a trust fund for compensation, so too should American companies that contributed to the Manhattan Project. Only when U.S. and Japanese companies and governments mutually accept responsibility through such compensation will there be an honest acknowledgement of the real costs of the use of the atomic bombs and slave labor.

David Palmer is Senior Lecturer in American Studies at Flinders University in Adelaide, Australia. Since 2000, his primary focus has been on the history of Japanese workers, especially those in shipbuilding, who experienced World War II and the atomic bombs.
His most recent publications include "The Straits of Dead Souls: One Man's Investigation into the Disappearance of Mitsubishi Hiroshima's Korean Forced Labourers," Japanese Studies, Dec. 2006, and "Korean Hibakusha, Japan's Supreme Court and the International Community: Can the U.S. and Japan Confront Forced Labor and Atomic Bombing?," Japan Focus, Feb. 20, 2008.

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David Palmer Senior Lecturer in American Studies Speaker Flinders University, Australia
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Unresolved disputes over wartime aggression continue to plague relations between Japan and its neighbors, even as increasing economic and cultural interaction in Northeast Asia show no signs of abating. Can a meaningful and lasting reconciliation be achieved, more than six decades after World War II and given postwar Japan's history of neglecting Asian victims of past injustices? In answering this question, what has been described as Japan's "history problem" must be reconsidered from a broader, trans-Pacific perspective that includes the United States.

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Brian Myers will talk about his new book The Cleanest Race: How the North Korean See Themselves and Why it Matters (January 2010).

Myers was born in New Jersey and raised in Bermuda, South Africa, and Germany.  He has a Ph.D. in North Korean Studies from the University of Tubingen, Germany.  His books include Han Sorya and North Korean Literature (1994) and A Reader's Manifesto (2002).

In addition to writing literary criticism for The Atlantic, of which he is a contributing editor, Myers regularly contributes articles on North Korea to the New York Times, the Wall Street Journal, and academic journals. He is a contributor to a book First Drafts of Korea: The U.S. Media and Perceptions of the Last Cold War Frontier (2009) published by The Walter H. Shorenstein Asia-Pacific Research Center of Stanford University.

This seminar is supported by the generous grant from Koret Foundation.

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Encina Hall
616 Serra St., 3rd floor
Stanford University
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Brian Myers Director of International Studies at Dongseo University in Korea Speaker
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