For the past ten years, Japan has undergone aggressive, government-driven reforms aimed at changing its financial systems, labor markets, and corporate governance institutions. Faced with the challenges of globalization and an ageing population, Japan undertook these reforms to regain its former competitiveness. What remains uncertain, however, is whether these reforms will also be effective in creating an environment
that is more favorable to entrepreneurship and innovation. If the reforms are effective, at what pace, and in what shape will new firms emerge? Will Japan’s system mirror the institutions that have evolved in regions such as Silicon Valley, or will it develop into a new framework of innovation?

The persistent decline in Japanese asset values during the 1990s engendered many policy and legal responses. Among these was a series of business policy and associated legal reforms intended to foster the creation of new companies, new industries, and new financial institutions. Starting in 1997, these reforms included changes in how firms are formed. For example, the capital required to start a stock-issuing firm was reduced from ten million yen to a mere one yen. The yugen kaisha—a secondary form of Japanese company—was also abolished and the limited liability partnership created instead. Holding companies were allowed, mergers were deregulated, treasury shares were authorized, and the liability of company directors was limited.

Additional reforms were promulgated to encourage new forms of financial intermediation. Tax benefits created for “angel” investors, foreign venture capitalists, foreign private equity, and foreign lawyers became common. Purchase of shares with shares, triangular mergers, and repurchase of shares were all allowed. Moreover, several new stock exchanges were created expressly for relatively new companies.

Corporate governance laws were also revised. For one, Japanese firms may now use U.S.-style board of director committees, with an upper limit placed on directors’ liabilities. Japanese auditors are now required to be outsiders, and consolidated accounting is likewise compulsory, as well as “mark-to-market” rules for financial reporting. These are just a few of the changes, all of which combine to increase transparency in Japan’s markets.

The results were noticeable. By 2006, new companies were garnering price-to-earnings ratios of greater than 100 to 1 in the new markets; the number of IPOs per year was comparable to the rate during the U.S. Internet bubble; and the mergers and acquisition market was transformed from one of the most moribund in the world to one of the most dynamic. Venture capital firms proliferated, as did new law firms, private equity firms, and foreign banks. Existing Japanese banks merged, new banks formed, and money-lending began again. Some new companies even gained sufficient liquidity and stature to turn their founders into celebrities and some of the wealthiest people in Japan. Rakuten, Mixi, ValueCommerce, and Cybird are just a few of these success stories. Japan is currently in its seventy-first month of economic expansion—the longest of the postwar period.

The future, however, is unclear. As Professor Yoko Ishikura, of Hitotsubashi University, recently observed at a SPRIE seminar at Stanford, “Japan is at a turning point and it is uncertain which direction it will choose.” For 2008, IPO valuations have returned to levels more comparable to those in the United States, and the climate for startups has moderated somewhat. New company startup rates are flat and IPO rates have recently dipped significantly. Some prominent studies of the entrepreneurial climate in various countries rank Japan among the least favorable. Many observers are impatient for more evidence of results from the reforms. It remains an open question whether Japan is being affected by the U.S. slowdown and commodity price increases, or if the country is simply retreating from it entrepreneurial gains.

In light of these developments, scholars remain curious: Are the reforms permanently changing the Japanese economy? Are the reforms sufficient to meet the challenges that Japan faces? Will the reforms be effective? Alternatively, are these reforms even desirable? SPRIE and the U.S.-Asia Technology Management Center, in cooperation with selected experts and research organizations in Japan, are undertaking
a major project to study the seemingly contradictory corporate and social climate in Japan, which is at present stretched between entrepreneurial and more conservative forces.

Japan’s economic relationship with the countries of the Pacific Rim—and indeed with the rest of the world—is vital to all of the economies involved. If Japan is transforming into a new economic culture, an understanding of that transformation is relevant both to global economic development and to the study of entrepreneurial growth.

As the most indebted country in the Organization for Economic Cooperation and Development (OECD), Japan’s dire fiscal situation is no secret. Yet despite its financial woes, in March 2008 the Japanese government failed to renew a relatively minor tax on gasoline that had been in force for thirty-four years. The government introduced a bill that would renew the so-called “provisional” gas tax. Although it passed the House of Representatives at the end of February, the Democratic Party of Japan (DPJ) blocked the bill in the opposition-controlled House of Councilors in March, causing the provisional tax to expire. With more than a two-thirds majority in the House of Representatives, the ruling Liberal Democratic Party (LDP)-led coalition overrode the House of Councilors at the end of April, and passed the extension of the provisional tax. What can one make of this episode and what does it say about the government’s ability to rebuild its precarious finances?

Prime Minister Yasuo Fukuda’s stance on the gasoline tax is an attempt to take the high ground, sticking to the position that the government must take painful but necessary steps to address Japan’s public debt crisis. After being selected as the head of the LDP and prime minister, Fukuda appeared set to prioritize fiscal reconstruction. He appointed well-known fiscal hawks to key party posts and cabinet positions and indicated a need to raise taxes. Fukuda soon backed away from a general tax increase, but on the provisional gasoline tax issue he stood his ground, arguing that its abolition would worsen Japan’s deficit and also run counter to the government’s effort to reduce greenhouse emissions.

The Fukuda administration’s stance on the provisional gasoline tax proved to be a disaster for both his cabinet and the LDP. The largest opposition party, the DPJ, skillfully turned the gasoline tax into an issue that it used to attack the LDP. During a recent by-election in Yamaguchi prefecture, historically a LDP stronghold, the DPJ candidate, Hiraoka Hideo, soundly defeated the LDP candidate, taking 70 percent of the vote. Hiraoka and the DPJ touted their success in abolishing the gasoline tax, while denouncing the government’s move to deduct health insurance premiums from seniors seventy-five years and older.

The DPJ successfully turned the provisional gasoline tax into a winning issue in large part because the tax has been viewed as a funding source that feeds the LDP-run pork barrel machine. The heart of the matter is not the tax, but how tax revenues are spent. Funds from the gasoline tax have been earmarked for road construction projects that are widely viewed as inefficient, corrupt, and driven above all by political considerations. Although the DPJ could only temporarily block the government’s bill to renew the gasoline tax, the action signaled the DPJ’s commitment to cutting wasteful government spending. The DPJ also advocates further constraints on road spending by abolishing the earmarking of funds from the basic, nonprovisional gasoline tax. Prime Minister Fukuda has now agreed to consider this proposal, indicating the extent to which public opinion has turned against such earmarking.

While the DPJ scored a political victory with its symbolic attack on road spending, it is less clear if it or the LDP will be able to take the much harder step of increasing taxes in the future. One proposal that has emerged is to earmark revenues from an increase of the national value-added tax (VAT) for social security spending. This proposal is intended to dampen resistance to the move by ensuring that the revenues will not be diverted to wasteful projects but rather used for popular welfare programs. Some within the LDP support such a plan. The DPJ has publicly endorsed turning the VAT into a “social security” tax, but it remains vague on the details. However, a poll from the Nikkei Shimbun revealed that only 34 percent of the population supports an increase in the VAT, even if the revenues are used for social security.

It has always been politically perilous to raise taxes. This fact is not lost on the LDP, which suffered declining support after it introduced the VAT in the 1980s and then raised it under Prime Minister Ryutaro Hashimoto (1996–98). This realization largely explains why LDP-led administrations have attempted to pursue fiscal reconstruction through cuts on the expenditure side while avoiding measures to increase revenue. From “fiscal reconstruction without tax increases” during the 1980s to Junichiro Koizumi’s structural
reforms without raising taxes, this formula has proved durable.

If Japan is to get serious about restoring its public finances, it cannot indefinitely postpone the issue of increasing revenue. The fundamental problem, however, is the public’s widespread belief that the government is wasteful, corrupt, and inefficient. Ultimately, if Japan is to succeed in raising taxes and rebuilding the nation’s finances, the LDP, DPJ, or any new party that may emerge will have to address this deep-seated public perception.

As a 2007-08 Shorenstein Fellow at Shorenstein APARC, John D. Ciorciari pursued a full and varied agenda of research and writing on Southeast Asia.

Fellowships are more often won on the promise of completing a book than books are finished before the fellowships end. Dr. John Ciorciari broke this “rule” by completing his book manuscript in Spring 2008 and submitting it to a university press for possible publication.

Based on his Oxford dissertation, the work is provisionally entitled “Hedging: Using Southeast Asian States as Case Studies.” In it, he examines the range of options that secondary states possess between outright alignment with and neutrality toward the great powers. He argues that secondary states normally seek to "hedge" by limiting their alignments. They do so to avoid the risks of tight security cooperation with the great powers, including diminished autonomy and entrapment, while reaping sufficient rewards in the form of protection. He presented his findings at a Southeast Asia Forum seminar on May 28, 2008 titled “Dating but Not Married: Southeast Asian Security Responses to the Rise of China.” See the link below for an audio file of the seminar.

In addition to finishing his book on hedging, Ciorciari used his fellowship period to pursue his research interest in Asian financial cooperation, which is increasingly central to broader political relations in the region. He focused on the Chiang Mai Initiative (CMI), an effort by China, Japan, South Korea, and the ten members of the Association of Southeast Asian Nations (ASEAN) to develop economic resilience by establishing regional mechanisms for balance-of-payments support.

Ciorciari collaborated on this study with Jennifer Amyx, a professor of political science at the University of Pennsylvania and herself a former Shorenstein Fellow and speaker for the Southeast Asian Forum (SEAF) at Shorenstein APARC. Ciorciari and Amyx acknowledge that establishing an effective financing mechanism under the CMI has proven to be a challenging task. Nevertheless, by fostering regular interaction among Asian central bankers and finance ministry officials, the CMI has begun to yield a range of spillover benefits conducive to regional financial resilience. (Schedules permitting, Ciorciari and Amyx may present some of their findings at a SEAF seminar at Stanford in the upcoming academic year.)

As a Shorenstein Fellow in 2007-08 Ciorciari also worked on two projects on Cambodia: a book chapter on the international politics surrounding the long-delayed and finally ongoing Khmer Rouge Tribunal, and an article on China’s relations with the Khmer Rouge regime during the late 1970s. The article argues that the Pol Pot regime effectively punched above its weight in an otherwise asymmetrical relationship by exploiting China's rigid conception of its security interest in Indochina. In studying the Sino-Cambodian alliance, Ciorciari was able to test and illustrate some of the arguments in his book manuscript as to how small states pursue leverage and autonomy in their relations with major powers.

In 2008 an Indonesian economist, Sudarno Sumarto, was chosen to become the second Shorenstein APARC/Asia Foundation Visiting Fellow. He will be in residence at Stanford during the 2009-2010 academic year.  

An edited summary of Dr. Sumarto's proposed research and writing at Stanford follows:

Facing the major damage wreaked by the Asian financial crisis of 1997-98 on already poor and/or vulnerable Indonesians, the government in Jakarta was forced to launch a series of emergency social safety nets.  These programs targeted multiple sectors:  employment, education, health, food security, and community empowerment.  

Now that a decade has gone by since these measures were undertaken, it is time to draw policy lessons from the experience.  Special attention will be paid in this project to the dynamics of the process of deciding and delivering social protection, the difficulty of enlisting or creating appropriate targeting and implementation mechanisms, institutional enablers and impediments, the role of civil society, the impact of commodity subsidy reforms, and the relevance of good (and bad) governance.  

The study will also draw comparisons between Indonesia's record of targeted social protection and the experiences of other developing countries.  

Dr. Sumarto heads the SMERU Research Institute (Jakarta).  He also lectures at the Bandung Institute of Technology, Universitas Nusa Bangsa (Bogor), and the University of Indonesia (Jakarta).  

Dr. Sumarto has contributed to more than sixty co-authored articles, chapters, reports, and working papers, including "Agricultural Growth and Poverty Reduction in Indonesia," in Beyond Food Production (2007); "Reducing Unemployment in Indonesia," SMERU Working Paper, 2007; and "Improving Student Performance in Public Primary Schools in Developing Countries:  Evidence from Indonesia," Education Economics, December 2006.

Dr. Sumarto has spoken on poverty and development issues in Australia, Chile, China, Egypt, Ethiopia, France, Japan, Morocco, Thailand, and the United Kingdom, among other countries.  He has a PhD and an MA from Vanderbilt University and a BSc Cum Laude from Satya Wacana Christian University (Salatiga), all in economics.  He and his wife Wiwik Widowati have three children.  

After the events of the past few days, I felt a need to update and expand on my note to you of last week about Dokdo.

First, as a preface for all that is to follow, I fully understand why Koreans feel very strongly about the Dokdo issue and, frankly, I personally sympathize with the ROK claim to the islets.

My basic understanding of the issue is as follows:

(1) The ROK has actual possession of the islets. Japan cannot take the matter to the international court unless the ROK agrees, and the ROK won't. Japan will not attempt to use force to take the islets. As far as I know, not a single country in the world wishes to get involved in the controversy between the ROK and Japan over Dokdo, and thus none will support Japan. In other words, there is no prospect that possession of the islets will ever change from the ROK to Japan (in fact, former Prime Minister Abe made a statement acknowledging this situation a few years ago).

(2) Because of (1) above, however, probably no country, much less the international community as a whole, is likely for the foreseeable future to formally support ROK sovereignty (as opposed to not challenging its actual possession) over Dokdo.

(3) Logically, therefore, the ROK's goals should be to (a) maintain actual physical possession of Dokdo, which, as explained above, is not a problem, (b) in the mid-term, persuade others in the international community that Korea's claim outweighs Japan's, and (c) thereby lay the basis, in the long run, for Japan's eventual dropping its claim and/or the international community actively supporting the ROK's claim.

(4) Given all of the above, tactically the ROK should take a confident, low-key, long-term, strategic approach toward Dokdo.

(a) Overreacting to offending Japanese steps or actions can play into the hands of the Japanese right-wing, both domestically in Japan where those Japanese not particularly interested in Dokdo may be offended and energized by Korean criticism of all "Japanese" and "Japan," and in the international community, where strong Korean reactions are widely reported and thus unintentionally result in increased publicity for the Japanese claim.

(b) Similarly, the ROK should take care not to "demand" that foreign countries support its position on Dokdo-for the time being that will not work and it risks offending those countries and thus hurting Korean interests overall-but confidently, diplomatically publicize its position based on the very best objective research on the issue.

(5) Regarding the recent controversy concerning the U.S., I agree fully that it was wise of President Bush to reverse the recent step by the Board on Geographic Names; the timing of the BGN step last week was extremely unfortunate. But for the ROK to develop a good strategy and good tactics on Dokdo for dealing with all countries, including the U.S., it is critically important for the ROK to correctly and fully analyze both the actions and the intentions of foreign countries.

As far as I can reconstruct what happened-and I caution that, as a former U.S. official, I have no access to confidential information and I am not a representative of the U.S. government-the BGN made a policy decision a year or more ago to note which territories are the subject of disputes around the globe.

Why then, the Korean media asks, did the BGN decide only last week to change the listing for Dokdo but not for other territories in the region, as has been asserted? It appears that bureaucratic procedures and resource limitations resulted in the BGN being very slow to make the actual changes mandated by its policy decision to specify territorial disputes.

What has not been noted in Korea, where the focus naturally is on the Dokdo issue, is that the BGN database has a huge number of errors and inconsistencies in its geographical listings, including territorial disputes, all over the world. Top U.S. government officials have publicly indicated that the BGN move was made by relatively low-level, technical officials who did not seek policy input from senior levels of the U.S. government. Clearly that was very unfortunate, and, for the U.S., the incident highlights the need for the BGN to seek such policy guidance in all cases.

As for the timing of the BGN change, it appears, ironically, that BGN officials were alerted to the controversy by media reporting about the strong Korean reaction to the latest Japanese step. (The Japanese step itself would have received virtually no coverage in the U.S. media if it had not been for the strong Korean reaction.) Acting without policy guidance related directly to Dokdo, the BGN officials apparently thought they were updating the database in response to the general policy change made a year or so earlier. I am aware of no indication that Japanese "lobbying" was behind the BGN move last week.

(6) I can thus easily understand why Koreans, based on their concerns and the information available to them, would construe the BGN action as "siding with" the Japanese position. But, in terms of developing ROK strategy and tactics, it is important, as I noted above, that the Korean government and people fully and accurately understand foreign intentions. In the U.S. case, it is clear that the U.S. government did not and does not intend to change its long-standing policy of not taking a position regarding Dokdo.

What happened in the U.S. was largely the result of pedestrian bureaucratic incompetence and failure to communicate internally within the government-not the result of a basic policy change, much less a conspiracy to support Japan. (I am reminded of the old and very wise saying that one should "never ascribe to conspiracy that which can be explained by stupidity.")

While Koreans of course want all countries, particularly their U.S. ally, to support their position on Dokdo, they should also recognize the fundamentally favorable situation of the ROK in regard to Dokdo: the international community, including the U.S., is not challenging and will not challenge the ROK's actual possession of Dokdo. Thus, as former Prime Minister Abe indicated, Dokdo will remain Korean, and Koreans can say confidently, "Dokdo is our land."

Over more than six decades, the partnership between the United States and the Republic of Korea has been subject to many stresses and strains, from the Korean War to coping with the challenge of North Korea’s nuclear ambitions. More recently, the democratization of South Korea has opened the alliance to much greater public scrutiny and pressures from an active and mobilized Korean public. Managing this strategic alliance in an era of democracy has been a focus of the research work on Korea conducted by FSI’s Walter H. Shorenstein Asia-Pacific Research Center.

With the election in December of Lee Myung-bak as South Korea’s president, ending two terms of progressive rule, Shorenstein APARC decided to launch a nonpartisan group of former senior U.S. government officials, scholars, and other American experts on Korea to explore how to revitalize the U.S. alliance with the Republic of Korea (ROK) after a decade of tensions. In partnership with the New York-based Korea Society, Shorenstein APARC assembled this policy study group at Stanford in early February for in-depth discussion of the challenges facing the alliance and then took the group to Korea for meetings with key figures, from President-elect Lee and his advisors to leaders of the opposition, Korean businessmen, and American diplomats and security officials.

Based on these intensive meetings, the members of this “New Beginnings” policy study group concluded that the United States now has a major opportunity to bolster and broaden its relationship with the ROK. Lee, Korea’s first businessman to be elected president and a self-proclaimed “pragmatist,” has stressed that he gives top priority to the United States in his foreign policy. His fixed five-year tenure will coincide with the entire first term of the next U.S. president, allowing the two new leaders an extended period of cooperation.

Immediately before Lee’s first visit to the United States as president in mid-April, New Beginnings members led by Shorenstein APARC Director Gi-Wook Shin, APARC Distinguished Fellow Michael H. Armacost, and Korea Society President Evans J.R. Revere visited Washington, D.C., and New York City to release their report, New Beginnings in the U.S.-ROK Alliance: Recommendations to U.S. Policymakers. They also addressed a forum in San Francisco co-hosted by the World Affairs Council and the Asia Society of Northern California on June 3 to discuss their recommendations and subsequent developments in U.S.-South Korean relations. The report received extensive coverage in the South Korean news media and was noted in American media as well.

Surrounded by a rising China, a more assertive Russia, a Japan seeking a greater international role, and a nuclear North Korea, the ROK can play a key role in working with the United States to maintain peace and stability in East Asia. No effort to address the nuclear and other challenges posed by North Korea is likely to succeed without the closest U.S.-South Korean cooperation. The ROK, as the world’s 13th-largest economy and one of Asia’s most democratic countries, is a model of the virtues of a market economy, of the values of freedom and human rights, and of alignment with the United States. The two countries are also bound by personal ties: 2 million people of Korean descent live in the United States, and 100,000 Koreans come to the United States each year for study and exchanges, more than from any other country.

President Lee’s election reflects four key changes in South Korea: (1) a shift from the political left back toward the center; (2) greater skepticism about North Korea; (3) increased wariness of China; and (4) enhanced support for the U.S.-ROK alliance. The protests against the United States seen in South Korea in 2002 were the result in part of transitory circumstances and no longer reflect the reality there.

President Lee seeks a global partnership with the United States while maintaining good relations with Korea’s neighbors, Japan, China, and Russia. He favors improved relations with North Korea and has stated his willingness to meet North Korean leader Kim Jong-Il. In major departures from the earlier “sunshine” policy of the South Korean government toward North Korea, however, Lee will not provide large-scale economic assistance to the North until after it abandons its nuclear weapons program. In another major departure from the previous ROK policy, he has also criticized human rights abuses in North Korea. Lee supports continued food and other humanitarian aid to the people of North Korea.

New Beginnings group members believe that the United States cannot afford to lose the opportunity presented by President Lee to build a global partnership with one of the United States’ most important allies. The group identified a number of steps that the United States, in cooperation with the ROK, could take to move the alliance into a new era (see sidebar).

The New Beginnings group has announced that it plans to continue its efforts in support of strengthened U.S.-South Korean relations. Among other projects, the group intends to present recommendations early next year to the South Korean government on how to develop a close relationship and bolster the alliance with the incoming U.S. administration.

Recommendations to United States Policymakers

• Global Partnership — Building on the cooperation between Presidents Bush and Lee, the new U.S. president next year should issue a vision statement with Lee detailing their partnership and goals for the alliance. To advise them, the two new presidents should establish a bi-national panel of distinguished Koreans and Americans. The United States and the ROK should also give increased emphasis to the foreign ministerial strategic dialogue they initiated in 2006.
• Security Alliance — We support the ongoing realignment of U.S. forces in the ROK. Congress should increase its budget for the relatively small U.S. portion of the total cost of its implementation. The decision to transfer wartime operational control of Korean forces back to the ROK in 2012 was likewise correct, but the United States should respond positively to any South Korean proposal to discuss conditions related to the transfer. We welcome the Lee administration’s apparent desire to review the main North Korea war plan and to prepare jointly for other contingencies, including that of a North Korean collapse. The United States should conduct regular, joint consultations with South Korea and other allies in East Asia to determine whether security conditions warrant changes in our respective force levels and, if so, in what direction.
• North Korea — The ROK election has brought the United States and South Korea into essential agreement, for the first time in seven years, on how to deal with North Korea and its nuclear aspirations. To avoid the danger that their North Korea policies will again diverge, they must establish stronger consultative mechanisms, including with Japan.
• Economy and Trade — Congress should ratify the U.S.-ROK Free Trade Agreement now. U.S. failure to approve the FTA would not only represent foregone business opportunities; it would damage U.S.-ROK relations and be seen by the international community as a weakening of U.S. self-confidence and engagement, in East Asia and around the globe.
• People-to-People Ties — The U.S. government should set an early target date to include the ROK in the Visa Waiver Program and encourage the Korean government to support a major expansion of the Fulbright Program’s English Teaching Assistant Program. The United States should create a new program to allow U.S. federal employees to intern in Korean ministries and increase the budget for the State Department’s International Visitor Program for young South Korean leaders. U.S. military personnel stationed in Korea should be joined by their families. The United States should, at long last, construct a new U.S. embassy in Seoul.

The July/August issue of Health Affairs, the leading U.S.-based health policy journal, focuses on China and India. The special issue includes an article on China’s pharmaceutical policy by five contributors to Prescribing Cultures and Pharmaceutical Policy in the Asia-Pacific, a book forthcoming in 2009 from the Shorenstein Asia-Pacific Research Center series with Brookings Institution Press. Chapters on Korea and Japan by Soonman Kwon (Seoul National University) and Toshiaki Iizuka (Aoyama Gakuin University) also appear in Chinese translation in the journal Bijiao (Comparative Studies), along with an overview paper (“Pharmaceutical policy reforms to separate prescribing from dispensing in Japan and South Korea: Possible implications for China”) by Karen Eggleston, Asian Health Policy Program Director.

As Eggleston writes in the introduction to Prescribing Cultures, pharmaceuticals and their regulation play an increasingly important and often contentious role in the health care systems of the Asia Pacific.  For example, some economies such as China have extraordinarily high drug spending as a percentage of total health spending; India and a few others host thriving domestic pharmaceutical industries of global importance, while controversy surrounds patents, trade-related aspects of intellectual property (TRIPS), and pharmaceutical pricing within bilateral trade agreements (Australia-US, Republic of Korea-US); nations throughout the region struggle with appropriate regulation of drugs, from patents to evidence-based purchasing (e.g., Australia’s Pharmaceuticals Benefit Scheme) and direct-to-consumer advertising; deeply-rooted traditions of indigenous medicine are modernizing and integrating into broader health care systems; and policies to separate prescribing and dispensing re-write the professional roles of physicians and pharmacists, with modifications to accommodate cultural norms and strong economic interests. Effective prescribing and pharmaceutical use will be central to controlling infectious diseases, both old and emerging; protecting the global public good of antimicrobial effectiveness; and treating the growing burden of chronic disease in the Asia Pacific.

The forthcoming book will explore these issues in detail, through a multi-disciplinary lens. The first section of the book features chapters on pharmaceutical policy within seven selected health care systems of the Asia Pacific: South Korea, Japan, Thailand, Taiwan, Australia, India, and China. The second section focuses on the cross-cutting themes of prescribing cultures and access versus innovation. Taken as a whole, the contributions aim to provide an evidence base for policy while acknowledging the historical and cultural context that makes policies distinctive.

Clear evidence suggests the importance of health service provider payment incentives for achieving efficiency, equal access, and quality, including attention to primary, secondary, and tertiary prevention. “Pay for performance” may be on the cusp of significant expansion in Asia, and reform away from fee-for-service has been underway for several years in several economies. Yet despite the policy relevance, the evidence base for evaluating payment reforms in Asia is still very limited.

China in particular has been undertaking significant reforms to its health care system in both rural and urban areas. With the expansion of insurance coverage and need to resolve incentive problems like “supporting medical care through drug sales,” there is an urgent need for evaluating alternative ways of paying health service providers. Evidence from policy reforms in specific regions of China, as well as other economies of the Asia-Pacific, can provide valuable evidence to help inform policy decisions about how to align provider incentives with policy goals of quality care at reasonable cost.

To illuminate these questions, the Asia Health Policy Program and several collaborating institutions are planning to convene a conference on health care provider payment incentives on November 7-8, 2008 in Beijing. The conference will highlight and seek to distill “best-practice” lessons from rigorous and policy-relevant evaluations of recent reforms in China and elsewhere in the Asia Pacific.

The organizing committee – including health economists from Shorenstein APARC, Peking University, Tsinghua University, and Seoul National University – reviewed submissions in June 2008 and accepted sixteen. The conference papers cover payment issues in Korea, Japan, China, Taiwan, Thailand, Tajikistan, the Philippines, and the US, and the disciplines of economics, health services research/health policy, public health, medicine, and ethics. Topics include institutionalized informal payments; the impact of global budget policies on high-cost patients; public-private partnerships; public-sector physicians owning private pharmacies; evidence-informed case payment rates; payment and hospital quality; bonuses and physician satisfaction; physician prescription choice between brand-name and generic drugs; and differences in pharmaceutical utilization across insurance plans that pay providers differently (fee-for-service versus capitation).

Policymakers from China’s National Development and Reform Commission and Ministry of Health will also speak at the conference. Selected research papers will be published through the Shorenstein Asia-Pacific Research Center either in a special volume or in a special issue of an English-language health policy journal.