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 2007 Shorenstein APARC and The Asia Foundation chose Dennis Arroyo to be the first Shorenstein APARC/Asia Foundation Visiting Fellow.  Arroyo spent the 2007-08 academic year researching and completing a monograph on "The Political Economy of Successful Reform:  Asian Stratagems."  An edited abstract follows:

Major economic reforms are often politically difficult, causing pain to voters and provoking unrest.  They may be opposed by politicians with short time horizons. They may collide with the established ideology and an entrenched ruling party.  They may be resisted by bureaucrats and by vested interests.  Obstacles to major economic reform can be daunting in democratic and autocratic polities alike.
 
And yet, somehow, past leaders of today's Asian dragons did implement vital economic reforms. "The Political Economy of Successful Reform:  Asian Stratagems" recounts the political maneuvers used by Asian leaders of economic reform in these countries at these pivotal times:  Thailand under General Prem Tinsulanonda; Vietnam during Doi Moi (or Renovation); Singapore under Lee Kuan Yew; China under Deng Xiaoping; India in the 1990s; and South Korea under Park Chung Hee.

The paper classifies these maneuvers as responses to the main political barriers to reform and develops a "playbook" of tactics for economic reformers.  To overcome ideological obstacles, for example, the reformers packaged and presented reforms as ways of strengthening the party in power. Reformers proceeded gradually.  Initially they sought win-win compromises. They blessed pro-market violations as pilot projects. They even created new provinces in order to dilute the anti-reform vote.

The full text of Arroyo's monograph has been published by the Stanford Center for International Development in its working paper series.

Arroyo came to Stanford well qualified to study economic reform techniques.  In 2005 he was named director for national planning and policy at the National Economic and Development Authority (NEDA) of the Philippines.  His duties included building public support for the economic reforms championed by NEDA.  He has consulted for the World Bank, the United Nations, and the survey research firm Social Weather Stations, and has written widely on socioeconomic topics.  His critique of the Philippine development plan won a mass media award for "best analysis."  He has degrees in economics from the University of the Philippines.

In May 2008 Arroyo presented his findings in a SEAF lecture entitled "The Foxy Art of Herding Dragons: How Sly Asian Leaders Pulled off Politically Difficult Economic Reforms."

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.  

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.