Hysterectomy is the most common non-pregnancy-related major surgery performed on women in the United States. Close to 600,000 women in the United States undergo the procedure each year, with annual costs exceeding $5 billion. By age 60, more than one-third of women in the United States have had a hysterectomy.

Many believe that the high U.S. hysterectomy rate is a result of an expansion of the accepted indications for hysterectomy. More reasons are listed for removal of the uterus than for any other organ, with indications ranging from life-threatening cancer of the genital tract to menstrual pain. In the United States, hysterectomy is widely accepted by medical professionals and by the public as an appropriate treatment for uterine cancer and for various common non-cancerous uterine conditions that produce disabling levels of pain, discomfort, uterine bleeding, emotional distress, and related symptoms.

With so many possible indications for hysterectomy, the decision as to when to perform the procedure may be a great contributing factor in the different rates of hysterectomy between countries. This study poses the question, "Does individual physician decision-making affect hysterectomy rates in different countries?"

Reprint from China's Political Economy (Singapore: World Scientific Publishing Co. Pte. Ltd. and Singapore UP Pte. Ltd., 1998).

Published as part of the "America's Alliances with Japan and Korea in a Changing Northeast Asia" Research Project.

This collection of papers stems from a recent World Bank project focused upon the contentious issue of whether government has played any positive role in the success of the so-called "high-performing" Asian economies. It goes beyond the influential World Bank volume The East Asian Miracle to chart a middle ground that recognizes diversity among the different East Asian economies, as well as the evolutionary nature of government intervention.

Published as part of the "America's Alliances with Japan and Korea in a Changing Northeast Asia" Research Project.

Zouping offers important general lessons for the study of China's rural transformation. The authors in this volume, all participants in a unique field research project undertaken from 1988 to 1992, address questions that are far from simple and about which there is some controversy.

The questions are grouped around two issues. The first is the role of local governments as economic actors. What is this role, how have they played it, and how can we explain their behavior? Have they dominated rural economies through public ownership of industry and local planning, or has the role of local governments diminished with the rise of market transactions and private ownership? The second issue is market reform and inequality. Have rural cadres enjoyed income advantages in the new market environment? Has the provision of such collective services as education and health care declined, leading to new forms of inequality?

The chapters on the role of local government all point to a single conclusion: one cannot explain the rapid development of Zouping without reference to the role of local governments and of local government officials as economic actors. Scholarly writings about the "transitional economies" have often ignored or distorted this aspect of China's reform experience. On the second issue, changes in inequality owing to market reform, the authors present mixed findings but contribute rich new data to the research on this issue.

Published as part of the "America's Alliances with Japan and Korea in a Changing Northeast Asia" Research Project.

China’s attitude toward the U.S.-Japan and U.S.-Korea alliances, particularly the former, has drawn a lot of attention in the post–Cold War era. How China views the utility and function of these two security alliances and reacts to them could well shape the dynamics of the alliances. From a historical perspective, however, this is not a new issue. China has lived with these alliances for almost half a century. To better understand China’s current concerns about the alliances and to predict its future posture, we might look for clues in what China has done in the past. This paper attempts to provide a broad survey of Chinese perceptions of the two security alliances in the Cold War period to elucidate Beijing’s post–Cold War policy orientation. By tracing the evolution of the Chinese calculus of the U.S.-Japan and U.S.- Korea alliances, it hopes to find answers to the following questions. What are some of the important variables or conditions that defined China’s attitudes and approaches to dealing with these two alliances? How do these variables or conditions interact with each other? Have they been constant or changing over time? Are they still relevant in the post–Cold War era, and to what extent?

The paper draws its findings mainly from the Chinese official media. While this may not be an ideal source, it nevertheless provides a systematic data basis for a historical analysis of continuity and change. There is no question that the official Chinese media, particularly before the 1980s, was full of rhetoric and propaganda. There has always been a gap between rhetoric and behavior in Chinese foreign policy, as in other countries. Nevertheless it is equally true that behind rhetoric always lie perceptions, self-serving or not, that provide “diagnostic propensities” and “choice propensities” of the Chinese leaders and elites, and thus have policy implications.

The findings of the paper suggest that China’s perceptions of the targets, internal structures, and functions of the U.S.-Japan and U.S.-Korean alliances have changed remark- ably over time, from extreme hostility to high tolerance. These changes resulted from the interactions of such factors as China’s assessment of the world balance of power, the well- being of its relationship with both indigenous and outside powers, and the priority of its national policy. The evolution of Chinese perceptions also illustrates that China need not view the two security alliances as inherently hostile to its interests. Under some circum- stances they can be considered useful or at least harmless. Beijing’s attitudes are often determined not by the two alliances per se but rather by its perception of the sources of threat to its security and whether these security alliances can alleviate or aggravate the threat. On the other hand, given the nature of China’s foreign policy, Beijing does not have intrinsic love for these alliances. Since the 1980s, China has not particularly endorsed any bilateral or multilateral military alliance in the region. Normatively China is also uneasy with the reality of the American military presence in the region and tends to see it as a short-term arrange- ment rather than a long-term phenomenon. During the Cold War, the Chinese perceived the two security alliances as either against China or with China. In the post–Cold War period, they have yet to be convinced that the function of the two alliances could be neither.

Published as part of the "America's Alliances with Japan and Korea in a Changing Northeast Asia" Research Project.

Alliances are organizations between or among independent entities that concert to produce “collective goods” for the mutual benefit of alliance members. The statement applies whether the alliances are between or among countries, corporations, universities, research centers, or other institutions. Of course, the nature of the collective goods, as well as the membership in the collectivity, differs across these cases. That the goods (or benefits) are“collective” means that their availability to one alliance member (or their production by any member) implies their availability to the other members of the alliance.

Because the beneficiaries of collective goods cannot readily be excluded from access to
them, the so-called “free rider” problem arises. As a result, “Let George do it” becomes the
prevalent incentive structure. The more George does, the less is the burden (i.e., “cost”) on
other alliance members, while the benefits are collectively available to all members.

Several corollaries follow with respect to the formation, functioning, and prospects of
alliances in general, and those in Northeast Asia in particular:

First, while the benefits of an alliance are available to all its members, their respective
valuations of these collective benefits may differ. It is also worth noting that non-alliance members—for example, China—may appraise the putative alliance products as representing
not benefits, but “dis-benefits” (threats or risks) for themselves.

Second, devising an appropriate formula for sharing the costs of producing the collective
alliance benefits is complicated by the aforementioned differences in valuations among
alliance members, as well as differences in their capacity and willingness to pay.

This paper addresses the general question of the collective burdens (costs) and benefits of
the U.S. alliances with Japan and Korea, as well as the respective capacities and willingness
of the alliance members to bear these burdens. The economics of these issues are inextricably linked with their politics, and so crisscrossing between these two domains occurs frequently in the paper.

The paper is divided into five sections. Section 2 addresses the economic capacities of the
alliance members to bear alliance costs. Section 3 deals with the costs—both economic and
non-economic—of each of the alliances. Section 4 assesses the security and other benefits of the alliances. Section 5 considers the politically dominated “willingness” of the alliance
members to bear alliance burdens. And Section 6 provides a concluding assessment of the
balance between the burdens and benefits of the two alliances, the interdependencies
between the two alliances, and ways of enhancing the alliances while mitigating the
drawbacks associated with what we refer to as the “China–Japan conundrum.”

Published as part of the "America's Alliances with Japan and Korea in a Changing Northeast Asia" Research Project.