How Do Type 2 Diabetes Mellitus (T2DM)-Related Complications and Socioeconomic Factors Impact Direct Medical Costs? A Cross-Sectional Study in Rural Southeast China
The Educational Gradient in Health in China
It has been well established that better educated individuals enjoy better health and longevity. In theory, the educational gradients in health could be flattening if diminishing returns to improved average education levels and the influence of earlier population health interventions outweigh the gradient-steepening effects of new medical and health technologies. This paper documents how the gradients are evolving in China, a rapidly developing country, about which little is known on this topic. Based on recent mortality data and nationally representative health surveys, we find large and, in some cases, steepening educational gradients. We also find that the gradients vary by cohort, gender and region. Further, we find that the gradients can only partially be accounted for by economic factors. These patterns highlight the double disadvantage of those with low education, and suggest the importance of policy interventions that foster both aspects of human capital for them.
Patient Copayments, Provider Incentives and Income Effects: Theory and Evidence from the Essential Medications List under China’s 2009 Healthcare Reform
Expanding access through insurance expansion can increase health‐care utilization through moral hazard. Reforming provider incentives to introduce more supply‐side cost sharing is increasingly viewed as crucial for affordable, sustainable access. Using both difference‐in‐differences and segmented regression analyses on a panel of 1,466 hypertensive and diabetic patients, we empirically examine Shandong province's initial implementation of China's 2009 Essential Medications List policy. The policy reduced drug sale markups to providers but also increased drug coverage benefits for patients. We find that providers appeared to compensate for lost drug revenues by increasing office visits, for which no fee reduction occurred. At the same time, physician agency (yielding to patient demand for pharmaceuticals) may have tempered provider incentives to reduce drug expenditures at the visit level. Taken together, the policy may have increased total spending or total out‐of‐pocket expenditures. Mandating payment reductions in a service that comprises a large portion of provider income may have unintended consequences.
U.S.-China Relations Fractious, Not Fragile, Says APARC Fellow
Forty years after the establishment of diplomatic relations between the United States and China, the two superpowers are competing and contesting every arena, from trade to AI research and from space exploration to maritime rights. Instead of what Americans referred to as engagement and Chinese called reform and opening, many experts and analysts now characterize the relations between the two countries as dangerously brittle. Some see a new kind of Cold War in the making. Such assertions, however, argues Shorenstein APARC Fellow Thomas Fingar, “both ignore history and impute a level of fragility that has not existed for many years.”
Fingar reflects on the U.S.-China bilateral relationship in a new article, “Forty years of formal—but not yet normal—relations,” published in the China International Strategy Review. He claims that the relationship is resilient and not destined for conflict, albeit it is beset by a host of aspirational, perceptual, and structural differences.
A political scientist and China specialist who served over two decades in senior government positions, Fingar urges readers to remember that assertions of fragility of the U.S.-China relationship undervalue the strength, scope, and significance of interdependence, shared interests, and constituencies in both countries. These, he says, have a substantial stake in the maintenance of at least minimally cooperative relations.
U.S.-China relations are indeed highly asymmetrical: Chinese citizens and organizations have far greater access to the United States than Americans do to China, notes Fingar. He also recognizes that the troubles that have soured the relationship are more intricate and often more sensitive than those of the past. Decades ago, most of the issues that arose were handled at the governmental level. But now “the number and variety of players with stakes in the relationship and disputes with counterpart actors are much greater.” Furthermore, explains Fingar, the U.S. business community is expressing a stronger voice for government action to change Chinese behavior and is not as consistent an advocate of stability in U.S. policy toward China as it used to be. “This is an extremely important development,” he says, “because it reverses a key dynamic in the U.S.-China relationship.”
Ultimately, however, the two countries and our institutions and people are linked by myriad ties that bring mutual benefits as well as the constraints of interdependence. “I remain confident that we will continue to be able to manage the relationship,” concludes Fingar. He expresses disappointment, though, that normalization of U.S.-China relations remains a work in progress and cautions that merely managing the relationship to prevent it from deteriorating is an unsatisfactory goal that should be unacceptable to both sides. Not only does such a low bar limit what each counterpart can achieve, but it also inhibits the kind of cooperation required to address transnational challenges like climate change, infectious disease, and proliferation of dangerous technologies.
Video: Is Trade Just a Side Issue in U.S.-China Disputes?
Karl Eikenberry, director of the U.S.-Asia Security Initiative, spoke with "Bloomberg Markets: Asia" about the ongoing trade disputes between the U.S. and China. Video of his interview—conducted on the sidelines of the Morgan Stanley China Summit in Beijing—is posted below.
Forty Years of Formal—but Not yet Normal—Relations
Ties between individuals and institutions in the United States and the People’s Republic of China have become broader, deeper, and stronger during the four decades since the establishment of formal diplomatic relations in 1979 and the relationship can no longer be described as fragile. However, it also cannot yet be considered a normal relationship, at least not from the perspective of American citizens, companies, and commentators on international affairs. The relationship between the two largest economies and military powers has many asymmetries. Chinese citizens and organizations have far greater access to the United States than Americans do to China and ordinary Americans increasingly perceive the relationship as unbalanced and unfair. The American business community, long the strongest supporter of U.S. engagement with China, has been alienated by Chinese actions and attitudes and, no longer, acts as a counterbalance to other constituencies dissatisfied with aspects of the relationship. The relationship is fractious but not destined for conflict. We have learned to solve or manage conflicts, but it is becoming harder to do so.
Audio: FSI Director, Oksenberg-Rohlen Fellow Discuss U.S.-China Conflict
“But as I read what the communist party, what President Xi says, I don't see the same fervor to the ideological dimension of what China is doing around the world...[compared to what] the Soviets were doing.”
It was during the 2019 Oksenberg Conference that FSI Director Michael McFaul made the preceding assessment. Titled On the Brink: A New Cold War with China, the conference sought to explore the causes underlying today’s intensified conflict between the United States and China. McFaul was joined on stage by APARC's Oksenberg-Rohlen Fellow David M. Lampton and China Program Director Jean Oi. Their panel followed an earlier fireside chat featuring keynote speaker Dr. Condoleezza Rice.
Rice, the 66th U.S. Secretary of State, opened the program with a wide-ranging conversation with Oi regarding our rapidly deteriorating trade relations with China. Among other topics, Secretary Rice drew contrasts between our current tensions with China and the Soviet-era Cold War; the potential sources of China’s increasing nationalism; and what the appropriate U.S. policy responses could be.
Condoleezza Rice (right) listens on as Jean Oi addresses the audience
Dr. Jean Oi (left) and Dr. Condoleezza Rice
Audio recordings and transcripts of the formal remarks by McFaul and Lampton are available below.
The annual Oksenberg Conference honors the legacy of Professor Michel Oksenberg. A renowned China scholar and senior fellow at Shorenstein APARC, Professor Oksenberg served as a key member of President Jimmy Carter’s National Security Council, guiding the United States towards normalized relations with China and consistently urging that the U.S. engage with Asia in a more considered manner.
Benjamin Cedric Larsen
Benjamin Cedric Larsen is a PhD Fellow at Copenhagen Business School (CBS) and The Chinese Academy of Sciences (CAS) in Beijing. He joined Stanford’s Shorenstein Asia-Pacific Research Center (APARC) as visiting student researcher from the spring of 2019 through spring 2020.
Benjamin holds a dual Master degree in Public Management from Copenhagen Business School and The Chinese Academy of Sciences in Beijing. Prior to pursuing his doctoral-degree, Benjamin worked professionally in China, holding positions across the Danish Foreign Ministry as well as China’s technology industry (NJU Electronics / JD AI).
Benjamin’s research interests relate to the organization of AI innovation, with a particular focus on the dynamics playing out in China. His research looks into the organization of leading AI ecosystems while highlighting the role of the state in the governance of digital platforms that shape innovation in AI.
Audio: Tariffs Expand for Goods Going Between the United States and China
Does the current trade-talk stalemate between the U.S. and China portend a larger confrontation? Oksenberg-Rohlen Fellow David Lampton says yes, and shared with VOA Asia reasons for why the two countries find themselves so much at odds. Listen below (first 8 minutes):