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Health insurance holds the promise of improving population health and survival and protecting people from catastrophic health spending. Yet evidence from lower- and middle-income countries on the impact of health insurance is limited. We investigated whether insurance expansion reduced adult mortality in rural China, taking advantage of differences across Chinese counties in the timing of the introduction of the New Cooperative Medical Scheme (NCMS). We assembled and analyzed newly collected data on NCMS implementation, linked to data from the Chinese Center for Disease Control and Prevention on cause-specific, age-standardized death rates and variables specific to county-year combinations for seventy-two counties in the period 2004–12. While mortality rates declined among rural residents during this period, we found little evidence that the expansion of health insurance through the NCMS contributed to this decline. However, our relatively large standard errors leave open the possibility that the NCMS had effects on mortality that we could not detect. Moreover, mortality benefits might arise only after many years of accumulated coverage.

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Health Affairs
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Karen Eggleston
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Rural areas of China have made remarkable progress in reducing adult mortality within the past 15 years yet broadened health insurance was not a casual factor in that decline, according to a new study by an international research team that includes Asia Health Policy Program Director Karen Eggleston.

The New Cooperative Medical Scheme (NCMS), a government-subsidized insurance program that began in 2002-03, expanded to cover all of rural China within a decade. Examining NCMS and cause-specific mortality data for a sample of 72 counties between 2004 and 2012, the researchers found that there were no significant effects of health insurance expansion on increased life expectancy.

The study, published in the September issue of Health Affairs, showed results consistent with previous studies that also did not find a correlation between insurance and survival, although much research confirms NCMS increased access to healthcare, including preventive services, and shielded families from high health expenditures.

Commenting on the study, Eggleston said population health policies remain central to China’s efforts to increase life expectancy and to bridge the gap between rural and urban areas.

Eggleston also noted that multiple factors beyond the availability of health care determine how long people live, and anticipates the research team will continue to explore the impacts of NCMS by extending the study to look at infants and youth.

Read the study (may require subscription) and view a related article on the Stanford Scope blog.

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Farmers dry star anise seeds in a country yard in Tanbin Township, China, Nov. 26, 2005.
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President Donald Trump's ominous threat to unleash “fire and fury” on North Korea succeeded at least in garnering the attention of not only Kim Jong Un but the globe. The vague assertion of readiness to carry out a preventive attack on North Korea, even to use nuclear weapons, roiled stock markets, sent Japanese to look for bomb shelters and prompted alarmed warnings against the use of force from both foes and allies, including South Korean President Moon Jae-in. The piece is available in Chinese, English and Japanese.

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Dun Jiao Du
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The most dangerous impact of North Korea’s long-range missile test this past week may not have been the one in the Sea of Japan, felt in Washington, Seoul and Tokyo. It was in Moscow where Chinese leader Xi Jinping and Russian President Vladimir Putin locked arms in a united front on how to respond to the growing North Korea crisis. The target of this front was not, however, North Korea. It was the United States, who the Sino-Russian axis accused of pursuing a military “buildup” in the region.

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Tokyo Business Today
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South Korean President Moon Jae-in and U.S. President Donald Trump recently held a summit in Washington, their first face-to-face meeting in a time of heightened tensions on the Korean Peninsula. Experts from the Shorenstein Asia-Pacific Research Center offered insights in a series of publications and press interviews.

In advance of the summit, William J. Perry Fellow Kathleen Stephens spoke on Bloomberg television about the challenges facing the United States and South Korea, and how those challenges would be prioritized during the bilateral meeting.

Moon would be bringing the message that the U.S.-South Korea alliance is a “strong one and that he remains committed to it,” and that, “only by working transparently and closely together” could the two countries address areas of concern, Stephens said.

“Only when Washington and Seoul are able to talk very frankly to each other and come up with a coordinated plan do we have any chance of making some progress on North Korea,” she added.

Stephens joined the program from Seoul, where a group of Shorenstein APARC faculty and fellows participated in a public seminar and the Korea-U.S. West Coast Strategic Forum, a biannual conference that seeks to foster dialogue about issues affecting the Korean Peninsula and the U.S.-South Korea alliance.

The seminar, held in conjunction with The Sejong Institute, received press coverage; such articles can be read on the Voice of America website (in Korean) and Sisa Journal website (in Korean).

In an analysis piece for Tokyo Business Today, Associate Director for Research Daniel Sneider assessed the outcomes of the summit between Moon and Trump, suggesting that their meeting was satisfactory – without signs of major discord.

“For the most part, this display of calculated pragmatism worked well. There was no visible daylight between the two leaders over how to handle the North and THAAD totally disappeared from the summit talk, at least in public and in the joint statement issued by the two governments.”

The summit, however, may prove to be a “temporary gain,” Sneider added. “Beneath the smiles, there was plenty of evidence of the gaps, and even the tensions, that exist between a progressive government in Seoul, one that echoes the views of its ideological predecessors of a decade ago, and a nationalist, conservative regime in Washington.”

Read the piece in English and Japanese.

Days after the summit, North Korea test-launched an intercontinental ballistic missile (ICBM), which the United States and South Korea followed by hosting joint military exercises.

Stephens spoke on WBUR radio about the ICBM test launch and the initial reactions of the Trump administration.

“If [President Trump’s] agenda is to take stronger defensive measures against North Korea, I think he will find strong partners in Japan and South Korea,” she said, noting that other measures, such as diplomacy and economic sanctions, have also been used to affect pressure on the regime.

Responding to a question about China’s relationship with North Korea, Stephens said Beijing has not exhausted all possible tools in its efforts to persuade Pyongyang to slow or abandon its nuclear and missile activities. This is because China fears a collapse of the regime and “takes a long view” in its calculus, she said.

This news item has been updated.

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U.S. President Donald Trump and South Korean President Moon Jae-in come out from the Oval Office to deliver joint statements in the Rose Garden at the White House on June 30, 2017, in Washington, DC.
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In the days leading up to the Washington summit between South Korean President Moon Jae-in and U.S. President Donald Trump, the tension in Seoul was hard to escape. Fears of an open clash between the two leaders, of a handshake that went on too long, or of a hostile early morning tweet directed at Moon were widespread. But when a senior national security advisor to Moon met a group of American visitors after the first day of talks, he was visibly relieved. The dinner between Moon and U.S. President Donald Trump went so well, he recounted with a slight smile, that it was extended 35 minutes.

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Toyo Keizai Online (Tokyo Business Today)
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Rising powers often seek to reshape the world order, triggering confrontations with those who seek to defend the status quo. In recent years, as international institutions have grown in prevalence and influence, they have increasingly become central arenas for international contestation. Phillip Y. Lipscy examines how international institutions evolve as countries seek to renegotiate the international order. He offers a new theory of institutional change and explains why some institutions change flexibly while others successfully resist or fall to the wayside. The book uses a wealth of empirical evidence - quantitative and qualitative - to evaluate the theory from international organizations such as the International Monetary Fund, World Bank, European Union, League of Nations, United Nations, the International Telecommunications Satellite Organization, and Internet Corporation for Assigned Names and Numbers. The book will be of particular interest to scholars interested in the historical and contemporary diplomacy of the United States, Japan, and China.

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Cambridge University Press
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Phillip Lipscy
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