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Donald K. Emmerson
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The United States and the ASEAN group of nations have further strengthened political, economic and security ties, after their second full-scale summit in New York.

President Barack Obama said the Association of Southeast Asian Nations, which groups ten countries, had the potential for true world leadership. President Obama also made it clear that he saw Asia as a vital plank of US foreign policy.

DR EMMERSON: In the run-up to the summit, there was a big question. Would the partnership be declared as being strategic in nature? That was a key word in the discussion and what happened was the leaders basically finessed the issue. It's not hard to suspect that they worried that if they declared a strategic partnership with the United States, this would cause alarm in Beijing. Because let's remember in the run-up to this summit, we've had a lot of activity - the split between China and Japan over the disputed islands, one could continue with some evidence of a more muscular Chinese foreign policy, its commitment to its claim to possess basically the entire South China Sea, escalating that to the level of a core interest, presumably equivalent to their interest in recovering Taiwan. I could go on, but in many case, it was understandable that the subtext of the meeting was what will China think? So basically what the summit did was to finesse the issue. They decided to pass on the question of raising the partnership to quote - a strategic level - unquote, to the ASEAN US Eminent Persons Group, presumably expert advisors that would be convened and would make recommendations down the road.

And one of the most remarkable things about the statement was how much ground it covered. I mean, among the topics and issues that the leaders committed themselves to do something about, were 14 as I count them, 14 different subjects. Human rights, educational change, trade and investment, science, technology, climate change, interfaith dialogue, disaster management, illicit trafficking, international terrorism, I could go on. So it is clear to me that one of the tasks that ASEAN and the US will have to face in the coming months, is to try to insert some sense of priority.

LAM: On that issue of priority, the US President, Barack Obama, of course, postponed a couple of visits to Indonesia due to pressing domestic demands. Did he in anyway express American commitment to the ASEAN region?

DR EMMERSON: Yes, this was particularly kind of, I suppose you could say, evident in the fact that the meeting occurred at all, finally it was organized. It lasted two hours. He was apparently quite engaged and engaging during that period of time. And I think there is no question that the United States under his administration is committed to South East Asia as a region, indeed has agreed with the leaders of ASEAN, that ASEAN should play a central role in the process of building regional cooperation in East Asia.

LAM: And, of course, one of the topics that came up as well was the South China Sea, that entire region, given the competing maritime and territorial claims vis-à-vis the Spratley and Paracel Island groups. Do you think China is watching the US relationship with ASEAN, this growing relationship - do you think Beijing might be watching it with unease?

DR EMMERSON: Yes, absolutely. I am confident that they are watching it with considerable unease and I note that the statement that the leaders made, made no reference whatsoever to the South China Sea, presumably because of sensitivity with regard to Beijing's possible reaction. The topic was implicitly mentioned, but not explicitly.

LAM: And what about within ASEAN, the grouping itself? The UN Secretary-General, Ban Ki-moon, on the weekend said that the ASEAN nations' credibility might suffer if they did not take a tougher line with Burma and this is in view of the upcoming elections in November. This is presumably directed at specifically China and India, but it could also be referenced to ASEAN could it not, because Burma is a member of ASEAN. Do you see that changing anytime soon with ASEAN, that ASEAN countries, leading members like Indonesia, Malaysia, Singapore, that they might take a stronger stand with the military junta in Rangoon?

DR EMMERSON: The election in Myanmar, if I can call it an election, since it will be highly compromised and manipulated will take place, at least is scheduled to take place November 7th. Indonesia does not take over the chairmanship of ASEAN until the 1st January. So the question is, since Indonesia is a democratic country, arguably, the most democratic of any country in South East Asia, will it use its opportunity to try to put pressure on Burma in the year 2011? My own view is that ASEAN will probably not fulfill Ban Ki-moon's hope, will not exercise significant pressure on the junta. Instead, we could get the opposite situation in which so long as there is not major violence associated with the election, it will essentially be received by ASEAN as a kind of minimally-acceptable basis for assuring the Burmese junta that ASEAN still treats them as a full member. In other words, it's quite possible that the junta may get away with what I take to be a kind of facade effort to legitimate their rule.

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Donald K. Emmerson, director of the Southeast Asia Forum
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Professor Lee will examine why South Korean labor unions have engaged in militant activism since the country's transition to democracy in 1987.  This situation contrasts with Taiwan, to which Korea's economic and political development is otherwise very similar.   Professor Lee will argue that the militant unionism reflects the weakness of Korea's democratic institutions, particularly its political parties.

Professor Lee received her doctoral degree in political science from Duke University and has been teaching at the State University of New York at Binghamton since 2006.  Her research has appeared in Studies in Comparative International Studies, Critical Asian Studies, Asian Survey, Korean Observer, and Asia-Pacific Forum.  Her book, tentatively entitled Democratic Politics and Labor Activism in East Asia, is forthcoming from Stanford University Press in 2011.

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Yoonkyung Lee Assistant Professor, Sociology and Department of Asian and Asian-American Studies, State University of New York at Binghamton Speaker
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A new AHPP working paper contributes to an important debate in law and health policy

Malpractice liability, along with medical technology and payment system distortions, regularly figures among the most-cited reasons for escalating health-care spending in the United States. On the one hand, Harvard economist Amitabh Chandra conservatively estimates that upwards of $60 billion, or 3 percent of total health care costs ($1.8 trillion), is spent annually as a result of direct litigation and indi­rect defensive medicine costs. On the other hand, tort reform advocates place the figure at $200 billion by extrapolating, to the entire U.S. population, the results of research conducted by Stanford professor Dan Kessler and Mark McClellan. Their 1996 study shows that tort reforms reduced provider liability costs for Medicare heart patients by 5 to 9 percent.

 

At the heart of these debates is the following question. Does medical malpractice liability achieve its dual goal of compensating victims of medical injuries and deterring medical errors, or does it merely encourage wasteful defensive medicine without improving patient health? Despite considerable empiri­cal research, there is little evidence that malpractice litigation deters medical negligence. The evidence is much stronger—though still hotly debated—that malpractice fears actually encourage physicians to engage in defensive medicine.

 

The newest release in the Asia health Policy Program working paper series, AHPP working paper #13 by Brian Chen, explores whether malpractice pressures affect physician behavior, patient health, and health care costs in Asia. Studying physicians’ response to legal changes in Taiwan, he finds that greater malpractice liability may, under certain circumstances, prompt physicians to perform more services without necessarily improving patient health.

 

Dr. Chen investigates how physicians’ test-ordering behavior and propensity to perform cesarean sections were affected first by a series of court rulings in Taiwan that increased physicians’ liability risks, and then by a subsequent amendment to the law that reversed the courts’ rulings. He finds that physicians faced with higher malpractice pressure increased laboratory tests as expected but unexpectedly reduced cesarean sections. The reduction in cesarean deliveries may be due to the fact that liability risks were more closely aligned with physicians’ standard of care after the court rulings. After the law was amended to negate the court decisions, physicians reversed their previous behavior, reducing laboratory tests and increasing cesarean deliveries. This pattern of behavior strongly suggests that physicians in Taiwan practice defensive medicine.

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Focus

In 2008, for the first time a majority of the world's population lived in cities. Rapidly rising standards of living and migration are contributing to an unprecedented worldwide surge in urbanization--in China alone, if trends continue, by 2025 more than 220 cities will each have more than one million inhabitants. The explosive growth of cities around the Pacific has widespread implications for energy use and has led to the demand for cities to become both smart and green.

But while billions of dollars of investments are pouring into urban energy solutions, and around the Pacific "low-carbon cities" and "eco-cities" are moving center stage, there are enormous challenges (and opportunities) facing the effective application of information technologies (IT), other innovative technologies and industrial growth.

The intersection of IT and environmental sustainability on the urban scale will require a complex integration of expertise, tools, and know-how from multiple disciplines--from building design and real estate development, to mobility and water systems, IT hardware and software, and energy providers. Although innovations in strategies and implementation are evolving quickly in pockets of excellence around the globe, early results have been highly uneven. Frameworks for understanding and analysis are still fragmented, innovative design and implementation rapidly changing, and best practices have yet to be defined.

Purpose
Led by SPRIE at Stanford University, this conference aims to gather an elite group of experts, decision makers, and thought leaders from across disciplines and geographical boundaries to focus on smart green cities around the Pacific. Participants will:

  • Pursue a deeper understanding of the complex interactions among the key drivers that impact the extent that cities are green and smart
  • Focus on core challenges of capitalizing on opportunities and overcoming obstacles--technological, economic, behavioral or political
  • Explore what innovations in strategy or practice are leading to positive outcomes, including human livability, financial viability, economic vitality, and environmental sustainability
  • Discuss implications for the evolution of markets and development of industries 
  • Lay the groundwork for future actions, such as industry strategies, research agendas, and policy recommendations

Participants
"Smart Green Cities" will invite a select group of government, business, and academic leaders from the United States and Asia for two days of expert presentations and fruitful discussion at Stanford University. The summit will enable participants to better lead to improved strategy, action, and outcomes for building the next generation of smart green cities.

Agenda
Agenda is preliminary and not all speakers are confirmed. Please download below

 

Sponsors
Many thanks to our sponsors for making this event possible. 

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Stanford Institute for Economic Policy Research (SIEPR)
John A. and Cynthia Fry Gunn Building
366 Galvez Street
Stanford, CA

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The extent and existence of "defensive medicine" -- excessive medical care to defend a physician against malpractice claims -- is a perennial subject of both policy and academic debate.  For example, malpractice liability and associated defensive medicine are among the most-cited reasons for escalating health-care spending in the United States.

In this colloquium, Dr. Brian Chen will present results from his research investigating the extent of defensive medicine in Taiwan. He studies the impact of a series of court rulings in Taiwan that increased physicians’ liability risks, and a subsequent amendment to the law that reversed the courts’ rulings, on physicians’ test-ordering behavior and propensity to perform Caesarean sections.  He finds that physicians faced with higher malpractice pressure increased laboratory tests as expected, but unexpectedly reduced Caesarean sections.  (The reduction in Caesarean deliveries may be due to the fact that liability risks were more closely aligned with physicians’ standard of care after the court rulings.) After the law was amended to negate the court decisions, physicians reversed their previous behavior by reducing laboratory tests and increasing Caesarean deliveries.

This pattern of behavior is highly suggestive of the existence of defensive medicine among physicians in Taiwan. In other words, by studying physicians' response to legal changes in Taiwan, we find that greater malpractice liability may, under certain circumstances, prompt physicians to perform more services without necessarily improving patient health.

Dr. Brian Chen recently completed his Ph.D. in Business Administration in the Business and Public Policy Group at the Haas School of Business, University of California at Berkeley. He received a Juris Doctor from Stanford Law School in 1997, and graduated summa cum laude from Harvard College in 1992.

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Shorenstein APARC
Stanford University
Encina Hall, Room E-301
Stanford, CA 94305-6055

(650) 736-0771 (650) 723-6530
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2011 AHPP/CEAS Visiting Scholar
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Dr. Brian Chen is currently a visiting scholar with the Asia Health Policy Program and Center for East Asian Studies at Stanford University. He was recently Shorenstein Asia-Pacific Research Center's 2009-2010 postdoctoral fellow in Comparative Health Policy. As a visiting scholar, Dr. Chen will conduct collaborative research about health of the elderly and chronic disease in China.

As an applied economist, Chen’s research focuses on the impact of incentives in health care organizations on provider and patient behavior. For his dissertation, Chen empirically examined how vertical integration and prohibition against self-referrals affected physician prescribing behavior. His job market paper was selected for presentation at the American Law and Economics Association’s Annual Meeting, the Academy of Management, the Canadian Law and Economics Association, the Conference on Empirical Legal Studies, and the First Annual Conference on Empirical Health Law and Policy at Georgetown Law Center in 2009.  The paper was also nominated for best paper based on a dissertation at the Academy of Management.

Chen comes to the Shorenstein Asia-Pacific Research Center not only with a multidisciplinary law and economics background, but also with an international perspective from having lived and worked in Taiwan, Japan, and France. He has a particularly intimate knowledge of the Taiwanese health care system from his experience as an assistant to the hospital administrator at a medical college in Taiwan.

During his past residence as a postdoctoral fellow with the Asia Health Policy Program, Chen conducted empirical research on cost containment policies in Taiwan and Japan and how those policies impacted provider behavior. His work also contributed to the program’s research activities on comparative health systems and health service delivery in the Asia-Pacific, a theme that encompasses the historical evolution of health policies; the role of the private sector and public-private partnerships; payment incentives and their impact on patients and providers; organizational innovation, contracting, and soft budget constraints; and chronic disease management and service coordination for aging populations.

Dr. Brian Chen recently completed his Ph.D. in Business Administration in the Business and Public Policy Group at the Haas School of Business, University of California at Berkeley. He received a Juris Doctor from Stanford Law School in 1997, and graduated summa cum laude from Harvard College in 1992.

Brian Chen Shorenstein-Spogli Fellow in Comparative Health Policy Speaker
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Authors
Brian Chen
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Malpractice liability, along with medical technology and payment system distortions, regularly figures among the most-cited reasons for escalating health-care spending in the United States. On the one hand, Harvard economist Amitabh Chandra conservatively estimates that upwards of $60 billion, or 3 percent of total health care costs ($1.8 trillion), is spent annually as a result of direct litigation and indirect defensive medicine costs. On the other hand, tort reform advocates place the figure at $200 billion by extrapolating, to the entire U.S. population, the results of research conducted by Stanford professor Dan Kessler and Mark McClellan. Their 1996 study shows that tort reforms reduced provider liability costs for Medicare heart patients by 5 to 9 percent.

At the heart of these debates is the following question. Does medical malpractice liability achieve its dual goal of compensating victims of medical injuries and deterring medical errors, or does it merely encourage wasteful defensive medicine without improving patient health? Despite considerable empirical research, there is little evidence that malpractice litigation deters medical negligence. The evidence is much stronger—though still hotly debated—that malpractice fears actually encourage physicians to engage in defensive medicine. My work at Shorenstein APARC explores whether malpractice pressures affect physician behavior, patient health, and health care costs in Asia. Studying physicians’ response to legal changes in Taiwan, I find that greater malpractice liability may, under certain circumstances, prompt physicians to perform more services without necessarily improving patient health.

In particular, I focus on how increased medical malpractice liability affects physicians in Taiwan who provide treatment to pregnant women. I have studied how a series of court rulings as well as an amendment to Taiwanese law between 1997 and 2004 impacted physicians’ test-ordering behavior and decisions to perform Caesarian sections. Traditionally, Taiwanese doctors are held accountable for medical malpractice under two bodies of law: tort law in the Civil Code, and criminal law for harm resulting from negligent acts in the course of professional operations. The latter, prosecutorial approach is rare among industrialized nations.

In January 1998, a Taipei District Court decision in favor of plaintiffs in a civil suit for damages sent shockwaves through the medical community. The district court judge disregarded the traditional tort requirement of proving the defendant’s negligence (or fault), and applied the “strict liability” doctrine of the Consumer Protection Law to impose liability on a medical provider without any showing of wrongdoing. The court decision—subsequently affirmed by the Taipei High Court on September 1, 1999 and by the Supreme Court on May 10, 2001—sparked resentment among medical professionals. Passions flared in heated debates between medical and legal scholars about whether medical services should be considered a covered “service” under the Consumer Protection Law. Economists and legal academics questioned whether the traditional justifications for imposing strict liability apply in the highly unpredictable practice of medicine, especially in obstetrics. The saga concluded in April 2004, when the legislature amended the Medical Law to require negligence or fault in medical malpractice cases.

My research considers the effect of these court rulings and legal amendments on physicians’ test-ordering behavior and their propensity to perform Caesarean sections. I identify two sources of variation in perceived risks of malpractice liability: (1) the differences between the level of exposure to malpractice risks due to the ownership structure and size of the physicians’ place of practice; and (2) the differences in perceived risks based on the physicians’ geographical location.

My results are consistent with the existence of defensive medicine. First, with respect to their propensity to increase laboratory tests and reduce Caesarean sections, physicians who own their clinics (“physician-owners”) in Taiwan reacted more strongly to the legal changes than did physicians who are salaried employees at larger hospitals (“nonowners”). Physician-owners’ behavior did not change, however, in discretionary expenditures that were not associated with defensive medicine. Second, physician-owners working in areas under the jurisdiction of the Taipei District Court reacted more strongly to legal change than did those practicing in Kaohsiung, Taiwan’s second largest city, at the opposite end of the island.

The negative connection between the likelihood of Caesarean deliveries and increased malpractice liability deserves special mention, since most published studies find a positive association between malpractice liability risks and Caesarean rates. However, economists Janet Currie and Bentley MacLeod at Columbia University suggest that reforms in which liability is closely aligned with defendant’s actual levels of care may produce the opposite effect. In the Taiwan context, increased medical malpractice liability accrues directly to the physician-owners. Since Caesarean sections are generally riskier than natural deliveries, it seems logical that higher tort liability in Taiwan may actually decrease the likelihood of deliveries by Caesarean sections. In this sense, my study confirms Currie and MacLeod’s predictions and empirical results.

My work contributes to our understanding of health law and policy in several concrete ways. First, I add support to the existence of defensive medicine, even in a non-Common Law jurisdiction. Since I focus on Taiwan—an environment that lacks malpractice insurance, in which physicians are either owners or employees at providers of varying sizes—my research isolates the pure effect of malpractice liability to a greater extent than do many current studies. Second, I show that interaction between the payment and legal systems may either enhance or mitigate the hypothetical pure effects of legal policies. In a fee-for-service system, physicians subject to higher malpractice risks appear much more willing to increase laboratory tests than to reduce profitable Caesarean sections. Third, my research indicates that, by altering physicians’ exposure to risks, different organizational forms and ownership structures of health care provision may affect defensive medicine at differing rates.

In sum, the practice of “defensive medicine” appears not to be a uniquely American phenomenon. Indeed, it may also play a role in health care cost escalations in Asia, especially under heightened physician liability regimes.

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Shorenstein APARC Dispatches are regular bulletins designed exclusively for our friends and supporters. Written by center faculty and scholars, Shorenstein APARC Dispatches deliver timely, succinct analysis on current events and trends in Asia, often discussing their potential implications for business.

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Since the inception of reform and opening-up thirty years ago, China has established a record of astonishing economic achievements and is, or will soon be, surpassing Japan as the world's second largest economy, something few people would have imagined three decades ago.

The information and communications technologies (ICT) industry is the backbone of the Chinese export driven growth strategy, which many argue as the primary driver of China's economic growth. Recent ICT policy initiatives demonstrate China's shifting strategy in pursuing a different path for the next phase of economic growth.

Promoting indigenous innovation and strengthening information security may be considered the two major thrusts of Chinese ICT policy initiatives. Technical standards, IPR treatments, government procurement, and special industry incentives are some examples of the former domain; internet filtering, compulsory certification of information security product, and encryption control are examples of the latter.

Many of these initiatives are controversial in the international trade arena. However, the real challenges of these policy initiatives concern whether they work to achieve the Chinese government's goal of maintaining sustainable growth. This presentation will attempt to evaluate these challenges.

Dr. John C. Chiang was appointed as Director of Global Innovation Research Center at Peking University in June 2008. He joined PKU in February 2006 as Professor in the Department of Management of Technology at the School of Software and Microelectronics. Dr. Chiang is also President of USITO, the organization representing five major US IT industry trade associations and close to 50 individual U.S. IT companies in China, a role he has held since October 2008.

Dr. Chiang came to China in 2000, joining Motorola China as Deputy GM of the infrastructure business unit, spearheading its post-WTO strategy. He then moved to Motorola China HQ, serving as Senior Director of Strategy and Business Development. In 2003, he served as Director of Motorola China R&D Institute, and in 2004, he became the founding president of Motorola (China) Technologies, Limited.

From October 2006 to September 2008, Dr. Chiang was a Partner in DragonBridge Capital, a U.S.-based merchant bank with China as its primary serving market.

Dr. Chiang was born in Beijing, raised in Taiwan, and received the Ph.D. from Johns Hopkins University in 1975. He received the EMBA from Georgia State University in 1989.

After his academic career, Dr. Chiang joined Bell Laboratories in 1979, and later held progressive technical and managerial positions at Racal-Milgo, Hayes, and GTE. He was Senior Vice President of Operations at KG Telecom and led the launch of the first private mobile services in Taiwan, during 1997-2000.

Dr. Chiang currently also serves as the Vice Chair of the China Association of Standards and as an Investment Advisor to the Beijing Municipal Government.

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John C. Chiang Director, Global Innovation Research Center Speaker Peking University
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Dr. Songs talk will focus on the question concerning interpretation and possible application of Article 121 of the 1982 United Nations Convention on the Law of the Sea (UNCLOS), in particular its third paragraph, to the selected disputed offshore islands or rocks that are situated in the Sea of Japan, the East China Sea, and the South China Sea. A number of recent developments occurred in the East Asian waters that are relevant to or have the potential to give rise to the problem of interpretation and application of the said article will first be cited. Then, a brief summary of the development of the "Regime of Islands" at UNCLOS III will be given, focusing in particular on those proposals made by the participating delegations to amend or delete entirely Article 121(3) of UNCLOS. The views of the law of the sea experts on interpretation and application of Article 121(3) will be examined. Several selected examples of state practices with regard to the application or interpretation of Article 121(3) will then be provided. This is to be followed by discussing the interpretation and possible application of Article 121(3) to the selected disputed offshore islands that are situated in the East Asian waters. Finally, several suggestions for possible amendment to Article 121 or policy measures to help deal with the confusion found in Article 121(3) will be offered.

Yann-huei Song received his undergraduate degree from National Chengchi University, Taipei, Taiwan, a Master's degree in Political Science from Indiana State University, Indiana, USA, a LL.M. degree from the University of California School of Law (Boalt Hall), Berkeley, California, USA, a doctoral degree in International Relations from Kent State University, Kent, Ohio, USA, and a JSD degree from the University of California School of Law (Boalt Hall), Berkeley.

Following graduation from Kent State University, Dr. Song taught at Department of Political Science, Indiana State University as Assistant Professor in 1988. He then returned to his country and taught as an Associate Professor at Institute of Maritime Law, National Taiwan Ocean University, Keelung, Taiwan in 1990. Currently, Dr. Song is a research fellow at the Institute of European and American Studies, Academia Sinica, Nankang, Taipei, Taiwan, and distinguished professor of the Graduate Institute of International Politics at National Ching Hsing University (NCHU), Taichung, Taiwan. He is also dean of the Office of International Affaris at NCHU.

Dr. Song's research interests are in the fields of International Law of the Sea, International Fisheries Law, International Environmental Law, National Ocean Policy Study, Naval Arms Control and Maritime Security. He has published articles in journals such as Political Geography Quarterly, Asian Survey, Marine Policy, Chinese Yearbook of International Law and Affairs, Issues and Studies, The American Asian Review, Ocean Development and International Law, EurAmerica, Ecology Law Review, the International Journal of Coastal and Marine Law, The Indonesian Quarterly and others.

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Shorenstein APARC
Stanford University
Encina Hall, Room E301
Stanford, CA 94305-6055

(650) 725-2429 (650) 723-6530
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Visiting Scholar
Yann-huei_Song.jpg PhD
Yann-huei Song Distinguished Professor the Graduate Institute of International Politics Speaker National Chung Hsing University, Taichung
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The Stanford China Program in cooperation with the Center for East Asian Studies will host a special series of seminars to mark 60 Years of the People's Republic of China (PRC). Over the course of the winter and spring terms, we will have six leading scholars, each examining one of the six decades of the PRC's history. Our premise is that history matters. The speaker on each decade will characterize their decade, note shifts within that time, identify the pivotal events, and discuss how the decade shaped what happened afterwards.

Barry Naughton is an authority on the Chinese economy, with an emphasis on issues relating to industry, trade, finance, and China's transition to a market economy. Recent research focuses on regional economic growth in the People's Republic of China and the relationship between foreign trade and investment and regional growth. He is also completing a general textbook on the Chinese economy. Recently completed projects have focused on Chinese trade and technology, in particular, the relationship between the development of the electronics industry in China, Taiwan and Hong Kong, and the growth of trade and investment among those economies. His book, Growing Out of the Plan: Chinese Economic Reform, 1978-1993, which was published in 1995, is a comprehensive study of China's development from a planned to a market economy that traces the distinctive strategy of transition followed by China, as well as China's superior growth performance. It received the Ohira Memorial Prize in 1996. Naughton is the author of numerous articles on the Chinese economy and is editor or co-editor of three other books: Reforming Asian Socialism: The Growth of Market Institutions, Urban Spaces in Contemporary China, and The China Circle: Economics and Technology in the PRC, Taiwan and Hong Kong. Naughton joined IR/PS in 1988 and was named to the Sokwanlok Chair in Chinese International Affairs in 1998.

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Barry Naughton Sokwanlok Chair of Chinese International Affairs at the Graduate School of International Relations and Pacific Studies Speaker UC San Diego
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