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Tracy Quek from the U.S. Bureau at The Straits Times Singapore Newspaper discusses the "Divided Memories and Reconciliation Project," a three-year project to examine how the main players in North-east Asia - China, Japan, South Korea and Taiwan - along with the United States, form their views of the past, or what the scholars call "historical memories."

In April 2005, fierce anti-Japanese protests broke out in China.

Triggered in part by Japan's approval of newly revised history textbooks which glossed over the Japanese wartime abuses of six decades ago, the demonstrations were the most provocative upsurge of anti-Japanese unrest China had seen in years.

It was not the first time problems of the historical sort had sparked trouble between the neighbours in North-East Asia.

But researchers at Stanford University's Walter H. Shorenstein Asia-Pacific Research Centre hope that their work will damp down future outbursts and open a path to lasting reconciliation.

Led by director Gi-Wook Shin and co-director Daniel C. Sneider, researchers are completing an ambitious three-year project to examine how the main players in North-east Asia - China, Japan, South Korea and Taiwan - along with the United States, form their views of the past, or what the scholars call "historical memories."

Entitled Divided Memories and Reconciliation, the project began in 2007 and is divided into three phases. The first stage involves comparing how shared historical events are depicted in history textbooks of the five societies, as history education plays a crucial role in shaping citizens' perspectives on the past.

The second stage, which began last year, looks at the treatment of the 1931-1951 wartime period in the films of China, Japan, South Korea, Taiwan and the US.

In the third phase, researchers will survey elite opinion makers in China, Japan, South Korea and the US for their views on historical issues.

The study, said Mr Sneider, stems from the understanding that unresolved historical issues are drivers of regional tension, and continue to bedevil relations to this day.

"The past is very much part of the present. Unresolved problems of the past feed mistrust and suspicion," he told The Sunday Times. "History issues also feed rising nationalism that can undermine government efforts to repair damaged relations."

Despite growing economic and cultural ties, wounds inflicted in the time of war and colonialism still fuel anti-Japanese sentiment in China and South Korea. The outcome of China's civil war resonates today in tension between the mainland and Taiwan.

The goal was not to forge a common historical account for the region or reach a consensus on specific events, said Mr Sneider. He noted that such attempts by historians and government committees have had limited success.

Stanford University historian Peter Duus explained: "Writing a common history is not feasible politically because the teaching of history in East Asian countries is tied to building and strengthening national identity."

Instead, Stanford researchers felt it was more fruitful to "try to recognise and understand how each society has developed its own distinctive memory of the past, and how that has affected its national identity and relations with others", commented Prof Shin.

Prof Duus and Prof Shin were writing in separate chapters included in a soon-to-be-published edited volume on the textbook study. Parts of the book were seen by The Sunday Times.

To facilitate the textbook study, researchers translated into English the most widely circulated high school history textbooks used in China, Japan, Taiwan, South Korea and the U.S.

Focusing on the period from the beginning of the Sino-Japanese war in 1931 until the formal end of the Pacific War with the San Francisco Peace Treaty in 1951, the researchers selected eight historical issues for translation.

These included the Japanese capture and occupation of Nanjing, China in 1937 and the atomic bombing of Japan in 1945.

Researchers included the US in the textbook study because of its participation in the Pacific War, as well as its role in shaping post-war dynamics in the region.

Looking at the translated textbook excerpts side by side would allow people to compare how historical memory is shaped in the different school systems for the first time, said Mr. Sneider.

The team then brought together historians and textbook writers, including those from Japan and China, in a conference in February last year to analyse the treatment of history in thetextbooks, and their impact on regional relations.

The experts found that the region's history texts were far from objective.

"Textbooks have been written specifically to promote a sense of national identity, and the politics of nationalism invariably affects their writing," wrote Professor Shin.

Both Taiwan and mainland China textbooks, for example, play up the victory over colonialism and imperialism. But while "both agree the defeat of the Japanese army ended a century of humiliation and established China as an international power, the path to victory is described differently and so is the outcome," Professor Duus commented.

The deepest disagreements between the mainland and Taiwanese textbooks are about the nature and effectiveness of Chinese resistance to the Japanese. The Chinese texts played down the role of the Kuomintang, while the Taiwanese texts make scant mention of the Chinese Communist Party's guerilla bases.

Compared with the Taiwanese textbooks, the Chinese texts dwelled on the brutality of the Japanese military in more graphic detail.

American textbooks, in general, were better than the Asian textbooks at encouraging critical thought. "You have a debate over the decision to drop the atomic bomb on Japan, or discussions of the events that led to Pearl Harbour, for example," Mr Sneider noted.

In contrast with Chinese and US textbooks, the tone in Japanese textbooks is "muted, neutral, bland", Prof Duus wrote. While they make no effort to conceal the brutality of Japanese forces towards occupied peoples, they do not give students much of an analytical construct to understand events, observed Mr. Sneider.

What the study made obvious was that the problem was not just with the Japanese historytextbooks, even though they have received most of the criticism. Experts point out that the textbooks which whitewashed wartime abuses are used in less than 2 per cent of Japanese schools.

"This is a problem for everybody," said Mr Sneider. "We are all participants in creating a divided, and to some degree, implicitly distorted understanding of the past."

The edited volume on the textbook study - which includes discussions from the February 2008 conference, and translated textbook excerpts - will be out next year. A teaching supplement based on the textbook study has been prepared for use by high school teachers in the US.

Mr Sneider said researchers hoped their work would show that "we need to take a dispassionate, comparative approach to history that recognises there is no single historical truth that everybody has to subscribe to".

He added: "There is room for discussion which can hopefully lead to reconciliation."

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When both physicians and pharmacists in Taiwan prescribed and dispensed drugs, many elderly people considered the two types of health care providers more or less synonymous (i.e., close substitutes). Two policies mandated in the 1990s changed this perception: National Health Insurance (NHI), which provides insurance coverage to all citizens, and a separation policy (SP) that forbids physicians from dispensing and pharmacists from prescribing drugs. The author finds that by providing an economic incentive to the previously uninsured elderly, NHI raised the probability that they would visit physicians, relative to their continuously insured counterparts. In particular, some previously uninsured elderly who once only visited pharmacists were more likely to also visit physicians after NHI was implemented. Following this, the SP made it more likely that all elderly patients would only visit physicians and buy drugs from on-site pharmacists hired by physicians—a result different than its policy goal.

Published: Chang, Kang-Hung. "The healer or the druggist: effects of two health care policies in Taiwan on elderly patients’ choice between physician and pharmacist services." International journal of health care finance and economics 9.2 (2009): 137-152.

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Asia Heath Policy Program working paper #5
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Karen Eggleston
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In December 2009, the Asia Health Policy Program celebrates the first anniversary of the launch of the AHPP working paper series on health and demographic change in the Asia-Pacific. The series showcases research by AHPP’s own affiliated faculty, postdoctoral fellows, and visiting scholars, as well as selected works by other scholars from the region.

To date AHPP has released eleven research papers in the series, by authors from China, South Korea, Thailand, Taiwan, Pakistan, and the US, with more on the way from Japan and Vietnam. Topics range from “The Effect of Informal Caregiving on Labor Market Outcomes in South Korea” and “Comparing Public and Private Hospitals in China,” to “Pandemic Influenza and the Globalization of Public Health.”  The working papers are available at the Asia Health Policy website.

AHPP considers quality research papers from leading research universities and think tanks across the Asia-Pacific region for inclusion in the working paper series. If interested, please contact Karen Eggleston.

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In the four years since a State Council think tank, the Development Research Center, bluntly declared the failure of three decades of healthcare reform, China has placed a high political priority on designing, building and financing a modern, equitable health delivery system that serves every last one of its 1.3 billion people. As publisher of practice-building trade magazines for medical specialists in China and India, Jeffrey Parker has developed unique and valuable perspectives on what's wrong with China's healthcare system -- and how Indian practitioners are able to deliver results despite a per-capita GDP that is roughly half of China's. Through an unprecedented China-India training exchange, Mr. Parker has begun testing whether Indian models of self-financed grassroots medical startup practices can help doctors shake free of China’s Stalinist paralysis without having to wait for sweeping programmatic reforms that are always on the horizon, but seem never to come. What's more, would such grassroots empowerment models not create unprecedented opportunities for participation by international investors who up to now have been largely marginalized in China's healthcare development?

In this lunchtime colloquium, Mr. Parker reviews his experiences in China and India over the past six years and looks at several exciting recent developments in China. These include:

  • An ambitious rural reimbursement scheme that already has begun to complete a nationwide healthcare safety net. The program is creating a vast pool of funds to finance rural medical services, but how will Beijing populate the countryside with sustainable grassroots practices?
  • The first domestic healthcare IPO, by which Aier Ophthalmology raised some $50 million as one of 28 debut listings in the Shenzhen's new "ChiNext" Growth Enterprise Market. New wind in the sails of healthcare privatization?
  • Licensing reforms that have begun delinking doctors' certification from their "work unit" hospitals under trials in Beijing and Yunnan, removing a vexing obstacle to hands-on surgical training of young practitioners. Will the breaking of senior doctors' "skills monopoly" create opportunities for private-sector training programs that will shake up China's Soviet-style residency programs?

Jeffrey Parker has lived in Greater China since 1990, first as a journalist and since 2003 as a publisher. His transition from chronicler of China's historic rise to active proponent of its economic development gives him a unique perspective on the opportunities still opening up in China -- and the challenges facing anyone keen to participate. With a twin B.A. in Asian Studies and Geography from U.C. Santa Barbara and Masters training in Journalism from Columbia University, Parker trimmed his sails for a China career from an early age. After early editorial jobs in New York and Washington, D.C., he was dispatched to Beijing by United Press International as senior correspondent in 1990. During the next 10 years with UPI and then Reuters, he covered a wide range of political, economic and social stories from postings in Hong Kong, Taiwan and the Peoples Republic. In his final two years at Reuters, Parker got his first taste of media development, launching local-language multimedia news and video feeds in China, Japan, Korea, India and Southeast Asia. Since 2003, Parker has built up a family of world-class doctors' magazines serving more than 50,000 specialists in China and India from the Shanghai base of ILX Media Group, where he is editorial director, chief operating officer, a corporate director and investor. Among his objectives is to help foster a badly needed transformation of medical practice across China by inspiring grassroots doctors to deliver high-quality, cost-effective services in rural and less-developed communities left behind by government health care.

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Jeffrey Parker Speaker ILX Media Group, Shanghai, PRC
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How do countries in the vast and diverse Asia-Pacific region differ in “prescribing cultures”? How do health systems in the region balance access to pharmaceuticals with incentives for innovation? How do the forces of globalization shape, and in turn are shaped by, cultural legacies about health and health care? These are the key questions addressed by the new Asia Health Policy Program book, Prescribing Cultures and Pharmaceutical Policy in the Asia Pacific.

AHPP held a book launch event September 23rd with three authors of the book detailing how pharmaceutical policies are interlinked globally and at the same time deeply rooted in local culture. 

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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.

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PrescribingCultures front cover

Pharmaceutical policies are interlinked globally and at the same time deeply rooted in local culture. Prescribing Cultures examines how pharmaceuticals and their regulation play an important and often contentious role in the health systems of the Asia-Pacific.

The first section of this timely book analyzes pharmaceutical policy in China, Korea, Japan, Thailand, Taiwan, Australia, and India. The second section focuses on two cross-cutting themes: differences in "prescribing cultures" and physician dispensing; and the challenge of balancing access to drugs with incentives for innovation.

The book's contributors discuss important issues for U.S. policy. These include such hot-button topics as drug imports from Asia, regulation of global supply chains to assure drug safety and quality, new legislation to encourage development of drugs for neglected diseases, and the impact that decisions about pricing, regulation, and bilateral trade agreements have on access to medicines at home and abroad. In Prescribing Cultures, pharmaceutical policy reveals the economic trade-offs, political compromises, and historical trajectories that shape health systems.

Prescribing Cultures also illustrates how cultural legacies shape and are shaped by the forces of globalization, and thus will be of interest to students and scholars well beyond the confines of health policy.

Desk, examination, or review copies can be requested through Stanford University Press

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Pharmaceutical policies are interlinked globally, yet deeply rooted in local culture. The newly published book Prescribing Cultures and Pharmaceutical Policy in the Asia-Pacific, edited by Karen Eggleston, examines how pharmaceuticals and their regulation play an important and often contentious role in the health systems of the Asia-Pacific.

In this colloquium, contributors to Prescribing Cultures discuss how the book analyzes pharmaceutical policy in China, Korea, Japan, Thailand, Taiwan, Australia, and India, focusing on two cross-cutting themes: differences in “prescribing cultures” and physician dispensing; and the challenge of balancing access to drugs with incentives for innovation.

As Michael Reich of Harvard University says in his Forward to Prescribing Cultures,

“The pharmaceutical sector…promises great benefits and also poses enormous risks.… Conflicts abound over public policies, industry strategies, payment mechanisms, professional associations, and dispensing practices—to name just a few of the regional controversies covered in this excellent book.

The tension between emphasizing innovation versus access -- a topic of hot debate on today’s global health policy agenda -- is examined in several chapters…

This book makes a special contribution to our understanding of the pharmaceutical sector in China… Globalization is galloping forward, with Chinese producers pushing the pace at breakneck speed. More and more, our safety depends on China’s ability to get its regulatory act together…”

The colloquium features presentations by Naoko Tomita (Keio University), Anita Wagner (Harvard University), and Karen Eggleston (Stanford FSI Shorenstein Asia-Pacific Research Center). They will give specific examples of how pharmaceutical policy serves as a window into the economic tradeoffs, political compromises, and historical trajectories that shape health systems, as well as how cultural legacies shape and are shaped by the forces of globalization.

Oksenberg Conference Room

Anita Wagner Speaker Harvard University
Naoko Tomita Speaker Keio University

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

(650) 723-9072 (650) 723-6530
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Senior Fellow at the Freeman Spogli Institute for International Studies
Center Fellow at the Center for Health Policy and the Center for Primary Care and Outcomes Research
Faculty Research Fellow of the National Bureau of Economic Research
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
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Karen Eggleston is a Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford University and Director of the Stanford Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center at FSI. She is also a Fellow with the Center for Innovation in Global Health at Stanford University School of Medicine, and a Faculty Research Fellow of the National Bureau of Economic Research (NBER). Her research focuses on government and market roles in the health sector and Asia health policy, especially in China, India, Japan, and Korea; healthcare productivity; and the economics of the demographic transition.

Eggleston earned her PhD in public policy from Harvard University and has MA degrees in economics and Asian studies from the University of Hawaii and a BA in Asian studies summa cum laude (valedictorian) from Dartmouth College. Eggleston studied in China for two years and was a Fulbright scholar in Korea. She served on the Strategic Technical Advisory Committee for the Asia Pacific Observatory on Health Systems and Policies and has been a consultant to the World Bank, the Asian Development Bank, and the WHO regarding health system reforms in the PRC.

Director of the Asia Health Policy Program, Shorenstein Asia-Pacific Research Center
Stanford Health Policy Associate
Faculty Fellow at the Stanford Center at Peking University, June and August of 2016
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