Sophia Hu, a Stanford student and prospective anthropology major, writes a summary of an annual forum that examines China’s health policy in comparative perspective

The Asia Health Policy Program held its Third Annual Forum on China’s Community Health Services and Primary Health Care Reform on June 22 in Beijing. The forum featured a diverse panel of speakers who addressed how to improve China’s primary care and community health care services. From discussing insurance plans to evaluating national policies and encouraging students to consider working as rural doctors, the speakers presented a wide array of research and experience. A brief summary of each presentation is detailed below.

Weichang Wang, director of the Ningxia Health Care Reform, discussed his experiences implementing a reformed health insurance payment system, originally developed by a team of researchers at Harvard and executed in Ningxia, China. Through this plan, his team created a medical insurance fund for the town that prioritized reimbursement for lower-level institutions, i.e. primary care centers. The plan resulted in increased accessibility, frequency of visits and patient satisfaction at primary care centers. It also saved money; however, some issues did arise such as how to develop accurate projections for the medical fund.

Quilin Chen of the Chinese Academy of Social Sciences, informed by his experience in Inner Mongolia, examined the disparity of hospitalization rates among different regions. He analyzed several factors, including financial incentives for patients and hospitals, regional differences in culture, and technological changes among primary care centers.

Jiaying Zhao of Australia National University and Shanghai University proposed using artificial intelligence (AI) to support primary care centers. She highlighted the benefits of AI, including how it can help inform physician decisions and bolster patient trust in primary care centers. Zhao, whose presentation motivated a spirited debate, shared important insights on the growing role of technology/CS in the health care field.

Jeroen Struijs of the Netherlands National Institute of Public Health and the Environment gave an overview of the primary care system in the Netherlands. With one of the most highly regarded systems in the world, the Netherlands prioritizes primary care-centric health care. He described how Dutch citizens seek care with their primary care physicians first – or face a penalty – before going on to specialists or hospitals. He also explained their bundled payment system. This system pays health services providers for a “bundle” of treatment for certain diseases, helping to align provider incentives with efficient convenient care, rather than fee-for-service which financially rewards quantity of services.

Hyuncheol Kim, an assistant professor at Cornell University, examined trends in long-term care insurance and public cancer screening programs in South Korea with a regression discontinuity design. His analyses helped to explain the relative success and failure of those programs. For example, his analysis was consistent with a theory that an intervention has a higher likelihood of failing if those receiving the intervention have other channels to receive benefits, i.e. patients are able to seek private as opposed to public insurance. His presentation also inspired discussion about primary care in Korea and the challenges Korea faces – similar to those in China – in trying to move away from a hospital-centric delivery system.

Lingui Li, director of Ningxia Medical University’s Public Sector Management Centre, delivered an overview of strategies to recruit health care workers in rural areas. He emphasized the need to balance primary public health service with primary clinical service and highlighted the dearth of doctors in villages.

Jinglin Yue, deputy dean of the Zhongshan University’s Institute of Public Administration, presented about his experiences establishing a hierarchical treatment system that aims to bring more people to primary care before pursuing treatment at hospitals. He explained the various incentives of the diverse interest groups involved, and emphasized the need for future government policies that support a 2-way referral system.

Xiaoguang Yang of Fudan University’s School of Public Health also described efforts to create a two-way referral system, based on his research of an integrated health system in Shenzhen. This initiative, using a people-centered reform paradigm, introduced the concept of “community of common destiny” to Luohu, China. The reformers tried to manage supply and demand using financial incentives to help providers including hospital groups coordinate in promoting a more integrated system.

Xiaoyun Liu of Peking University examined the efficacy of a new national program that contracts with students to commit to practicing medicine in rural areas in exchange for free medical school tuition. Using surveys, he gathered data on why students chose the program and where they chose to become rural doctors, among other factors. He then used this data to propose changes to enhance the effectiveness of the program.

Guanyang Zou, a researcher at Queen Margaret University, presented an overview of international experiences or “models” of health and social care that catered specifically to aging populations. These models included the integration of ambulatory medical care and aspects of social care and long-term care services.

Bei Lu of the University of New South Wales took an economic approach toward addressing the issue of long-term care for elderly populations. In her research, she worked closely with policymakers in Qingdao, China, and used a model to estimate how long-term care insurance could be structured so that the elderly could get optimal care without imposing a disproportionate financial burden on young taxpayers and fairly compensate providers.

Each presentation contributed important knowledge toward understanding primary care in China and elicited substantial discussion. This forum would not have been possible without the participation of the numerous speakers and the generous support of the Asia Health Policy Program and Chinese affiliates.

Asked to summarize his biography and career, Donald K. Emmerson notes the legacy of an itinerant childhood: his curiosity about the world and his relish of difference, variety and surprise. A well-respected Southeast Asia scholar at Stanford since 1999, he admits to a contrarian streak and corresponding regard for Socratic discourse. His publications in 2014 include essays on epistemology, one forthcoming in Pacific Affairs, the other in Producing Indonesia: The State of the Field of Indonesian Studies.

Emmerson is a senior fellow emeritus at the Freeman Spogli Institute for International Studies (FSI), an affiliated faculty member of the Center on Democracy, Development and the Rule of Law, an affiliated scholar in the Abbasi Program in Islamic Studies, and director of the Southeast Asia Program at the Shorenstein Asia-Pacific Research Center. Recently he spoke with Shorenstein APARC about his life and career within and beyond academe.

Your father was a U.S. Foreign Service Officer. Did that background affect your professional life?

Indeed it did. Thanks to my dad’s career, I grew up all over the world. We changed countries every two years. I was born in Japan, spent most of my childhood in Peru, the USSR, Pakistan, India and Lebanon, lived for various lengths of time in France, Nigeria, Southern Rhodesia (now Zimbabwe) and the Netherlands, and traveled extensively in other countries. Constantly changing places fostered an appetite for novelty and surprise. Rotating through different cultures, languages, and schools bred empathy and curiosity. The vulnerability and ignorance of a newly arrived stranger gave rise to the pleasure of asking questions and, later, questioning the answers. Now I encourage my students to enjoy and learn from their own encounters with what is unfamiliar, in homework and fieldwork alike. 

Were you always focused on Southeast Asia? 

No. I had visited Southeast Asia earlier, but a fortuitous failure in grad school play a key role in my decision to concentrate on Southeast Asia. At Yale I planned a dissertation on African nationalism. I applied for fieldwork support to every funding source I could think of, but all of the envelopes I received in reply were thin. Fortunately, I had already developed an interest in Indonesia, and was offered last-minute funding from Yale to begin learning Indonesian. Two years of fieldwork in Jakarta yielded a dissertation that became my first book, Indonesia’s Elite: Political Culture and Cultural Politics. I sometimes think I should reimburse the African Studies Council for covering my tuition at Yale – doubtless among the worst investments they ever made. 

Indonesia stimulated my curiosity in several directions. Living in an archipelago led me to maritime studies and to writing on the rivalries in the South China Sea. Fieldwork among Madurese fishermen inspired Rethinking Artisanal Fisheries Development: Western Concepts, Asian Experiences. Experiences with Islam in Indonesia and Malaysia channeled my earlier impressions of Muslim societies into scholarship and motivated a debate with an anthropologist in the book Islamism: Contested Perspectives on Political Islam. 

What led you to Stanford?

In the early 1980s, I took two years of leave from the University of Wisconsin-Madison to become a visiting scholar at Stanford, and later I returned to The Farm for shorter periods. At Stanford I enjoyed gaining fresh perspectives from colleagues in the wider contexts of East Asia and the Asia-Pacific region. In 1999, I accepted an appointment as a senior fellow in FSI to start and run a program on Southeast Asia at Stanford with initial support from the Luce Foundation.

As a fellow, most of your time is focused on research, but you also proctor a fellowship program and have led student trips overseas. How have you found the experience advising younger scholars?

In 2006, I took a talented and motivated group of Stanford undergrads to Singapore for a Bing Overseas Seminar. I turned them loose to conduct original field research in the city-state, including focusing on sensitive topics such as Singapore’s use of laws and courts to punish political opposition. Despite the critical nature of some of their findings, a selection was published in a student journal at the National University of Singapore (NUS). NUS then sent a contingent of its own students to Stanford for a research seminar that I was pleased to host. I encouraged the NUS students to break out of the Stanford “bubble” and include in their projects not only the accomplishments of Silicon Valley but its problems as well, including those evident in East Palo Alto.

That exchange also helped lay the groundwork for an endowment whereby NUS and Stanford annually and jointly select a deserving applicant to receive the Lee Kong China NUS-Stanford Distinguished Fellowship on Contemporary Southeast Asia. The 2014 recipient is Lee Jones, a scholar from the University of London who will write on regional efforts to combat non-traditional security threats such as air pollution, money laundering and pandemic disease.

Where does the American “pivot to Asia” now stand, and how does it inform your work? 

Events in Iran, Iraq, Afghanistan, Syria and now in Crimea as well, have pulled American attention away from Southeast Asia. Yet the reasons for priority interest in the region have not gone away. East Asia remains the planet’s most consequential zone of economic growth. No other region is more directly exposed to the potentially clashing interests and actions of the world’s major states – China, Japan, India and the United States. The eleven countries of Southeast Asia – 630 million people – could become a concourse for peaceful trans-Pacific cooperation, or the locus of a new Sino-American cold war. It is in that hopeful yet risky context that I am presently researching China’s relations with Southeast Asia, especially regarding the South China Sea, and taking part in exchanges between Stanford scholars and our counterparts in Southeast Asia and China. 

Tell us something we don’t know about you.

Okay. Here are three instructive failures I experienced in 1999, the year I joined the Stanford faculty. I was evacuated from East Timor, along with other international observers, to escape massive violence by pro-Indonesian vigilantes bent on punishing the population for voting for independence. The press pass around my neck failed to protect me from the tear gas used to disperse demonstrators at that year’s meeting of the World Trade Organization – the “Battle of Seattle.” And in North Carolina in semifinal competition at the 1999 National Poetry Slam, performing as Mel Koronelos, I went down to well-deserved defeat at the hands of a terrific black rapper named DC Renegade, whose skit included the imaginary machine-gunning of Mel himself, who enjoyed toppling backward to complete the scene. 

The Faculty Spotlight Q&A series highlights a different faculty member at Shorenstein APARC each month giving a personal look at his or her teaching approaches and outlook on related topics and upcoming activities.

World War Two, the most violent period in the modern history of Europe and Asia (1937–1945), left deep scars still evident on both continents. Numerous and often conflicting narratives exist about the wartime era, ranging from personal memoirs to official accounts of wartime actions. Many issues, from collaboration to responsibility for war crimes, remain unresolved. In Europe some issues that have been buried for decades, such as the record of collaboration with Nazi occupiers, are now resurfacing. In Northeast Asia, World War Two’s complex, painful legacy continues to impact popular culture, education, diplomacy, and even economic relations.

While differences exist in the wartime circumstances and reconciliation processes of Europe and Asia, many valuable lessons can be gained through a study of the experiences on both continents. The Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) facilitated a comparative dialogue on World War Two, bringing together 15 noted experts for the Colonialism, Collaboration, and Criminality conference, held June 16 to 17 at Stanford. Each of the event’s five panels paired an Asia and a Europe scholar addressing a common theme.

The debate over remembrance of World War Two

Asia’s relative lack of progress in achieving reconciliation of the painful legacies of the war in Asia and the Pacific continues to bedevil current relations in the region. This is a consequence of the way the Cold War interrupted the resolution of wartime issues and blocked dialogue over the past, particularly between Japan, China, and South Korea, suggested Daniel C. Sneider, associate director for research at Shorenstein APARC. The widely held image of an unrepentant Japan ignores the fierce debate within Japan over wartime memory, often obscured by the prominence of rightwing nationalist views. Meanwhile, within China and Korea, wartime memory is also increasingly contested ground, from the issue of collaboration to the emergence of a more nationalist narrative in China, further complicating relations among those Asian neighbors.

Daniel Chirot, a professor of international studies at the University of Washington, emphasized that immediate postwar economic and security needs, including the growth of Communism, accelerated West Germany’s willingness to reconcile with its Western neighbors. He concurred with Sneider, saying that no such imperative existed in Northeast Asia until the need for economic cooperation three decades after the war. He suggested that the growth of regional integration might, as in Europe, drive Northeast Asia toward greater reconciliation.

Divided memories

Justice for sensitive historical human rights issues, such as World War Two atrocities, bears increasing importance in today’s ever-globalized economic and political climate, stated Thomas Berger, a professor of international relations at Boston University. Berger noted the challenge that Japan’s factional politics poses to a revision of the country’s official wartime narrative, and suggested that a strong regional structure, such as the European Union, could effectively facilitate reconciliation in Northeast Asia.

Frances Gouda, a professor of political science at the University of Amsterdam, examined the use of Anne Frank and former Indonesian president Sukarno as “icons of memory” in Dutch interpretations of World War Two. She asserted that Frank’s victimization allows people to come to terms with Nazi war crimes, but that Sukarno’s vilification as a Japanese collaborator oversimplifies history and allows the Netherlands to avoid confronting its own colonial past.

Collaboration and resistance

France’s Vichy regime, responsible both for collaborating with the Nazis and acting independently to persecute Jewish citizens, remains a painful and unresolved subject in the country’s contemporary quest for national identity, said Julian Jackson, a professor of history at Queen Mary, University of London. He pointed to French president Nicolas Sarkozy’s act of making a national martyr out of Guy Môquet, a young communist who died resisting the German Occupation, as a key example of the complexities involved in trying to come to terms with France’s past.

Ongoing territorial disputes over islands located between Japan and its neighbors in China and Korea are a product of the unresolved legacy of the wartime era in Asia. Sovereignty over those islands was left deliberately unresolved by the 1951 San Francisco Peace Treaty which formally ended the war, suggested Alexis Dudden, a professor of history from the University of Connecticut. As a result, the territorial disputes have become a battleground on which larger questions of historical memory about the war are contested, not only by Japanese conservatives but also by Koreans and Chinese, she said.

Former Japanese Prime Minister Yoshida Shigeru’s press statement at the San Francisco Peace Treaty.

(U.S. National Archives)

Paths to reconciliation

Gi-Wook Shin, director of Shorenstein APARC and a professor of sociology, suggested that while Europe’s experience with war and reconciliation offers lessons for Asia, significant differences exist between the wartime and post-war situations of the two continents, and that reconciliation in Asia requires time. Increased economic interaction between the countries in Northeast Asia serves less to foster reconciliation, he said, than to spur competition for regional dominance. Shin emphasized that the United States, which has greatly impacted the region’s post-war history, can play a critical role as a facilitator in establishing lasting regional accord.

The Nazi regime’s systematic attempt to completely wipe out all traces of Jewish history and culture in Europe, even as closely bound as it was with Germany’s own traditions, is a unique case, stated Fania Oz-Salzberger, a professor of history at Haifa and Monash Universities. She explored universal elements in the German-Jewish reconciliation experience, noting, like Shin and Chirot, the important element of time that is needed to reflect upon painful events of the past. Oz-Salzberger especially spoke of the healing that takes place at the level of society and culture, sometimes even before governments are ready to reconcile with one another.

Continuing political impacts

Gilbert Rozman, a professor of sociology at Princeton University, suggested that Northeast Asia’s wartime history debates will continue to complicate regional relations unless China, Japan, and Korea reach a point of mutual reconciliation. He noted the role that Japan’s government, in the 1980s during its financial heyday, and more recently, China’s leaders during a similarly strong economic era, have played in prolonging the debate. 

Memories of war are transmitted across the years through a complex process involving multiple actors and they can later influence political behavior, explained MIT political science professor Roger Petersen. He described the process within the context of the Lithuania’s successful declaration of independence from the former Soviet Union in January 1991. Petersen stated that Lithuanian émigrés, in part, helped keep the narrative of Soviet aggression and Lithuanian martyrdom alive until the conditions were right for action many decades later.

The Colonialism, Collaboration, and Criminality conference grew out of Shorenstein APARC’s Divided Memories and Reconciliation project, which for the past three years has examined the legacy of war-era memories in Northeast Asia and the United States and explored possible means of reconciliation. Shorenstein APARC has already published the first in a series of four books based on the project, and an edited volume of papers from the June 2011 conference is forthcoming next year.