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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.

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Anita Wagner Speaker Harvard University
Naoko Tomita Speaker Keio University

Shorenstein APARC
Stanford University
Encina Hall E301
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Senior Fellow at the Freeman Spogli Institute for International Studies
Professor, by courtesy, Health Policy
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, Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center
Stanford Health Policy Associate
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Karen Eggleston Speaker Stanford University
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Out-of-pocket (OoP) household health expenditures are among the most difficult factors to measure in the context of National Health Accounts (NHA). Yet their measurement is important: OoP household expenditures are typically the first or second largest source of health care financing in developing countries. Their incorrect measurement can undermine the credibility of total health spending estimates and thus NHA statistics, which are an otherwise important resource for policy makers. In most countries, private expenditures account for the biggest margin of error in national health spending estimates and represent the most substantial barrier to reliable international comparisons. Differences in accounting methods explain much of the discrepancy across nations. To further the academic investigation of this important issue, this paper focuses on OoP household health expenditures in Pakistan’s NHA and suggests steps toward estimating such expenditures more effectively.

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In this session of the Shorenstein APARC Corporate Affiliate Visiting Fellows Research Presentations, the following will be presented:

Hiroyuki Koyano, "The Strategy for Accerlation of Patent Examination - Focusing on Human Resource Management"

The number of patent application filings has increased across the world as a result of the globalization of the world economy. In addition, technology has become more complex and the demands for a quality patent has grown. Working against this trend, the period of patent examination has become longer, so patent offices have adopted plans to remedy the situation and accelerate patent examination. Hiroyuki Koyano attempts to compare the United States Patent and Trademark Office’s (USPTO) plans with those of JPO’s and analyze the problems focusing mainly on human resource management.

Mitsue Kurihara, "The Recent M&A Boom in Japan"

Mergers and Acquisitons in Japan have been booming since the late 1990s. What initially started as a method for industrial rehabilitation, today, M&A is put to use by many companies as part of their corporate strategy. Utilizing her experiences as an advisor for M&A, Kurihara researches the remarkable trend in the boom of Japanese M&A over the last ten years, as well as the future of Japanese M&A market in terms of where it should be headed.

Bhavna Sharma, “Polymorphisms in Breast Cancer Mutation Carriers: Comparative Studies in Caucasian and Hong Kong Population”

Breast cancer rates differ significantly in Asia compared to the United States and other western countries.  Lifestyle and genetic differences between these populations are probably causes of this variation.  Sharma presents findings from her study that hypothesized that the genetic breast cancer risk factors that differ between BRCA1/2 mutation carriers in Asia and the U.S. may result in a different magnitude of breast cancer risk among Asians versus Caucasians who carry BRCA1/2 mutations.

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Corporate Affiliate Visiting Fellow
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Hiroyuki Koyano is a corporate affiliate visiting fellow at Shorenstein APARC for 2008-09. He joined the Japan Patent Office (JPO), government of Japan in 1994 and has worked for JPO as a patent examiner, handling patent applications mainly in the field of construction and housing equipments. In 2003, he was in charge of researching trends on patent applications in the fields of physics, optics and construction. In 2006, he was also assigned to a position where he managed the outsourcing of prior art searches for expediting the examination process. He received his BS in agriculture from the University of Tokyo.

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Hiroyuki Koyano Corporate Affiliate Visiting Fellow, Japan Patent Office Speaker
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Mitsue Kurihara is a corporate affiliate visiting fellow at Shorenstein APARC for 2008-09 and 2009-10. Prior to joining Shorenstein APARC, she worked at the Development Bank of Japan (DBJ) for twenty years. She has comprehensive experience in policy-based financing, in addition to having been involved in the merger of Japan Development Bank with Hokkaido-Tohoku Development Finance Public Corporation into DBJ during her term in the Treasury Department. Over the past five years, she has leveraged her wide network of regional bank and enterprise connections to provide advice on various industrial restructuring and other M&A deals. Kurihara’s latest position at the DBJ was as director in the Department for Business Development (in charge of advisory services for mergers, acquisitions, divestitures, and corporate strategy planning). 

Kurihara was also assigned for a time at the Ministry of Education, Culture, Sports, Science and Technology. She graduated from Hitotsubashi University with a BA in law.

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Mitsue Kurihara Corporate Affiliate Visiting Fellow, Development Bank of Japan Speaker
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Bhavna Sharma is a corporate affiliate visiting fellow at Shorenstein APARC for 2008-09. Prior to joining Shorenstein APARC, she has been working for Reliance Life Sciences in Navi Mumbai (India), as Laboratory Manager, Molecular Medicine. Her job responsibilities include Laboratory Management - allocation of routine diagnostic tests, review & approval of diagnostic test results, documentation preparation for standard operating procedures, protocol of analysis, test report formats, validation documents, planning for inter/intra -laboratory validation & quality control testing, and organizing plans for training. Sharma is doing her post-graduate work in Microbiology and previously worked in Molecular Medicine at Jaslok Hospital and Research Centre, Laboratory of Cancer Genes at Cancer Research Institute prior to joining Reliance Life Sciences in June 2001.

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Bhavna Sharma Corporate Affiliate Visiting Fellow, Reliance Industries, India Speaker
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This presentation will discuss the current clinical diagnostic business scenario and the business opportunities available with a focus on the U.S. market.

 

About the speaker:

Sivaraman Vasudevan is a corporate affiliate visiting fellow at Shorenstein APARC for 2008-09.  Prior to joining Shorenstein APARC, he has been working for Reliance Life Sciences in Bangalore, India as Regional Head in charge of sales opoerations for Eastern and Southern parts of India.  His job responsibilities include developing business plans, implementing strategies and achieving sales targets.  Additionally, he is part of an elite corporate team in developing national and regional marketing strategies. 

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Sivaraman Vasudevan is a corporate affiliate visiting fellow at Shorenstein APARC for 2008-09. Prior to joining Shorenstein APARC, he has been working for Reliance Life Sciences in Bangalore (India) as Regional Head in charge of sales operations for Eastern and Southern parts of India. His job responsibilities include developing business plans, implementing strategies and achieving sales targets. Additionally, he is part of an elite corporate team in developing national and regional marketing strategies. Sivaraman did his Graduation in Statistics and Diploma in Management and worked in sales and marketing at Bayer Pharmaceuticals prior to joining Reliance Life Sciences in February 2004.

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Sivaraman Vasudevan Speaker
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The objective of this paper is to examine the ‘soft power' exercised by associations formed by the Indian diaspora in the United States, as it relates to: (a) building up the image of India as a deserving member of the global elite - politically, culturally and economically, and, then, (b) using that image to achieve certain goals for their country of origin. The term "association" is used to denote both formal non-profit organizations, such as trade associations, and informal non-profit organizations. The latter includes informal networks created by e-mail groups, as well as initiatives of limited life-span created to achieve specific aims, such as reducing anti-dumping tariffs on steel imports from India or passing the US-India nuclear fuel agreement.

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Rafiq Dossani

As the winter turns to spring and the cherry trees blossom, Japan confronts challenges in every domain: economics and business, security and defense, diplomacy and politics.  The troubled global economy has decimated Japanese exports and manufacturing production has plummeted.  The National Diet remains polarized and unpopular candidates are squaring off for what can only be an indecisive battle.  North Korea promises to launch rockets and  threatens worse, while pressure grows for Japan to contribute to the war in Afghanistan. 

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Venture capital (VC) investment provides a unique mechanism for gauging the technological and entrepreneurial sophistication of a national economy. It is no surprise, then, that the two giants of Asia—China and India—have rapidly become important destinations for VC investment. The latest data available from Ernst & Young reveals an astonishing development: China received more VC investment than any nation except the United States. India, though lagging behind China, still received $862 million. To compare, over $30 billion in VC money was invested in the United States in 2007; $823 million was invested in Canada. Clearly, China and India are becoming nodes for the global VC practice. Many of the largest and most prestigious Silicon Valley VC firms have established significant presences in both nations.

China and India differ in many ways, but with respect to the development of VC they share important characteristics. Until late 2008, both nations had rapidly growing consumer economies. The Chinese and Indian governments and populations both agree that education—and particularly engineering—is critical to their future. Both China and India are leaders in sending their graduate students abroad, which has created a pool of well-trained nationals overseas who can advise their peers at home, or even return home themselves to set up new ventures. Many of these Chinese and Indian nationals have worked in U.S. sciences and engineering-based firms. Such professional experience, especially during the last two decades, has laid the basis for successful technology-based entrepreneurship, and the growth in VC that accompanies it.

When VC investing is viewed globally, U.S. dominance is unquestioned. In the United States, 30–35 percent of all VC-financed firms are located in the San Francisco Bay area. Another 10–12 percent are located in the Boston and New York areas, respectively. In India and China, VC investments are similarly concentrated, and generally occur in locations with the greatest concentrations of highly educated persons. As Table 1 indicates, the investment concentration is remarkable. Forty percent of all the VC-funded firms are located in Beijing, 26 percent are in Shanghai, and the Southern Chinese triangle of Shenzhen, Guangzhou, and Hong Kong accounts for another 14 percent. VC investment in China is even more concentrated than in the United States.

Table 1 VC Investments in China and India by City, 2004–2007
(more than 5 investments per city)

Chinese City    Number of Firms    Percent    Indian City    Number of Firms    Percent
Beijing                   213                  40          Bangalore           55                    38
Shanghai               137                  26          Mumbai              31                    21
Shenzhen                36                    7          Chennai             21                     14
Hong Kong              19                    4          New Delhi           16                    11
Guangzhou             16                    3           Hyderabad          11                     8
Hangzhou               13                    2           Pune                   8                      5
Nanjing                  11                    2             n/a       
Suzhou                    9                    2             n/a       
Wuhan                     7                    1             n/a       
Others                   66                   13           Others                4                      3
Unknown                  1                    0          Unknown             0                       0
Total                      528               100            Total                146                  100
Binational                9                    2          Binational             45                    31


VC-backed startups in India, though more diffuse in terms of the top six, are more concentrated overall. Three city regions—Bangalore (38 percent), Mumbai (21 percent), and Chennai (14 percent)—attract the largest investment. However, when including Delhi (11 percent), Hyderabad (8 percent), and Pune (5 percent), these six cities account for an even greater percentage of overall VC investment. The most technology-oriented cities in both nations, Beijing and Bangalore, have received approximately 40 percent of all VC investment. The second largest recipients are Shanghai and Mumbai, which are also the financial capitals.

In China, an enormous economy growing at nearly 10 percent per year even as it emerges from a socialist past, there are significant opportunities in infrastructure development and in supplying the burgeoning underserved consumer market. In a recent Ernst & Young report, Fan Zhang, one of the founding managing partners of Sequoia Capital China, was quoted as saying that “one of the factors that attracted Sequoia Capital to China is the country’s booming consumer market that provides an opportunity to create companies to define certain sectors and fill the need for strong brands, not only in technology but also tech-related consumer services and more traditional industries.”

Zhang is correct—VC investing in China does not directly compete with U.S. firms seeking VC investment. Table 2 shows the fields that VC firms are targeting in China. The table is divided into two binary categories—whether the firm receiving the investment targets the domestic or the global market across a variety of industries, and whether a given firm is in a high technology or non-high technology sector. Chinese firms, even those in technology-based fields, overwhelmingly target the domestic market (87 percent). The Internet has given rise to the largest number of VC startups, nearly all of which are focused on the Sinophone market. Two other key areas—software (10 percent) and mobile phone applications (10 percent)—also cater almost exclusively to the Chinese market. This domestic focus suggests that it will be quite some time before VC-backed Chinese firms threaten counterpart firms in the United States. A possible exception may be semiconductor design, where there are some Chinese startups. Though few Chinese VC-financed firms are likely to be directly competitive with U.S. firms in global markets, many of these Chinese firms compete ferociously against U.S. multinationals trying to make their own inroads into the Chinese domestic market.

Table 2 VC Investments in China and India by Sector and Market, 2004–2007

                                         India                               China
Sector                      Domestic*    Global         Domestic **    Global

Semiconductors               0               7                  22                20
Internet                        16               3                144                  2
Software                         2             14                  55                  4
Communications              1               4                  23                  9
Services                          4             53                  28                  9
Mobile phone                   7              5                   51                  1
Media                             2              0                    35                 0
Healthcare                      1               4                   26                 4
Retail                             1               1                   19                  0
Miscellaneous                  2               0                  20                  2
Components                    0               0                   2                   1
Energy                            0               0                   6                   8
Environment                    0               0                   5                   1
Manufacturing                  0               0                 25                  6
Total                              34             91                461                67

 

* Domestic firms are identified as those that made no apparent attempt to serve overseas markets.

The profile of Indian firms differs from those in China. First, Indian firms are internationally oriented (73 percent); only 27 percent focus on the domestic market. With respect to sector concentration, VC investing in India favors the services sector (46 percent) and software (13 percent). This is not surprising, given India’s well-known comparative advantage in these arenas. Unlike most VC-backed companies in China, many Indian firms may well create competition for U.S. service firms, despite the less developed nature of the Indian economy as a whole.

China and India continue to attract significant VC investment, albeit in different sectors. Today, China is second only to the United States in terms of VC investing, and this is unlikely to change. In China, the preponderance of VC investment is geared to the rapidly growing internal market. The size and unique nature of this market offers entrepreneurs lucrative opportunities to provide “knock-off” U.S. Internet sites for the Chinese market. There are Chinese interpretations of Yahoo!, Google, eBay, Facebook, and Monster.com that service Chinese customers. These firms are self-limited by the language; as such, they do not threaten companies overseas. Moreover, these Chinese companies do not own unique or global class technology that could challenge larger multinational players. It is unclear whether this situation will change over time.

Indian firms differ from Chinese firms in their strong outward orientation. In percentage terms, more Indian than Chinese firms operate in hard-core technology fields. Thus, while China currently enjoys greater VC investment, it is possible that Indian firms may ultimately play a bigger role in the global economy.

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Since 1995, the offshoring of services to India has rapidly evolved from a curiosity only studied by a few scholars to a phenomenon portending a major shift in the geography of global economic activity. The article examines the evolution of Indian global services provision quantitatively and qualitatively through the use of four case studies. The first case study examines the challenge that the Indian information technology systems integrators (ITSIs) pose to the formerly larger—but now roughly comparable in terms of employment—incumbent developed-nation ITSIs. Because IT systems have become central to nearly every enterprise, the second case study illustrates the wide variety of enterprises that now have significant Indian offshore operations. The third case study describes the rapid growth of offshore integrated circuit design in India, a nation with now commercial-scale integrated circuit production. The final case study describes the emergence of high-opportunity entrepreneurial startups in India and the increasing number of Silicon Valley startups that very early in their lives or even as part of their business model have significant operations in India. The concluding discussion situates India within the global economy and speculates upon its future evolution.

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Rafiq Dossani
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Asia’s economies have been hard hit by the current global financial crisis, despite in most cases enjoying strong macroeconomic fundamentals and stable financial systems.  Early hopes were that the region might be “decoupled” from the Western world’s financial woes and even able to lend the West a hand through high growth and the investment of large foreign exchange reserves.  But that optimism has been dashed by slumping exports, plunging commodity prices, and capital outflows.  The region’s most open, advanced and globally-integrated economies—Hong Kong, Singapore, and Taiwan—are already in severe recession, with Japan, Korea and Malaysia not far behind, and dramatic slowdowns are underway in China, India, Indonesia, Thailand and Vietnam.  What role did Asian countries play in the genesis of the global crisis, and why have they been so severely impacted?  How is their recovery likely to be shaped by market developments and institutional changes in the West, and in Asia itself in response to the crisis?  Will the region’s embrace of accelerated globalization and marketization following the 1997-98 Asian financial crisis now be retarded or reversed?

Linda Lim is a leading authority on Asian economies, Asian business, and the impacts of the current global financial crisis on Asia, and she has published widely on these topics. Her current research is on the ASEAN countries’ growing economic linkages with China.

Forthcoming in 2009 are Globalizing State, Disappearing Nation: The Impact of Foreign Participation in the Singapore Economy (with Lee Soo Ann) and Rethinking Singapore’s Economic Growth Model. She serves on the executive committees of the Center for Chinese Studies and the Center for International Business Education at the University of Michigan, where formerly she headed the Center for Southeast Asian Studies. Before coming to Michigan, she taught economic development and political economy at Swarthmore. A native of Singapore, she obtained her degrees in economics from Cambridge (BA), Yale (MA), and Michigan (PhD).

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Linda Yuen-Ching Lim Professor of Strategy, Stephen M. Ross School of Business Speaker University of Michigan
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