Addressing Inequalities in Health Care

Liang’s summer medical school project examined the prevalence of receiving annual eye screenings among South Korean adult patients with type 2 diabetes and how access to that care differed across demographic and socioeconomic groups over time. The goal was to investigate why screening rates for diabetic retinopathy, a complication of type 2 diabetes, remain low in South Korea, despite the country having universal health insurance coverage and guidelines that recommend annual eye screenings to prevent this leading cause of blindness.

He worked on this project with co-advisors Eggleston and Young Kyung Do, a professor in Seoul National University’s Department of Health Policy and Management and AHPP’s inaugural postdoctoral fellow. They found that lower-income patients with diabetes experienced barriers to quality diabetes care and had lower access to annual diabetes-related eye screenings.

For Liang, these results underscored a deeper lesson: even strong health systems with universal health insurance coverage have structural socioeconomic inequities that leave vulnerable groups behind. The findings helped solidify his conviction that improving health care requires more than clinical training alone. 

The project culminated in Liang’s presentation of the findings at the 2021 AcademyHealth Annual Research Meeting and spurred a new sense of purpose. ”It grew into a life-changing journey at Stanford,” Liang says.

That journey has led him to collaborate with researchers from around the world, particularly in Japan, Korea, and China, utilizing large-scale data to advance population health and applying population health methods to research topics ranging from maternal and child health to mental health, aging, and inflammatory skin diseases.

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Liang in South Korea. Photo courtesy of Richard Liang.

From Research to Health Policy Impact

Over the years, Liang evolved from a mentee of Eggleston into a collaborator on projects in Korea and elsewhere. As COVID-19 disrupted health services worldwide, he joined Eggleston and a team of researchers in studying the impact of the pandemic on chronic disease care in India, China, Hong Kong, Korea, and Vietnam. Their findings showed that marginalized and rural communities in those countries were hit especially hard, with negative consequences for population health that reached far beyond those directly infected with the virus.

He and Eggleston also co-authored a study on preferences for telemedicine services among patients with diabetes and hypertension in South Korea during the early COVID-19 pandemic. The research drew the attention of the Prime Minister’s Office in Korea, which used it to guide national policy on telemedicine, a field still lacking a formal legal framework in the country.

For Liang, it was proof of the available opportunities to make tangible improvements in population health by combining rigorous research with policy engagement and drawing on insights across medicine, public health, and the social sciences.

“As a medical student researcher with experiences across different East Asian countries, I witnessed firsthand many pressing challenges in health and society, from rapidly aging populations to rising rates of chronic diseases,” he says. “To tackle these issues holistically, there is a growing need to bring together diverse perspectives, but regional collaborations in medical and public health research have been scarce, and rarer still between the biomedical and social sciences.”

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Liang in China on a field visit during a 2025 summer seminar co-taught by Professors Eggleston and Williams. Photo courtesy of Richard Liang.

A Second Academic Home

Eggleston describes Liang as a model of interdisciplinary scholarship. In addition to medical school and doctoral research, he has carved out space to pursue his passion for East Asian studies. He has taken classes with APARC and affiliated faculty on topics ranging from health and politics in modern China to historical and cultural perspectives on North Korea, science and literature in East Asia, and tech policy, innovation, and startup ecosystems in Silicon Valley and Japan.

“The various classes and seminars I’ve attended through APARC, and subsequently as an East Asian Studies master’s student, have helped me think more critically about how the science and practice of medicine impact policy and society, and vice versa,” Liang says. Thanks to these experiences, he also found “a second academic home away from the medical school — a community that shares the recognition of the need to strengthen dialogue and cooperation across the Pacific and that actively encourages the interdisciplinary environment necessary to make my aspirations a reality.”

Most recently, he participated in a summer seminar on AI-enabled global public health and population health management, co-taught by Eggleston and Michelle Williams, a professor of epidemiology and population health at Stanford’s School of Medicine. Offered via the Stanford Center at Peking University, this three-week seminar focused on advancing global health through cross-cultural collaboration and the application of cutting-edge technology in population health and health policy decision-making. 

“During this program, I not only got to share my experiences from conducting population health research across East Asia, but also learn from and alongside fellow students across different disciplines, spanning from international relations to computer science,” Liang notes. He especially enjoyed meeting local Chinese graduate students and providing feedback and near-peer mentorship as an upper-year graduate student.

The seminar also led to exploring additional opportunities for research collaborations to study the implications of long-term annual health screenings across China. Liang, Eggleston, and Williams plan to expand this collaborative work.

Preparing to Become a Better Care Provider

Liang’s work across borders and disciplines not only advances research but also deepens the perspective of cultural humility he brings to his future role as a physician.

“The cross-cultural experiences and fruitful academic exchanges I’ve learned through as a Stanford graduate student not only inform my research in different countries, but also help prepare me to become a better care provider for my future patients,” he says.

For his achievements, Liang has earned multiple honors, including a Young Investigator Collegiality Award from the International and Japanese Societies for Investigative Dermatology, the Critical Language Scholarship in Korean from the U.S. Department of State, and the Stanford Center for Asian Health Research and Education Seed Grant.

He is looking forward to finishing medical school, attending a residency program, and continuing an interdisciplinary career that advances human health and well-being.

Reflecting on the fleeting nature of student life, his advice to fellow students is to remember that “Your time as a Stanford student can really fly by, so make sure to explore the opportunities that speak to you and offerings across the university, by organizations like APARC and the Freeman Spogli Institute for International Studies. The Bechtel International Center’s Office of Global Scholarships and the Hume Center for Writing and Speaking are also wonderful resources to get started.”

It is advice he has embodied himself, building a career at the intersection of medicine, public health, and East Asian studies, one project at a time.

The Walter H. Shorenstein Asia-Pacific Research Center (APARC) is pleased to invite applications for a suite of fellowships in contemporary Asia studies to begin in fall quarter 2026.

The Center offers postdoctoral fellowships that promote multidisciplinary research on Asia health policy, contemporary Japan, and contemporary Asia broadly defined, as well as postdoctoral fellowships and visiting scholar positions with the Stanford Next Asia Policy Lab and a visiting fellow position on contemporary Taiwan. Learn more about each opportunity and its specific application requirements:

2026-27 Asia Health Policy Program Postdoctoral Fellowship

Hosted by the Asia Health Policy Program at APARC, the fellowship is awarded to one recent PhD recipient undertaking original research on contemporary health or healthcare policy of high relevance to countries in the Asia-Pacific region, especially developing countries. Appointments are for one year beginning in fall quarter 2026. The application deadline is December 1, 2025.

2026-27 Japan Program Postdoctoral Fellowship

Hosted by the Japan Program at APARC, the fellowship supports research on contemporary Japan in a broad range of disciplines, including political science, economics, sociology, law, policy studies, and international relations. Appointments are for one year beginning in fall quarter 2026. The application deadline is December 1, 2025.  

2026-27 Shorenstein Postdoctoral Fellowship on Contemporary Asia

APARC offers two postdoctoral fellowship positions to junior scholars for research and writing on contemporary Asia. The primary research areas focus on political, economic, or social change in the Asia-Pacific region (including Northeast, Southeast, and South Asia), or international relations and international political economy in the region. Appointments are for one year beginning in fall quarter 2026. The application deadline is December 1, 2025. 
 

2026-27 Taiwan Program Visiting Fellowship

Hosted by the Taiwan Program at APARC, the fellowship is awarded to one mid-career to senior-level expert with extensive experience studying contemporary Taiwan. The fellowship research focus is on issues related to how Taiwan can meet the challenges and opportunities of economic, social, technological, environmental, and institutional adaptation in the coming decades, using a variety of disciplines, including the social sciences, public policy, and business. The application deadline is March 1, 2026.  
 

Alzheimer’s disease and related dementias (ADRD) are putting a significant strain on families and healthcare systems worldwide, and with increasing life expectancies, they pose an escalating global challenge. As one of the world’s fastest aging economies, South Korea’s efforts to address the burden of care for people living with ADRD offer valuable lessons for other nations grappling with the social and economic pressures of the demographic transition.

A new comprehensive review of Korea’s programs and policies to promote healthy aging and diagnose, treat, and care for people living with ADRD sheds light on progress and ongoing challenges. Published in the May 2025 issue of Alzheimer's & Dementia: The Journal of the Alzheimer's Association, the review offers insights from Korea’s strategies that resonate far beyond its borders.

The co-authors – Stanford health economist Karen Eggleston, the director of APARC’s Asia Health Policy Program (AHPP), and Daejung Kim, an associate research fellow at the Korea Institute for Health and Social Affairs – focus on recent policies supporting “aging in place” for independent seniors and palliative care for those needing greater support.

Eggleston and Kim used a mixed-methods review of dementia care in Korea over the past 25 years, combining a critical analysis of peer-reviewed social science and health policy studies in both English and Korean, quantitative analysis of Korean statistical agency data compared with other OECD countries, and interviews with local policymakers and welfare administrators in a region with a high proportion of elderly population.

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Social and Policy Pressures in a Rapidly Aging Economy

Korea is aging fast, and the prevalence of ADRD among older adults is expected to surge, as is the projected social and economic toll of dementia care. Demographic and economic projections suggest that the annual cost of ADRD in Korea would increase from 0.9 percent to almost four percent of GDP from 2019 to 2050.

“Korea’s demographic transition, like its economic development, has been compressed into just a few generations,” Eggleston and Kim explain. “As a result, its triumph of longevity and current extra-low fertility engender social strains and policy pressures to address the burgeoning needs for long-term services and support – including prevention of ADRD, investing in early detection, and providing appropriate care for people with ADRD, which often involves addressing the broader social issue of financial support for older adults and detecting cognitive decline in those still engaged in the labor force.”

A Foundation for Dementia Care Service Delivery

Korea has taken decisive steps to build a comprehensive system for dementia care, leveraging its national health insurance and long-term care insurance (LTCI). This dual insurance framework aims to reduce unnecessary hospitalizations and shift social care away from medical settings.

Research shows that “the adoption of LTCI in 2008 helped to address regional disparities by providing nationwide risk pooling for long-term care services,” but the system still faces hurdles. Within Korea’s private-dominated service delivery system, the public-private balance varies significantly across different services, coordination between healthcare and long-term care services remains fragmented, and there is a need for better integration of community-based support.

Furthermore, “social insurance is no panacea for mitigating disparities and securing financial support for the most vulnerable citizens, such as people with ADRD and their families,” Eggleston and Kim note. Out-of-pocket payments for medical care still constitute a substantial portion of Korean household consumption.

Livelihood and Workforce Challenges

In light of Korea’s limited sources of financial support for its older citizens, the country has relatively high labor force participation, especially among older men. This high level of employment of older Koreans may bode ill in an economy where many of the “senior employment” positions – primarily low-paying roles in the service sector – are not age-friendly.

Giving elderly persons a reason to get up in the morning has its benefits, Eggleston and Kim note, but having them perform service jobs is not a sustainable way to support livelihoods and healthy aging. “How decision-making by cognitively impaired individuals affects health and financial well-being can be considered the defining feature of the economics perspective on ADRD and its social impacts,” the co-authors say.

The growing demand for professional dementia care strains Korea’s caregiving workforce in other ways. Amid the shortage and aging of caregivers, much of dementia care falls on unpaid family members, often women in their 50s, lowering their rates of labor force participation in prime age. The burden on these informal caregivers is profound.

The authors note that “Korea needs more strategies to recruit, retain, and empower a knowledgeable and resilient caregiving workforce.”

Prevention and Early Diagnosis: A Mixed Picture

Early detection is critical for planning care and support for people with ADRD, and Korea is taking steps to design programs and incentives for healthy aging habits and early ADRD detection. These efforts, however, require stronger staffing and funding to offer more personalized and coordinated care.

Another set of challenges stems from the underuse of existing long-term services and support programs and the need to diversify them. Currently, providers have weak incentives to offer palliative care, while families and patients often struggle to choose comfort care over ongoing medical treatments.

Policymakers must also expand the target group of beneficiaries and diversify long-term services and support for daily life, including promoting a reduction in risk factors associated with dementia, such as low educational attainment, smoking, physical inactivity, uncontrolled chronic diseases, and depression. Eggleston and Kim call for developing “additional care service types such as hospital companion and nutrition support services” and integrating new technologies as part of a diversified, long-term aging-in-place care system.

Expanding Care Options 

The demographic transition has been accompanied by shifting social norms regarding responsibilities and caregiving, meaning significantly fewer Koreans believe care for older parents is the sole responsibility of family members. Accordingly, Korean policies aim to strengthen home- and community-based services (HCBS). Yet, the country’s share of at-home care recipients remains lower than in many peer economies.

“Making the vision of quality HCBS a reality involves multiple dimensions of financing and service delivery, tailored to local and individual circumstances while supporting equitable access nationally for those in need,” write Eggleston and Kim.

Institutional care in residential facilities remains a necessity for frail older people with ADRD and multiple comorbidities. While the supply of such service providers has greatly improved and long-term care insurance coverage has enhanced their affordability for families, wide disparities in quality of care for those in residential facilities persist. Meanwhile, hospice and palliative care remain largely an underdeveloped care option for people with ADRD in Korea.

Lessons for Aging Economies

South Korea’s dementia care journey illustrates the complex balancing act of addressing the multiple dimensions of a rapid demographic transition. The country’s efforts to promote healthy aging and diagnose, treat, and care for people with ADRD offer valuable insights for other economies that must prepare to provide long-term support for their aging populations.

One major imperative in Korea and elsewhere is ensuring that dementia care policies and programs are based on robust evidence. “To utilize limited resources most effectively, it will be critical to design and collect policy-relevant evidence about what works for people with ADRD and their care partners,” Eggleston and Kim write.