Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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Abstract

Background: Body mass index (BMI) and waist circumference (WC) are used in risk assessment for the development of noncommunicable diseases (NCDs) worldwide. Within a Cambodian population, this study aimed to identify an appropriate BMI and WC cutoff to capture those individuals that are overweight and have an elevated risk of vascular disease.

Methodology/Principal Findings: We used nationally representative cross-sectional data from the STEP survey conducted by the Department of Preventive Medicine, Ministry of Health, Cambodia in 2010. In total, 5,015 subjects between age 25 and 64 years were included in the analyses. Chi-square, Fisher’s Exact test and Student t-test, and multiple logistic regression were performed. Of total, 35.6% (n=1,786) were men, and 64.4% (n=3,229) were women. Mean age was 43.0 years (SD = 11.2 years) and 43.6 years (SD = 10.9 years) for men and women, respectively. Significant association of subjects with hypertension and hypercholesterolemia was found in those with BMI $23.0 kg/m2 and with WC .80.0 cm in both sexes. The Area Under the Curve (AUC) from Receiver Operating Characteristic curves was significantly greater in both sexes (all p-values, 0.001) when BMI of 23.0 kg/m2 was used as the cutoff point for overweight compared to that using WHO BMI classification for overweight (BMI $25.0 kg/m2) for detecting the three cardiovascular risk factors. Similarly, AUC was also significantly higher in men (p-value, 0.001) when using WC of 80.0 cm as the cutoff point for central obesity compared to that recommended by WHO (WC $94.0 cm in men).

Conclusion: Lower cutoffs for BMI and WC should be used to identify of risks of hypertension, diabetes, and hypercholesterolemia for Cambodian aged between 25 and 64 years.

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1
Publication Type
Journal Articles
Journal Publisher
PLoS ONE
Authors
Siyan Yi
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We measure the degree of supplier-induced demand in newborn treatment, by exploiting changes in reimbursement arising from the introduction in Japan of the partial prospective payment system (PPS). Under the partial PPS, neonatal intensive care unit (NICU) utilization became relatively more profitable than other procedures, since it was excluded from prospective payments. We find that hospitals respond to PPS adoption by increasing NICU utilization and more frequently manipulating infants' reported birth weights -- the latter of which is a measure that determines the infant's maximum allowable length of stay in NICU. This induced demand substantially increases hospitals' reimbursements.

 
Hitoshi Shigeoka received a B.A. (2001) and an MA (2003) in chemical engineering from University of Tokyo, and master of international affairs (2006) and PhD in economics (2012) from Columbia University. Hitoshi’s research interests include health, labor, public economics, and experimental economics. His current research involves estimating the demand elasticity of health care utilization, examining the degree of supplier-induced demand by physicians and hospitals, examining the effects of competition and peer-to-peer teaching on learning, and investigating how the long-term incentives of mothers affect the timing of births.

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Hitoshi Shigeoka Assistant Professor Speaker Simon Fraser University
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We use retrospectively reported data on smoking behavior of residents of Mainland China and Taiwan to compare and contrast patterns in smoking behavior over the life-course of individuals in these two regions. Because we construct the life-history of smoking for all survey respondents, our data cover an exceptionally long period of time – up to fifty years in both samples. During this period, both societies experienced substantial social and economic changes. The two regions developed at much different rates and the political systems of the two areas evolved in very different ways. More importantly, governments in the two areas set policies that caused the flow of information about the health risks of smoking to differ across the regions and over time. We exploit these differences, using counts of articles in newspapers from 1951 to present, to explore whether and how the arrival of information affected life-course smoking decisions of residents in the two areas. We also present evidence that suggests how prices/taxes and key historical events might have affected decisions to smoke.

Dean Lillard received his PhD in economics from the University of Chicago in 1991. From 1991 to 2012, he was a faculty member and senior research associate in the Department of Policy Analysis and Management at Cornell University. In August 2012 he joined the Department Human Sciences at Ohio State University as an Associate Professor. He is Director and Project Manager of the Cross-National Equivalent File study that produces cross-national data. He is a member of the American Economics Association, the Population Association of America, the International Association for Research on Income and Wealth, the International Health Economics Association, the American Society for Health Economics, a Research Associate at the German Institute for Economic Research in Berlin, Germany, and a Research Associate of the National Bureau of Economic Research. He serves on the advisory board of the Danish National Institute for Social Research in Copenhagen, Denmark and the Cross-National Studies: Interdisciplinary Research and Training Program – a collaborative program run by the Polish Academy of Sciences (PAN), and together with the Mershon Centre at OSU.

Dean Lillard's current research focuses on health economics, the economics of schooling, and international comparisons of economic behavior. His research in health economics is primarily focused on the economics of the marketing and consumption of cigarettes and alcohol. His research on the economics of schooling includes studies of direct effects of policy on educational outcomes and on the role that education plays in other economic behaviors such as smoking, production of health, and earnings. His cross-national research ranges widely from comparisons of the role that obesity plays in determining labor market outcomes to comparisons of smoking behavior cross-nationally.

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Dean R. Lillard Associate Professor, Department Human Sciences Speaker Ohio State University
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How do demand- and supply-side incentives interact, when there are potentially large provider income effects? We develop a simple model and empirically test it with data from China’s Essential Medications List (EML) policy, which reduced patient copayments and changed provider incentives by removing a large source of revenue from primary care providers: drug dispensing revenues. Using a panel of patient-level spending and clinical data for Chinese patients with diabetes or hypertension over two and a half years, we find evidence of strategic provider response that dampened the impact of patient copayment reductions. Resource use and patient out-of-pocket spending did not change, when taking account of patient utilization outside primary care.

This paper has been published: Brian Chen, Y. Tony Yang, and Karen Eggleston, 2017.  Patient Copayments, Provider Incentives and Income Effects: Theory and Evidence from the Essential Medications List under China’s 2009 Healthcare Reform,” World Medical & Health Policy 9(1): 24–44."

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1
Publication Type
Working Papers
Publication Date
Journal Publisher
Asia Health Policy Program working paper # 37
Authors
Karen Eggleston

Shorenstein APARC
Encina Hall E332
616 Serra Street
Stanford, CA 94305-6055

(650) 724-5710 (510) 705-2049 (650) 723-6530
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Developing Asia Health Policy Fellow
IMG_4537.jpg MD

Gendengarjaa Baigalimaa joins the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) during the 2013-2014 acedemic year as the Asia Health Policy Program Fellow. She joins APARC from the Mongolian National Cancer Center, where she serves as a Gynecological Oncologist.

During her appointment as Health Policy Fellow, she will conduct a comparative study of how knowledge of cervical cancer risk factors has influenced behavior changes in Mongolia before and after the introduction of the National Cervical Cancer Program.

Baigalimaa is the Executive Director of Mongolian Society of Gynecological Oncologists and is also a member of the International Gynecological Cancer Society (IGCS) in Mongolia, Russia, and France.

Baigalimaa holds a MD from Minsk Belarussia Medical University. She also received a Masters in Health Science from Mongolian Medical University. She is fluent in both Russian and English.

Shorenstein APARC
Encina Hall C331
616 Serra Street
Stanford, CA 94305-6055

(650) 724-5656 (650) 723-6530
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2013-2014 Asia Health Policy Postdoctoral Fellow
triyana_photo.jpg PhD

Margaret (Maggie) Triyana’s main research interests are inequality and human capital investments in developing countries. In particular, she is interested in the effects social policy changes on children’s health outcomes. As a Postdoctoral Fellow, she will analyze the effects of rural-urban migration in Indonesia and China, as well as the impact of health insurance expansion in Indonesia and Vietnam.

Triyana received a PhD in Public Policy from the University of Chicago in 2013.

 

Working Papers

“Do Health Care Providers Respond to Demand-Side Incentives? Evidence from Indonesia“

“The Effects of Community and Household Interventions on Birth Outcomes: Evidence from Indonesia”

“The Longer Term Effects of the ‘Midwife in the Village’ Program in Indonesia”

“The Sources of Wage Growth in a Developing Country” (with Ioana Marinescu)

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