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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The Walter H. Shorenstein Asia-Pacific Research Center (APARC) is pleased to announce a suite of training, fellowship, and funding opportunities to support Stanford students interested in the area of contemporary Asia. APARC invites highly motivated and dedicated undergraduate- and graduate-level students to apply for these offerings:

APARC Summer 2023 Research Assistant Internships

APARC seeks current Stanford students to join our team as paid research assistant interns for the duration of the summer 2023 quarter. Research assistants work with assigned APARC faculty members on varied issues related to the politics, economies, populations, security, foreign policies, and international relations of the countries of the Asia-Pacific region. This summer's projects include:

  • The Biopolitics of Cigarette Smoking and Production
  • The Bureaucratic State: A Personnel Management Lens
  • China’s Largest Corporations
  • Healthy Aging in Asia
  • Hiding in Plain Sight: How China Became A Great Power
  • Nationalism and Racism in Asia
  • U.S. Rivals: Construct or Reality?  
     

All summer research assistant positions will be on campus for eight weeks. The hourly pay rate is $17.25 for undergraduate students, $25 for graduate students.

The deadline for submitting applications and letters of recommendation is March 1, 2023.

Please follow these application guidelines:

I. Prepare the following materials:


II. Fill out the online application form for summer 2023, including the above two attachments, and submit the complete form.

III. Arrange for a letter of recommendation from a faculty to be sent directly to Shorenstein APARC. Please note: the faculty members should email their letters directly to Kristen Lee at kllee@stanford.edu. We will consider only applications that include all supporting documents.

For more information and details about each summer research project, visit the Summer Research Assistant Internships Page >


APARC 2023-24 Predoctoral Fellowship

APARC supports Stanford Ph.D. candidates who specialize in contemporary Asia topics. The Center offers a stipend of $37,230 for the 2023-24 academic year, plus Stanford's Terminal Graduate Registration (TGR) fee for three quarters. We expect fellows to remain in residence at the Center throughout the year and to participate in Center activities.

Applications for the 2023-24 fellowship cycle of the APARC Predoctoral Fellowship are due March 1, 2023.

Please follow these application guidelines:

I. Prepare the following materials:

  • A current CV;
  • A cover letter including a brief description of your dissertation (up to 5 double-spaced pages);
  • A copy of your transcripts. Transcripts should cover all graduate work and include evidence of recently-completed work.

II. Fill out the following online application form, including the above three attachments, and submit the complete application form.

III. Arrange for two (2) letters of recommendation from members of your dissertation committee to be sent directly to Shorenstein APARC.  
Please note: the faculty/advisors should email their letters directly to Kristen Lee at kllee@stanford.edu.

We will consider only applications that include all supporting documents. The Center will give priority to candidates who are prepared to finish their degree by the end of the 2023-24 academic year.

For more information, visit the APARC Predoctoral Fellowship Page >


APARC Diversity Grant

APARC's diversity grant supports Stanford undergraduate and graduate students from underrepresented minorities who are interested in contemporary Asia. The Center will award a maximum of $10,000 per grant to support a wide range of research expenses.

The Center is reviewing grant applications on a rolling basis.  
To be considered for the grant, please follow these application guidelines:

I. Prepare the following materials:

  • A statement describing the proposed research activity or project (no more than three pages);
  • A current CV;
  • An itemized budget request explaining research expense needs.

II. Fill out the following online application form, including the above three attachments, and submit the complete application form.

III. Arrange for a letter of recommendation from a faculty to be sent directly to APARC.  

Please note: the faculty members should email their letters directly to Kristen Lee at kllee@stanford.edu.

For more information, visit the APARC Diversity Grant page >

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Tongtong Zhang
Q&As

Predoctoral Fellow Spotlight: Tongtong Zhang Examines Channels for Public Deliberation in China

Political Scientist and APARC Predoctoral Fellow Tongtong Zhang explores how the Chinese Communist Party maintains control through various forms of political communication.
Predoctoral Fellow Spotlight: Tongtong Zhang Examines Channels for Public Deliberation in China
Portrait of Ma'ili Yee, 2020-21 APARC Diversity Fellow
News

Student Spotlight: Ma’ili Yee Illuminates a Vision for Building the Blue Pacific Continent

With support from Shorenstein APARC’s Diversity Grant, coterminal student Ma’ili Yee (BA ’20, MA ’21) reveals how Pacific island nations are responding to the U.S.-China rivalry by developing a collective strategy for their region.
Student Spotlight: Ma’ili Yee Illuminates a Vision for Building the Blue Pacific Continent
Stanford main quad at night and text calling for nominations for APARC's 2023 Shorenstein Journalism Award.
News

Nominations Open for 2023 Shorenstein Journalism Award

Sponsored by Stanford University’s Shorenstein Asia-Pacific Research Center, the annual award recognizes outstanding journalists and journalism organizations for excellence in coverage of the Asia-Pacific region. News editors, publishers, scholars, and organizations focused on Asia research and analysis are invited to submit nominations for the 2023 award through February 15.
Nominations Open for 2023 Shorenstein Journalism Award
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Student Opportunities: Summer RAs, Predoc Fellows, Diversity Grant Funding
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To support Stanford students working in the area of contemporary Asia, the Shorenstein Asia-Pacific Center is offering research assistant positions for the duration of the 2023 summer quarter, a predoctoral fellowship for the duration of the 2023-24 academic year, and a Diversity Grant that funds research activities by students from underrepresented minorities.

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The combination of COVID-19 and global uncertainties — from wars, cost-of-living crises, high cross-national public debts, and impending global recession — creates new challenges for affordable access to new medicines around the world. Using insights from his research on price regulation, incentives for innovation, and universal health coverage in global bio-pharmaceutical markets, Chirantan Chatterjee will consider how the future may unravel for affordable access to new medicines in the Global North and South.

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Chirantan Chatterjee is an applied microeconomist and a Reader in the Economics of Innovation at the University of Sussex. He is also a Visiting Fellow at the Hoover Institution, Stanford University, and Visiting Faculty, IIM Ahmedabad, India. His research interests are in the economics of innovation, pharmaceutical economics, and global health. He has published in top peer-reviewed journals like Management Science, RAND Journal of Economics, Journal of Development Economics, Journal of Health Economics, Research Policy, Production and Operations Management, Journal of Business Ethics, Journal of Environmental Economics & Management and Social Science & Medicine among others. His new co-edited book on Covid-19 and Grand Challenges for Health, Innovation and Economy is forthcoming in 2023 with World Scientific. Chatterjee's research has in the past been supported by the NSF during his dissertation work at Carnegie Mellon University from where he obtained his PhD in 2011. His current research is supported by the Wellcome Trust India Alliance & Johns Hopkins Alliance for a Healthy World. Chatterjee has also consulted for the United Nations, World Bank, and the World Health Organization on Covid-19, Universal Health Coverage, and Incentives for Medical Innovation. View more on his personal website at www.chirantanchatterjee.com.

Jianan Yang

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Chirantan Chatterjee Reader in Economics of Innovation, Science Policy Research Unit, Business School, University of Sussex; Visiting Fellow Hoover Institution, Stanford University; Visiting Faculty, IIM Ahmedabad, India
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Register: bit.ly/3FTrJhg

Incentives for health behaviors are an increasingly important policy tool in both developed and developing countries, and there is widespread interest in improving their effectiveness. However, different contracts are likely to be more effective for different people. Mechanism design offers two strategies to improve contract effectiveness—tagging on observables (i.e., 3rd-degree price discrimination), and offering a menu of contract choices (i.e., 2nd-degree price discrimination)—but a key concern with both is that participants with private information might self-select into contracts that are favorable to the agent but less effective from the perspective of the principal. We adapt each of these strategies to customize incentive contracts for walking. Using a randomized controlled trial among more than 5,000 adults in urban India, we show that both mechanisms increase physical activity, leading to a 75% increase in steps walked relative to the effect of a one-size-fits-all benchmark. Moreover, we find that the concern that participants will self-select into less effective contracts is not only misplaced, but exactly backwards. Instead, a common force in health behavior settings—commitment motives—leads agents to prefer more effective contracts under both mechanisms. In particular, sophisticated time-inconsistent agents demand contracts that commit their future selves to walk more, bringing their preferences in partial alignment with the principal and improving the effectiveness of customization.

 

Ariel Zucker 111722Ariel Zucker is an assistant professor in the Department of Economics at UC Santa Cruz. Her research studies policies to improve health and environmental conditions among underserved communities worldwide. Many of her projects focus on countering behavioral biases in personal decision making. Prior to arriving in Santa Cruz, Dr. Zucker did a postdoc at UC Berkeley ARE, and earned her Ph.D. in economics from MIT.

Jianan Yang

Via Zoom Webinar.

Ariel Zucker Assistant Professor of Economics, University of California Santa Cruz
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South Korea aspires to achieve the status of a global vaccine hub as a national strategic policy priority. South Korea’s biomanufacturing industry has ramped up the development and production of therapeutic treatments and vaccines to meet the public health demands of the pandemic. The government has responded by promoting public-private partnerships to expand vaccine production capacity to meet current and future needs domestically and abroad in LMICs. To bolster this strategy, the government has entered into partnerships with international organizations, namely the WHO, ADB, and IVI, by establishing training hub programs for a global biomanufacturing workforce in 2022.

This paper examines South Korea’s mechanisms and strategy towards becoming a vaccine hub, the origins of which predate the Covid-19 pandemic but were again spurred by vaccine nationalism and challenges to access early in the pandemic.

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Co-sponsored by Peking University and the Asia Health Policy Program

Time cost of healthcare is important but is largely overlooked in the literature. This paper investigates how time cost affects the healthcare usage in both China and the US. Using the retirement age policy in both countries, we first employ a Regression Discontinuity Design (RDD) and show that the hospitalization rate persistently increases by 20-30 percent just after retirement age. The effects are larger and more significant among the people with higher time costs prior to retirement. Then, we use the school starting date and provide further significant evidence of the impact of time cost on hospitalization among the age-eligible children. These results underline the remarkable impact of time cost on healthcare usage and provide a more comprehensive picture of moral hazard in health insurance.

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Wei Huang 102022
Dr HUANG Wei is an Associate Professor at the National School of Development (NSD), Peking University. Previously, he was an assistant professor at Emory University and National University of Singapore. He received his Ph.D. in economics from Harvard in 2016. His research fields include public economics, labor economics, and health economics. His research work has been published in journals such as Review of Economic and Statistics, American Economic Journal: Applied Economics, Nature, Journal of Economic Perspectives, Journal of Development Economics, Journal of Labor Economics, etc. He is a co-editor for Economics of Transition.

Jianan Yang

Via Zoom Webinar.

Wei Huang Associate Professor, the National School of Development (NSD), Peking University
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Asia Health Policy Postdoctoral Fellow, 2022-23
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Jianan Yang joined the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) as the 2022-2023 Developing Asia Health Policy Postdoctoral Fellow. She recently obtained her Ph.D. in Economics at the University of California San Diego. She holds B.A. in Economics and Mathematics from the Renmin University of China. Her research lies in the intersection of development and health economics and revolves around what drives the sub-optimal healthcare-seeking behaviors in developing countries and how they can be improved by leveraging price or non-price mechanisms.

Yang views health as a fundamental part of human development. People in developing countries usually face additional barriers to accessing healthcare resources because of underqualified providers on the one side, lower income levels, insufficient insurance coverages, and a lack of information on the other side. Because markets in healthcare settings are usually characterized by imperfect competition and government regulations, Yang thinks it is important to evaluate the policies’ impacts on various aspects of the healthcare system. Through understanding the underlying constraints, we can think about how the policy can be designed more efficiently.

Yang’s dissertation studied how patients’ chronic condition drug utilization responds to price reductions in China. By documenting a larger increase in utilization and a meaningful reduction in underuse among the uninsured, the study suggests that the price elasticities would be higher in developing countries and there will be larger welfare benefits from such price reductions resulting from squeezing out the price markups of the pharmaceutical companies due to market power. The finding suggests that cost is a barrier to both drug take-up and adherence, especially among the lower-income population who meanwhile are more likely to not have insurance coverage.

At APARC, Yang further accessed the underlying factors affecting people’s healthcare-seeking behaviors including the role of cost, information, and behavioral bias. She also extended her research agenda to the other sectors of the healthcare system. 

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As healthcare costs for patients with non-communicable diseases such as diabetes have risen, governments and healthcare providers have sought creative measures to align financial incentives with better patient outcomes. One incentive payment system known as “pay-for-performance” (P4P), in which providers are beholden to metric-driven outcomes, represents a potential path forward for healthcare providers to improve healthcare processes, resulting in higher quality and better patient health outcomes. The evidence on the effectiveness of P4P programs, however, is mixed.

To address this uncertainty, a new study, published in The European Journal of Healthcare Economics, assesses the effectiveness, in monetary terms, of a P4P program for patients with diabetes at a hospital system in Taiwan. 

The study coauthors, including APARC’s Asia Health Policy Program Director and FSI Senior Fellow Karen Eggleston, employed new patient-level data on clinical indicators, utilization, and expenditures, combined with data from the national death registry, to better understand the costs and benefits of the P4P program. Their results show that Taiwan’s implementation of the P4P program for diabetic care yielded positive results in terms of net value, defined as the value of life years gained minus the cost of care.


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Assessing Net Value of Taiwan’s P4P

Taiwan’s Bureau of National Health Insurance (now National Health Insurance Administration) introduced P4P in 2001 and enhanced the program in 2006 with an incentive for pay-for-reporting of outcomes. Financial incentives were used to encourage continuity of care with metrics such as new patient enrollment, follow-up visits, and annual reports, each tied to a specific monetary value. The program’s features are common across P4P, so the study’s findings have implications in other settings that incorporate similar designs in their P4P programs.

The study compares two different groups of patients at a large regional hospital in Taiwan, one consisting of newly enrolled P4P patients and another using P4P patients who have been enrolled since the beginning of the program. The researchers leverage detailed clinical data not used in previous assessments of the P4P program to better identify both costs and longer-term clinical outcomes based on measured biomarkers and predicted mortality.

Using an economic cost-benefit analysis conducted from a budgetary perspective, the study is the first analysis of any P4P program that estimates changes in the quality-adjusted price index relative to usual care. The authors consider health benefits in terms of survival and predicted survival and convert them into monetary terms. This net value approach is especially useful for policymakers and healthcare administrators who implement value-based purchasing and monitor outcomes for any service delivery innovation over time.

“These encouraging findings of the positive value of quality improvement net of expenditures adds evidence to the literature that has found mixed results of P4P programs.”

The study finds that Taiwan’s P4P program provided a positive net value for payers and patients, ranging from $40,084 USD to $348,717 USD. These positive net value results are primarily derived from health outcomes as measured by lower mortality rates in the P4P versus non-P4P cohorts, across both newly enrolled and continuously enrolled groups of patients. According to the authors, “these encouraging findings of the positive value of quality improvement net of expenditures adds evidence to the literature that has found mixed results of P4P programs.” 

 This study develops a new model for assessing the net value of service delivery innovations like P4P programs that can be applied in other contexts globally, providing healthcare systems researchers with new tools to better understand an emergent option for incentivized care. With a more economically-translatable understanding of P4P programs, this research helps build the bridge between the oft-disparate worlds of healthcare and policy.

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Two old men
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Education Level Will Widen Disparity in Health Outcomes of the Future Elderly Population, New Study Projects

In the first study to compare the progression of educational disparities in disability across two rapidly aging Asian societies, APARC coauthors Cynthia Chen and Karen Eggleston project that from 2015 to 2050, elders with high educational attainment will have a lower prevalence of functional disability and chronic conditions compared to elderly with low educational attainment.
Education Level Will Widen Disparity in Health Outcomes of the Future Elderly Population, New Study Projects
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New Approaches to Aging: Understanding and Managing Society-Level Characteristics in Elderly Populations

Broadening the existing scholarship on aging and the needs of different societal groups, Cynthia Chen, Visiting Scholar at APARC’s Asia Health Policy Program, presents nuanced and comprehensive aging metrics that account for the critical factors that influence societal function.
New Approaches to Aging: Understanding and Managing Society-Level Characteristics in Elderly Populations
A trio of elderly women in Japan
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Japanese Population Projected to Live Longer Without Dementia

A new microsimulation projects that over the next 20 years, Japanese people will live longer without dementia, but older women with a less than high school education will benefit less than men.
Japanese Population Projected to Live Longer Without Dementia
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Doctor and nurse working on computer together. Female medical professionals are wearing uniforms. They are standing in hospital corridor. Portra/Getty Images
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In the first study to evaluate pay-for-performance implementation at a hospital system in Taiwan, APARC’s Asia Health Policy Program Director Karen Eggleston and co-authors reveal how incentive-based measures to ensure continuity and quality of care resulted in positive health outcomes.

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Global Affiliate Visiting Scholar, 2022-23
Reliance Life Sciences
Jitukrushna Swain

Jitukrushna Swain is a global affiliate visiting scholar at the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) for 2022-23. Swain has over thirteen years of experience in business development, core scientific research and project management of pharmaceutical products and has been with Reliance Life Sciences Pvt. Ltd., India since 2015. Currently, he is designated as Senior Manager in the Corporate Development team. His current responsibilities include business development for international regulated market (including out-licensing deals for Finished Dose Formulations and client management); cross-functional coordination for product registration and market launch; portfolio management; sales and distribution network development for pharmaceutical products; and supporting the international clients by query response to techno-commercial requirements. Swain received his master's degree in bio-technology with specialization in industrial microbiology and fermentation technology from Sambualpur University, India in 2009.

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Pay-for-Performance (P4P) to better manage chronic conditions has yielded mixed results. A better understanding of the cost and benefit of P4P is needed to improve program assessment.

To this end, we assessed the effect of a P4P program using a quasi-experimental intervention and control design. Two different intervention groups were used, one consisting of newly enrolled P4P patients, and another using P4P patients who have been enrolled since the beginning of the study. Patient-level data on clinical indicators, utilization and expenditures, linked with national death registry, were collected for diabetic patients at a large regional hospital in Taiwan between 2007 and 2013. Net value, defined as the value of life years gained minus the cost of care, is calculated and compared for the intervention group of P4P patients with propensity score-matched non-P4P samples.

We found that Taiwan’s implementation of the P4P program for diabetic care yielded positive net values, ranging from $40,084 USD to $348,717 USD, with higher net values in the continuous enrollment model.

Our results suggest that the health benefits from P4P enrollment may require a sufficient time frame to manifest, so a net value approach incorporating future predicted mortality risks may be especially important for studying chronic disease management. Future research on the mechanisms by which the Taiwan P4P program helped improve outcomes could help translate our findings to other clinical contexts.

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European Journal of Healthcare Economics
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Karen Eggleston
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Noa Ronkin
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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 fall quarter 2023.

The Center offers postdoctoral fellowships that promote multidisciplinary research on contemporary Japan and contemporary Asia broadly defined, inaugural postdoctoral fellowships and visiting scholar positions as part of the newly launched Stanford Next Asia Policy Lab, and a fellowship for experts on Southeast Asia. Learn more about each opportunity and its eligibility and specific application requirements:

Postdoctoral Fellowship on Contemporary Japan

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 2023. The application deadline is December 1, 2022.
 

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 2023. The application deadline is December 1, 2022.
 

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Protesters in Myanmar stand on a picture of General Min Aung Hlaing
Commentary

It’s Time to Help Myanmar’s Resistance Prevail

The country’s brutal coup regime is no candidate for political compromise.
It’s Time to Help Myanmar’s Resistance Prevail
Chinese soldier
Commentary

China Hasn’t Reached the Peak of Its Power

Why Beijing can afford to bide Its time
China Hasn’t Reached the Peak of Its Power
Members of K-pop band BTS speak at a press briefing at the White House.
Commentary

Will Hallyu Swell to a Tidal Wave? Korea's Future as a Cultural Superpower

The Korean Wave, which has unique characteristics and continues to evolve in intriguing directions, could become a first mover on the global cultural scene.
Will Hallyu Swell to a Tidal Wave? Korea's Future as a Cultural Superpower
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The Center offers a suite of fellowships for Asia researchers to begin fall quarter 2023. These include postdoctoral fellowships on contemporary Japan and the Asia-Pacific region, inaugural postdoctoral fellowships and visiting scholar positions with the newly launched Stanford Next Asia Policy Lab, and fellowships for experts on Southeast Asia.

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