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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Dr. Shea will talk with us about her research on menopause and aging among Chinese women and issues surrounding romance, sex, and marriage in later life in mainland China, as part three of the colloquium series on "The Implications of Demographic Change in China," co-sponsored by the Stanford China Program and the Asia Health Policy Program. 

A sociocultural anthropologist who specializes in medical and psychological anthropology and Chinese culture, Dr. Shea's research interests include gender issues, health and healing, aging and the lifecycle, and intergenerational issues. She has spent three cumulative years living, studying, and doing research in the People's Republic of China.

Dr. Shea earned a B.A. in Asian Studies from Dartmouth College in 1989, followed by an M.A. and Ph.D. in Anthropology from Harvard University in 1994 and 1998.

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Jeanne Shea Associate Professor, Department of Anthropology Speaker University of Vermont
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Karen Eggleston
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The July/August issue of Health Affairs, the leading U.S.-based health policy journal, focuses on China and India. The special issue includes an article on China’s pharmaceutical policy by five contributors to Prescribing Cultures and Pharmaceutical Policy in the Asia-Pacific, a book forthcoming in 2009 from the Shorenstein Asia-Pacific Research Center series with Brookings Institution Press. Chapters on Korea and Japan by Soonman Kwon (Seoul National University) and Toshiaki Iizuka (Aoyama Gakuin University) also appear in Chinese translation in the journal Bijiao (Comparative Studies), along with an overview paper (“Pharmaceutical policy reforms to separate prescribing from dispensing in Japan and South Korea: Possible implications for China”) by Karen Eggleston, Asian Health Policy Program Director.

As Eggleston writes in the introduction to Prescribing Cultures, pharmaceuticals and their regulation play an increasingly important and often contentious role in the health care systems of the Asia Pacific.  For example, some economies such as China have extraordinarily high drug spending as a percentage of total health spending; India and a few others host thriving domestic pharmaceutical industries of global importance, while controversy surrounds patents, trade-related aspects of intellectual property (TRIPS), and pharmaceutical pricing within bilateral trade agreements (Australia-US, Republic of Korea-US); nations throughout the region struggle with appropriate regulation of drugs, from patents to evidence-based purchasing (e.g., Australia’s Pharmaceuticals Benefit Scheme) and direct-to-consumer advertising; deeply-rooted traditions of indigenous medicine are modernizing and integrating into broader health care systems; and policies to separate prescribing and dispensing re-write the professional roles of physicians and pharmacists, with modifications to accommodate cultural norms and strong economic interests. Effective prescribing and pharmaceutical use will be central to controlling infectious diseases, both old and emerging; protecting the global public good of antimicrobial effectiveness; and treating the growing burden of chronic disease in the Asia Pacific.

The forthcoming book will explore these issues in detail, through a multi-disciplinary lens. The first section of the book features chapters on pharmaceutical policy within seven selected health care systems of the Asia Pacific: South Korea, Japan, Thailand, Taiwan, Australia, India, and China. The second section focuses on the cross-cutting themes of prescribing cultures and access versus innovation. Taken as a whole, the contributions aim to provide an evidence base for policy while acknowledging the historical and cultural context that makes policies distinctive.

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Health Affairs 072008
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Clear evidence suggests the importance of health service provider payment incentives for achieving efficiency, equal access, and quality, including attention to primary, secondary, and tertiary prevention. “Pay for performance” may be on the cusp of significant expansion in Asia, and reform away from fee-for-service has been underway for several years in several economies. Yet despite the policy relevance, the evidence base for evaluating payment reforms in Asia is still very limited.

China in particular has been undertaking significant reforms to its health care system in both rural and urban areas. With the expansion of insurance coverage and need to resolve incentive problems like “supporting medical care through drug sales,” there is an urgent need for evaluating alternative ways of paying health service providers. Evidence from policy reforms in specific regions of China, as well as other economies of the Asia-Pacific, can provide valuable evidence to help inform policy decisions about how to align provider incentives with policy goals of quality care at reasonable cost.

To illuminate these questions, the Asia Health Policy Program and several collaborating institutions are planning to convene a conference on health care provider payment incentives on November 7-8, 2008 in Beijing. The conference will highlight and seek to distill “best-practice” lessons from rigorous and policy-relevant evaluations of recent reforms in China and elsewhere in the Asia Pacific.

The organizing committee – including health economists from Shorenstein APARC, Peking University, Tsinghua University, and Seoul National University – reviewed submissions in June 2008 and accepted sixteen. The conference papers cover payment issues in Korea, Japan, China, Taiwan, Thailand, Tajikistan, the Philippines, and the US, and the disciplines of economics, health services research/health policy, public health, medicine, and ethics. Topics include institutionalized informal payments; the impact of global budget policies on high-cost patients; public-private partnerships; public-sector physicians owning private pharmacies; evidence-informed case payment rates; payment and hospital quality; bonuses and physician satisfaction; physician prescription choice between brand-name and generic drugs; and differences in pharmaceutical utilization across insurance plans that pay providers differently (fee-for-service versus capitation).

Policymakers from China’s National Development and Reform Commission and Ministry of Health will also speak at the conference. Selected research papers will be published through the Shorenstein Asia-Pacific Research Center either in a special volume or in a special issue of an English-language health policy journal.

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Contradictory goals plague China’s pharmaceutical policy. The government wants to develop the domestic pharmaceutical industry and has used drug pricing to cross-subsidize public hospitals. Yet the government also aims to control pharmaceutical spending through price caps and profit-margin regulations to guarantee access even for poor patients. The resulting system has distorted market incentives, increased consumer cost, and financially rewarded inappropriate prescribing, thus undermining public health. Though pharmaceuticals account for about half of total healthcare expenditures in China, representing 43% of expenditure per inpatient episode and 51% of expenditure per outpatient visit, some essential medicines are unavailable or of questionable quality.

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John Morrison will give an overview of Sino-US cooperation on social insurance regulation
with a focus on health policy, as one window into Sino-US relations on the verge of the
Olympics.

Mr. Morrison is Montana Insurance Commissioner and Vice Chair of the National Association of Insurance Commissioners (NAIC) International Committee, in charge of cooperation with Asia. His talk will draw from his April visit to China with the NAIC President for bilateral meetings with the Chinese counterpart, the China Insurance Regulatory Commission (CIRC), as well as participation in the the US-China Insurance Dialogues with the US Trade Representative on May 15-16, 2008, in Hangzhou, PRC.

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John Morrison Insurance Commissioner Speaker State of Montana
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Postdoctoral Fellow in Asia Health Policy Program, 2008-09
Do.JPG MD, PhD

Young Kyung Do is the inaugural Postdoctoral Fellow in the Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center. He completed his Ph.D. in health policy and administration at the University of North Carolina at Chapel Hill School of Public Health in August 2008. He has also earned M.D. and Master of Public Health degrees from Seoul National University (in 1997 and 2003, respectively). He earned board certification in preventive medicine from the Korean Medical Association in 2004. His research interests include population aging and health care, comparative health policy, health and development, quality of care, program evaluation, and quantitative methods in health research.

He received the First Prize Award in the Graduate Student Paper Competition in the Korea Labor and Income Panel Study Conference in 2007. He also is the recipient of the Harry T. Phillips Award for Outstanding Teaching by a Doctoral Student from the UNC Department of Health Policy and Administration in 2007. In May 2008, he was selected as a New Investigator in Global Health by the Global Health Council.

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Teh-wei Hu is a Professor Emeritus of health economics at the University of California, Berkeley.  At Berkeley, he served as associate dean (1999-2002) and department chair (1990-1993) in the School of Public Health.  He received his PhD in Economics from the University of Wisconsin.  

During the past 40 years, Professor Hu has been teaching and conducting research in health economics, particularly in healthcare financing and the economics of tobacco control.  Hu was a Fulbright scholar in China. He has served as consultant or advisor to the World Bank, the World Health Organization, the National Institutes of Health, the Institute of Medicine, the Rand Corporation, the Ministry of Health in the People's Republic of China, Department of Health and Welfare in Hong Kong, Department of Health in the Republic of China (Taiwan), and many private research institutions and foundations. 

Professor Hu will speak to us immediately after an April trip to China, sharing his research and perspectives on the economics of tobacco control and the debate about healthcare system reforms in China (including a possible link between the two through financing expansions in coverage through increased tobacco taxation).

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Teh-wei Hu Professor Emeritus Speaker University of California, Berkeley, School of Public Health
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The Asia Health Policy Program of the Shorenstein Asia-Pacific Research Center invites scholars from multiple disciplines to join the Asia-Pacific Health Policy Forum (APHPF) by creating your own account on our website.  Your information will be saved in our online database, searchable by name, country or region of focus, discipline, and topic.  

The mission of the Asia-Pacific Health Policy Forum (APHPF) is to serve as a resource for social science research, teaching, and evidence-based policymaking about health and healthcare in the Asia-Pacific region. 

Specifically, APHPF aims to

  • encourage collaboration among social scientists doing research on health policy in the Asia-Pacific region;
  • serve as a resource for teaching about health and healthcare in specific countries and regions within the Asia-Pacific;
  • provide analysis to inform policy, by offering a forum for rapid dissemination of policy-relevant research results, as well as by linking organizations, programs, conferences and white papers about specific health policy issues; and
  • raise awareness and foster dialogue among researchers, policymakers, and business about cross-cutting themes and global challenges of health and healthcare access, quality, and cost, within the specific historical and cultural contexts of the diverse nations of the Asia-Pacific. 

We encourage all researchers with an interest in health and healthcare in the Asia-Pacific to create an account and to submit information about upcoming conferences and sessions within larger disciplinary conferences that focus on any aspect of health policy in the Asia-Pacific to the Forum coordinator, Karen Eggleston

There are no membership dues, as the Forum is currently supported by the Asian Health Policy Program of the Shorenstein Asia-Pacific Research Center at Stanford University.

The Asia-Pacific Health Policy Forum represents a multidisciplinary effort to build organizational linkages and work toward developing an Asia-Pacific parallel to the European Observatory on Health Systems and Policy.

With your help, the APHPF can develop into a vibrant resource and networking support for all of us seeking to understand and improve health and healthcare systems in the region.

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The Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center is pleased to announce that Dr. Young Kyung Do has been awarded the %fellowship1% for 2008-2009.

Dr. Do is currently completing his Ph.D. in health policy and administration at the University of North Carolina at Chapel Hill School of Public Health. He is particularly interested in policy challenges associated with rapid population aging in East Asia. His dissertation examines informal care in South Korea and its effects on health care use and caregivers’ labor force participation. Dr. Do has also earned M.D. and Master of Public Health degrees from Seoul National University (in 1997 and 2003, respectively). He earned board certification in preventive medicine from the Korean Medical Association in 2004. While at the University of North Carolina at Chapel Hill, Dr. Do has participated in several research projects and published collaborative research on topics ranging from methodology for causal inference to empirical analysis of disparities in health care use.

While at Shorenstein APARC, Dr. Do will undertake comparative study of public long-term care insurance in Japan and South Korea. He will also begin comparative empirical analysis of the effect of long-term care insurance on informal caregiving, elderly health care, and informal caregivers’ labor force participation in Japan and South Korea. Dr. Do will work closely with the Center’s program on Asian health policy on such activities as the colloquium series on health and aging in the Asia-Pacific and an “Aging Asia” conference.

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