Elections
Paragraphs

According to hitherto available data, health expenditures in Pakistan are relatively low in international comparison. Data1F published by the World Health Organization (WHO) for the year 2005 shows a lack of Pakistani health expenditures in most indicators, compared to other low-income countries (LIC). To answer the question whether these results reflect the real situation in Pakistan or whether they exist due to statistical problems, Pakistan, for the first time, developed its National Health Accounts (NHA) in 2009. Only the availability of good estimates of health expenditures allows for evidence-based policymaking and therefore good governance.

The results clearly indicate that the situation in Pakistan is better than what was earlier estimated; however, the total health expenditure (THE) is still low compared to neighboring countries and other LIC. As a result, it is clear that the WHO health expenditure figures for Pakistan are understated, because they mainly comprise public and household out-of-pocket expenditures on health. Expenditures of many other entities, like military, cantonment boards, autonomous bodies, private hospitals, and so on, have not been taken into account in earlier estimations. Therefore, expenditure figures of NHA Pakistan are higher than those of WHO. Overall, the official NHA results show that THE is 27 percent higher than the WHO figure.

Furthermore, this paper cross-checks NHA results with other already available data sources on household expenditure. This comparison includes preliminary results of the Family Budget Survey (FBS), which also includes health items as well as National Accounts (NA) data. In line with this comparison, we calculate a raising factor that can be used for the adjustment of NHA results according to NA. The raised NHA result shows 102 percent higher out-of-pocket (OOP) spending on health; this would result in OOP health expenditures of $25.15 USD per capita (compared to only $12.45 USD per capita in the NHA estimation). This result, based on the NA figure with $33 USD THE per capita, leads to a different evaluation in international comparison, since it nearly reaches the level of India, with $37.5 USD and more than the average of all LIC with $27 USD.

All Publications button
1
Publication Type
Working Papers
Publication Date
Journal Publisher
AHPP working paper #14
Authors
Paragraphs

China is transforming itself, and the world is adapting in response. Profound forces have reshaped the country's socioeconomic and political landscapes, but they have also brought challenges—growing pains—that China must face if it is to continue its upward trajectory.

Despite its successes, China is experiencing sharp growing pains. Rising levels of protest have accompanied the country's wrenching structural transformation. Corruption has prompted some observers to claim that the Chinese government is nothing short of a "predatory state." Legal reform continues to languish. Given that such challenges remain, can it be said that China's structural changes have succeeded? Or is the country trapped in transition?

"Growing Pains deserves the attention of every scholar interested in contemporary China." -Scott Kennedy, Indiana University

Growing Pains contains new analytical and empirical research from preeminent scholars working on contemporary China. These scholars identify which of the many problems thought to threaten China's reforms are not as serious as some interpreters claim, as well as those that have already been solved. Further, they point to other high-profile challenges, some of which truly are serious and loom on the horizon. With thoughtful, nuanced analysis, the contributors tackle thorny issues in China's ongoing reforms—employment, land policy, village elections, family planning, health care, social inequality, and environmental degradation—and use rich survey data and on-the-ground observation to assess the severity of the problems and the likelihood of near-term solutions.

Moving beyond the hype and hysteria that often characterize conversations about contemporary China, Growing Pains seeks to present not an optimistic or pessimistic perspective but rather an objective, empirically based view of the country's transition.

Examination copies: Desk, examination, or review copies can be requested through Stanford University Press.

All Publications button
1
Publication Type
Books
Publication Date
Subtitle

Tensions and Opportunity in China's Transformation

Authors
Jean C. Oi
Scott Rozelle
Xueguang Zhou
Book Publisher
Shorenstein APARC
Paragraphs

Objective: To show the pattern of patient satisfaction with top-level delivery organizations (Level 2 and Level 3 hospitals), and using neo-institutionalism approach to explain the relatively low satisfaction and to explore the limitations with top providers, focusing on how to improve the competence of Level 2 and Level 3 hospitals at both the individual hospital level and the whole delivery system level.

Data Sources/Study Setting: The household survey by the National Bureau of Statistics in China in 2008; China Health Statistics Yearbooks.

Data Collection/Extraction Methods: The analysis uses a 2008 sample medical experiences of 5,036 residents from 17 provinces collected in a household survey by the National Bureau of Statistics in China. The linear regression model, the structural difference regression model, and the ordered probit model are used in our framework.

Principal Findings: The imbalance between the needs of patients and the limited competence of top-level providers, and the conflict between the business expansion and the limited competence of those providers are deeply and widely influenced by patterns of patient needs, the top providers’ expansion, and the institutional environment.

Conclusions: In order to effectively respond to patient needs, top and lower level providers need to set their own individual priorities. The government needs to improve institutional arrangements to respond to patient needs with the development of a fair and appropriate reimbursement and compensation pricing mechanism, and with further evaluation of top level providers’ advanced and limited health services.

All Publications button
1
Publication Type
Working Papers
Publication Date
Journal Publisher
Asia Health Policy Program working paper #19
Authors
Qunhong Shen
-

After the Sichuan 5.12 earthquake, many people in the disaster area suffered from mental health problems. To decrease morbidity from mental disease, the Sichuan authorities worked with diverse hospitals to establish a “three-level network of psychiatric prevention and treatment.” The goal was to disseminate knowledge about prevention and treatment for psychiatric conditions from doctors to recipients, especially regarding symptoms. How to disseminate such knowledge effectively and efficiently deserves study. Based on a sample of 146 doctor-recipient pairs from 52 hospitals in diverse areas of China (including Sichuan, Beijing, and Guangzhou), this study examines the impact of knowledge characteristics, the network status of the doctor, the network status of the hospital with which the doctor is affiliated, and the relationship quality between doctor and recipient on the effectiveness and efficiency of knowledge transfer from the doctor to patient. Findings indicate that high-status doctors are more effective in knowledge transfer. In addition, low-status hospitals were found to have a positive effect on knowledge transfer efficiency. In particular, results highlight the strong positive impact that the quality of the relationship between the doctor and patient has on both the efficiency and effectiveness of knowledge transfer. Finally, findings suggest that the relationship between knowledge characteristics and knowledge transfer is partially mediated by the relationship quality between the doctor and the recipient.

Philippines Conference Room

Shorenstein APARC
Stanford University
Encina Hall E301
Stanford, CA 94305-6055

(650) 723-9741 (650) 723-6530
0
Visiting Scholar, 2009-2011
1050-5.JPG PhD

Zhe Zhang is an assistant professor of organization management at the School of Management, Xi'an Jiaotong University, China, where she also received her PhD. Her research focuses on public-private partnerships, corporate governance, and corporate social responsibility. She has published in the Journal of High Technology Management Research, International Journal of Health Care Finance & Economics, Management and Organization Review, and the International Journal of Networking and Virtual Organizations.

(Amy) Zhe Zhang Visiting Scholar, 2009-2011 Speaker Shorenstein APARC
Seminars
News Type
News
Date
Paragraphs
In September 2009, President Barack Obama's administration announced a new U.S. policy direction for relations with Burma/Myanmar. Over the past year, this new course has moved the United States away from previous efforts to isolate Burma's ruling generals, balancing economic sanctions with "pragmatic engagement." Against this backdrop, the Asia Society established a task force on U.S. Policy toward Burma/Myanmar to provide concrete recommendations for how the United States could best approach this new path of engagement. The task force released its policy recommendation report in March 2010. With elections set to be held in Burma on November 7 for the first time in 20 years, the Asia Society has released a task force report update, which provides an overview of key developments that have unfolded during recent months. Donald K. Emmerson, director of SEAF, is a member of the task force.
Hero Image
Emmerson Op EdWeb1
All News button
1
Paragraphs

Since 1978, China has been primarily market-focused in its provision of health care and social services. The market-driven health care system has been characterized by perverse incentives for individual providers, patients, and hospitals that are inducing improper provision of care: overprescription of pharmaceuticals and high-tech testing, lack of effective primary care and gatekeeping, and competition for patients instead of referral. The national health care reform document that was made public in April 2009 recognizes this failure of the market in health care in China. The document suggests potential policies for improvement on the current system that are focused primarily on a targeted increase in government funding and an increased, changing role for the government. We assess the potential of this national health care reform to achieve the stated goals, and conclude that the reform as designed is necessary but insufficient. For the reform to meet its goals, the promised increase in funding should be accompanied by improved data collection, regional piloting, and a strong regulatory and purchasing role for the government in aligning incentives for individual and institutional payers, providers, and patients.

All Publications button
1
Publication Type
Working Papers
Publication Date
Journal Publisher
Asia Health Policy Program working paper #18
Authors
Authors
Donald K. Emmerson
News Type
News
Date
Paragraphs

The United States and the ASEAN group of nations have further strengthened political, economic and security ties, after their second full-scale summit in New York.

President Barack Obama said the Association of Southeast Asian Nations, which groups ten countries, had the potential for true world leadership. President Obama also made it clear that he saw Asia as a vital plank of US foreign policy.

DR EMMERSON: In the run-up to the summit, there was a big question. Would the partnership be declared as being strategic in nature? That was a key word in the discussion and what happened was the leaders basically finessed the issue. It's not hard to suspect that they worried that if they declared a strategic partnership with the United States, this would cause alarm in Beijing. Because let's remember in the run-up to this summit, we've had a lot of activity - the split between China and Japan over the disputed islands, one could continue with some evidence of a more muscular Chinese foreign policy, its commitment to its claim to possess basically the entire South China Sea, escalating that to the level of a core interest, presumably equivalent to their interest in recovering Taiwan. I could go on, but in many case, it was understandable that the subtext of the meeting was what will China think? So basically what the summit did was to finesse the issue. They decided to pass on the question of raising the partnership to quote - a strategic level - unquote, to the ASEAN US Eminent Persons Group, presumably expert advisors that would be convened and would make recommendations down the road.

And one of the most remarkable things about the statement was how much ground it covered. I mean, among the topics and issues that the leaders committed themselves to do something about, were 14 as I count them, 14 different subjects. Human rights, educational change, trade and investment, science, technology, climate change, interfaith dialogue, disaster management, illicit trafficking, international terrorism, I could go on. So it is clear to me that one of the tasks that ASEAN and the US will have to face in the coming months, is to try to insert some sense of priority.

LAM: On that issue of priority, the US President, Barack Obama, of course, postponed a couple of visits to Indonesia due to pressing domestic demands. Did he in anyway express American commitment to the ASEAN region?

DR EMMERSON: Yes, this was particularly kind of, I suppose you could say, evident in the fact that the meeting occurred at all, finally it was organized. It lasted two hours. He was apparently quite engaged and engaging during that period of time. And I think there is no question that the United States under his administration is committed to South East Asia as a region, indeed has agreed with the leaders of ASEAN, that ASEAN should play a central role in the process of building regional cooperation in East Asia.

LAM: And, of course, one of the topics that came up as well was the South China Sea, that entire region, given the competing maritime and territorial claims vis-à-vis the Spratley and Paracel Island groups. Do you think China is watching the US relationship with ASEAN, this growing relationship - do you think Beijing might be watching it with unease?

DR EMMERSON: Yes, absolutely. I am confident that they are watching it with considerable unease and I note that the statement that the leaders made, made no reference whatsoever to the South China Sea, presumably because of sensitivity with regard to Beijing's possible reaction. The topic was implicitly mentioned, but not explicitly.

LAM: And what about within ASEAN, the grouping itself? The UN Secretary-General, Ban Ki-moon, on the weekend said that the ASEAN nations' credibility might suffer if they did not take a tougher line with Burma and this is in view of the upcoming elections in November. This is presumably directed at specifically China and India, but it could also be referenced to ASEAN could it not, because Burma is a member of ASEAN. Do you see that changing anytime soon with ASEAN, that ASEAN countries, leading members like Indonesia, Malaysia, Singapore, that they might take a stronger stand with the military junta in Rangoon?

DR EMMERSON: The election in Myanmar, if I can call it an election, since it will be highly compromised and manipulated will take place, at least is scheduled to take place November 7th. Indonesia does not take over the chairmanship of ASEAN until the 1st January. So the question is, since Indonesia is a democratic country, arguably, the most democratic of any country in South East Asia, will it use its opportunity to try to put pressure on Burma in the year 2011? My own view is that ASEAN will probably not fulfill Ban Ki-moon's hope, will not exercise significant pressure on the junta. Instead, we could get the opposite situation in which so long as there is not major violence associated with the election, it will essentially be received by ASEAN as a kind of minimally-acceptable basis for assuring the Burmese junta that ASEAN still treats them as a full member. In other words, it's quite possible that the junta may get away with what I take to be a kind of facade effort to legitimate their rule.

Hero Image
D Emmerson headshot2
Donald K. Emmerson, director of the Southeast Asia Forum
All News button
1
Authors
News Type
News
Date
Paragraphs

The ‘fair society' motto has been the centerpiece in the second half of the Lee Administration.

-Gi-Wook Shin, director of Shorenstein APARC and KSP


On August 8, 2010, South Korean President Lee Myung-bak put into place the largest cabinet reorganization since he took office, nominating 48 year-old Kim Tae-ho as prime minister. However, after only 21 days, failing to pass a confirmation hearing of Parliament, Kim Tae-ho took the initiative to declare his resignation while waiting for Parliament to take action following the vote on his prime minister nomination. South Korea's prime minister [post] is without any real power; however, with a high parliamentary status, it is also in reality an important auxiliary to the president. Now into the second half of Lee Myung-bak's term, confronted with the dilemma of needing to identify a prime minister for a fourth time, one cannot help but raise the question: what is going on with South Korean politics?

The ruling Grand National Party hoped to pariah Kim Tae-ho, who in the prime of life, would have been able to give Li Myung-bak's government an infusion of "reform," "communication," and a "fresh" approach, but the opposition party also questioned Kim Tae-ho's political qualifications. From August 24-25, when the Parliament confirmation hearings convened, the Democratic Party also threw in several heavy accusations-Kim Tae-hoe's receiving bribes and illegal loans to raise campaign funds, having a public bus for his personal use, ordering full-time civil servants to do housework, and his wife accepting bribes and improperly managed properties-and strongly opposed Kim Tae-ho as Prime Minister. Gi-Wook Shin, director of Stanford University's Shorenstein Asia-Pacific Research Center, says: "These allegations are not new. Though the prosecution has cleared Kim of bribery charges, I think the fact that he lied about his ties with Park Yeon-cha, a convicted businessman at the center of a high-profile bribery scandal, was the last straw. A photo also surfaced after the hearing showing Kim standing next to Park at a date several months earlier than Kim testified to having made his first acquaintance with Park." Park Yeon-cha is the former chairman of Taekwang Industrial. By the end of 2008's "Park Yeon-cha Gate" [scandal], numerous South Korean political figures were involved in the bribery scandal,  and former President Roh Moo-hyun also committed suicide.

"Kim Tae-ho's ambiguous statements have also left the ruling party and the public feeling disappointed. Kim Tae-ho was not widely known outside of his South Gyeongsang Province office. President Li Myung-bak praised him to South Korean society for being young, for having strength and charisma, and for being an honest, reliable politician. Now voters naturally are questioning his integrity and this has become a barrier for Lee Myung-bak's administration," says Dr. Insung Lee, director of Yonsei University's East Asia International Studies Institute.

Kim Tae-ho believes there are some accusations that are not very fair. Dr. Shin suggests: "What Kim meant by "unfair" was the fact that his confirmation hearing focused in large part on making personal attacks on Kim, and throwing harsh criticism of the ruling party, rather than serving its purpose to prove he was unqualified for the PM position." This no doubt exposed the intense power struggle between South Korea's political factions, and even differences within the Grand National Party.

"Lee Myung-bak should not introduce the subject of Kim Tae-ho when talking about matters of the next presidential election," says Dr. Lee. In 2004, Kim was elected governor of South Gyeongsang Province, becoming the youngest governor. During the time that he was the provincial governor, he actively promoted the "South Coast Sunbelt" development plan as a national project. Through word of mouth, he easily won the 2008 local government re-elections. According to the Constitution, Lee Myung-bak is unable to run for president again. Because of this, public opinion holds that he had the intention to train Kim Tae-hoe for the 2012 presidential candidacy. "The opposition party members at the hearing increasingly attacked Kim Tae-ho, in part to prevent this kind of arrangement from taking place," says Dr. Lee.

Dr. Chung-In Moon, professor of political science at Yonsei University pointed out: "People believe that Lee Myung-bak selected Kim Tai-ho to compete in the 2012 general election against in-party rival Park Geun-hye. Since this card is obsolete, Lee Myung-bak now cannot help but stand with Park Geun-hye. I cannot decide for certain how long this will last-the Lee camp will certainly find their own candidate." The internal struggle between the Grand National Party's inner factions was exposed in the battle of the recent Sejong City construction plan amendment. Park Geun-hye, the daughter of the leading "Second Faction's" former president Park Chung-hee, publicly sang a different tune towards Lee Myung-bak, displaying a hope to follow up with the plan to promote the construction of Sejong City. At the time of Parliament's vote, 50 of the ruling party's 168 members voted against the pro-Park opposition party. After former Prime Minister Chung Un-chan announced he would resign, Park Geun-hye raised the issue, holding Lee Myung-bak to be the primary lead of the Sejong City amendment and the one who should bear the responsibility.

On the day that Kim Tae-ho made his declaration to resign the prime minister nomination, those nominated to be the Minister of Culture, Sports, and Tourism and Minister of Education and Economics, also took the initiative to resign because of the suspicion of having accepted bribes. After several days, Foreign Minister Yu Myung-hwan was also forced to resign due to the incident of his daughter's receiving "special admission" to become a senior civil servant. President Lee Myung-bak expressed: "I accept their resignation. I believe this will lead to the starting point of a fair society." Dr. Gi-Wook Shin believes: "The 'fair society' motto has been the centerpiece in the second half of the Lee Administration. As President Lee said in his liberation day speech in August 2010, 'A fair society is where each individual has to take responsibility for the outcome of his or her undertakings . . . A fair society constitutes the ethical and practical infrastructure for the advancement of the Republic.' To this effect, Lee reportedly instructed his secretariat to toughen the screening of ethical backgrounds of candidates for top government posts. Putting emphasis on higher ethical and moral standards can be seen as a positive sign of Korea's democratic advancement. It is not the only measure, but it is also an important measure for the betterment of South Korean politics."    

Translation by Sarah Lin Bhatia

 

 

 

Hero Image
SeoulBlueHouse2
All News button
1
Subscribe to Elections