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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.

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Donald K. Emmerson, director of the Southeast Asia Forum
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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

 

 

 

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Daniel and Nancy Okimoto Conference Room

Daniel Sneider Speaker
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The Republic of the Philippines began on the path to universal coverage with the passage of the National Health Insurance Act of 1995 (Republic Act 7875) which established the Philippine Health Insurance Corporation (PhilHealth) . Building on the Philippine Medicare program which began in 1971, PhilHealth has expanded coverage to more than 80% of the population with basic benefits, but accounts for only 10% of total health financing—wide population coverage with thin public benefits. An extensive system of private insurance provides additional benefits for high-income Filipino households. While the Philippines is pursuing a public insurance approach with private add-ons, Hawaii has mandated private employment-based coverage through the Pre-paid Health Care Act of 1974 and operates under a Congressionally granted ERISA exemption as well as an exemption from the Affordable Care Act of 2010. Combining the employer mandate with generous Medicaid and SCHIP programs, Hawaii has achieved a coverage rate exceeding 90% of the resident population with extensive benefit packages. The presenter will provide an overview of the two systems and present original research on the labor market effects and public insurance effects of the Hawaii system.

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Dr. Gerard Russo Associate Professor of the Department of Economics and Adjunct Fellow, East-West Center, Research Program Speaker University of Hawai'i at Manoa
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The Democratic Party of Japan (DPJ) lost the majority of seats in the upper house of parliament in nationwide elections on July 12, 2010. Daniel C. Sneider discusses implications for Japan's foreign policy following the election, particularly with regard to Japan's relationship with the United States.

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The Chinese health care system has experienced profound changes like retrenchment of state financial support in the past decades. These changes have prompted the Chinese media and some academics to suggest that patients have a relatively low level of trust in physicians in today's China. In this colloquium, Dr. Tam reports the results of his survey of patient trust in physicians in Beijing's public hospitals. The survey was conducted by Horizon Research Group between November 2009 and January 2010, and 434 patients were interviewed.
 
The survey asked the respondents their degree of trust regarding the following three dimensions: physician agency, competence, and information provision. The survey finds a relatively high level of patient trust in physicians in Beijing public hospitals. Additionally, the survey data highlight three major determinants of patient trust in physicians, namely exposure to negative media reports about physicians and hospitals; the patient's self-assessed health status; and the patient’s level of education and income.
 
Waikeung Tam received his Ph.D. in political science at the University of Chicago in 2009. He is currently a Research Fellow at the LKY School of Public Policy at the National University of Singapore. His research focuses on public policy, political development, law and society, with special reference to China and Hong Kong. His research has been published in China Review, Asian Perspective, Journal of Contemporary Asia, and Law & Social Inquiry.

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Waikeung Tam Speaker National University of Singapore
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Donald K. Emmerson
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How does a corrupt government stop corruption? What if that government is democratic, and must cultivate the support of political parties that are themselves corrupt? Is fostering reform in such a political economy the equivalent of trying to make snow in hell?

These questions may be overstated, but the dilemmas they convey are all too real. Witness the storm of concern triggered by the recent resignation of the highest-profile reformist in Indonesia, Sri Mulyani Indrawati, from her linchpin job as minister of finance in a country that was ranked the most corrupt and the most democratic in Southeast Asia in 2009.

Sri Mulyani waged unremitting war on graft. Under her stewardship of the finance ministry, more than 150 of its personnel were dishonorably discharged. Nearly 2,000 more were otherwise punished for infractions. She led a vigorous campaign against tax cheats. Among them were rich and influential people who had grown accustomed to absconding with funds they owed the government.

Euromoney named her ‘finance minister of the year’ in 2006—a post she had only taken up the year before. In 2008 and again in 2009 Forbes magazine admiringly listed her among ‘the 100 most powerful women in the world.’ Correspondingly, on the heels of her resignation on 5 May 2010, Indonesian stocks and rupiahs fell.

Indonesian president Susilo Bambang Yudhoyono (SBY) was directly elected to that office in 2004 and, for a second five-year term, in 2009. As president he has opposed corruption and championed reform. Fatefully, however, in 2004 he chose a wealthy businessman, Aburizal Bakrie, to join his government as coordinating minister for the economy.

In 2006 in East Java, a Bakrie-controlled company using an unprotected drill while probing for gas may have triggered a mud volcano that would swallow more than a dozen villages and render more than 15,000 people homeless. In 2010 the volcano continued to spew an estimated 100,000 tons of mud daily onto the surface. Bakrie’s reputation for probity was not enhanced when, reportedly against Mulyani’s advice, he insisted on denying responsibility for the disaster. Instead he blamed an undersea earthquake that had struck off the south coast of Java, some 250 kilometers away, two days before the mud erupted. Opinions remain divided as to what caused what.

An unambiguously man-made crisis in 2008, the global financial meltdown, shrank the Jakarta stock market, Bakrie’s holdings included. Trading on the exchange was temporarily suspended. Bakrie urged his fellow cabinet member Mulyani to extend the suspension. She refused. He was furious. Her relations with him worsened further when she slapped travel bans on certain Bakrie company executives accused of tax evasion.

In 2009 Bakrie became chair of the Golkar Party. Toward the end of that year he led a fierce campaign in the Indonesian legislature against both Mulyani and another nonpartisan technocrat, Indonesian vice-president Boediono, for malfeasance related to the government’s decision in 2008 to rescue an ailing financial institution, Bank Century. The bailout may have prevented a spiral of withdrawals, and thus helped Indonesia weather the global crisis, but the effort cost far more than expected, and some of the infusions apparently benefited key depositors more than the bank itself.

Legitimate financial questions were soon superseded, however, by a thoroughly political effort on the part of politicians and their supporters opposed to Mulyani and her reforms to oust not only her but the vice-president as well. Mulyani’s and Boediono’s opponents included, in addition to Bakrie, others whose circumstancial links to corruption she had uncovered.

An anti-Mulyani case in point is the Justice and Welfare Party (PKS). Despite priding itself on upholding Islamic ethics and opposing corruption, the PKS rejected allegations that one of its legislators, Muhammad Misbakhun, could have been implicated in a fictitious Bank Century letter of credit for US $22.5 million. When, at the end of April 2010, Misbakhun was arrested and detained on a warrant signed by the national police official in charge of economic and tax crimes, PKS leaders accused the police of having an ulterior motive. The party had by then, in effect, joined the anti-Mulyani chorus.

Subjected to intense and prolonged criticism by these politicians in the glare of the media, Mulyani had ample reason to quit the spotlight, resign, and leave Indonesia. (On 1 June 2010 she will become a managing director of the World Bank in Washington DC.) But her long record of nonpartisan tenacity in the struggle against corruption makes it hard to believe that she simply lost her will to fight. For the time being it is impossible to rule out that she was sacrificed for the sake of a restoration of political comity between SBY and his opponents.

The irony is that Golkar and the PKS had joined with SBY’s Democrat Party to form a ruling coalition, to which they continue to belong. SBY had built that coalition with the expectation that its members, having joined the government, would support it, including its campaign against corruption.

That inclusive or ‘rainbow’ strategy was a triple failure. First, cabinet posts that might have been held by competent and ethical nonpartisans motivated by a desire for public service were allocated instead to partisans whose skills and motives, shall we say, varied. Governance suffered. Second, coalition-party leaders who were given ministerial posts in return for ensuring broad legislative backing for the government in the legislature either would not or could not deliver that support. Cooptation failed. Third, some ruling-team politicians, who might have at least stood back from the fray, instead jumped in, seemingly hoping to blunt the government’s efforts to diminish corruption and improve governance while protecting themselves and furthering their own careers. Discipline frayed.

Mulyani has resigned. Has Bakrie won?

In a recent conversation, an off-the-record analyst anticipated ‘more stability, which, in Indonesia, correlates inversely with reform.’ He could be wrong. But it may not be coincidental that on 6 May 2010, one day after Mulyani announced her resignation, SBY met with ruling-coalition leaders. Or that the meeting launched a Coalition Parties Forum whose daily activities will be led by none other than the chair of the Golkar Party, Aburizal Bakrie. Or that Bakrie reported that SBY had agreed that the Forum would not try to bind the coalition to a common position. Or that, again according to Bakrie, whereas previously the coalition parties were only asked to help safeguard the government’s policies, henceforth they would be asked to help determine them as well. Much will depend on Mulyani’s replacement as minister of finance, and on whether he or she is told to stop rocking the boat.

If Mulyani’s remarkable legacy is indeed erased, illiberal circles in Singapore may think, ‘We thought so. Democracy does thwart reform.’ But my own judgment in hindsight will be less sweeping.

Indonesia’s Democrat Party is still basically an extension of the appealing personality of SBY. Over the six years since he was first elected president, more time, energy, and resources could have been invested in deepening the roots and popularity of the party itself. Had those assets been so spent, the Democrats might have been able, in the legislative elections of 2009, to enlarge their contingent of lawmakers enough to be able to rule, not by the dubious grace of Sri Mulyani’s antagonists, but in SBY’s and his party’s own right—subject to democracy’s checks and balances, yes, but freed of the need to cobble together a coalitional rainbow of colors that clash.

Donald K. Emmerson heads the Southeast Asia Forum at Stanford University and is also the editor of Hard Choices: Security, Democracy, and Regionalism in Southeast Asia. (Stanford/ISEAS, 2008/9)

A heartening number of analysts helpfully commented on an earlier draft of this essay.  While protecting their privacy by not naming them, I am grateful to them.  Complementing my focus here on the politics of Sri Mulyani’s exit is the economic context ably reviewed by Arianto A. Patunru and Christian von Luebke in their ‘Survey of Recent Developments’ in the Bulletin of Indonesian Economic Studies, 46: 1 (2010, 7-31.)

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What explains the recent large swings in the behavior of Japanese voters? Last August, for the first time in the post-WWII era, Japan's leading political party, the Liberal Democratic Party, lost power, making way for a new DPJ government. During the preceding months leading up to the lower house elections in August 2009, popular media coverage pointed to fundamental structural changes in the Japanese political economy as the underlying causes for changing voter preferences. To what extent can structural changes in the economy and society explain changing voter behavior and electoral outcomes? Japan's two decade old stagnating economy, rapidly graying society, and post-industrial advanced economic structure provide an ideal case for studying this question. Using both national and sub-national level data spanning two decades, we test both popular theories and conventional wisdom about the political effects of a graying society, widening income disparities, and industrial structural change.

Kay Shimizu is an Assistant Professor in the Department of Political Science at Columbia University. She received her undergraduate degree and PhD in political science from Stanford University (2008). Her research concerns the political economy of Japan and China, with a focus on fiscal politics, central local relations, and the politics of economic structural change. Her book manuscript, Private Money as Public Funds: the Politics of Japan's Recessionary Economy, examines the role of private financial institutions in Japan's political struggles to adjust to a changing economic and demographic landscape. She is on leave during the 2009-2010 academic year as an Advanced Research Fellow at the Weatherhead Center for International Affairs Program on US Japan Relations at Harvard University.

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Kay Shimizu Assistant Professor, Political Science, Columbia University (currently on leave) & Advanced Research Fellow, Weatherhead Center for International Affairs Program on US Japan Relations, Harvard University Speaker
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Karen Eggleston
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In early spring, historic health reform passes, extending insurance to millions of uninsured. Despite problems with workplace-based coverage, controversy over government subsidies for insurance premiums, and disparities across a large and diverse nation, dramatic shift to a single-payer system was seen as impractical.

Instead, reforms focus on expanding current social insurance programs as well as new initiatives to cover the uninsured, improve quality, and control spending. They provide a basic floor, subsidized for the poorest, but preserve consumer freedom to choose in health care. No government body dictates choice of doctor or hospital; investor-owned and private not-for-profits compete alongside government-run providers like community health centers and rural hospitals.

Left to be addressed in later phases are the difficult questions of how to slow the relentless pace of health care spending increases -- driven in part by technological change and population aging, but also perverse incentives embedded in fee-for-service payment and fragmented delivery. Pushed through despite multiple crises confronting the leadership, the final landmark health reform works in conjunction with measures enacted as part of the fiscal stimulus package to strengthen the healthcare system. Some provisions take effect immediately; others will take many years to unfold.

President Obama’s triumph on his top domestic priority? Actually, there were no votes along partisan lines, no controversy over abortion. I am describing health reform in China, which was announced almost exactly a year ago.

We do not hear much about the parallels in the US and Chinese social policy. But we cannot fully understand each other if we ignore these commonalities. We do not hear much about those who, in both societies, have been rendered destitute merely because they or a family member became sick or injured in a system with a social safety net full of gaping holes.

It will surprise many Americans to know that government financing as a share of total health spending was lower in socialist China over the last decade than in the United States. Now China has pledged about US$124 billion over 3 years to expand basic health insurance, strengthen public health and primary care, and reform public hospitals.

In China, the injustice of differential access to life-saving healthcare had sparked cases of social unrest. The April 2009 reform announcement was the culmination of years of post-SARS (2003) soul searching for a healthcare system befitting China’s dynamically transforming society. Special interests block change. (Sound familiar?) The CPC Central Committee and the State Council acknowledge that successful health reform will be “an arduous and long-term task”.  

If the US can pass sweeping health reform despite an unprecedented financial crisis, and China can envision universal health coverage for 1.3 billion while “getting old before getting rich,” then together we should be able to look past our many differences to focus on our common interests. Our two proud nations must work together to confront numerous challenges, such as upholding regional stability (e.g. on the Korean peninsula); redressing global economic imbalances (increasing health insurance can help spur China towards more domestic consumption); and investing in “green tech” for a warming planet and “grey tech” for an aging society.

 

* * *

When searching for insights about how other countries deal with similar challenges, Americans often look to Europe and Canada. Rarer is the comparison to counterparts across the Pacific. Yet President Obama has clearly articulated the vision of the US as a Pacific Nation, and there are developments around the Pacific Rim that merit consideration in our debates.  

Australia pioneered cost-effectiveness in health care purchasing, while the US continues to debate whether cost should be part of comparative effectiveness research and policy decisions.

Both Japan and South Korea, like Germany, have enacted long term care insurance to smooth the transition to an aging society. Their experiences might be fruitful as we implement the first national government-run long-term care insurance program, a little-heralded component of the newly passed legislation (and a fitting legacy of Senator Edward Kennedy).

Japan and Singapore provide universal coverage to older populations than ours with health systems that, although surprisingly different from each other in terms of public financing and role of market forces, both ranked among the best in the world -- and far higher than the US -- in the World Health Organization’s ranking of health systems in the year 2000. Although one may quibble with the ranking, it is indisputable that Japan spends a much smaller share of GDP on healthcare than the US does, despite being one of the oldest and longest-lived societies in the history of the world and having (like the US) a fee-for-service payment system.

Japan and South Korea are also democracies, where health policies occasionally engender heated debates. In South Korea, physicians went on nationwide strike three times to oppose the separation of prescribing from dispensing. Although Japan’s incremental reforms rarely spur such drama, the passions aroused by end-of-life care – embodied in the bizarre “death panels” controversy in the US health reform debate of 2009 – has its counterpart in the bitter nickname for Japan’s separate insurance plan for the oldest old: “hurry-up-and-die” insurance.

Yet Japan, Singapore, and Hong Kong all offer health systems that provide reasonable risk protection and quality of care for populations older than ours, with a diverse range of government and market roles in financing and delivery, while spending far less per capita than the US.

No system has all the answers. But the US and our neighbors across the vast Pacific have a common interest in sharing what we’ve found that works for health reform. Despite divergence in our political and economic systems, we all value long, healthy lives for ourselves and our children -- and we’re united in health reforms that try to further that goal.

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Background: The literature comparing private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from high-income and established market economies. Studies from developing and transitional economies remain scarce, especially regarding patient case-mix and quality of care in public and private hospitals, even though countries such as China have expanded a mixed-ownership approach to service delivery. The purpose of this study is to compare the operations and performance of public and private hospitals in Guangdong Province, China, focusing on differences in patient case-mix and quality of care.

Methods: We analyze survey data collected from 362 government-owned and private hospitals in Guangdong Province in 2005, combining mandatorily reported administrative data with a survey instrument designed for this study. We use univariate and multi-variate regression analyses to compare hospital characteristics and to identify factors associated with simple measures of structural quality and patient outcomes.

Results: Compared to private hospitals, government hospitals have a higher average value of total assets, more pieces of expensive medical equipment, more employees, and more physicians (controlling for hospital beds, urban location, insurance network, and university affiliation). Government and for-profit private hospitals do not statistically differ in total staffing, although for-profits have proportionally more support staff and fewer medical
professionals. Mortality rates for non-government non-profit and for-profit hospitals do not statistically differ from those of government hospitals of similar size, accreditation level, and patient mix.

Conclusions: In combination with other evidence on health service delivery in China, our results suggest that changes in ownership type alone are unlikely to dramatically improve or harm overall quality. System incentives need to be designed to reward desired hospital performance and protect vulnerable patients, regardless of hospital ownership type.

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Karen Eggleston
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