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Begin New Search Political Geography Asia Publishing Institution Walter H. Shorenstein Asia-Pacific Research Center

11. The Effects of India’s COVID-19 Lockdown on Critical Non-COVID Health Care and Outcomes

Author:
Radhika Jain and Pascaline Dupas
Publication Date:
09-2020
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
India’s COVID-19 lockdown is widely believed to have disrupted critical health services, but its effect on non-COVID health outcomes is largely unknown. Comparing mortality trends among dialysis patients in the eight months around the lockdown with the previous year, we document a 64% increase in mortality between March and May 2020 and an estimated 22-25% total excess mortality through July 2020. The mortality increase is greater among females and disadvantaged groups. Barriers to transportation and disruptions in hospital services appear to be the main drivers of increased morbidity and mortality. The results highlight the unintended consequences of the lockdown on critical and life-saving non-COVID health services that must be taken into account in the implementation of future policy efforts to control the spread of pandemics.
Topic:
Public Health, Transportation, Pandemic, COVID-19, and Hospitals
Political Geography:
India and Asia

12. Healing One-fifth of Humanity: Progress and Challenges for China’s Health System

Author:
Karen Eggleston
Publication Date:
10-2019
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
China’s national health reforms over the past two decades have brought the system closer to the modern, safe, reliable and accessible health system that is commensurate with China’s dramatic economic growth, improvement in living standards, and high hopes for the next generation. Celebrating a decade this year, China’s national health reforms of 2009 consolidated a system of social health insurance covering the entire population for basic health services, contributing to a surge in healthcare utilization while reducing out-of-pocket costs to patients – which declined from 56% to 28% of total health expenditures between 2003 and 2017. An expanded basic public health service package, funded by per capita government budget allocations that include a higher central government subsidy for lower income provinces, provides basic population health services to all Chinese. A higher percentage of Chinese accessed hospital admissions in 2017 than in the average high-income (OECD) country – a large increase from the turn of the 21st century.i A recent re-shuffle of the governance structure consolidates the purchaser role for social health insurance schemes under the newly created National Healthcare Security Administration, with most other health sector functions under the re-christened National Health Commission, among other changes. China’s world-leading technological prowess in multiple fields spanning digital commerce to artificial intelligence—and accompanying innovative business models such as WeDoctor that have not yet been fully integrated into the health system—hold promise for supporting higher quality and more convenient healthcare for China’s 1.4 billion.
Topic:
Health, Science and Technology, Governance, and Health Care Policy
Political Geography:
China and Asia

13. Rural-Urban Disparities in the Utilization of Mental Health Inpatient Services in China: The Role of Health Insurance

Author:
Junfang Xu, Jian Wang, Madeleine King, Ruiyun Liu, Fenghua Yu, Jinshui Xing, Lei Su, and Mingshan Lu
Publication Date:
01-2018
Content Type:
Commentary and Analysis
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Reducing rural-urban disparities in health and health care has been a key policy goal for the Chinese government. With mental health becoming an increasingly significant public health issue in China, empirical evidence of disparities in the use of mental health services can guide steps to reduce them. We conducted this study to inform China’s on-going health-care reform through examining how health insurance might reduce rural-urban disparities in the utilization of mental health inpatient services in China.
Topic:
Health, Health Care Policy, Mental Health, Urban, and Rural
Political Geography:
China and Asia

14. Substance Abuse Policy in Thailand: Current Challenges and Future Strategies

Author:
Darika Saingam
Publication Date:
01-2018
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Substance abuse has been an important social and public health problem in Thailand for decades. The National Household Survey on Substance and Alcohol Use in Thailand, which has been conducted six times, shows that substance abuse has steadily increased. Extrapolated country-wide in recent data, the estimated number of people who have used at least one addictive substance at some time in their lives was 2,964,444 or 5.8% of the total population aged 12 - 65 years. Kratom, Methamphetamine, methamphetamine hydrochloride crystal (ice), and cannabis were the most prevalent substances of abuse. Historical documentation and policy reports were used in this study. The objectives of this study were to complete a document review, determine the effectiveness of previous measures to control illegal substance abuse in Thailand, and consider options for the future. Controlling illegal substance abuse in the future and minimizing total harm requires a delicate balance of efforts to reduce the prevalence, quantity, and harmful effects of substances. Drug policy interventions should be continually evaluated for their effectiveness. The strategies relevant to drug policy, apart from primary prevention, are health services for chronic drug users, reform of criminal sanctions against drug addicts, and legalization of kratom.
Topic:
Health, Drugs, and Substance Abuse
Political Geography:
Asia and Thailand

15. Organizing Old Age Pensions for India’s Informal Workers: A Case Study of a Sector-Driven Approach

Author:
M.R. Narayana
Publication Date:
04-2018
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
About 88 percent of India’s total labor force is composed of informal (officially labeled “unorganized”) workers. As many as 388 million such workers lack old age income security by way of a pension system. The Atal Pension Yojana (APY) is the latest contributory, national-level old age pension scheme for unorganized workers, with an entry age of 18–40 years. In other words, all current unorganized workers above the age of 40 are excluded. How could a national pension system viably guarantee equal pension benefits to all current unorganized workers? This paper considers how such a system might work by offering a case study of a non-contributory pension scheme for building and other construction workers in Karnataka State, India. The results indicate that this state-level pension scheme, fully funded by sector-specific receipts, is financially viable and sustainable with high levels of coverage and adequacy. The robustness of these results is shown via sensitivity analyses of discount rates, inflation rates, and growth rates of specific purpose tax collections. Additional analyses outline the scenarios under which pension benefits could be extended to all informal workers in the sector studied.
Topic:
Labor Issues, Work Culture, Unions, and Pension
Political Geography:
India and Asia

16. Dual Practice of Public Hospital Physicians in Vietnam

Author:
Ngan Do and Young Kyung Do
Publication Date:
04-2018
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Although many public hospital physicians in Vietnam offer private service on the side, little is known about the magnitude and nature of the phenomenon of so-called dual practice, let alone the dynamics between the public and private health sectors. This study investigates how and to what degree public hospital physicians engage in private practice. It also examines the commitment of dual practitioners to the public sector. The analysis is based on a hospital-based survey of 483 physicians at 10 public hospitals in four provinces of Vietnam. Nearly half of the participants in the study sample reported themselves as dual practitioners. Various types of private practice were mentioned. Private practice at health facilities owned by the private sector was the most prevalent, followed by private practice delivered at health facilities owned by the dual practitioners themselves. Private practice inside public hospitals was also noted. Dual practitioners were likely to be senior and hold management positions inside their public hospitals. Substantial income differences were found between dual practitioners and those physicians practicing in only the public sector. The majority of dual practitioners, however, reported the willingness to give up private practice if certain conditions were met, such as a basic salary increase or non-pecuniary benefits. The main reasons dual practitioners gave for not leaving the public sector included a sense of public responsibility and opportunities to gain a broader professional network and more training. This study reiterates the significant challenges associated with dual practice, including its financial implications and possible effects on health care quality and access. The need for a high-quality workforce committed to the public sector is particularly critical, given the possibility of universal insurance coverage. Future research should address the need to improve data collection on physicians’ dual practice and incorporate the topic in policy debates on health reform.
Topic:
Health, Health Care Policy, Reform, and Hospitals
Political Geography:
Asia and Vietnam

17. Economic Dimensions of Personalized and Precision Medicine in Asia: Evidence from Breast Cancer Treatment in Taiwan

Author:
Jui-fen Rachel Lu and Karen Eggleston
Publication Date:
04-2018
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
High costs of precision medicine raise concerns about exacerbating income-related disparities in healthcare utilization and health outcomes. One approach to expanding coverage in Asia has been to cover the precision therapy but require the pharmaceutical firm to cover the costs of the companion diagnostic test. Taiwan’s National Health Insurance (NHI) adopted this approach for lung cancer, colorectal cancer and leukemia, but not for the first target therapy covered by NHI, trastuzumab for the treatment of HER2-positive breast cancer. Analyzing a unique dataset linking medical claims, cancer registry data and proxies for income between 2004 and 2015, we find that lower-income patients are more likely to be diagnosed with later stages of breast cancer, and this pattern renders NHI coverage of anti-HER2 therapy pro-poor even before full coverage of the diagnostic tests. Moreover, the expansion of NHI coverage—including the FISH diagnostic test and trastuzumab for early-stage breast cancer—strengthened the pro-poor distribution of genetic testing and target treatment, albeit only marginally. The extent of pharmaceutical company coverage of testing and its impact on patient access are topics of our ongoing research, contrasting breast cancer with colorectal cancer.
Topic:
Health, Health Care Policy, Economic Inequality, and Medicine
Political Geography:
Taiwan and Asia

18. Taiwan's Place in the Evolving Security Environment of East Asia

Author:
Kharis Templeman
Publication Date:
07-2018
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
In March 2018 the Taiwan Democracy and Security Project, a part of the U.S.-Asia Security Initiative at Stanford University’s Shorenstein Asia- Pacific Research Center, convened a workshop that examined Taiwan’s place in the evolving security environment of East Asia. Participants from the United States, Taiwan, and elsewhere in Asia were experts on a wide array of economic, diplomatic, and security topics. The discussions at the workshop were intended to place Taiwan’s security challenges in a broader regional context, to consider possible obstacles to and opportunities for greater multilateral cooperation on security issues, and to devise a set of recommendations for steps that Taiwan and its friends and partners could take to enhance regional security relationships.
Topic:
International Relations, Security, Military Strategy, and Democracy
Political Geography:
China, Taiwan, and Asia

19. ASEAN @ 50, Southeast Asia @ Risk: What Should Be Done?

Author:
Asia-Pacific Research Center
Publication Date:
01-2018
Content Type:
Policy Brief
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
In October 2017, twenty-two scholars from eight countries attended a workshop titled “ASEAN @ 50, Southeast Asia @ Risk: What should be done?” The workshop was designed to facilitate a frank and creative discussion of policy recommendations, with the intention of providing the resulting proposals to ASEAN member states and other regional powers. Following two days of discussion and debate, the attendees produced a series of specific policy recommendations (SPRs).
Topic:
International Affairs
Political Geography:
Asia

20. People with Disabilities in a Changing North Korea

Author:
Katharina Zellweger
Publication Date:
01-2014
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
"People with Disabilities in a Changing North Korea" details the situation that people with disabilities face in the Democratic People's Republic of North Korea (DPRK). Despite its reputation as a repressive, closed society where human rights are routinely abused, there are in fact institutions in the DPRK that work to address the needs of the disabled, and a number of non-governmental organizations providing aid to disabled people are active in the country. In this paper, Katharina Zellweger attempts to provide "an informed and balanced view of what it means to live with disabilities in North Korea and current work to assist the disabled."
Topic:
Health, Human Welfare, and Governance
Political Geography:
Asia and North Korea