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Begin New Search Topic Health Content Type Working Paper Publishing Institution Walter H. Shorenstein Asia-Pacific Research Center Publication Year within 25 Years Publication Year within 10 Years

1. Intended and Unintended Consequences of a New Limit on Working Hours in South Korea: Implications for Precarious Employment

Author:
Sungchul Park and Hansoo Ko
Publication Date:
06-2020
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Effective as of July 1, 2018, South Korea set a new cap on employees’ weekly working hours, decreasing the maximum number from 68 to 52. In this study, we comprehensively analyze the effectiveness of the law’s implementation by observing changes in work time, health status, health care utilization, health behavior, monthly expenses, and satisfaction between pre- and post-implementation periods (2014–2017 vs. 2019). We find evidence of both intended and unintended consequences—and, in this last category, some are beneficial and some not. As intended, employees eligible for the 52-hour work week saw their average working hours decrease, while their monthly spending on leisure increased substantially. A beneficial unintended consequence was that work time also decreased in firms with less than 300 employees that had not yet implemented the 52-hour work schedule (they have done so since, in January 2020). Among adverse unintended consequences, the most notable were heterogeneous effects across employment types (full-time vs. precarious employment) and, in particular, negative impacts on precarious employees (that is, those facing relatively high levels of job insecurity). Despite almost no change in their work time, precarious employees saw substantial increases in outpatient visits and monthly expenses for health care, indicating suggestive evidence of adverse health consequences. Another adverse unintended consequence was that overall job satisfaction decreased among several groups of employees. This may reflect a heavy workload among employees still expected to work overtime, especially experienced employees or those working in large firms. While employment rates increased after the new schedule’s implementation, the majority were in precarious jobs. This has negative implications because of the adverse health impacts of being in precarious employment; also, the workload of experienced employees in this field might have intensified amid all the new hiring. Our findings suggest key policy recommendations for how to leverage the benefits of the 52-hour cap on weekly working hours while addressing its negative unintended consequences.
Topic:
Health, Labor Issues, Employment, and Labor Policies
Political Geography:
Asia and South Korea

2. 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

3. 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

4. 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

5. 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

6. How Individuals’ Birth Weight and Later Risk Factors Interact to Determine Their Risk of Cardiovascular Disease: A Longitudinal Study in the Philippines

Author:
Marjorie Pajaron
Publication Date:
12-2018
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Cardiovascular diseases (CVDs), which are disorders of the heart and blood vessels, are the world’s leading cause of death (WHO, 2016). The transition from infectious diseases to non-communicable diseases (NCDs), primarily CVDs, as the primary cause of mortality and morbidity worldwide— combined with the economic burden associated with heart-related diseases—prompted the World Health Organization (WHO) and its regional offices to identify CVDs’ risk factors (WHO, 2016). This paper examines these risk factors with a focus on the fetal environment and its interaction with adult body mass index (BMI), using longitudinal data from the Cebu Longitudinal Health and Nutrition Survey (CLHNS). Using a Cox proportional hazards model to estimate hazard ratios adjusted for age and risk factors in adulthood, such as cigarette smoking, the results suggest that there is a positive association between birth weight and heart disease. In addition, when birth weight is interacted with BMI, raised blood pressure is found to be higher among those who were bigger infants at birth and grew to be lighter adults, suggesting centile crossing. Probit models are also used for sensitivity analysis, and the results are consistent with those of the hazards model. Other factors such as adult obesity and a smoking habit are also positively associated with hypertension and CVD.
Topic:
Health, Medicine, Risk Factors, and Birthing
Political Geography:
Global Focus

7. The Impact of Energy Access on Mothers’ Health, Labor, and Time Allocation

Author:
Marjorie Pajaron
Publication Date:
12-2018
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
This paper shows that, for mothers in Cebu, Philippines, access to electricity and the type of cooking fuel used at home affect both health outcomes and also how time is allocated, including for paid work. First, the use of fuelwood for cooking adversely affects the health of mothers, who are traditionally responsible for cooking and are often at home, taking care of their families. This result is consistent across different econometric specifications. Second, shifting to a more efficient source of energy allows women more time to be engaged in the labor force, including in micro enterprises. It also enables them to reallocate their time and efforts away from household chores (cooking, tending animals, and childcare) toward caring for themselves (improved personal hygiene and rest). Drafting and strengthening existing gender-sensitive energy policies and programs can, therefore, help the welfare of mothers in the Philippines, where 54% of households rely on fuelwood, and where the resulting indoor air pollution has a particularly adverse impact on women.
Topic:
Gender Issues, Health, and Birthing
Political Geography:
Philippines and Asia-Pacific

8. The Impact of Adolescents’ Risky Health Behaviors on Their Later Economic Outcomes

Author:
Marjorie Pajaron
Publication Date:
11-2018
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Risky health behaviors such as illicit drug use, smoking, overconsumption of alcohol, violence, and early sexual activity have contemporaneous and intertemporal adverse health and economic outcomes. The health-related and economic costs to individuals and to society overall are particularly pronounced when adolescents are the ones engaging in one or more of such behaviors. This paper uses longitudinal data from the Philippines (from the Cebu Longitudinal Health and Nutrition Survey) to examine the long-term impact of adolescents’ risky behaviors in 2002 (related to sex, tobacco, alcohol, and violence, but not drugs) on their economic outcomes in 2009 (related to participation in the labor force, educational attainment, and family formation). The results reveal that risky behaviors are most likely to affect educational outcomes. Teenagers who smoked at least one cigarette a day were 21% less likely to be in college several years later, and this difference was 17% for those who had an early sexual initiation, and 7% for those who consumed alcohol at least once a week. Labor outcomes were also adversely affected.
Topic:
Health, Labor Issues, Behavior, Socioeconomics, and Risk Factors
Political Geography:
Philippines and Asia-Pacific

9. 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