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Begin New Search Topic Human Welfare Publishing Institution Walter H. Shorenstein Asia-Pacific Research Center

1. 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

2. Emerging Infectious Disease Surveillance in Southeast Asia: Cambodia, Indonesia, and the Naval Area Medical Research Unit 2

Author:
Sophal Ear
Publication Date:
02-2012
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Emerging infectious diseases (EIDs) pose international security threats because of their potential to inflict harm upon humans, crops, livestock, health infrastructure, and economies. The following questions stimulated the research described in this paper: What infrastructure is necessary to enable EID surveillance in developing countries? What cultural, political, and economic challenges stand in the way of setting up such infrastructure? And are there general principles that might guide engagement with developing countries and support EID surveillance infrastructure? Using the U.S. Naval Area Medical Research Unit No. 2 as common denominator, this paper compares barriers to EID surveillance in Cambodia and Indonesia and presents key factors—uncovered through extensive interviews—that constrain disease surveillance systems. In Cambodia, the key factors that emerged were low salaries, poor staff and human resources management, the effect of patronage networks, a culture of donor dependence, contrasting priorities between the government and international donors, and a lack of compensation for animal culling. The Cambodian military has also played a part. The government ceased a merit-based salary supplement scheme for civil servants after the military is alleged to have demanded similar pay incentives that donors had no interest in funding. In Indonesia the key issues emerging as barriers to effective surveillance include poor host-donor relationships, including differing host-donor priorities and a misunderstanding of NAMRU-2 by Indonesian authorities; low salaries; a decline in the qualifications of personnel in the Ministry of Health; poor compensation for animal culling; and difficulties incentivizing local-level reporting in an era of decentralization. As the interviews with in-country practitioners revealed, low levels of development in general are the main impediments to building EID surveillance infrastructure and are perhaps beyond the scope of health and scientific agencies at this point. Nevertheless, promoting greater understanding of these issues is a critical first step in mitigating negative outcomes.
Topic:
Agriculture, Economics, Health, Human Welfare, and Infrastructure
Political Geography:
Indonesia, Cambodia, and Southeast Asia

3. Pharmaceutical Price Regulation: Macro-Level Evidence from China between 1997 and 2008

Author:
Qiong Zhang, Binzhen Wu, and Xue Qiao
Publication Date:
01-2012
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
This paper uses macro-level data between 1997 and 2008 to evaluate the effects of China's pharmaceutical price regulations. We find that these regulations had short-run effects on medicine price indexes, reducing them by less than 0.5 percentage points. The effects could have been slightly reinforced when these regulations were imposed on more medicines. However, these regulations failed to reduce household health expenditures and the average profitability of the pharmaceutical industry, and firms on the break-even edge were worse off. Finally, although these regulations have no significant effects on the price of substitutes or complements for medicines, they increased expensive medicine imports.
Topic:
Economics, Health, Human Welfare, Industrial Policy, International Trade and Finance, and Markets
Political Geography:
China

4. Principal-Agent Problems in Health Care: Evidence from Prescribing Patterns of Private Providers in Vietnam

Publication Date:
12-2009
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
The principal-agent problem in health care asserts that providers, being imperfect agents for patients, will act to maximize their profits at the expense of the patients' interests. This problem applies especially where professional regulations are lacking and incentives exist to directly link providers' actions to their profits, such as a fee-for-service payment system. The current analysis tests for the existence of the principal-agent problem in the private health market in Vietnam by examining the prescribing patterns of the private providers. We show that (1) private providers were able to induce demand by prescribing more drugs than public providers for a similar illness and patient profile; (2) private providers were significantly more likely to prescribe injection drugs to gain trust among the patients; and (3) patients' education as a source of information and empowerment has enabled them to mitigate the demand inducement by the providers. Our hypotheses were supported with evidence from Vietnam National Health Survey 2001 and 2002, the first and, so far, only comprehensive health survey in the country.
Topic:
Health and Human Welfare
Political Geography:
Asia, Australia/Pacific, and Southeast Asia

5. The healer or the druggist: Effects of two health care policies in Taiwan on elderly patients' choice between physician and pharmacist services

Author:
Kang-Hung Chang
Publication Date:
03-2009
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
When both physicians and pharmacists in Taiwan prescribed and dispensed drugs, many elderly people considered the two types of health care providers more or less synonymous (i.e., close substitutes). Two policies mandated in the 1990s changed this perception: National Health Insurance (NHI), which provides insurance coverage to all citizens, and a separation policy (SP) that forbids physicians from dispensing and pharmacists from prescribing drugs. The author finds that by providing an economic incentive to the previously uninsured elderly, NHI raised the probability that they would visit physicians, relative to their continuously insured counterparts. In particular, some previously uninsured elderly who once only visited pharmacists were more likely to also visit physicians after NHI was implemented. Following this, the SP made it more likely that all elderly patients would only visit physicians and buy drugs from on-site pharmacists hired by physicians—a result different than its policy goal.
Topic:
Demographics, Health, and Human Welfare
Political Geography:
Israel, Taiwan, and Asia

6. Allocation of control rights and cooperation efficiency in public-private partnerships: Theory and evidence from the Chinese pharmaceutical industry

Author:
Zhe Zhang, Ming Jia, and Difang Wan
Publication Date:
03-2009
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
This article uses incomplete contract theory to study the allocation of control rights in public-private partnerships (PPPs) between pharmaceutical enterprises and nonprofit organizations; it also investigates how this allocation influences cooperation efficiency. We first develop a mathematic model for the allocation of control rights and its influence on cooperation efficiency, and then derive some basic hypotheses from the model. The results of an empirical test show that the allocation of control rights influences how enterprises invest in PPPs. A proper allocation provides incentives for firms to make fewer self-interested and more public-interested investments. Such an allocation also improves the cooperation efficiency of PPPs.
Topic:
Demographics, Health, and Human Welfare
Political Geography:
China, Israel, and Asia

7. Incentives in China's Healthcare Delivery System

Author:
Karen Eggleston
Publication Date:
10-2008
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
The economic approach of comparative and historical institutional analysis (Aoki 2001, Greif 2006) has virtually never been used in theoretical studies of healthcare incentives. This paper seeks to help fill this gap by exploring the explanatory power of such an approach for understanding incentives in China's healthcare delivery system. It focuses on positive analysis of why China's health system incentives evolved the way they did. The first section analyzes the institution of physician dispensing (MDD) and reforms toward separation of prescribing from dispensing (SPD), in historical and comparative perspective. It shows, for example, how MDD was a self-reinforcing institution; the longer a society remains under MDD, the higher the associated costs of supplier-induced demand can be before implementing SPD becomes the efficient self-enforcing social institution. Rapid technological change and adoption of universal coverage are likely to trigger SPD reforms. The second section seeks to explain the pattern and impact of price regulation and hospital payment reforms in contemporary China, which also reflect the legacy of MDD.
Topic:
Government, Health, and Human Welfare
Political Geography:
China, Israel, and Asia

8. Has the Use of Physician Gatekeepers Declined among HMOs? Evidence from the United States

Author:
Hai Fang, Hong Liu, and John A. Rizzo
Publication Date:
12-2008
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Since the mid-1980s, health maintenance organizations (HMOs) have grown rapidly in the United States. Despite initial successes in constraining health care costs, HMOs have come under increasing criticism due to their restrictive practices. To remain viable, this would seem to suggest that HMOs have to change at least some of these behaviors. However, there is little empirical evidence on how restrictive aspects of HMOs may be changing. The present study investigates one mechanism for constraining costs that is often associated with HMOs – the role of the primary care physician as a gatekeeper (e.g., monitoring patients' use of specialist physicians). In particular, we estimate the effect of primary care physician involvement with HMOs on the percentage of their patients for whom these physicians serve as gatekeepers. We examine these relationships over two time periods: 2000-2001 and 2004-2005. Because physicians can choose whether and to what extent they will participate in HMOs, we employ instrumental variables (IV) estimation to correct for endogeneity of the HMO measure. Although the single-equation estimates suggest that the role of HMOs in terms of requiring primary care physicians to serve as gatekeepers diminished modestly over time, the endogeneity-corrected estimates show no changes between the two time periods. Thus, one major tool used by HMOs to constrain health care costs – the physician as gatekeeper – has not declined even in the era of managed care backlash.
Topic:
Demographics, Health, and Human Welfare
Political Geography:
United States

9. Food Security in North Korea: Designing Realistic Possibilities

Author:
Randall Ireson
Publication Date:
02-2006
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Between about 1990 and 1996, North Korea experienced what can only be described as a catastrophic economic collapse, which included a 70 percent reduction in food production compared to the late 1980s. The Democratic People's Republic of Korea (DPRK) initially insisted that the agriculture collapse was a consequence of natural disasters. However, it is clear that the seeds of this catastrophe had been planted decades earlier, the result of ill-advised and ultimately unsustainable national agricultural policies. Yet difficult as the situation is, it is not without options for significant improvement. This paper outlines a strategy for agricultural revitalization in North Korea, which could, in the foreseeable future, enable the DPRK to produce—domestically and in a sustainable manner—nearly all the food needed to supply a basic balanced diet for its population. Whether this strategy can be implemented, or indeed whether it is the best strategy for the DPRK in the longer term, depends on many factors outside the farm sector, including world and regional international political issues, and DPRK policy choices regarding participation in world trade and commerce.
Topic:
International Relations, Government, Health, and Human Welfare
Political Geography:
Asia, North Korea, and Korea