Organizer: Karen N. Eggleston, Stanford University, USA Discussants: Qiulin Chen, Stanford University, USA; Sang Hyop Lee, University of Hawaii, Manoa, USA This “border-crossing” session involves multiple disciplines – economics, demography, public policy, medicine, and epidemiology – and covers multiple countries. The research is nevertheless cohesive: all presentations focus on demographic change and health policy in East Asia.
The demographic trends in East Asia show a clear sequence of population aging, with Japan followed by South Korea and then China. Will social policy response shape a period of growing old-age dependency into one of security and opportunity? Andrew Mason and colleague argue that maintaining economic growth in Asia will require policies that encourage savings and investment in human capital. Qiulin Chen then compares China’s policies to its Asian neighbors regarding support for the elderly and investments in children and families.
Eggleston and co-authors examine how China is seeking to guarantee access to affordable primary health care, including for the growing number of Chinese suffering from chronic disease. The new Essential Medications List will make medications more affordable, especially for elderly patients of lower socioeconomic status; but those patients may also be especially vulnerable to provider manipulation to substitute more profitable services for essential drugs. The third paper also provides empirical evidence about a controversial topic: the effects of including private clinics and hospitals in China’s largely government-controlled health system.
Finally, infectious diseases still ravage the most vulnerable populations in East Asia, with global implications. Dr. Perry’s description of a unique consortium effort to assist North Korea with controlling tuberculosis, including the difficult political context of these humanitarian efforts, will be sure to stimulate significant audience discussion.
Over the next forty years, the most important demographic trend in Asia and the Pacific will be population aging. This has primarily been an industrialized country phenomenon to this point, but by 2050 many other countries in the region will have aged dramatically. Rapid increase in elderly populations may bring two important goals of countries in the region into sharp conflict. The first is to develop socioeconomic systems that will provide economic security to a growing number of elderly people. The second is to sustain strong economic growth over the next forty years. The ultimate economic success of these two goals will rely on policies yet to be implemented, and the most important ones will be policies that encourage savings, investment in human capital, and well-functioning financial and labor markets.
This research uses recently compiled datasets based on National Transfer Accounts (NTA) to study public policies in China compared to other countries in Asia regarding intergenerational transfers, social insurance, and public services for families (including health, pensions, education, and housing). NTA is an accounting system for measuring intergenerational transfers at the aggregate level in a manner consistent with National Income and Product Accounts for a given country. NTA provides estimates of economic flows across age groups that arise primarily because children and the elderly consume more than they produce, relying on reallocations from the working ages. An important tool for examining the social, political, and economic implications of population aging, the NTA project has about 40 country members.
China, Korea, Japan, and some other Asian countries included in the NTA project are in the process of rapid economic and demographic change. Reform of the public sector will be an unavoidable issue to deal with given the rapid aging and the implicit risk of economic recession. We can forecast the change in population structure for these countries in the future 30-50 years, and estimate the effect of population change on the structure of private transfers, aggregate public transfers, household structure, and other public policies (such as the education, health and pensions), based on the current estimation of NTA accounts with some forecast of possible changes in the future.
One goal of China’s 2009 health reforms is to guarantee all Chinese access to basic health care. Policies encourage use of newly-defined “essential medications” at low cost to patients, and try to shift patients toward community-based rather than hospital-based services. Our research examines early evidence regarding how effective these reforms have been in one of China’s most populous provinces, Shandong.
The new “Essential Medications List” gives patients better insurance coverage for essential drugs, and providers are encouraged to prescribe those drugs. However, doctors and hospitals now make a lower profit margin from dispensing essential medications to patients. We compare treatment and control sites before and after the reform. Preliminary results suggest benefits for some patients (differing according to insurance coverage and clinical need), attenuated by providers’ strategic response.
We also summarize results from a natural experiment in contracting with private providers for urban primary and preventive health services. Using data spanning one year before and after the policy including the private sector, compared to a nearby city that did not such a reform, we find that government and private community health stations did not statistically differ in quality of performance. In contrast, the comparator city had lower performance and a large gap between public and private providers. These results suggest that ownership-neutral policies can strengthen primary health services.
Since the famines of the 1990’s, rates of tuberculosis (TB) in North Korea have risen dramatically and are now among the highest in the world outside of sub-Saharan Africa. The Stanford-led Bay Area Tuberculosis Consortium was organized to promote opportunities for professional collaboration with North Korea on mutual interests in TB control. Dr. Sharon Perry, School of Medicine research scientist and director of the project, will describe the consortium's work with the DPRK Ministry of Public Health and a US non-governmental organization to develop the country's first laboratory with capacity to diagnose tuberculosis by culture and drug susceptibility testing. Implications of the project for maintaining humanitarian ties and building regional cooperation on TB control will also be outlined.
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