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  • Author: Arzan Tarapore
  • Publication Date: 01-2020
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: he method of major/minor trends developed in this report suggests that the roots of apparently surprising future behavior can be found in a close reading of a target state’s history. Using this method, the report outlines three unlikely but plausible alternative futures of India as a strategic actor. The first scenario envisions India as a Hindu-nationalist revisionist power hostile to Pakistan but accommodating of China; in the second, it is a militarily risk-acceptant state that provokes dangerous crises with China; and in the third scenario, India is a staunch competitor to China that achieves some success through partnerships with other U.S. rivals like Russia and Iran. These scenarios are designed not to predict the future but to sensitize U.S. policymakers to possible strategic disruptions. They also serve to highlight risks and tensions in current policy.
  • Topic: International Relations, Foreign Policy, Conflict, Strategic Interests
  • Political Geography: Russia, United States, China, Europe, India, Asia, North America
  • 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, Health Care Policy
  • Political Geography: China, 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, Democracy
  • Political Geography: China, Taiwan, Asia
  • Author: Masahiko Aoki
  • Publication Date: 06-2014
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: This paper argues that game-theoretic approach is incomplete for institutional studies, because comparative institutions as well as institutional changes involve a possibility of multiple equilibria. In order to solve the common knowledge problem, this paper proposes to unify game theoretic thought with an analysis of public representations/propositions to summarize salient features of the recursive/emergent states of play. From this perspective the paper tries to reconcile differences in three accounts of institutions, endogenous outcome, exogenous rules and constitutive rules accounts. Then, the unified approach is applied to comparative and historical cases of the Tokugawa Japan and the Qing China. Specifically it sheds new light into the coalitional nature of Tokugawa Baku-Han regime nesting the fundamental Samurai-village pact as well as the tendency toward decentralization of political violence and fiscal competence to the provincial level toward the end of the Qing China. From these new historical interpretations, endogenous strategic forces and associated public propositions leading to institutional changes through the Meiji Restoration and the Xinhai Revolution are identified and compared.
  • Topic: Nationalism, Political Theory, Governance
  • Political Geography: China
  • Author: Brian K. Chen
  • Publication Date: 09-2013
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: How do demand - and supply - side incentives interact, when there are potentially large provider income effects? We develop a simple model and empirically test it with data from China's Essential Medications List (EML) policy, which reduced patient copayments and changed provider incentives by removing a large source of revenue from primary care providers: drug dispensing revenues. Using a panel of patient - level spending and clinical data for Chinese patients with diabetes or hypertension over two and a half years, we find evidence of strategic provider response that dampened the impact of patient copayment reductions. Resource use and patient out - of - pocket spending did not change, when taking account of patient utilization outs ide primary care.
  • Topic: Communism, Health, Governance
  • Political Geography: China, Israel
  • Author: Walter H. Shorenstein
  • Publication Date: 06-2013
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: Meeting after North Korea had raised tensions on the Korean Peninsula in the spring, participants in the Tenth Korea-U.S. West Coast Strategic Forum focused on the implications for the Korean Peninsula of leadership changes in North and South Korea and especially China. Participants also focused on regional dynamics, including increased confrontation between China and Japan and various, sometimes conflicting, efforts to increase regional economic integration in Northeast Asia.
  • Topic: Conflict Resolution, Defense Policy, Arms Control and Proliferation, Diplomacy, Nuclear Weapons, Weapons of Mass Destruction, Bilateral Relations, Sanctions
  • Political Geography: United States, Japan, China, Israel, Asia
  • Author: Qiong Zhang, Binzhen Wu, 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, Markets
  • Political Geography: China
  • Author: Qiong Zhang, Chong-En Bai
  • Publication Date: 12-2011
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: China's economic growth over the past three decades is unprecedented. Although this growth is commonly attributed to a high domestic savings rate among “thrifty” Chinese, savings alone cannot promote economic growth unless productivity has continuously grown for such a long period. This article uses a one-sector, neoclassical growth model to calibrate the economy to Chinese data since 1952 and finds that measuring changes in total factor productivity between 1952 and 2005 can well capture the secular movements in the Chinese savings rate. Far from supporting the widespread belief that China's savings rate is too high, this article argues that even thrifty Chinese “under-saved” for most of the years during this period; furthermore, the fiscal reforms of 1983 and 1985 further suppressed saving behavior, especially China's economic growth over the past three decades is unprecedented. Although this growth is commonly attributed to a high domestic savings rate among “thrifty” Chinese, savings alone cannot promote economic growth unless productivity has continuously grown for such a long period. This article uses a one-sector, neoclassical growth model to calibrate the economy to Chinese data since 1952 and finds that measuring changes in total factor productivity between 1952 and 2005 can well capture the secular movements in the Chinese savings rate. Far from supporting the widespread belief that China's savings rate is too high, this article argues that even thrifty Chinese “under-saved” for most of the years during this period; furthermore, the fiscal reforms of 1983 and 1985 further suppressed saving behavior, especially when initially implemented. In presenting such findings, this article at least partly solves the so-called “Chinese savings puzzle.”
  • Topic: Development, Economics, International Trade and Finance, Monetary Policy
  • Political Geography: China
  • Author: Qunhong Shen, Liyang Tang, Yilin Feng, Jenny Tang
  • Publication Date: 11-2010
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: The increasing importance of patient satisfaction is a common trend for the global health delivery system. This development is one of the consequences of wider social movements toward consumerism (Sitzia and Wood 1997) and also is the result of the new public management (Christoffer 2002).
  • Topic: Communism, Development, Government, Health Care Policy
  • Political Geography: China
  • Author: Meghan Bruce
  • Publication Date: 10-2010
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: Since 1978, China has been primarily market-focused in its provision of health care and social services. The market-driven health care system has been characterized by perverse incentives for individual providers, patients, and hospitals that are inducing improper provision of care: overprescription of pharmaceuticals and hightech testing, lack of effective primary care and gatekeeping, and competition for patients instead of referral. The national health care reform document that was made public in April 2009 recognizes this failure of the market in health care in China. The document suggests potential policies for improvement on the current system that are focused primarily on a targeted increase in government funding and an increased, changing role for the government. We assess the potential of this national health care reform to achieve the stated goals, and conclude that the reform as designed is necessary but insufficient. For the reform to meet its goals, the promised increase in funding should be accompanied by improved data collection, regional piloting, and a strong regulatory and purchasing role for the government in aligning incentives for individual and institutional payers, providers, and patients.
  • Topic: Health, Markets
  • Political Geography: China, Israel
  • Author: Qunhong Shen, Liyang Tang
  • Publication Date: 09-2010
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: Many Chinese express dissatisfaction with their healthcare system with the popular phrase Kan bing nan, kan bing gui ("medical treatment is difficult to access and expensive"). Critics have cited inefficiencies in delivery and poor quality of services. Determining the pattern of patient satisfaction with health services in China-and the causes of patient dissatisfaction-may help to improve health care not only in China but in countries in similar predicaments throughout the world.
  • Topic: Economics, Markets, Social Stratification, Health Care Policy
  • Political Geography: China
  • Author: Donald K. Emmerson
  • Publication Date: 02-2009
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: No crisis is uniformly global. The suffering and the opportunity that a “global” crisis entails are always unevenly distributed across countries, and unevenly across the population inside any one country. That said, one can nevertheless argue that we—not the old royal “we” but, more presumptuously, the new global “we”—are in January 2009 experiencing the latest of four dramatic changes that major parts of the world have undergone over the last twenty years. In 1989, of course, the Berlin Wall was breached, ending the Cold War, followed by the implosion of Lenin's Soviet dystopia two years later. Nor did the 1989 massacre of proreform demonstrators in Tiananmen Square revive a command economy in China. Instead it kept the polity shut so that Deng's economy could continue to open.
  • Topic: International Relations, Globalization, International Political Economy
  • Political Geography: United States, China, America, Israel, Asia, Berlin
  • Author: Zhe Zhang, Ming Jia, 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, Human Welfare
  • Political Geography: China, Israel, Asia
  • Author: Karen Eggleston, Mingshan Lu, Congdong Li, Jian Wang, Zhe Yang, Jing Zhang
  • Publication Date: 04-2009
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: Government and private roles in this segment of health service delivery remain controversial in China, as in many countries. Using 2004 data from over 360 government-owned and private hospitals in Guangdong Province, we find that non-government hospitals serve an overlapping but distinct market. They are smaller, newer market entrants, more likely to specialize, and less likely to be included in urban social insurance networks. We also document differences in staffing and financial performance, but no systematic ownership differences in simple measures of quality, controlling for size, location, case-mix and other confounding factors.
  • Topic: Demographics, Government, Health, Privatization
  • Political Geography: China, Israel, Guangdong
  • Author: Karen Eggleston, Mingshan Lu, Congdong Li, Jian Wang, Zhe Yang, Jing Zhang, Yu-Chu Shen
  • Publication Date: 03-2009
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: Using data from 276 general acute hospitals in the Pearl River Delta region of Guangdong Province from 2002 and 2004, we construct a preliminary metric of budget constraint softness. We find that, controlling for hospital size, ownership, and other factors, a Chinese hospital's probability of receiving government financial support is inversely associated with the hospital's previous net revenue, an association consistent with soft budget constraints.
  • Topic: Government, Health, Financial Crisis
  • Political Geography: China, Asia
  • Author: Cunrui Huang, Haocai Liang, Cordia Chu, Shannon Rutherford, Qingshan Geng
  • Publication Date: 09-2009
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: China continues to face great challenges in meeting the health needs of its large population. The challenges are not just lack of resources, but also how to use existing resources more efficiently, more effectively, and more equitably. Now a major unaddressed challenge facing China is how to reform an inefficient, poorly organized health care delivery system. The objective of this study is to analyze the role of private health care provision in China and discuss the implications of increasing private-sector development for improving health system performance.
  • Topic: Government, Health
  • Political Geography: China, Asia
  • Author: Dennis Arroyo
  • Publication Date: 06-2008
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: Major economic reforms are often politically difficult, causing pain to voters and provoking unrest. They may be opposed by politicians with short time horizons. They may collide with the established ideology and an entrenched ruling party. They may be resisted by bureaucrats and by vested interests. Obstacles to major economic reform can be daunting in democratic and autocratic polities alike.
  • Topic: Economics, Government, Political Economy
  • Political Geography: China, India, Asia, South Korea, Vietnam, Singapore, Thailand
  • 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, Human Welfare
  • Political Geography: China, Israel, Asia
  • Author: Fangbin Qiao, Jim Wilen, Jikun Huang
  • Publication Date: 02-2007
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: The goal of this study is to discuss why China and perhaps other developing countries may not need a refuge policy for Bacillus thuringiensis (Bt) cotton. We describe in detail the different elements that a nation—especially a developing one—should be considering when deciding if a refuge policy is needed. Drawing on a review of scientific data, economic analysis of other cases and a simulation exercise using a bio-economic model that we have produced to examine this question, we show that in the case of Bt cotton in China, the approach of not requiring special cotton refuges is defensible.
  • Topic: Agriculture, Economics
  • Political Geography: China, Asia
  • Author: Jikun Huang, Jun Yang, Scott Rozelle
  • Publication Date: 02-2007
  • Content Type: Working Paper
  • Institution: Walter H. Shorenstein Asia-Pacific Research Center
  • Abstract: China's economy has experienced remarkable growth since economic reforms were initiated in the late 1970s and pushed forward by a number of complementary policies. Since the mid-1980s, rural township and village-owned enterprises (TVEs) development; measures to provide a better market environment through domestic market reform; fiscal and financial expansions; the devaluation of exchange rate; trade liberalisation; the expansion of special economic zones to attract foreign direct investment (FDI); the state-owned enterprise (SOE) reform; agricultural market liberalisation, and many other reforms have all contributed to China's economic growth. In response, the annual growth rate of gross domestic product (GDP) was about nearly 10% in 1979–2004 (National Bureau of Statistics of China 2005).
  • Topic: Agriculture, International Trade and Finance
  • Political Geography: China, Asia, Australia, Australia/Pacific