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1. 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

2. 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

3. Prevention and Control of Chronic Non-communicable Disease in Nine Pacific Rim Cities

Author:
Karen Eggleston, Meng Kin Lin, Kun Chen, Yunxian Yu, Sung-Il Cho, Sian Griffiths, EK Yeoh, Jamal Hisham Hashim, Masamine Jimba, Carl Anderson Johnson, Paula Palmer, Vu-Anh Le, Huu-Bich Tran, Ngoc-Quang La, and Bambang Wispriyono
Publication Date:
12-2010
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Populous, economically dynamic, and rapidly urbanizing, the Asia Pacific both reflects and strongly shapes trends in global public health. A comparative assessment of chronic disease prevalence, risk factors, and policy responses in nine Pacific Rim cities shows that chronic diseases are rapidly becoming the leading cause of morbidity and mortality even in the lower income cities of the Pacific Rim. Policy responses are heterogeneous, with few sufficiently funded or adequately informed by evidence. Much could be learned from comparative research and rigorous evaluation of prevention and control initiatives in this region.
Topic:
Globalization and Health
Political Geography:
Asia and Australia/Pacific

4. Comparing Public and Private Hospitals in China: Evidence from Guangdong

Author:
Karen Eggleston, Mingshan Lu, Congdong Li, Jian Wang, Zhe Yang, and 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, and Privatization
Political Geography:
China, Israel, and Guangdong

5. Soft budget constraints in China: Evidence from the Guangdong hospital industry

Author:
Karen Eggleston, Mingshan Lu, Congdong Li, Jian Wang, Zhe Yang, Jing Zhang, and 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, and Financial Crisis
Political Geography:
China and Asia

6. Pandemic Influenza and the Globalization of Public Health

Author:
Karen Eggleston, Qiong Zhang, and Michele Barry
Publication Date:
11-2009
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Globalization means a threat to any of the world's peoples is a threat to all the world's peoples. As American journalist Laurie Garrett says in her famous book The Coming Plague: Newly Emerging Diseases in a World out of Balance, none of us can escape from a pandemic in our increasingly globalized world. Most of us are active members in prosperous communities, whose daily lives involve interactions with dozens of people of varied backgrounds; even if we were Robinson Crusoes safely living a life of autarky on an isolated island, a fly or bird could bring an avian or swine flu virus to puncture our well-protected balance.
Topic:
Globalization, Health, and Humanitarian Aid
Political Geography:
Global Focus

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