Search

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

1. Recalibration of the Framingham Equations in the Thai Population

Author:
Panrasri Khonputsa, JL Veerman, M Bertram, S Yamwong, P Vathesatogkit, SS Lim, and T Vos
Publication Date:
04-2011
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
We derived equations for predicting cardiovascular disease (CVD) risks for Thai men and women, separately, over a specific time period using associations between risk factors and CVD events from the Framingham cohort study. The equations were recalibrated against the cumulative risks estimated for Thailand. Equations were developed separately for predicting risks of ischemic heart disease (IHD) and stroke. Recalibration of the Framingham equations reduced the CVD risks predicted for Thai men by 97% and for Thai women by 10%. The correction was largest at younger ages. In older women, recalibration increased the predicted risk. When compared with an existing equation for Thai men our recalibrated Framingham equation produced similar predictions for CVD risks over 8 years. However, the recalibrated Framingham equations are more flexible because they can be used for predicting risks over any time span and for women and men.
Topic:
Demographics and Health
Political Geography:
Thailand and Southeast Asia

2. The Effect of Coresidence with an Adult Child on Depressive Symptoms among Older Widowed Women in South Korea: An Instrumental Variable Estimation

Author:
Young Kyung Do and Chetna Malhotra
Publication Date:
11-2010
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
The objective of this paper is to estimate the causal effect of coresidence with an adult child on depressive symptoms among older widowed women in South Korea. Data from the first and second waves of the Korea Longitudinal Study of Aging were used. Analysis was restricted to widowed women aged ? 65 years with at least one living child (N=2,449). We use an instrumental variable approach that exploits the cultural setting where number of sons predicts the probability of an elderly woman's coresidence with an adult child but is not directly correlated with the mother's depressive symptoms. Our models adjust for age, education, total assets, residence, functional limitations, self-rated health, and various illnesses. Our robust estimation results indicate that, among older widowed women, coresidence with an adult child has a significant protective effect on depressive symptoms, but that this effect does not necessarily benefit those with clinically relevant depressive symptoms. Future demographic and social transitions in South Korea portend that older women's increasing vulnerability to poor mental health is an important though less visible public health challenge.
Topic:
Demographics, Gender Issues, and Health
Political Geography:
Israel and South Korea

3. Aging Risk and Health Care Cost in Korea

Author:
Byong Ho Tchoe and Sang-Ho Nam
Publication Date:
02-2009
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
It is generally perceived that health care cost is increasing because of population aging. In Korea, the number of people over 65 years of age was 3.1 percent of the population in 1970, 5.1 percent in 1990, 7.2 percent in 2000, and 9.1 percent in 2005. These figures show that the period of time in which an aging population increases by 2 percent is getting shorter; thus aging has been accelerating.
Topic:
Demographics and Health
Political Geography:
Israel, Asia, and Korea

4. Does your health care depend on how your insurer pays providers? Variation in utilization and outcomes in Thailand

Author:
Sanita Hirunrassamee and Sauwakon Ratanawijitrasin
Publication Date:
03-2009
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Hospitals in Thailand operate in a multiple insurance payment environment. This paper examines 1) access to medicines and other medical technologies, 2) treatment outcomes, and 3) efficiency in resource use, among beneficiaries of the three government health insurance schemes in Thailand. Using 2003-2005 inpatient data for patients with three tracer diseases from three government hospitals, we find that utilization of more expensive items differs between patients whose insurers pay on a closed- or open-ended basis. Where new vs. conventional drugs are both available, patients whose insurer pays on a fee-for-service basis tend to have greater access to new drugs, compared to patients whose insurer pays on a capitated or case basis. Similar patterns were found where there are options between originator vs. generic drugs, drugs in different dosage forms, and more vs. less advanced diagnostic technologies. Effects of insurance payment are more pronounced where price gaps among the medical technologies are significant. Efficiency results are mixed, depending on nature of the disease conditions and type of resources required for treatment.
Topic:
Demographics and Health
Political Geography:
Thailand 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. 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

8. The Effect of Informal Caregiving on Labor Market Outcomes in South Korea

Author:
Young Kyung Do
Publication Date:
12-2008
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Embedded in traditional culture perpetuating family-centered elderly care, informal care is still viewed as a family or moral issue rather than a social and policy issue in South Korea. Using newly available micro data from the Korean Longitudinal Study of Aging, this study investigates the effect of informal caregiving on labor market outcomes in South Korea. By doing so, this study provides evidence to inform elderly long-term care policy in South Korea, and also fills a gap in the international literature by providing results from an Asian country. Empirical analyses address various methodological issues by investigating gender differences, by examining both extensive and intensive labor market adjustments with two definitions of labor force participation, by employing different functional forms of care intensity, and by accounting for the potential endogeneity of informal care as well as intergenerational co-residence. Robust findings suggest negative effects of informal caregiving on labor market outcomes among women, but not among men. Compared with otherwise similar non-caregivers, female intensive caregivers who provide at least more than 10 hours of care per week are at an increased risk of being out of the labor force by 15.2 percentage points. When examining the probability of employment in the formal sector only, the effect magnitude is smaller. Among employed women, more intensive caregivers receive lower hourly wages by 1.65K Korean Won than otherwise similar non-caregivers. Informal care is already an important economic issue in South Korea even though aging is still at an early stage.
Topic:
Demographics, Health, and Markets
Political Geography:
Israel, Asia, and South Korea

9. 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

10. Emerging Third Stage Peri-Urbanization: Functional Specialization in the Hangzhou Peri-Urban Region

Author:
Douglas Webster, Jianming Cai, Binyi Luo, and Larisa Muller
Publication Date:
10-2003
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Hangzhou Municipality is the provincial capital of Zhejiang, on China's east coast. It forms part of the Yangtze River Delta (YRD) region. Hangzhou was “opened up” in the mid-1980s, following Deng Xiaoping's visit to the South, resulting in an almost immediate flood of foreign and domestic investment in manufacturing. This initial investment was significantly in the peri-urban areas, i.e., outside the built-up area. The authors have been following development in the Hangzhou extended urban region, with emphasis on peri-urbanization processes, since 2000. A previous APARC discussion paper describes findings of preliminary field research on the Hangzhou–Ningbo Corridor, conducted in August 2000 and March 2001. The present paper zooms in on two peri-urban clusters in the Hangzhou extended urban region, and assesses their development over time. The goal of the research is to better understand how a peri-urban region changes—particularly in terms of firm evolution, labor characteristics, and spatial dynamics—as it becomes more economically and demographically mature. This paper also examines such changes in the context of the increasing cost structures and emerging competitors, primarily from other areas in China, that the Hangzhou peri-urban region now faces.
Topic:
Demographics, Economics, and Industrial Policy
Political Geography:
China, Asia, and Maryland