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32. 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
33. 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
34. 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
35. 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
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