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

51. 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

52. 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

53. 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

54. 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

55. 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

56. 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

57. Out-of-pocket household health expenditures and their use in National Health Accounts: Evidence from Pakistan

Author:
Christian Lorenz
Publication Date:
08-2009
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Out-of-pocket (OoP) household health expenditures are among the most difficult factors to measure in the context of National Health Accounts (NHA). Yet their measurement is important: OoP household expendi-tures are typically the first or second largest source of health care financing in developing countries. Their incorrect measurement can undermine the credibility of total health spending estimates and thus NHA statistics, which are an otherwise important resource for policy makers. In most countries, private expenditures account for the biggest margin of error in national health spending estimates and represent the most substantial barrier to reliable international comparisons. Differences in accounting methods explain much of the discrepancy across nations. To further the academic investigation of this important issue, this paper focuses on OoP household health expenditures in Pakistan's NHA and suggests steps toward estimating such expenditures more effectively.
Topic:
Health
Political Geography:
Pakistan, South Asia, and Asia

58. Crisis and Consensus; America and ASEAN in a New Global Context

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, and International Political Economy
Political Geography:
United States, China, America, Israel, Asia, and Berlin

59. The Emerging Role of Private Health Care Provision in China

Author:
Cunrui Huang, Haocai Liang, Cordia Chu, Shannon Rutherford, and 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 and Health
Political Geography:
China and Asia

60. Principal-Agent Problems in Health Care: Evidence from Prescribing Patterns of Private Providers in Vietnam

Publication Date:
12-2009
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
The principal-agent problem in health care asserts that providers, being imperfect agents for patients, will act to maximize their profits at the expense of the patients' interests. This problem applies especially where professional regulations are lacking and incentives exist to directly link providers' actions to their profits, such as a fee-for-service payment system. The current analysis tests for the existence of the principal-agent problem in the private health market in Vietnam by examining the prescribing patterns of the private providers. We show that (1) private providers were able to induce demand by prescribing more drugs than public providers for a similar illness and patient profile; (2) private providers were significantly more likely to prescribe injection drugs to gain trust among the patients; and (3) patients' education as a source of information and empowerment has enabled them to mitigate the demand inducement by the providers. Our hypotheses were supported with evidence from Vietnam National Health Survey 2001 and 2002, the first and, so far, only comprehensive health survey in the country.
Topic:
Health and Human Welfare
Political Geography:
Asia, Australia/Pacific, and Southeast Asia