Search

Begin New Search Author Karen Eggleston Publication Year within 10 Years

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