Japan’s Public Universal Health Insurance System Reform: Lessons for Achieving and Maintaining Universal Health Care Coverage
Related Multimedia
Japan’s Public Universal Health Insurance System Reform: Lessons for Achieving and Maintaining Universal Health Care Coverage
Related Multimedia
Health insurance no guarantee for diabetes care in developing countries
News Type
News
Date
Paragraphs
As incomes rise around the world, health experts expect a more troubling figure to increase as well: the number of diabetics in developing countries.
In China and India – two of the world’s most populous nations with fast-paced economies – the prevalence of diabetes is expected to double by 2025. Between 15 and 20 percent of their adult population will develop the disease as household budgets increase, diets change to include more calories and new health problems emerge.
But China, India and other developing countries are not fully prepared to deal with the rising trend of diabetes. And a growing number of diabetics aren’t getting the care they need to prevent serious complications, Stanford researchers say.
Even with insurance, many diabetics don’t have essential medications that could help them manage their conditions. In many cases, people are spending a great deal of their household incomes to pay for their treatment, said Jeremy Goldhaber-Fiebert, an assistant professor of medicine who led the research team.
“Public and private health insurance programs aren’t providing sufficient protection for diabetics in many developing countries,” said Goldhaber-Fiebert, a faculty member at Stanford Health Policy at the university’s Freeman Spogli Institute for International Studies. “People with insurance aren’t doing markedly better than those who don’t have it. Health insurance and health systems need to be re-oriented to better address chronic diseases like diabetes.”
Findings from the study are online and will be published in the Jan. 24 edition of Diabetes Care, the journal of the American Diabetes Association. The journal article was co-authored by Jay Bhattacharya, an associate professor of medicine and Stanford Health Policy faculty member; and Crystal Smith-Spangler, an instructor at Stanford’s Department of Medicine and an investigator at the Palo Alto VA Health Care System.
Failure to adequately manage diabetes will lead to more severe health problems like blindness, heart disease and kidney failure. It also harms the otherwise healthy, Goldhaber-Fiebert said.
Diabetes often strikes people at an age when they’re taking care of children and elderly parents. To sideline these primary caretakers as dependants will lead to a heavy burden for communities and create an obstacle for economic growth, he added.
Using responses to a global survey conducted by the World Health Organization in 2002 and 2003, Goldhaber-Fiebert and his colleagues examined data from 35 low- and middle-income countries in Asia, Latin America, Africa and Eastern Europe to determine whether diabetics with insurance were more likely to have medication than those without insurance.
They also wanted to know whether insured diabetics have a lower risk of “catastrophic medical spending,” a term the researchers define as spending more than 25 percent of a household income on medical care.
“Surprisingly, diabetics with insurance were no more likely to have the medications they need than uninsured diabetics,” Goldhaber-Fiebert said. “They were also no less likely to suffer catastrophic medical spending.”
There are many reasons why health insurance may not protect diabetics in developing countries against high out-of-pocket spending. In some cases, there’s a lack of sufficient medication – such as insulin – that regulate glucose levels. Without those drugs, there’s a greater risk of complications that often lead to more hospitalizations and more expenses.
In other cases, co-payments and deductibles are too high. Sometimes, drugs and medical services to prevent diabetes complications are not covered. And doctors and hospitals don’t always accept insurance.
“Better policies are needed to provide sufficient protection and care for diabetics in the developing world,” Goldhaber-Fiebert said.
Without medications to manage diabetes and prevent secondary complications, the condition will worsen and the burden of catastrophic spending will increase, he said.
“It’s important to get ahead of the curve and prepare so there’s an infrastructure in place to deal with these health and cost issues,” he said.
While preventing diabetes in the first place would be ideal, programs and policies must be established to care for the many cases that will surely continue to exist.
“There isn’t a single country that’s managed to entirely arrest or reverse the trend of diabetes,” he said. “Programs that focus on primary prevention are extremely important, but the reality is that the developing world faces hundreds of millions of diabetes cases that are unlikely to all be prevented.”
Hero Image
All News button
1
Cigarette Citadels, Remapping Theory and Policy, Cigarette Factories in and Outside of China
-
At present, the tobacco industry produces some six trillion cigarettes worldwide every year. Six trillion cigarettes per annum, each ready to release smoke filled with highly addictive nicotine and powerful carcinogens. A third of all these sticks were produced in China last year. In 2011, the world’s largest cigarette maker by volume, the China National Tobacco Corporation, contributed an all-time high of U.S. $214 billion in profits and taxes to the Chinese government, up 22 percent year-on-year. Currently the greatest cause of preventable death in the world, the cigarette is likely to kill ten times as many people in the 21st century as it did in the 20th century, epidemiologists tell us, with China bearing the largest burden. Until now, much global health research and intervention has focused with limited success on the cigarette consumer—addressing how one or another variable prompts people to take up or quit smoking, whether the cue for the consumer is biological, psychological, spatial, financial or symbolic. What though of the industrial sources of tobacco-related diseases? Where are the six trillion cigarettes that are released into circulation each year manufactured? Where are they rolled, wrapped, and boxed for shipment? This presentation will introduce the Cigarette Citadels Project, an innovative application of participatory GIS. With special attention given to China’s network of cigarette factories, Matthew Kohrman will explain how the Cigarette Citadels Project not only reveals conceptual roadblocks in public health policy but also lacuna in social theory pertaining to the state and the politics of life.
Matthew Kohrman joined Stanford’s faculty in 1999. His research and writing bring multiple methods to bear on the ways health, culture, and politics are interrelated. Focusing on the People's Republic of China, he engages various intellectual terrains such as governmentality, gender theory, political economy, critical science studies, and embodiment. His first monograph, Bodies of Difference: Experiences of Disability and Institutional Advocacy in the Making of Modern China, examines links between the emergence of a state-sponsored disability-advocacy organization and the lives of Chinese men who have trouble walking. In recent years, Kohrman has been conducting research projects aimed at analyzing and intervening in the biopolitics of cigarette smoking and production. These projects expand upon analytical themes of Kohrman’s disability research and engage in novel ways techniques of public health.
This event is part of the China's Looming Challenges series.
Philippines Conference Room
Matthew Kohrman
Stanford University
Department of Anthropology
Building 50, Central Quad
Stanford, California 94305-2034
0
kohrman@stanford.edu
Associate Professor of Anthropology
Senior Fellow, by courtesy, at the Freeman Spogli Institute for International Studies
Faculty Affiliate at the Walter H. Shorenstein Asia-Pacific Research Center
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
Matthew Kohrman joined Stanford’s faculty in 1999. His research and writing bring multiple methods to bear on the ways health, culture, and politics are interrelated. Focusing on the People's Republic of China, he engages various intellectual terrains such as governmentality, gender theory, political economy, critical science studies, and embodiment. His first monograph, Bodies of Difference: Experiences of Disability and Institutional Advocacy in the Making of Modern China, examines links between the emergence of a state-sponsored disability-advocacy organization and the lives of Chinese men who have trouble walking. In recent years, Kohrman has been conducting research projects aimed at analyzing and intervening in the biopolitics of cigarette smoking and production. These projects expand upon analytical themes of Kohrman’s disability research and engage in novel ways techniques of public health.
Hide publication sections
Off
Seminars
Do Different Health Insurance Plans in China Create Disparities in Health Care Utilization and Expenditures?
-
Venue Changed to the Philippines Conference Room
China has recently reformed its health care system with the intent of providing universal coverage for basic health care to every Chinese citizen. Three separate health insurance plans have recently been launched to achieve this objective: the rural newly cooperative medical scheme, urban resident health insurance, and urban employee-based health insurance. Each plan differs substantially in terms of insurers, insured population, premiums, and benefits packages. Using data from the 2009 China Health and Nutrition Survey, Hai Fang will discuss a study that investigates whether and to what extend different health insurance plans have created disparities in health care utilization and expenditure.
Hai Fang is an assistant professor in the Department of Health Systems, Management, and Policy at the University of Colorado Denver, and a research associate in the Kennedy School of Government at Harvard University. He earned his doctorate in economics and master of public health from the State University of New York at Stony Brook in 2006. Before joining the University of Colorado Denver, he taught at the University of California, Davis, and the University of Miami. His research interests include health economics, labor economics, and public health.
Philippines Conference Room
Hai Fang
Associate Professor, Department of Health Systems, Management, and Policy
Speaker
University of Colorado Denver
Seminars
The Growth of Private Hospitals and Public-Private Partnerships in Asia: Good or Bad for Health?
-
This colloquium will discuss the state of evidence, challenges, and research agenda regarding the growth of private hospitals and public-private hospital partnerships in developing Asia.
Dominic Montagu is an assistant professor of epidemiology and biostatistics and lead of the Health Systems Initiative at the Global Health Group of the University of California, San Francisco (UCSF). His work is focused on private delivery of health services in developing countries and on market function for health services and health commodities. He has active field research projects ongoing in Nigeria and Myanmar. Montagu holds masters degrees in business administration and public health, as well as a doctorate in public health, from the University of California, Berkeley (UC Berkeley). He has worked extensively in Africa and Asia, and teaches on the private sector in developing countries, and on the regulation of private hospitals and public-private-partnerships at UCSF, UC Berkeley, and on behalf of the World Bank Institute.
Philippines Conference Room
Dominic Montagu
Speaker
University of California, San Francisco
Seminars
Redefining Security Along the Food/Health Nexus
-
FSI's second major conference on global underdevelopment brought together worldwide thought leaders to explore the root causes of global underdevelopment and to provide fresh insights on the links between international security and universal access to adequate food, health care and water.
Redefining Security Along the Food/Health Nexus Conference website
Frances C. Arrillaga Alumni Center
Kofi Annan
former Secretary-General, the United Nations, Nobel Peace laureate, chairman of the Alliance for a Green Revolution in Africa
Keynote Speaker
Jeff Raikes
CEO, the Bill & Melinda Gates Foundation
Keynote Speaker
Robert Gates
former U.S. secretary of Defense
Keynote Speaker
David Bloom
Clarence James Gamble Professor of Economics and Demography; chair, Department of Global Health and Population, Harvard School of Public Health
Panelist
Mariano-Florentino Cuéllar
Professor and Deane F. Johnson Faculty Scholar, Stanford Law School; co-director, Center for International Security and Cooperation
Panelist
Jenna Davis
473 Via Ortega, Y2E2, Room 255
Stanford, CA 94305-4020
0
jennadavis@stanford.edu
Professor, Department of Civil and Environmental Engineering
Jennifer (“Jenna”) Davis is a Professor in the Department of Civil and Environmental Engineering and the Higgins-Magid Senior Fellow at the Woods Institute for the Environment, both of Stanford University. She also heads the Stanford Program on Water, Health & Development. Professor Davis’ research and teaching is focused at the interface of engineered water supply and sanitation systems and their users, particularly in developing countries. She has conducted field research in more than 20 countries, including most recently Zambia, Bangladesh, and Uganda.
Higgins-Magid Faculty Senior Fellow, Stanford Woods Institute for the Environment
Alex Evans
head of research, Program on Resource Scarcity, Climate Change and Multilateralism at the Center on International Cooperation, New York University
Panelist
Donald Francis
co-founder, Global Solutions for Infectious Diseases
Panelist
David Lazarus
former senior advisor for rural affairs, Domestic Policy Council, the White House, and former senior advisor to the secretary of agriculture
Panelist
Jenny Martinez
professor of law and Justin M. Roach Faculty Scholar, Stanford Law School
Panelist
Grant Miller
Encina Commons Room 101,
615 Crothers Way,
Stanford, CA 94305-6006
0
ngmiller@stanford.edu
Henry J. Kaiser, Jr. Professor
Professor, Health Policy
Senior Fellow at the Freeman Spogli Institute for International Studies
Senior Fellow at the Stanford Institute for Economic Policy Research
Professor, Economics (by courtesy)
As a health and development economist based at the Stanford School of Medicine, Dr. Miller's overarching focus is research and teaching aimed at developing more effective health improvement strategies for developing countries.
His agenda addresses three major interrelated themes: First, what are the major causes of population health improvement around the world and over time? His projects addressing this question are retrospective observational studies that focus both on historical health improvement and the determinants of population health in developing countries today. Second, what are the behavioral underpinnings of the major determinants of population health improvement? Policy relevance and generalizability require knowing not only which factors have contributed most to population health gains, but also why. Third, how can programs and policies use these behavioral insights to improve population health more effectively? The ultimate test of policy relevance is the ability to help formulate new strategies using these insights that are effective.
Faculty Fellow, Stanford Center on Global Poverty and Development
Faculty Affiliate, Stanford Center for Latin American Studies
Faculty Affiliate, Woods Institute for the Environment
Faculty Affiliate, Interdisciplinary Program in Environment & Resources
Faculty Affiliate, Stanford Center on China's Economy and Institutions
CV
Document
grant_miller-cv.pdf
(245.85 KB)
Hide publication sections
Off
Onesmo K. ole-MoiYoi
chair, Kenya Agricultural Research Institute & Consortium; senior advisor, Aga Khan University
Panelist
Gary Schoolnik
professor of medicine (infectious diseases), and microbiology and immunology, Stanford School of Medicine; senior fellow, Woods Institute for the Environment and FSI
Panelist
Ray Yip
director, China Program, Global Health Program, the Bill & Melinda Gates Foundation
Panelist
Conferences
