Health Care

In this study, we discuss the historical and policy background of expanded private health insurance in South Korea. Looking at the public-private mix of health care financing and its impacts, we conduct a comparative study of 30 member countries of the Organisation for Economic Co-operation and Development (OECD) over the period 1980–2007 to ask whether private health insurance can counterbalance limited government financing, high out-of-pocket payments, and the persistent financial deficit of South Korea’s National Health Insurance system. The panel analyses of OECD Health Data 2009 suggest that private health insurance financing is unlikely to reduce government spending on health care and social security. Also we find little evidence that out-of-pocket payments will be replaced by private health insurance payments. Private health insurance payments, however, are found to have a statistically significant positive association with total spending on health care, which indicates that the coverage effect of private health insurance—in addition to national health insurance—may exceed the efficiency gain through the market competition that private insurers may deliver to the health care sector. These findings leave it unclear whether private initiatives in health care financing will be as effective as the policy advocates hope for, in dealing with the challenges of national health insurance in South Korea. Further studies of how public and private insurers, and providers and consumers interplay in response to  a given structure of private-public mix in financing are warranted to decide the right balance between private coverage and publicly provided universal coverage.

Philippines Conference Room

Jaeun Shin Associate Professor of Economic Speaker KDI School of Public Policy and Management

Columbia University, MSPH
Dept. of Health Policy & Mgmt.
600 West 168th Street, 6th Fl.
New York, NY 10032

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Professor, Department of Health Policy and Management, Joseph Mailman School of Public Health, Columbia University
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Dr. John Rowe is the Julius B. Richmond Professor of Health Policy and Aging at the Columbia University Mailman School of Public Health.  Previously, from 2000 until his retirement in late 2006, Dr. Rowe served as Chairman and CEO of Aetna, Inc., one of the nation's leading health care and related benefits organizations.  Before his tenure at Aetna, from 1998 to 2000, Dr. Rowe served as President and Chief Executive Officer of Mount Sinai NYU Health, one of the nation’s largest academic health care organizations. From 1988 to 1998, prior to the Mount Sinai-NYU Health merger, Dr. Rowe was President of the Mount Sinai Hospital and the Mount Sinai School of Medicine in New York City.

Before joining Mount Sinai, Dr. Rowe was a Professor of Medicine and the founding Director of the Division on Aging at the Harvard Medical School, as well as Chief of Gerontology at Boston’s Beth Israel Hospital.  He was Director of the MacArthur Foundation Research Network on Successful Aging and is co-author, with Robert Kahn, Ph.D., of Successful Aging (Pantheon, 1998). Currently, Dr. Rowe leads the MacArthur Foundation’s Network on An Aging Society .

Dr. Rowe was elected a Fellow of the American Academy of Arts and Sciences and a member of the Institute of Medicine of the National Academy of Sciences. He  serves on the Board of Trustees of the Rockefeller Foundation and is Chairman of the Board of Trustees at the Marine Biological Laboratory in Woods Hole, Massachusetts and the Board of Overseers of Columbia University’s Mailman School of Public Health. He is Chair of the Advisory Council of Stanford University’s Center on Longevity, and  was a founding Commissioner of the Medicare Payment Advisory Commission ( Medpac) and Chair of the board of Trustees of the University of Connecticut. 

Adjunct Affiliate at the Center for Health Policy and the Department of Health Policy
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Nathan Eagle, Founder and CEO of txteagle spoke at the weekly Liberation Technology Seminar Series on Dececember 2, 2010 about mobile phone usage in the developing world.

Although txteagle began in 2007 as a purely academic project, the current goal of the company and of its founder and CEO, Nathan Eagle, is to give one billion people a five percent raise. In his presentation, Eagle described the context for which txteagle was designed, how the company's focus has evolved over the past three years, and what steps the company is taking to move closer to achieving this goal in the future.

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Eagle began by offering some background information to explain the initial impetus behind txteagle. Today, about 63% of global mobile phone usage takes place in the developing world, making airtime usage in emerging markets worth about $200 billion a year. Mobile phone users at the so-called "Base of the Pyramid" typically spend 10% of their income on mobile phone airtime. Through his experience living in emerging markets and teaching mobile application development in universities across sub-Saharan Africa, Eagle began to see that a significant opportunity space existed to reduce the cost of airtime for people at the base of the pyramid, in effect giving these people a raise.

Mobile applications developed as a part of MIT's Entrepreneurial Research on Programming and Research on Mobiles (EPROM) project offered some insights into the potential of mobile-based tools. In Rwanda, where electricity is a prepaid service, one of Eagle's former students quickly cornered a significant share of the market by creating scratch cards for crediting one's electricity bill via mobile phone. In Eastern Kenya, a program called SMS Blood Bank was created to enable real time monitoring of blood supplies at local district hospitals in Eastern Kenya. Although SMS reporting of low blood levels resolved the huge amount of latency in the system of local district hospitals (where responses to dips in supply had typically taken up to 4 weeks), the price of reporting blood levels via SMS represented a pay cut for local nurses; despite nurses' initial enthusiasm, SMS reporting tapered off within weeks. When the idea of sending about 10 cents of airtime to compensate nurses for each SMS report of blood level data proved a success, the model behind txteagle was born.

Designed as a means to monetize people's downtime, txteagle has grown rapidly through partnerships with over 220 mobile operators in about 80 countries around the world. In turn for helping these operators analyze their customer data, txteagle has gained access to about 2.1 billion mobile subscribers. Partnering with txteagle is a winning proposition for mobile operators, since the airtime compensation mobile subscribers receive from txteagle improves operators' Average Revenue per User (ARPU), a statistic that had been plummeting as more and more poor people became mobile phone users. By enabling people to carry out work via web browsers or SMS and compensating them via mobile money or airtime, txteagle has become a market leader at efficiently gathering data in the developing world.

Since txteagle was first created, the company has attempted to move from an outsourcing/back-office model to an emphasis on work that leverages a person's unique local knowledge and information. Typically outsourced tasks such as forms processing, audio transcription, inventory management, data cleaning, tagging, and internet search, tend to be less rewarding to the worker. By focusing on local data instead, txteagle enables unprecedented insight into emerging markets, all while optimizing engagement with local customers. Typical tasks include: maps and directions, local market prices and businesses, survey research and polling, and other forms of local knowledge gathering.

One of txteagle's central initiatives, GroundTruth, leverages this local knowledge-based model to carry out better market research. Today, global brands are already spending about $125 billion annually in emerging markets to engage the "next billion," but they typically carry out this research in a sub-optimal way. Through the txteagle platform, Eagle suggests, brands and organizations can use advertising money to design better products and services, conduct market research, and carry out brand engagement. Recent success cases include the use of txteagle to help a program of the United Nations to reach survey respondents directly and to enable the World Bank to obtain better local market price data at lower cost. 

Although txteagle's rapid growth and early successes have been encouraging, the company has ambitious goals for the next two years. The company began by focusing on outside sales through its GroundTruth market research program. Next year, the company  hopes to generate syndicated data and ultimately to create a self-source platform enabling anyone to conduct their own population-level surveys.  By continuing to focus on improving the quality of both their data and workers over time, txteagle aims to have an even greater positive impact on the incomes of the hundreds of millions of mobile phone users at the base of the pyramid.

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After the Sichuan 5.12 earthquake, many people in the disaster area suffered from mental health problems. To decrease morbidity from mental disease, the Sichuan authorities worked with diverse hospitals to establish a “three-level network of psychiatric prevention and treatment.” The goal was to disseminate knowledge about prevention and treatment for psychiatric conditions from doctors to recipients, especially regarding symptoms. How to disseminate such knowledge effectively and efficiently deserves study. Based on a sample of 146 doctor-recipient pairs from 52 hospitals in diverse areas of China (including Sichuan, Beijing, and Guangzhou), this study examines the impact of knowledge characteristics, the network status of the doctor, the network status of the hospital with which the doctor is affiliated, and the relationship quality between doctor and recipient on the effectiveness and efficiency of knowledge transfer from the doctor to patient. Findings indicate that high-status doctors are more effective in knowledge transfer. In addition, low-status hospitals were found to have a positive effect on knowledge transfer efficiency. In particular, results highlight the strong positive impact that the quality of the relationship between the doctor and patient has on both the efficiency and effectiveness of knowledge transfer. Finally, findings suggest that the relationship between knowledge characteristics and knowledge transfer is partially mediated by the relationship quality between the doctor and the recipient.

Philippines Conference Room

Shorenstein APARC
Stanford University
Encina Hall E301
Stanford, CA 94305-6055

(650) 723-9741 (650) 723-6530
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Visiting Scholar, 2009-2011
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Zhe Zhang is an assistant professor of organization management at the School of Management, Xi'an Jiaotong University, China, where she also received her PhD. Her research focuses on public-private partnerships, corporate governance, and corporate social responsibility. She has published in the Journal of High Technology Management Research, International Journal of Health Care Finance & Economics, Management and Organization Review, and the International Journal of Networking and Virtual Organizations.

(Amy) Zhe Zhang Visiting Scholar, 2009-2011 Speaker Shorenstein APARC
Seminars

117 Encina Commons
Stanford, CA 94305

(650) 736-0405 (650) 723-1919
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Martin Connor is presently a Harkness Fellow in Health Care Policy and Practice.  These fellowships are delivered by the Commonwealth Fund and support mid-career physicians and health service managers and researchers to study in the US.  During his time at CHP/PCOR Martin will be studying integrated care and its potential to contribute to the delivery system aspects of Health Reform as well as maintaining long standing interests in policy developments in the UK and developments in physician leadership and accountability.

Prior to starting the fellowship, Martin was Director of the Trafford Integrated Care Organisation Programme in the UK NHS, as the follow on to his role as Deputy Chief Executive at Trafford PCT in Manchester, England.

Before this, he worked from 2005-08 as special policy adviser to the Department of Health in Northern Ireland, leading the development of national policy at Permanent Secretary and ministerial level.  He went on to lead the reform programme and established the Service Delivery Unit in Northern Ireland.  This transformed waiting times for elective assessment and treatment, increased the involvement of clinical professionals in decision making and the developed a novel, high frequency, patient level information base to support strategic decision making.

Between 2002 - 2005, he was Associate Director (Health Reform) for the Greater Manchester Strategic Health Authority.  He co-authored the strategy for GMSHA, which led to the area moving from 'special measures' to 'high performing' within 2 years.  This strategy included the first health authority-wide demand management system in the NHS that was commended by the Audit Commission.

In his twenties, he studied classical and linguistic philosophy following the award of a studentship from Durham University where he received his doctorate in 2001.  He joined the NHS on the graduate management training programme in 1999.

Adjunct Affiliate at the Center for Health Policy and the Department of Health Policy
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Karen Eggleston
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Karen Eggleston, Director of the Asia Health Policy Program, seeks to hire two research assistants at the advanced undergraduate or graduate social science level to assist with several projects, including an international comparative study of government financing for health service provision and provider payment. The RA should have a solid background in microeconomics; some background in health economics and comparative health policy; and near-native fluency in English. Knowledge of another European or Asian language (especially Chinese, Japanese, or Korean) would be an advantage. Ideally the RA would be a student whose own studies are related to the topic of health care financing and payment incentives in developing and/or transitional economies, or more generally in public economics, the government sector, and social protection policies. The work would be for autumn quarter, with possibility of extension to winter quarter. Compensation is competitive and commensurate with RA experience. Please send CV and brief statement of interest and related qualifications to Karen Eggleston at karene@stanford.edu by September 24th.

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Dr. Katzenstein completed his undergraduate and medical degrees as well as a residency in Internal Medicine and Fellowship training in Infectious Diseases at the University of California San Diego. He continued fellowship training in virology and Infectious Diseases with Dr. Colin Jordan at U.C. Davis, moving to the University of Minnesota to a faculty position in Infectious Disease in 1984. He was a visiting lecturer for two years in the Departments of Medical Microbiology and Medicine at the University University of Zimbabwe as the AIDS epidemic was first recognized in Southern Africa. In 1987, he returned to the U.S. to take up a senior research fellowship at the Center for Biologics Evaluation and Research (CBER) at the Food and Drug Administration in the Vaccine Branch, evaluating early candidate HIV Vaccines and diagnostics. Dr. Katzenstein returned to California in 1989 to work with Dr. Thomas Merigan and the AIDS Clinical Trials Group. He continues an active collaboration with his colleagues in Zimbabwe and Southern Africa in prevention, perinatal transmission and vaccine research. At Stanford, Dr. Katzenstein participates in studies of multiple drugs and drug combinations in Clinical Trials in the U.S. and Europe and is the principal investigator for Stanford's Virology Service Laboratory in the center for AIDS Research. At Stanford he teaches an undergraduate course in Global AIDS, attends on the Infectious Disease service and supervises both laboratory and clinical fellows conducting AIDS Research. He remains actively involved in studies of HIV infection in Zimbabwe, spending 2-3 months a year in Southern Africa.

Professor Katzenstein's research interests include treatment and evaluation of HIV infection in the United States and Europe through the AIDS Clinical Trials Group (ACTG). His international HIV pathogenesis work includes studies in Zimbabwe, South Africa. The lab currently is focused on drug resistance, envelope tropism and the pathogenesis of HIV.

Encina West 208

Helen Stacy Moderator
David Katzenstein Professor (Research), Medicine - Infectious Diseases; Member, Bio-X Speaker Stanford University
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