Jointly with partners throughout Asia, the Asia Health Policy Program (AHPP) at Shorenstein APARC has developed comparative research on health care use, medical spending, and clinical outcomes for patients with diabetes in the region and other parts of the world as a lens for understanding the economics of chronic disease management. Karen Eggleston, AHPP director and APARC deputy director, recently traveled to South Korea, where she led three project-related events.

On November 29, a workshop on Net Value Diabetes Management was held at Seoul National University (SNU) School of Medicine. This was the third such workshop convened through the project, following two previous ones held in Beijing at the Stanford Center at Peking University. Another workshop, on diabetes modeling, hosted by the Mt. Hood Diabetes Challenge Network, was held at Chung Ang University on December 1. Finally, on December 5, Eggleston held an information session, titled Comparative Economics Research on Diabetes, during the 2019 International Diabetes Federation (IDF) at BEXCO in Busan. These events were also made available through video conferencing to enable remote participation by collaborators who were unable to travel to Korea.

[Learn more about AHPP’s Net Value in Diabetes Management research project]

Diabetes Net Value Workshop

The workshop brought together team members from multiple health systems — including South Korea, Japan, Taiwan, Hong Kong, Thailand, India, the Netherlands, and the United States — to discuss comparative research on the economics of diabetes control. Eggleston shared the results of a study outlined in a working paper on the net value of diabetes management in Japan, the Netherlands, Taiwan, and Hong Kong. This research is part of a broader series of studies aimed to help address the policy challenge of finding the best strategies to improve health through cost effective prevention and healthcare productivity in chronic disease management.

The key to this research was to measure changes in quality or health outcomes over time by predicting mortality risk using blood pressure, blood sugar, and other factors amenable to patient and provider control and improvement (controlling for age and duration of diabetes diagnosis). The research seeks to understand how we can control cost and eliminate waste without cutting out the things that are valuable and improving people’s quality of life. Further studies probe determinants of relative net value of a pay-for-performance program in Taiwan, adherence to medications and vertical integration in Japan, and net value based on a randomized controlled trial in India.

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Young Kyung Do of SNU reported that according to his evaluation project for diabetes care, the quality of care and treatment in South Korea has improved and is similar to Hong Kong and Singapore. The goal of the program is to provide more comprehensive care to diabetes patients.

Talitha Feestra of the Netherlands net value team presented her proposal for joint research to develop new prediction models for specific populations as a core component of health economics decision models in Diabetes. Feestra will take the lead to develop the plan and time frame for the continuation of this research in 2020.

Several additional comparative studies were proposed and discussed. Participants who attended the workshop and contributed to discussion included Junfeng Wang from the Netherlands net value team; Jianchao Quan and Carmen Ng from Hong Kong University; Daejung Kim from the Korea Institute for Health and Social Affairs (KIHASA); Taehoon Lee, Eun Sil Yoon, and Hongsoo Kim from SNU; Piya Hanvoravongchai from Chulalongkorn University; and Gregory Ang from National University of Singapore. Remote participants included Vismanathan Baskar from Madras Diabetes Research Foundation; Wasin Laohavinij from Chulalongkorn University (visiting Stanford University autumn quarter); and Rachel Lu from Chang Gung University.

Mt. Hood Diabetes Challenge Workshop on Diabetes Modeling

Philip Clarke from the Health Economics Research Center, University of Oxford, presented the history of insulin as a cure for diabetes and discussed in detail methods for economic modeling of diabetes, including quality of life and diabetes cost, drawing from his rich experience developing the UK Prospective Diabetes Study outcomes model. The second presenter was Andrew Palmer of University of Tasmania, Australia. His presentation included many additional economic modeling pointers, especially regarding drawing in the literature for building models.

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We are grateful to Professors Clarke and Palmer for graciously allowing the AHPP network researchers to join the workshop both in person and remotely, adding to their chronic disease modeling skills, and for inviting Karen Eggleston to present a keynote at the Mt Hood conference that took place before the modeling workshop.

Information Session: Comparative Economics Research on Diabetes

The third and final component of the diabetes research events was held on December 5 as part of the International Diabetes Federation congress in Busan, Korea, and presented the network to clinicians and public health researchers. Participants from China, India, and Australia attended. They shared updates on their individual projects and discussed methods and ideas for future collaboration.

The science of cyber risk looks at a broad spectrum of risks across a variety of digital platforms. Often though, the work done within the field is limited by a failure to explore the knowledge of other fields, such as behavioral science, economics, law, management science, and political science. In a new Science Magazine article, “Cyber Risk Research Impeded by Disciplinary Barriers,” cyber risk experts and researchers at Stanford University make a compelling case for the importance of a cross-disciplinary approach. Gregory Falco, security researcher at the Program on Geopolitics, Technology, and Governance, and lead author of the paper, talked recently with the Cyber Policy Center about the need for a holistic approach, both within the study of cyber risk, and at a company level when an attack occurs.

CPC: Your recent perspective paper in Science Magazine highlights the issue of terminology when it comes to how organizations and institutions define a cyber attack. Why is it so important to have consistent naming when we are talking about cyber risk?

Falco: With any scientific discipline or field, there is a language for engaging with other experts. If there’s no consistent language or at least dialect for communication around cyber risk, it’s difficult to engage with scholars from different disciplines. For example: The phrase “cyber event” is contested and the threshold for what an organization considers to be a cyber event varies substantially. Some organizations consider someone pinging their network as a cyber event, others only consider something a cyber event once an intrusion has been publicly disclosed. So there’s a disparity when comparing metrics of cyber events from organization to organization because of the different thresholds of what’s considered an event.

CPC: We’ve all been sent one of those emails letting us know our data may have been compromised and your paper points out it’s nearly impossible to put foolproof protections into place; attacks are inevitable. Given that, how should companies weigh the various ways they can protect themselves?

Falco: The first exercise each organization should go through when they decide to be serious about cyber risk is to prioritize their assets. What is business critical? What is safety critical? Then, like all other risks, a cost-benefit analysis must be done for each asset based on its priority. If the asset is safety-critical, then resources should be allocated to help protect that asset or at least ensure its resilience. Trade-offs are inevitable, no company has unlimited resources. But starting with an understanding of where the priorities are, is critical.

CPC: In companies, cyber security often falls entirely to the Chief Information Security Officer (CISO). Your paper argues that’s shortsighted. What is gained when a company takes a more holistic approach?

Falco: Distributing responsibility across the organization catalyzes a security culture. A security culture is one where there is a constant vigilance or at least broad awareness of cybersecurity concerns throughout the organization. Fostering a security culture is often suggested as a mechanism to help reduce cyber risk in organizations. The problem with not distributing responsibility is that when something happens, it’s too easy to resort to finger-pointing at the CISO, and that’s counterproductive. Efforts after an attack should be on responding and being resilient, not finding the scapegoat.

CPC: Cyber risk largely focuses on prevention, but your paper argues that it’s what happens after an attack in that needs greater attention. Why is that?

Falco: Every organization will be attacked. However organizations can differentiate themselves from a cyber risk standpoint by appropriately managing the situation after an attack. Some of the most significant damages to organizations can be reputational if communication after an attack is unclear or botched. Poor communication after an attack can result in major regulatory fines or valuation adjustments as seen in cases like Yahoo and that can have major business implications. Communications aren’t the only important element of post-attack response. A thorough post-mortem of the organization’s response to the attack can be an important learning experience and a way to plan for future attacks.

CPC: Protecting against cyber attacks and the losses that go with them can obviously be costly for companies. You make a case for collaboration among different fields, say among data scientists and economists. How can that be encouraged?

Falco: We argue that cross-disciplinary collaboration rarely happens organically. Therefore, we call on funding agencies like the NSF or DARPA to specify a preference for cross disciplinary research when funding cyber risk projects. Typically, this isn’t currently a feature of calls for proposals, but for cyber risk programs it should be. We encourage researchers to explore cyber risk questions at the margins of their discipline. Those questions may lend themselves to potential overlap with other disciplines and foster a starting point for cross-disciplinary collaboration.

For more on these topics, see a full list of recent publications from the Cyber Policy Center and the Program on Geopolitics, Technology, and Governance.

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