“Emerging democracies must demonstrate that they can solve governance problems and meet citizens’ expectations for freedom, justice, a better life, and a fairer society.”

If the big global story of the 1980s and 1990s was the remarkable expansion of democracy, the bad news of this decade is that democracy is slipping into recession. In the two decades following the Portuguese revolution in 1974, the number of democracies tripled (from 40 to 120) and the percentage of the world’s states that are at least electoral democracies more than doubled (to about 60 percent). Since the late 1990s however, there has been little if any net progress in democracy. To be sure, significant new transitions to democracy took place in countries like Mexico, Indonesia, Serbia, Georgia, and Ukraine. But globally, the democratic wave has been neutralized and is now at risk of being overtaken by an authoritarian undertow, which has extinguished democracy in such states as Pakistan, Russia, Nigeria, Venezuela, Bangladesh and Kenya. In fact, two-thirds (15) of all the reversals of democracy (23) since 1974 have taken place just in the last eight years, since the October 1999 military coup in Pakistan.

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Two other negative trends are important to note. One is the implosion of democratic openings in the Arab world. Under pressure from the George W. Bush administration beginning in 2003, several authoritarian Arab regimes liberalized political life and held competitive, multiparty elections. Then, Islamist political forces made dramatic gains in Egypt and Lebanon and won a majority of seats in Palestine and Iraq — and suddenly the Bush Administration got cold feet. Arab democrats who had surfaced and mobilized felt abandoned and betrayed. The liberal secular politician Ayman Nour, who had the temerity to challenge President Hosni Mubarak in Egypt’s first contested presidential election, languishes in prison three years later. The country’s political opening is now frozen, while more than a billion dollars in American aid continues to flow to the regime.

The second negative trend is that authoritarian states have, unfortunately, learned some of the lessons of democratic breakthroughs of the past decade, particularly the color revolutions that brought down neocommunist autocracies in Serbia, Georgia, Ukraine, and Kyrgyzstan. As a result, they have closed political space, swallowed up or arrested independent media, crushed independent political opposition, sabotaged or shut down innovative uses of the Internet, and sought to block or sever external flows of democratic assistance. Vladimir Putin’s Russia (with its sinister cabal of savvy Kremlin “political technologists”) has blazed the trail in this authoritarian pushback, but China, Belarus, Iran, Azerbaijan, Uzbekistan, and other “post” communist and Middle Eastern dictatorships have followed suit. To make matters worse, China and Russia have drawn together with the Central Asian dictatorships in a new club, the Shanghai Cooperation Organization, to formalize and advance their authoritarian pushback.

To renew democratic progress in the world, we must understand the reasons for the democratic recession. Authoritarian learning is one. Another has been the inconsistent and often unilateralist policies of the United States. Although President Bush has done much to put democracy promotion at the center of American foreign policy and has substantially increased funding for U.S. democracy assistance programs, he has also alienated potential allies in the effort to advance democracy globally by associating democracy promotion with the use of (largely unilateral) force, as in Iraq; by promoting democracy with a tone that was often self-righteous and a style that was too often poorly coordinated with our democratic allies; and then by failing to sustain pressure for democratic change when the going got rough in the Middle East.

Structural factors have also driven the recession of democracy. One has had to do with the global political economy. As the price of oil has gone up, the prospects for democracy have receded. Russia, Nigeria, and Venezuela have all seen their democracies slip back into authoritarianism as oil prices have skyrocketed, sending huge new infusions of discretionary revenue into the hands of autocratic leaders, which they have used to buy off opponents and strengthen their security apparatuses. In Iran and Azerbaijan, surging oil revenues have shored up authoritarian states that once seemed vulnerable.

A second and more pervasive factor has had to do with the performance of the new democracies. Some new democracies are holding their own (like Mali) and even making progress (like Brazil and Indonesia) in the face of enormous accumulated problems and challenges. But the general reality, even in these countries, is that democracy often does not work for average citizens. Rather, it is blighted by multiple forms of bad governance: abusive police and security forces, domineering local oligarchies, inept and indifferent state bureaucracies, corrupt and pliant judiciaries, and ruling elites who routinely shred the rule of law in the quest to get rich in office. As a result, citizens grow alienated from democracy and become susceptible to the patronage crumbs of corrupt political bosses and the demagogic appeals of authoritarian populists like Putin in Russia and Hugo Chávez in Venezuela.

“If democracies do not work better to contain crime and corruption, generate economic growth, relieve economic inequality, and secure freedom and a rule of law, people will eventually lose faith and turn to authoritarian alternatives.”Before democracy can spread further, it must take deeper root where it has already sprouted. Emerging democracies must demonstrate that they can solve governance problems and meet citizens’ expectations for freedom, justice, a better life, and a fairer society. If democracies do not work better to contain crime and corruption, generate economic growth, relieve economic inequality, and secure freedom and a rule of law, people will eventually lose faith and turn to authoritarian alternatives. Struggling democracies must be consolidated, so that all levels of society become enduringly committed to democracy as the best form of government and to the country’s constitutional norms and restraints. Western governments and international aid donors can assist in this process by making most foreign aid contingent on key principles of good governance: a free press, an independent judiciary, and vigorous, independently led institutions to control corruption. International donors also need to expand their efforts to assist these institutions of horizontal accountability as well as initiatives in civil society that monitor the conduct of government and press for institutional reform.

The only way to stem the democratic recession is to show that democracy really is the best form of government — that it can not only provide political freedom but also improve social justice and human welfare.

Leading matters is an inspirational stanford tour that reveals how the university is changing and reinventing itself. Designed exclusively for Stanford alumni, family, and friends, Leading Matters is being held in 17 locations that stretch from London to Hong Kong. Speakers include Stanford President John Hennessy, distinguished deans, and faculty. Each event features thought-provoking faculty panels, stimulating seminars, and a state-of-the-art media presentation.

Several FSI faculty members presented their research findings at Leading Matters events in Seattle, San Diego, and Hong Kong, which were sponsored by The Stanford Challenge and the Stanford Alumni Association.

In Seattle, on January 26, FSI faculty led the panel, “Emerging Superpowers: Influence and Supremacy in the 21st Century,” which addressed how the landscape of world power has evolved since the end of the Cold War and what factors contribute to the making of current superpowers.

The panel, moderated by Dean Robert Joss of the Graduate School of Business, included William J. Perry, Michael and Barbara Berberian Professor, FSI Senior Fellow, and the 19th secretary of defense; Michael A. McFaul, professor of political science, Peter and Helen Bing Senior Fellow, Hoover Institution, and director of CDDRL; and Stephen J. Stedman, professor of political science (by courtesy) and senior fellow at CISAC and FSI. Said Perry, on efforts to reduce nuclear arms worldwide, “If we want to end the dangers that nuclear weapons pose to our civilization, we should not be waiting for divine intervention. We ourselves must take the necessary action.”

Rosamond L. Naylor, director of the Program on Food Security and the Environment and Julie Wrigley Senior Fellow, presented as part of the panel, “Big Plans for a Small Planet: Can We Feed the World Without Wrecking the Oceans?” moderated by Dean Pamela Matson of the School of Earth Sciences. Addressing some of the economic and environmental ramifications of the world’s growing dependence on the oceans for food, Naylor said, “Promoting environmentally sustainable fish farming operations requires knowledge of waste flows from open netpens, the ecological impacts of farming on wild fish populations, the economics of farming, and the regulatory Decisive Gifts Enable Summer Fellows Program to Continue with Bold Vision institutions governing the industry. Stanford is unique in integrating all of these factors into its analysis of the aquaculture sector.”

In San Diego, on March 8, Dean Richard Saller of the School of Humanities and Sciences moderated a panel on “Clash of Cultures,” featuring Stephen D. Krasner, Graham H. Stuart Professor of International Relations and FSI Senior Fellow; Abbas Milani, Moghadam Director of Iranian Studies, research fellow and co-director of the Iran Democracy Project at the Hoover Institution; and Martha Crenshaw, professor of political science (by courtesy) and senior fellow at CISAC and FSI. They explored how cultural differences influence power relations between nations in the post–Cold War world. Said Crenshaw, “Actually, the ‘new’ terrorism is not so different from the ‘old’ in terms of goals, methods, and organization. Terrorism in a variety of forms has occurred in all cultural contexts. What all expressions of the phenomenon have in common is political motivation. Terrorist violence is best understood as politics, not culture.”

In Hong Kong on April 19, President Hennessy and FSI Director Coit D. Blacker addressed the changing balance of power between the U.S., China, and India. Scott Rozelle, Helen F. Farnsworth Senior Fellow, spoke on the panel, “Troubled Waters,” moderated by Dean Pamela Matson. Noting that more than 1.1 billion people have no access to safe or plentiful water, Rozelle addressed implications for global health and economic development.

Asked Rozelle, “Is China facing a water crisis? Some say yes. It could destablize China. It could even push China to ‘starve the world’ by reducing its ability to produce food and force it to turn to international markets, which would push up the cost of food globally. Can Stanford’s research help build ‘bridges’— sound policy bridges — over troubled waters? Should Freeman Spogli Institute researchers be involved in such work? We believe the answer is unequivocally yes. We are getting involved in the solutions to society’s most complicated problems. We are building partnerships with government officials, academics, and community leaders — and most of all the poorest of the poor, in trying to become builders of bridges.”

With more than a million dollars in committed new funding, CDDRL’s Stanford Summer Fellows on Democracy and Development marches into its fifth year with a sustainable future and also a new name: the Draper Hills Summer Fellows on Democracy and Development. The program’s new name recognizes the generous commitments of William Draper III and Ingrid von Mangoldt Hills to fund the program and enable it to continue its bold vision.

William Draper made his gift to honor his father, Maj. Gen. William H. Draper, Jr.; Ingrid von Mangoldt Hills made her gift in honor of her late husband, Reuben W. Hills.

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Reuben W. Hills was a San Francisco philanthropist and president and chairman of the board of Hills Bros. Coffee. He was also vice president and director of the San Francisco Opera and trustee of the Fine Arts Museum of San Francisco. In 1992 he and his wife Ingrid started a nonprofit organization, The Hills Project, to connect inner-city youth with visual and performing arts. The project reaches out to 3,300 children in San Francisco and Berkeley schools, offering field trips to the San Francisco Ballet, museums, artists’ studios, and other cultural institutions as well as visits by artists.

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The generous support of Bill Draper and Ingrid von Mangoldt Hills enables CDDRL to continue to create a community of democratic activists dedicated to building new linkages among democracy, sustainable development, good governance, and the rule of law in transitioning nations.

Over more than six decades, the partnership between the United States and the Republic of Korea has been subject to many stresses and strains, from the Korean War to coping with the challenge of North Korea’s nuclear ambitions. More recently, the democratization of South Korea has opened the alliance to much greater public scrutiny and pressures from an active and mobilized Korean public. Managing this strategic alliance in an era of democracy has been a focus of the research work on Korea conducted by FSI’s Walter H. Shorenstein Asia-Pacific Research Center.

With the election in December of Lee Myung-bak as South Korea’s president, ending two terms of progressive rule, Shorenstein APARC decided to launch a nonpartisan group of former senior U.S. government officials, scholars, and other American experts on Korea to explore how to revitalize the U.S. alliance with the Republic of Korea (ROK) after a decade of tensions. In partnership with the New York-based Korea Society, Shorenstein APARC assembled this policy study group at Stanford in early February for in-depth discussion of the challenges facing the alliance and then took the group to Korea for meetings with key figures, from President-elect Lee and his advisors to leaders of the opposition, Korean businessmen, and American diplomats and security officials.

Based on these intensive meetings, the members of this “New Beginnings” policy study group concluded that the United States now has a major opportunity to bolster and broaden its relationship with the ROK. Lee, Korea’s first businessman to be elected president and a self-proclaimed “pragmatist,” has stressed that he gives top priority to the United States in his foreign policy. His fixed five-year tenure will coincide with the entire first term of the next U.S. president, allowing the two new leaders an extended period of cooperation.

Immediately before Lee’s first visit to the United States as president in mid-April, New Beginnings members led by Shorenstein APARC Director Gi-Wook Shin, APARC Distinguished Fellow Michael H. Armacost, and Korea Society President Evans J.R. Revere visited Washington, D.C., and New York City to release their report, New Beginnings in the U.S.-ROK Alliance: Recommendations to U.S. Policymakers. They also addressed a forum in San Francisco co-hosted by the World Affairs Council and the Asia Society of Northern California on June 3 to discuss their recommendations and subsequent developments in U.S.-South Korean relations. The report received extensive coverage in the South Korean news media and was noted in American media as well.

Surrounded by a rising China, a more assertive Russia, a Japan seeking a greater international role, and a nuclear North Korea, the ROK can play a key role in working with the United States to maintain peace and stability in East Asia. No effort to address the nuclear and other challenges posed by North Korea is likely to succeed without the closest U.S.-South Korean cooperation. The ROK, as the world’s 13th-largest economy and one of Asia’s most democratic countries, is a model of the virtues of a market economy, of the values of freedom and human rights, and of alignment with the United States. The two countries are also bound by personal ties: 2 million people of Korean descent live in the United States, and 100,000 Koreans come to the United States each year for study and exchanges, more than from any other country.

President Lee’s election reflects four key changes in South Korea: (1) a shift from the political left back toward the center; (2) greater skepticism about North Korea; (3) increased wariness of China; and (4) enhanced support for the U.S.-ROK alliance. The protests against the United States seen in South Korea in 2002 were the result in part of transitory circumstances and no longer reflect the reality there.

President Lee seeks a global partnership with the United States while maintaining good relations with Korea’s neighbors, Japan, China, and Russia. He favors improved relations with North Korea and has stated his willingness to meet North Korean leader Kim Jong-Il. In major departures from the earlier “sunshine” policy of the South Korean government toward North Korea, however, Lee will not provide large-scale economic assistance to the North until after it abandons its nuclear weapons program. In another major departure from the previous ROK policy, he has also criticized human rights abuses in North Korea. Lee supports continued food and other humanitarian aid to the people of North Korea.

New Beginnings group members believe that the United States cannot afford to lose the opportunity presented by President Lee to build a global partnership with one of the United States’ most important allies. The group identified a number of steps that the United States, in cooperation with the ROK, could take to move the alliance into a new era (see sidebar).

The New Beginnings group has announced that it plans to continue its efforts in support of strengthened U.S.-South Korean relations. Among other projects, the group intends to present recommendations early next year to the South Korean government on how to develop a close relationship and bolster the alliance with the incoming U.S. administration.

Recommendations to United States Policymakers

• Global Partnership — Building on the cooperation between Presidents Bush and Lee, the new U.S. president next year should issue a vision statement with Lee detailing their partnership and goals for the alliance. To advise them, the two new presidents should establish a bi-national panel of distinguished Koreans and Americans. The United States and the ROK should also give increased emphasis to the foreign ministerial strategic dialogue they initiated in 2006.
• Security Alliance — We support the ongoing realignment of U.S. forces in the ROK. Congress should increase its budget for the relatively small U.S. portion of the total cost of its implementation. The decision to transfer wartime operational control of Korean forces back to the ROK in 2012 was likewise correct, but the United States should respond positively to any South Korean proposal to discuss conditions related to the transfer. We welcome the Lee administration’s apparent desire to review the main North Korea war plan and to prepare jointly for other contingencies, including that of a North Korean collapse. The United States should conduct regular, joint consultations with South Korea and other allies in East Asia to determine whether security conditions warrant changes in our respective force levels and, if so, in what direction.
• North Korea — The ROK election has brought the United States and South Korea into essential agreement, for the first time in seven years, on how to deal with North Korea and its nuclear aspirations. To avoid the danger that their North Korea policies will again diverge, they must establish stronger consultative mechanisms, including with Japan.
• Economy and Trade — Congress should ratify the U.S.-ROK Free Trade Agreement now. U.S. failure to approve the FTA would not only represent foregone business opportunities; it would damage U.S.-ROK relations and be seen by the international community as a weakening of U.S. self-confidence and engagement, in East Asia and around the globe.
• People-to-People Ties — The U.S. government should set an early target date to include the ROK in the Visa Waiver Program and encourage the Korean government to support a major expansion of the Fulbright Program’s English Teaching Assistant Program. The United States should create a new program to allow U.S. federal employees to intern in Korean ministries and increase the budget for the State Department’s International Visitor Program for young South Korean leaders. U.S. military personnel stationed in Korea should be joined by their families. The United States should, at long last, construct a new U.S. embassy in Seoul.

CISAC science fellow Undraa Agvaanluvsan faces no small task this summer: She has returned to her native Mongolia to help draft first-time legal and security protocols to ensure that the country’s uranium-based nuclear industry develops safely while also attracting international investment. “Our government needs to be prepared to move ahead,” the nuclear physicist said. “Mining needs to be regulated, there need to be laws specific to uranium so that extraction won’t cause a risk to security.”

Mongolia boasts rich uranium reserves and the mining industry contributes to about 25 percent of the country’s economy. Before the collapse of the Soviet Union, Russian partners exported Mongolian uranium ore for military purposes to a well-guarded enrichment facility in nearby Angarsk, Siberia, Undraa said. (Mongolians use only one name — Agvaanluvsan is Undraa’s late father’s name.) After the collapse of the Soviet Union in 1991, mining in Mongolia almost stopped. “Today the security concern is completely different,” Undraa said. “It is said that some people even dig uranium, among other minerals, out of the ground with no legal right to do so. They’re called ‘ninjas.’ It’s worrisome and it’s completely unregulated.”

According to Undraa, foreign investors want to develop Mongolia’s uranium mines quickly. “Mining companies may be supportive of nuclear nonproliferation but their main objective is their business bottom-line,” she said. “There is not enough concern for security. The area we’re concerned with — nonproliferation and national security — seems very far from them.”

Since November, Undraa has split her time between CISAC and Lawrence Livermore National Laboratory, where she has worked in the lab’s nuclear experimental group for three years. At CISAC, she has focused on the development of Mongolia’s civilian nuclear industry and how such changes are influencing the country’s fledgling democracy and market economy. Mongolia was a socialist state until a peaceful democratic revolution took place in 1990. The vast, landlocked country, squeezed between Russia and China with a population of 3 million, is now a multiparty capitalist democracy.

Undraa, 35, plans to return to Encina Hall this fall to continue this work with CISAC Co-Director Siegfried S. Hecker and consulting professor Chaim Braun. Under the auspices of the recently established Mongolian-American Scientific Research Center in Ulaanbaatar, the scientist is helping to organize two international conferences in the Mongolian capital this September on uranium mining and nuclear physics. Undraa hopes the conference findings will help her country, a non-nuclear weapons state, develop uranium mining profitably and responsibly.

“Mongolia plans to build a nuclear industry, starting from a zero baseline,” Undraa’s research plan states. “With a clean slate, how should Mongolia develop its uranium industry? What does Mongolia need to do to position itself as a trustworthy, global supplier of uranium?”

“With a clean slate, how should Mongolia develop its uranium industry? What does Mongolia need to do to position itself as a trustworthy, global supplier of uranium?”Undraa also wants to assess whether it makes economic sense for a developing Mongolia to turn to nuclear power or construct high-pressure coal-powered plants, which cost less and are faster to build and operate. She is acutely aware of the effects of climate change — in the late 1990s and early 2000s, millions of livestock across Mongolia’s steppes and deserts died due to harsh winters and summer droughts. “I have family members who lost their nomadic way of life — camels, sheep, goats, cattle died,” she said. “They had to move to the city because there was no point staying in the countryside.” As a result, the population of Ulaanbaatar has soared in recent years, with a parallel increase in pollution from coal fires burned by people living in traditional gers or yurts. “People say the pollution there is worse than Mexico City, worse than Beijing,” the scientist said.

Mining for Mongolia

On the uranium production front, Undraa wants to investigate whether her country should develop its own enrichment plant or collaborate with the Soviet-era facility in Angarsk. AREVA, the French multinational industrial nuclear power conglomerate, also is interested in building a power plant in Mongolia in exchange for raw uranium, she said.

An alterative proposal suggested by Sidney Drell, CISAC founding co-director, and Burton Richter, SLAC director emeritus, would establish a multinational uranium enrichment facility in Mongolia with possible collaboration from Japan, a country with a good track record for nuclear transparency. Such a facility could help meet the demands of growing energy markets in nearby China, India, and South Korea. Undraa said she supports exploring this option, which could bolster Mongolia’s position as a global producer of enriched uranium for nuclear power plants. “Mongolia is a democracy with friendly relations with Russia, China, the European Union, Japan, North and South Korea, as well as the United States,” she said during a May 7 presentation at CISAC. “This is a long shot,” Hecker said. “But perhaps an enriched uranium fuel guarantee from Mongolia instead of the United States may be more successful in keeping some countries from building their own enrichment facilities.”

Science as a tool to effect policy

Undraa hopes that her hands-on research at CISAC will help her homeland. “Being from Stanford has given me a platform to talk to the uranium mining people,” she said. “It gives me a right to talk to them as a scientist who is concerned with these global issues.”

The work brings Undraa full circle — as a teenager she wanted to become a diplomat but her father, a coal miner, was pro-western and pro-democratic during the socialist period and he knew that his daughter would face difficulties if she tried to enter the field. He instilled in Undraa what she calls “an American way” of thinking. “I was a very American girl in communist Mongolia in the 1980s,” she said smiling. “What he said was, ‘You’re entitled to have a view, so have a view. You’re entitled to ask questions, so ask questions.’” He also stressed the importance of pursuing education. Undraa took that lesson to heart, excelling in mathematics, then earning bachelor’s and master’s degrees in physics from the National University of Mongolia and a doctorate from North Carolina State University.

In addition to helping Mongolia develop protocols for uranium mining and enrichment, Undraa and her husband, Dugersuren Dashdorj, also a nuclear physicist, and like-minded colleagues such as the country’s foreign minister, Sanjaasuren Oyen — the first Mongolian to earn a doctorate from Cambridge — are considering plans to establish their nation’s first major interdisciplinary research English-language university. The project is representative of Undraa’s drive to make a difference in Mongolia. “We don’t have to be bound by how it has been done in the past,” she said. “We can do it differently. We realize this is not a one-to-two-year project — it will take decades to establish. But one has to start somewhere.”

The July/August issue of Health Affairs, the leading U.S.-based health policy journal, focuses on China and India. The special issue includes an article on China’s pharmaceutical policy by five contributors to Prescribing Cultures and Pharmaceutical Policy in the Asia-Pacific, a book forthcoming in 2009 from the Shorenstein Asia-Pacific Research Center series with Brookings Institution Press. Chapters on Korea and Japan by Soonman Kwon (Seoul National University) and Toshiaki Iizuka (Aoyama Gakuin University) also appear in Chinese translation in the journal Bijiao (Comparative Studies), along with an overview paper (“Pharmaceutical policy reforms to separate prescribing from dispensing in Japan and South Korea: Possible implications for China”) by Karen Eggleston, Asian Health Policy Program Director.

As Eggleston writes in the introduction to Prescribing Cultures, pharmaceuticals and their regulation play an increasingly important and often contentious role in the health care systems of the Asia Pacific.  For example, some economies such as China have extraordinarily high drug spending as a percentage of total health spending; India and a few others host thriving domestic pharmaceutical industries of global importance, while controversy surrounds patents, trade-related aspects of intellectual property (TRIPS), and pharmaceutical pricing within bilateral trade agreements (Australia-US, Republic of Korea-US); nations throughout the region struggle with appropriate regulation of drugs, from patents to evidence-based purchasing (e.g., Australia’s Pharmaceuticals Benefit Scheme) and direct-to-consumer advertising; deeply-rooted traditions of indigenous medicine are modernizing and integrating into broader health care systems; and policies to separate prescribing and dispensing re-write the professional roles of physicians and pharmacists, with modifications to accommodate cultural norms and strong economic interests. Effective prescribing and pharmaceutical use will be central to controlling infectious diseases, both old and emerging; protecting the global public good of antimicrobial effectiveness; and treating the growing burden of chronic disease in the Asia Pacific.

The forthcoming book will explore these issues in detail, through a multi-disciplinary lens. The first section of the book features chapters on pharmaceutical policy within seven selected health care systems of the Asia Pacific: South Korea, Japan, Thailand, Taiwan, Australia, India, and China. The second section focuses on the cross-cutting themes of prescribing cultures and access versus innovation. Taken as a whole, the contributions aim to provide an evidence base for policy while acknowledging the historical and cultural context that makes policies distinctive.

Clear evidence suggests the importance of health service provider payment incentives for achieving efficiency, equal access, and quality, including attention to primary, secondary, and tertiary prevention. “Pay for performance” may be on the cusp of significant expansion in Asia, and reform away from fee-for-service has been underway for several years in several economies. Yet despite the policy relevance, the evidence base for evaluating payment reforms in Asia is still very limited.

China in particular has been undertaking significant reforms to its health care system in both rural and urban areas. With the expansion of insurance coverage and need to resolve incentive problems like “supporting medical care through drug sales,” there is an urgent need for evaluating alternative ways of paying health service providers. Evidence from policy reforms in specific regions of China, as well as other economies of the Asia-Pacific, can provide valuable evidence to help inform policy decisions about how to align provider incentives with policy goals of quality care at reasonable cost.

To illuminate these questions, the Asia Health Policy Program and several collaborating institutions are planning to convene a conference on health care provider payment incentives on November 7-8, 2008 in Beijing. The conference will highlight and seek to distill “best-practice” lessons from rigorous and policy-relevant evaluations of recent reforms in China and elsewhere in the Asia Pacific.

The organizing committee – including health economists from Shorenstein APARC, Peking University, Tsinghua University, and Seoul National University – reviewed submissions in June 2008 and accepted sixteen. The conference papers cover payment issues in Korea, Japan, China, Taiwan, Thailand, Tajikistan, the Philippines, and the US, and the disciplines of economics, health services research/health policy, public health, medicine, and ethics. Topics include institutionalized informal payments; the impact of global budget policies on high-cost patients; public-private partnerships; public-sector physicians owning private pharmacies; evidence-informed case payment rates; payment and hospital quality; bonuses and physician satisfaction; physician prescription choice between brand-name and generic drugs; and differences in pharmaceutical utilization across insurance plans that pay providers differently (fee-for-service versus capitation).

Policymakers from China’s National Development and Reform Commission and Ministry of Health will also speak at the conference. Selected research papers will be published through the Shorenstein Asia-Pacific Research Center either in a special volume or in a special issue of an English-language health policy journal.

In Political Change in China: Comparisons with Taiwan, CDDRL's Democracy in Taiwan program marshals commentary from leading experts on what lessons, if any, Taiwan's experience of democratization might hold for China's future. The volume was co-edited by Larry Diamond and includes a chapter by Weitseng Chen, one of CDDRL's 2007-08 Hewlett Fellows.