From October 19th to 22nd, REAP's partner at Shaanxi Normal University, the Center for Experimental Economics in Education (CEEE), held a conference gathering representatives from 10 universities across China and more than 20 foundations, NGOs, and government education departments to exchange experiences regarding education development programs and impact evaluation in China.  Founded in January of 2014, CEEE aims to raise the quality and effectiveness of education policy and projects throughout China not only by conducting action research, but also by leading training sessions to help other academic research teams, government officials, and NGO and foundation members understand the importance of evidence-based action and the core principles and basic methodology of impact evaluation.

During the conference, CEEE led the participants through a comprehensive training in impact evaluation and provided a forum for participants to share their own diverse experiences in the field of education development.  Participants also visited a field site for one of REAP's Computer Assisted Learning projects in order to understand how impact evaluation is conducted in the field.  Recalling the four day conference, one participant said, "Before, we all went out to look for the disease believing we already had the prescription in hand. Now we finally understand how to analyze the causal chain underlying a problem in order to find a real solution."

The first in a series of workshops, this conference marks a step forward in REAP's overarching goal to promote evidence-based action in China and bring about effective and cost-efficient education policies and programs for the benefit of rural China's children.

Read more (in Chinese) here.

On November 1, REAP and REAP's partner organization, the Center for Experimental Economics in Education (CEEE) at Shaanxi Normal University, became official Giving Partners of TOMS Shoes, LLC.  TOMS adheres to a "One for One" philosophy, and is committed to donating one pair of shoes to a child in need for each pair of shoes purchased.  This partnership with TOMS is a novel attempt to deliver shoes to children in Shaanxi, Ningxia, Qinghai, Gansu, Guizhou, and other rural areas. 

TOMS contacted REAP and CEEE after hearing about REAP's history of carrying out large-scale research across rural China, as highlighted by REAP and CEEE distributing eyeglasses to more than 4,700 students (for our Seeing is Learning research project) and providing infant nutrition packets to 1,000 infants (as part of our Baby Nutrition research project).  REAP and CEEE's field team will give over 120,000 pairs of TOMS shoes in conjunction with ongoing research projects in the area.

Read more (in Chinese) here.

China Education Daily, a national newspaper published by the Department of Education with daily readership in the millions, published a feature article highlighting REAP research on teacher performance pay structures in rural China.  The article rapidly caught the attention of policymakers and educators across China and was widely circulated on a number of China's largest news media websites. 

What is teacher performance pay, and why does it matter?  Students in rural schools in China are falling behind.  Much of the burden for why students from China’s rural schools perform poorly may fall on teachers, as studies from both developed and developing countries, including China, consistently show that teachers are one of the (if not the) most important factors affecting student achievement.  Despite their importance, teachers in rural schools in China often lack strong incentives to help students--especially lower-achieving students--learn.  Surprisingly, almost nothing is known about how to incentivize teachers in rural China to help their students.  "Performance pay" is designed to address this problem by providing contracts to teachers that tie their pay to students test scores, with the goal of raising teacher quality and ultimately student achievement.

The Chinese government is also highly interested in addressing this problem, and in 2009 launched the Teacher Performance Pay Policy asking schools to implement teacher performance pay.  However, in 2012 REAP researchers found that 46% of rural schools still had not implemented teacher incentive programs, and in most cases teacher incentive programs that were in place did not lead to improved student achievement. 

Therefore, REAP researchers designed an intervention to test three different teacher incentive designs, with the goal of identifying which scheme boosted student achievement the most.  The "Pay-for-Percentile" design, which rewarded teachers for focusing on low-achieving students in addition to high-achievers--and thereby differs sharply from most incentive schemes that have been implemented in China--generated remarkable improvements in overall student test scores (learn more about the project here).  These results have significant implications for how to raise the quality of schooling across China.

Read the full article (in Chinese) here, or see the English translation below.

A middle class is emerging in China, and simultaneously, its population is rapidly aging. These two phenomena are impacting the country’s traditional consumer habits, including spending on healthcare. Experts say private-sector services are one important part of the future of China’s healthcare system, and perhaps also a sign of what’s to come for other countries in the region. Entrepreneurs can provide innovative services that cater widely to consumers and support a shift toward integrated care for health promotion and long-term management of chronic disease, also supplementing resources available in traditional public facilities.

Three experts visited the Walter H. Shorenstein Asia-Pacific Research Center and shared perspectives on those trends at the panel discussion, “Healthcare Entrepreneurs in East Asia: Innovations in Primary Care and Beyond,” hosted by the Asia Health Policy Program.

Historically, healthcare services in China have been almost entirely government-run. A patient would go to a public clinic, stand in a queue, and receive treatment within a few hours – being referred elsewhere if additional treatment was required.

Now, the private sector is growing, based on the promise of improved care and an enhanced experience, both removing the waiting line and ushering in new technologies. The government has also issued several policies encouraging “social capital” investment in health and fitness services.

The private sector for preventative care services now holds around fifteen percent of the entire marketplace in China, and “is expected to get much bigger over the next five years,” said Lee Ligang Zhang, the founding chairman and chief executive officer of iKang, a healthcare group based in Beijing.

Zhang oversees the company’s operation of 50 self-owned healthcare centers and an extended network of 300 affiliates. iKang is one of many groups catering to a growing consumer base of corporate workers and senior managers seeking care outside of the public system.

Comparative view

Increased development of premium healthcare facilities is not only emerging in China, but also in neighboring Taiwan. Since 1995, Taiwan implemented a national health insurance system, and has been lauded for its success in service provision.

Taiwan transitioned its healthcare market to universal coverage. Under this system, a patient can essentially “shop around” and select where to go for services, most of which are covered under the country’s insurance collective system at public or private providers.

“On average, every Taiwanese goes to see a doctor 14 times a year, compared to five times a year in the United States, and two times [a year] in China,” said Dr. Fred Hun-Jean Yang, a physician and chairman of MissionCare, Inc.

Such numbers reflect the higher availability of services compared to China, he said. Even as a small island, Taiwan has over 15,000 clinics and the price for services is generally affordable for the average citizen. Despite this availability of public and private services, Taiwan’s newer healthcare entrepreneurs seek to fill a market demand shaped by similar factors as in China. Yang says technology and the efficiency of the private sector healthcare system is attracting new consumers.

Missioncare is headquartered in northern Taiwan’s Taoyuan City and consists of four community hospitals with a larger network of clinics across the country as well as coordinated long-term care services for the elderly and those with chronic disease. The group has already expanded into China, and plans to integrate healthcare innovations, such as wearable monitoring and mobile payment.

Patient-centric service

Chinese citizens, particularly those with greater expendable income, are more willing to pay out-of-pocket for an improved patient experience, the panelists said.

“The consumer psyche is important,” said Dr. Wei Siang Yu, the founder of the Borderless Healthcare Group (BHG), a group of companies based in Singapore that focuses largely on health telecommunications.

One perspective is that consumers desire a “high-end” environment made possible by tailored design aesthetics and effective branding. Guided by this trend, Yu, a business executive and physician by training, started the “smart cities, smart homes” initiative at BHG.

BHG is now launching an incubator model in Shanghai, which combines intelligent design aesthetics with patient care, and is planning to localize such centers across China. The model is referred to as an “experience center,” rather than a hospital or clinic, and healthcare services – examinations, operations and value-added activities like wellness and education activities – are all centralized in one location.

Looking ahead, Yu said healthcare is likely to move even further away from the traditional hospital setting, and more toward experiential and home-based care models.

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