Tottori Prefecture—the least populous prefecture in Japan known for its seafood and stunning natural beauty, including its iconic sand dunes—is now collaborating with Stanford University. The first kanji character of Tottori means “bird” and the recent launching of a new online course, Stanford e-Tottori, is helping high school students to gain a bird’s-eye view of U.S. society and culture with a focus on U.S.–Japan relations.

On July 18, 2016, SPICE Director Gary Mukai participated in an opening ceremony in Tottori for Stanford e-Tottori. The ceremony included opening remarks by Governor Shinji Hirai, greetings from Superintendent of Education Hitoshi Yamamoto, comments by Mukai, and reflections by Tottori native, Takeshi Homma, Founder and CEO at HOMMA, Inc., Silicon Valley. In his comments, Mukai thanked Governor Hirai for his unwavering support of this collaboration between the Tottori Prefectural Board of Education and Stanford University, and also made a historical note about Tottori Prefecture’s relations with the United States by noting, “Hajimu Fujii, who was born in 1886 in Takashiro, Tottori, left Tottori for the United States in 1906. Hajimu Fujii became a Japanese-American community leader in the state of Idaho. In the 1930s, Fujii was recognized as the first Japanese pioneer in large-scale onion farming.”

Mukai was followed by Tottori Nishi High School student Shue Shiinoki, who read a “Resolution Declaration,” representing the 36 students who were selected to participate in the inaugural Stanford e-Tottori course. Mukai and Homma had the pleasure of visiting Tottori Nishi High School as well as Seishokaichi Junior and Senior High School during their visit.

The Stanford e-Tottori course instructor is Jonas Edman, who is an Instructional Designer at SPICE. As of mid-December 2016, Edman has facilitated three “virtual classes” on the following

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Edman, an alumnus of the American School in Japan, recently reflected that the rigor of taking a course solely taught in English has proven to be challenging to the Tottori students but that he is clearly noting progress in the students who are willing to take on the challenge. Koji Tsubaki, Teachers’ Consultant, Tottori Prefectural Board of Education, also recently commented, “Students in Tottori Prefecture are full of excitement to learn about the contents of the SPICE Stanford e-Tottori program, accelerating their development of self-expression skills. They are overflowing with questions for deeper understanding.”

Recently, Edman introduced Stanford e-Tottori to a delegation of business people from Tottori Prefecture who visited SPICE on November 16. The delegation was led by Tottori Bank, Ltd. Chairman Masahiko Miyazaki. Homma was not only instrumental in bringing the delegation to Stanford but also suggested the initial idea of developing Stanford e-Tottori. Chairman Miyazaki expressed his gratitude to Homma, Edman, and Mukai for making Stanford e-Tottori a reality.

During the delegation’s tour of Stanford University, many of the business people expressed hopes that their own children or grandchildren will someday be able to enroll in Stanford e-Tottori. Many also expressed agreement with one of the goals of Stanford e-Tottori, that is, to encourage students in Tottori to study in the United States either as exchange students or as undergraduate or graduate students.

Given Japan’s national focus on internationalizing the curriculum and preparing students to “think globally,” the timing of Stanford e-Tottori is ideal. SPICE’s hope is that someday the Tottori students’ birds-eye view of U.S. society and culture with a focus on U.S.–Japan relations—provided through Stanford e-Tottori—will become useful background information for them when they visit the United States as students, as business people, or in other capacities.

"Since the end of World War II, the most crucial underpinning of freedom in the world has been the vigor of the advanced liberal democracies and the alliances that bound them together. Through the Cold War, the key multilateral anchors were NATO, the expanding European Union, and the U.S.-Japan security alliance. With the end of the Cold War and the expansion of NATO and the EU to virtually all of Central and Eastern Europe, liberal democracy seemed ascendant and secure as never before in history. Under the shrewd and relentless assault of a resurgent Russian authoritarian state, all of this has come under strain with a speed and scope that few in the West have fully comprehended, and that puts the future of liberal democracy in the world squarely where Vladimir Putin wants it: in doubt and on the defensive" writes Larry Diamond, Senior Fellow at the Freeman Spogli Institute for International Studies, for The Atlantic. Read the whole article here.

"In Silicon Valley, where I live, the word “disruption” has an overwhelmingly positive valence: Thousands of smart, young people arrive here every year hoping to disrupt established ways of doing business — and become very rich in the process. For almost everyone else, however, disruption is a bad thing," writes CDDRL Mosbacher Director, Francis Fukuyama for New York Times. Read the article here.

"With Russia’s domestic politics and renewed international ambitions as a backdrop, Trump must think hard about what he wants to prevent in dealing with Putin’s Russia, and what he wants to achieve. Presumably, he wants to prevent outright war with Russia over Ukraine, Syria, or America’s NATO allies in the Baltics." - writes Kathryn Stoner, Director of the Ford Dorsey Program in International Policy Studies, in The Atlantic. Read the article here. 

Stanford economist Takeo Hoshi joined Nikkei CNBC’s television program “Night Express” in Tokyo to discuss what a U.S. presidency under Donald Trump holds for trade policy, U.S.-Japan relations and the global economy.
 
Hoshi, who is also the Japan Program director at the Shorenstein Asia-Pacific Research Center, said that, while many of the next administration’s plans remain uncertain, the president-elect's first task would be to bridge divisions among Republicans so it can move ahead on policy decision-making.
 
The television segment can be viewed in Japanese here.

 

Kathryn Stoner, Director of the Ford Dorsey Program in International Policy Studies and a Senior Fellow at the Freeman Spogli Institute for International Studies, debates for the New York Times with Matthew Rojansky, the Director of the Kennan Institute at the Wilson Center, about the U.S. foreign policy challenges, arguing that there is no natural conflict between two powers.  "As the long history of cooperation demonstrates, there is no structural reason Russia and the U.S. cannot get along. They have and did for over 30 years. It was Putin’s offer of asylum to rogue U.S. security contractor Edward Snowden in 2013, followed by his unanticipated demand that the U.S. Agency for International Development leave Russia the same year, harassment of the U.S. ambassador and other embassy officials since, and finally his seizure of Crimea in Ukraine in 2014 and support of a low boil conflict in eastern Ukraine that ended cooperation. The next U.S. president will inherit not a “Russia problem” but a Putin problem, which makes Trump’s position not only odd, but dangerous." Read more here. 

As health-care costs climb ever upward, controlling expenses without sacrificing high-quality care becomes increasingly important. Payment systems based on the value of care are emerging as a way to combat rising costs.

Many researchers like Jason Wang, an associate professor of pediatrics and a Stanford Health Policy core faculty member, have found that bundled payment systems may help health-care institutions achieve better value of care.

In a new study in the Journal of the American Medical Association Oncology, Wang and his co-authors show that a value-based bundled payment system is associated with cost containment and improvement in care, even improving chances for survival.

The study examined Taiwan’s bundled pay-for-performance (PFP) system for breast cancer. Instead of the traditional fee-for-service (FFS) system that is typical in the United States — in which every test, surgery and exam is billed individually — this system includes all aspects of treatment in a single established cost, or bundled payment.

Based on guidelines set by Taiwan’s National Health Insurance Administration (NHIA), the pilot program reimbursed health-care institutions’ costs for breast cancer treatment based on the patient’s cancer stage, 0 to IV. Institutions that exceeded the NHIA’s standards received a financial bonus as an incentive for better performance.

The study followed 4,215 patients in the bundled-care system over a five-year period, comparing the quality of their care, the cost of their treatment and the outcomes of their treatment to 12,506 similar patients in the traditional FFS system.

The authors found that patients in the bundled-payment system received better care throughout treatment, were more likely to survive, and contained medical costs over time, compared to their peers in the FFS system.

Costs for patients in the bundled payment system remained about the same throughout the study. However, the cost of treatment for those in the FFS system steadily increased throughout the study period. By the end, even health-care institutions receiving the maximum bonus incentive would incur lower costs than those in the FFS system.

Yet even though their treatment was cheaper, patients in the bundled system experienced better results. Patients using the bundled system had significantly higher survival rates for cancer stages 0 to III, and they were more likely to receive higher quality care based on quality indicators.

This is largely due to the better coordination of care made necessary by the bundled system, according to Wang.

“When you play in an orchestra, the whole group needs to play together, so it plays the right tune,” said Wang. “Focusing on value for the patient and the health-care system forces people to play the same tune.”

Wang believes the lessons learned from Taiwan’s program could be applied in other parts of the world, including the United States, which is currently moving toward bundled cancer care.

Though the U.S. already bundles care for conditions like appendicitis and chemotherapy — in which costs are fairly predictable — many hospital administrators fear that broadening the use of bundled payments for more complex conditions is too risky, financially.

Wang does not share their misgivings.

“People say, ‘We can’t do this for a very complex disease.’ It’s not true,” he said. “When we went outside of the U.S., we started to find systems that work.”

Wang found that when institutions can coordinate care for patients — that is, when a single institution manages all aspects of a patient’s care — the patient is more likely to have better outcomes.

“If institutions take the leadership of providing the infrastructure to coordinate care, they can really deliver better care with the same or lower costs.”

There are benefits for the institutions, too. Right now, because health insurance providers may accept or reject particular costs in an unpredictable way, care institutions never know how much they’re going to get paid for a service. But in a bundled payment system, costs are much more stable and revenue easier to predict.

Considering the benefits, Wang hopes the Taiwan breast cancer study will show institutions in the United States and around the world that bundled payments for cancer can be done on a broad scale.

The value, he said, is worth the risk.