Universal Health Coverage (UHC) is a well-embraced policy goal in the 21th century, which aims to ensure financial risk protection while assuring access to quality care.  However, up to this date, out-of-pocket (OOP) payment remains the principal means of financing health care throughout much of Asia, which leaves people financially unprotected in the face of illness.  High OOP payment at point of service is likely to either make people become medically impoverished after paying for health care, or force people to forgo treatment needed, which is detrimental to one’s health.   This presentation is based on empirical results derived from EQUITAP  (Equity in Asia-Pacific Health Systems) Project II on catastrophic payment that aims to estimate the magnitude and distribution of OOP payments for health care in 23 countries and territories in the Asia-Pacific Region in 2007.  We also draw comparisons to the results in 2000 as changes arise due to various reforms implemented since 2000.

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Her research interests are in assessing the impact of the NHI program on health care markets and household consumption patterns, and comparative health systems in the Asia-Pacific region with a focus on equity performance.  She is a long-time and active member of the Equitap (Equity in Asia-Pacific Health Systems) research network.  Professor Lu has also been appointed to serve on several advisory boards to the Taiwan Ministry of Health and Welfare and National Health Insurance Administration, Ministry of Science and Technology.

She received the Minister Wang Jin Naw Memorial Award for Best Paper in Health Care Management in 2002 and was the recipient of the IBM Faculty Award in 2009.

- Please note that this is a joint CISAC/Science seminar -

Join Chairman of the National Intelligence Council (NIC) Greg Treverton for a discussion on the NIC's work and how it connects to U.S. policy and wider global forecasting, along with a preview of the NIC's upcoming Global Trends report. 

About the Speaker: Dr. Treverton started his duties as Chairman of the National Intelligence Council on September 8, 2014. Prior to his selection, Treverton held several leadership positions at RAND Corporation, including director of the RAND Center for Global Risk and Security, director of the International Security and Defense Policy Center, and associate dean of the Pardee RAND Graduate School. His work at RAND examined terrorism, intelligence and law enforcement, as well as new forms of public–private partnership. 

Treverton has served in government for the first Senate Select Committee on Intelligence, handling Europe for the National Security Council and later, as vice chair of the National Intelligence Council (1993–1995), overseeing the writing of America's National Intelligence Estimates. 

His RAND publications on intelligence include: “Reorganizing U.S. Domestic Intelligence: Assessing the Options” (2008), “Assessing the Tradecraft of Intelligence Analysis” (with C. Bryan Gabbard, 2008) and “The Next Steps in Reshaping Intelligence” (2005). Two books, Intelligence for an Age of Terror and Reshaping National Intelligence for an Age of Information, were published by Cambridge University Press in 2009 and 2001, respectively. 

Treverton holds an A.B. summa cum laude from Princeton University and an M.P.P. and Ph.D. in economics and politics from Harvard University. 

Abstract:

One of the key objectives of introducing a compulsory health insurance is to provide citizens, regardless of socioeconomic status, with financial risk protection against unexpected catastrophic expenditures in the face of illness.  South Korea and Taiwan achieved universal health coverage (UHC) through mandatory social insurance schemes in 1989 and 1995, respectively.  Despite both countries' efforts to achieve the goal of financial risk protection for more than two decades, past research has demonstrated that household out-of-pocket (OOP) payment still accounts for more than one-third of total health expenditures in both countries.  When OOP payment represents a significant share of financial sources for health care, one should be particularly concerned about the distribution of such payments, in particular, catastrophic health expenditures, across households of differing economic levels.  This talk sets out to examine the change in the incidence and distribution of catastrophic health expenditures before and after the introduction of the National Health Insurance programs in South Korea and Taiwan.

Given similarity in the health and National Health Insurance (NHI) system characteristics observed in South Korea and Taiwan, substantial variation in the distribution of catastrophic payment among households was noted. The rich are more likely to incur catastrophic payment in South Korea, but the opposite trend is noted in Taiwan.  Further assessment on the impact of universal health coverage (UHC) on reducing catastrophic headcount (defined as the proportion of households incurring catastrophic health payment) is observed in Taiwan, but not in South Korea.  We found that when South Korea introduced the NHI program with a limited benefit package and high copayment, it produced little effect (if not none) in reducing financial burden in terms of proportion of catastrophic headcount. On the contrary, the impact of universal health coverage on catastrophic headcount ranged from -1.82% to -4.08% for Taiwan, due to the provision of a rather comprehensive benefit package with modest copayment. While UHC is a well-lauded policy goal and may be a magic word for many countries striving for the achievement, it is definitely not a panacea to resolve the incidence of catastrophic payment and potential medical impoverishment.  To provide sufficient financial protection against unexpected medical expenses, the design of the benefit coverage and risk sharing mechanism is key to the success of effectively achieving UHC. 

Bio

Jui-fen Rachel Lu, Sc.D., is the Fulbright Visiting Scholar at Center for East Asian Studies, Stanford University, and a Professor at Chang Gung University (CGU) in Taiwan, where she teaches comparative health systems, health economics, and health care financing and has served as department chair (2000-2004), Associate Dean (2009-2010) and Dean of College of Management (2010-2013).  She earned her B.S. from National Taiwan University, and her M.S. and Sc.D. from Harvard University, and she was also a Takemi Fellow at Harvard (2004-2005).  Prof. Lu is currently the President of Taiwan Society of Health Economics (TaiSHE) and an Honorary Professor at Hong Kong University (2007-2017).  Dr. Lu was also the recipient of IBM Faculty Award in 2009.   

Her research focuses on 1) the equity issues of the health care system; 2) impact of the NHI program on health care market and household consumption patterns; 3) comparative health systems in Asia-Pacific region.  She is a long-time and active member of Equitap (Equity in Asia-Pacific Health Systems) research network and was the coordinator for the catastrophic payment component of Equitap II research project which involved 21 country teams and was jointly funded by IDRC, AusAID, and ADB.  Professor Lu has also been appointed to serve as a member on various government committees dealing with health care issues in Taiwan.  

The three key countries in Northeast Asia are in different economic stages: China is developing, Korea is already developed, and Japan is in a post-development stage. Japan’s early modernization, which encompassed economic, social, and political reforms, raised the country to a position of Asian leadership for a century, up to the 1980s. Korea copied the Japanese model beginning in the 1960s, and China began its own serious economic reforms in the early 1980s. By the 2000s, Korea had surpassed Japan in some economic sectors, and China’s economy, by dint of its scale, now threatens to overwhelm its neighbors’. At the same time, all three societies share deep roots in Chinese civilization and Confucian culture. Yet, as modernity and globalization increasingly affect all of Asia, that traditional culture is gradually being modified. In the process of these economic and cultural changes, three new and different strategic cultures and national personalities are emerging. Asia scholar and author Katy Oh will examine the changes among the countries of Northeast Asia and how they are affecting their relationships with one another.

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This public event is made possible through the generous support of the Koret Foundation.
 

Abstract: Various regions of the world struggle to properly manage their freshwater resources in a sustainable manner. Even a greater number of regions are vulnerable to supply disruptions that can last for a year or more.  This talk will provide a global overview of water supply vulnerability with respect to demand, endowment, institutions, and infrastructure.  Examples of regional hydroeconomic models to evaluate potential management policies will be discussed with a focus on our approach to the challenges of coupling human-natural systems.  

About the Speaker: Steven Gorelick is the Cyrus F. Tolman Professor in the School of Earth, Energy, and Environmental Sciences and Senior Fellow at the Woods Institute for the Environment. At Stanford since 1988, he directs the Global Freshwater Initiative, which employs an interdisciplinary approach to analyzing water-supply vulnerability in developing nations. Past and current projects include those in Mexico, India, Vietnam, Cambodia, and Jordan. Much of his work involves development of hydrologic-economic models to evaluate the likely effectiveness of policy instruments such as taxes, quotas, and regulations. Projects also have evaluated the viability of an agricultural water rental market and alternatives to enhance food security. He has over 140 publications in 22 different science and engineering journals (including Science, Nature, and PNAS), and three commercialized patents. His 2010 book, Oil Panic and the Global Crisis, debated the notion of imminent global oil depletion. He is a member of the US National Academy of Engineering (NAE), and he has received Guggenheim and Fulbright fellowships. 

This event is off the record.