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Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract

In the private market for Medicare supplemental insurance, also known as Medigap, policymakers have experimented with several regulatory solutions, including an initial open enrollment period, guaranteed renewal, bans on differential pricing, and bans on rejections. In this paper, I study how bans on differential pricing and rejections affect premiums and coverage levels, compared to a regime that combines an initial open enrollment period with guaranteed renewal. I document two important effects. First, bans on differential pricing and rejections lead to substantial cross-subsidization from young to old. Under a ban on differential pricing, the youngest buyers see premiums that are $240 (16 percent) higher; when this is combined with a ban on rejections, the youngest buyers see premiums that are $640 (36 percent) higher. Second, a ban on rejections undoes consumers’ incentives to buy early. A ban on differential pricing and rejections leads to a 12 percentage point (46 percent) reduction in early buying. I present evidence for the importance of this mechanism, which is often assumed in the theoretical literature but seldom documented empirically. This interpretation is corroborated by an event study of individuals who experience health shocks.

Vilsa Curto
Seminars
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Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract

Using modeling methodologies, at least three groups have suggested that the high expense of US healthcare is justified by the systematic increase in US life expectancy over the last 60 years. Papers describing these models are frequently cited in both the academic literature and in policy briefs. In this analysis, assumptions underlying the three models are linked to recent systematic literature reviews. Using estimates based on recent RCTs, the models are reconstructed and subjected to sensitivity analysis. The results suggest that the benefits of high-technology interventions have been overestimated, while the effects of social and behavioral factors, including cigarette smoking cessation, may have been underestimated. The analysis is highly sensitive to assumptions about the percentage of variance in outcomes attributable to medical technology.

Bio

Robert M. Kaplan, is currently a Fellow at the Center for Advanced Studies in the Behavioral Sciences at Stanford University, where he works with Stanford’s Clinical Excellence Research Center (CERC). He has served as Chief Science Officer at the US Agency for Health Care Research and Quality (AHRQ) and Associate Director of the National Institutes of Health, where he led the behavioral and social sciences programs.  He was formerly Distinguished Professor of Health Services and Medicine at UCLA, where he led the UCLA/RAND AHRQ health services training program and the UCLA/RAND CDC Prevention Research Center. He was Chair of the Department of Health Services from 2004 to 2009.  From 1997 to 2004 he was Professor and Chair of the Department of Family and Preventive Medicine, at the University of California, San Diego. He is a past President of several organizations, including the American Psychological Association Division of Health Psychology, Section J of the American Association for the Advancement of Science (Pacific), the International Society for Quality of Life Research, the Society for Behavioral Medicine, and the Academy of Behavioral Medicine Research. Kaplan is a former Editor-in-Chief of Health Psychology and of the Annals of Behavioral Medicine.  His 20 books and over 500 articles or chapters have been cited more than 28,000 times and the ISI includes him in the listing of the most cited authors in his field (defined as above the 99.5th percentile). Kaplan is an elected member of the National Academy of Medicine (formerly the Institute of Medicine).

Robert Kaplan
Seminars
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"Modeling Disease for Effective Control: Tuberculosis in India"

 

Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

 

Abstract:

Simulation and optimization frameworks that incorporate individual heterogeneity can be powerful tools to inform health policy decisions, particularly decisions about how to efficiently control infectious diseases in resource-constrained settings.  We apply such models to assess policies for control of tuberculosis (TB) in India, where more than two million people have TB.

We first use a microsimulation model to uncover the changing dynamics of drug-resistant (DR) TB. We find that nearly half of new DR TB cases in India are transmission-generated, as opposed to treatment-generated, and we project this proportion to continue to rise, implying that strategies that disrupt DR transmission may provide greater DR prevalence reductions over time.  We then incorporate healthcare costs into the simulation and find that both new diagnostics and institutional reform policies that refer patients in informal, private TB clinics to public clinics using approved treatment regimens would both be cost-effective ways of combatting TB in India. However, these institutional reforms should be prioritized if insufficient resources are available to implement both types of policies nationally. Building on the microsimulation results, we use dynamic programming methods to design patient-specific DR TB testing algorithms that can reduce over-testing, reduce costs, and quickly identify DR TB patients. We estimate that the optimal DR TB testing algorithm identified by our analysis will decrease healthcare costs by an average of $4000 per patient by averting downstream transmission.

Sze-chuan Suen
Seminars
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Masa ISHII is founder and a Managing Director of AZCA, Inc., a management consulting firm specializing in US-Japan corporate development for high technology companies.  To date, AZCA has helped numerous companies in Japan and US in developing their new business across the Pacific Ocean.  Masa is also a Managing Director of AZCA Venture Partners, a venture capital firm whose most recent fund specializes in the domain where IT/Electronics and Life science converge.  Formerly, Masa worked at McKinsey & Company, Inc. and at IBM. Masa is a frequent speaker and writer on issues involving international business development in the high technology industry. He is a visiting professor at Waseda University Business School and at Graduate School of Engineering, Shizuoka University.  Masa holds a Bachelor of Engineering in mathematical engineering and instrumentation physics from the University of Tokyo and a Master of Science in computer science from Stanford University.

 

SEMINAR DESCRIPTION:

It was in early 1970s that Japanese companies first started interacting with Silicon Valley.  As Silicon Valley grew, many Japanese companies started trying to work with high-tech start-ups in Silicon Valley with the purpose of innovating and developing new businesses. More recently, start-up companies and SMEs from Japan have started taking root in Silicon Valley by fully taking advantage of its high technology infrastructure.  In doing so, however, many Japanese companies failed to achieve their strategic goals.  These hard-learned lessons over time are bound to be forgotten as the new generation of Japanese companies attempt to enter the Silicon Valley’s ecosystem unless they are recorded and the memory is institutionalized. Having lived and worked between Japan and Silicon Valley over the past 30 years, the speaker will share an insider's view of large firms, start-ups and entrepreneurs since the 1970s and his direct experience and reminiscence in dealing with companies in Japan and Silicon Valley, so that the long-built up experience of firms entering this region for the last 40 years can prove to be of benefit to others in the future.

RSVP REQUIRED:

AGENDA:
4:15pm: Doors open
4:30pm-5:30pm: Lecture, followed by discussion
5:30pm-6:00pm: Networking

For more information about the Silicon Valley-New Japan Project please visit: http://www.stanford-svnj.org/

Philippines Conference RoomEncina Hall, 3rd Floor616 Serra SteetStanford, CA 94305
Masa Ishii, Managing Director of AZCA, Inc and Visiting Professor, WASEDA Business School; Graduate School of Engineering, Shizuoka University
Seminars
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april 19 flyer
In 2015, Taiwan National Health Insurance (NHI) is celebrating its 20th anniversary since its historical inauguration in 1995. The NHI program, which provides universal health coverage (UHC) to Taiwan’s population of 23 million, has had a profound impact on Taiwan's health care market.   This seminar will showcase Taiwan's NHI scheme, the challenges encountered, and the market responses.

The single-payer NHI program, operated by National Health Insurance Administration (NHIA), was established through integrating three existing social insurance schemes and extended the coverage to the then uninsured 43% of the population. Taiwan NHI offers comprehensive benefit coverage that includes ambulatory care as well as inpatient services. On the service side, Taiwan has a market-oriented health care delivery system, reflecting its free-enterprise economy, as evidenced by the pluralistic organization of health services. Hospital ownership is mixed where public hospitals only account for 35% of all beds. Sixty-three percent of allopathic physicians are salaried employees of hospitals; the remainder, fee-for-service private practitioners. Over the years, hospitals have developed large outpatient departments and affiliated clinics for primary care in order to maintain inpatient volume and compete with private practitioners who operate free-standing clinics with beds. There is no gate keeping mechanism and the insured essentially enjoy complete freedom of choice which is likely a source of overuse.

NHI revenue mainly relies on payroll-based premiums, supplemented by a levy on non-payroll income and government subsidies. In 2013, NHI spent roughly NTD 492 (USD 16.4) billion on medical claims, accounting for approximately 52% of national health expenditures, and in total, Taiwan devoted 6.6% of GDP to health.  As a single payer, NHIA has effectively exploited its market power to experiment with various payment reforms in its 20-year history.  NHIA gradually set up separate global budgets for dental services, Chinese medicines, primary care services, and hospital services since 1998.  The annual growth rate of the total NHI budget is negotiated among stakeholders. 

Our seminar will look to the future with presentations on innovative healthcare delivery models and coping strategies by private hospitals.

Shorenstein APARC
Stanford University
Encina Hall E301
Stanford, CA 94305-6055

(650) 723-9072 (650) 723-6530
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Senior Fellow at the Freeman Spogli Institute for International Studies
Center Fellow at the Center for Health Policy and the Center for Primary Care and Outcomes Research
Faculty Research Fellow of the National Bureau of Economic Research
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
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Karen Eggleston is a Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford University and Director of the Stanford Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center at FSI. She is also a Fellow with the Center for Innovation in Global Health at Stanford University School of Medicine, and a Faculty Research Fellow of the National Bureau of Economic Research (NBER). Her research focuses on government and market roles in the health sector and Asia health policy, especially in China, India, Japan, and Korea; healthcare productivity; and the economics of the demographic transition.

Eggleston earned her PhD in public policy from Harvard University and has MA degrees in economics and Asian studies from the University of Hawaii and a BA in Asian studies summa cum laude (valedictorian) from Dartmouth College. Eggleston studied in China for two years and was a Fulbright scholar in Korea. She served on the Strategic Technical Advisory Committee for the Asia Pacific Observatory on Health Systems and Policies and has been a consultant to the World Bank, the Asian Development Bank, and the WHO regarding health system reforms in the PRC.

Director of the Asia Health Policy Program, Shorenstein Asia-Pacific Research Center
Stanford Health Policy Associate
Faculty Fellow at the Stanford Center at Peking University, June and August of 2016
CV
Date Label
Moderator Director, Asia Health Policy Program, Shorenstein Asia Pacific Research Center, Stanford University
Jui-fen Rachel Lu Professor, Department of Health Care Management Speaker Chang Gung University, Taiwan
C. Jason Wang Associate Professor (General Pediatric), Co-Chair, Mobile Health and Other New Technologies, Center for Population Health Sciences Speaker Stanford University
Fred Hung-Jen Yang Visiting Fellow, APARC, Stanford University Speaker CEO, MissionCare, Taiwan
Seminars
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Abstract: The Federal response to dual use pathogens is being actively debated. We are at a critical juncture between free science exploration and government policy. Should science be regulated? We impede discovery and innovation at our peril. Yet, this issue must be viewed through the lens of the looming  infectious disease threat, globalization and its consequences, and environmental challenges such as climate change.

About the Speaker: Lucy Shapiro is a Professor in the Department of Developmental Biology at Stanford University School of Medicine where she holds the Virginia and D. K. Ludwig Chair in Cancer Research and is the Director of Stanford’s Beckman Center for Molecular & Genetic Medicine. She is a member of the scientific advisory boards of the Ludwig Institute for Cancer Research, the Pasteur Institute in Paris, and the Lawrence Berkeley National Labs and is a member of the Board of Directors of Pacific Biosciences, Inc. She founded the anti-infectives discovery company, Anacor Pharmaceuticals, that was recently sold to Pfizer. She has co-founded a second company, Boragen LLC, providing novel antifungals for agriculture and the environment. Her studies of the control of the bacterial cell cycle and the establishment of cell fate has yielded fundamental insights into the living cell and garnered her multiple awards including the International Canadian Gairdner Award, the Abbott Lifetime Achievement Award, the Selman Waksman Award and the Horwitz Prize. In 2013 President Obama awarded her the US National Medal of Science. She is an elected member of the US National Academy of Sciences, the National Academy of Medicine, and the American Academy of Arts & Sciences.

Lucy Shapiro Professor, Department of Developmental Biology, School of Medicine Stanford University
Seminars
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Abstract: Somebody once said, “What a damn fool can do for a dollar, an engineer can do for a nickel.” Thinking about cost as an engineering constraint brings new life to ideas. This is what makes the difference between an idea influencing a hundred people or a billion. With our planet literally teeming with problems (ecological, health and social), it’s time to take cost constraints into serious consideration. As physicists, we like to make stuff. We use these skills (and field work) to design solutions for extremely resource constrained settings, specially in the field of global health. I will discuss our current work from field diagnostics to high-throughput vector ecology and hands on science education and talk about it’s implication in a global context. I will also discuss outcomes, and lessons from a global experiment - Foldscope (a 50 cent origami microscope); where we shipped 50,000 origami microscopes around the world (130+) countries enabling curious users to discover and explore the microscopic world surrounding them. 

About the Speaker: Manu Prakash is an assistant professor in bioengineering. He leads a curiosity driven research group, focused on technological interventions in extreme resource-poor settings, tackling global public health problems. A physicist and a prolific inventor, his inventions include a 50 cent “print-and-fold” paper microscope, a $5 chemistry lab, a computer that works by moving water droplets in a magnetic fields, and Oscan, a 3-D printed smartphone add-on that helps diagnose oral carcinomas responsible for 40% of cancer-related deaths in India. Professor Prakash has been distinguished as a Frederick E. Terman Fellow (2011-2013), a Pew Scholar (2013-2017), a top innovator under 35 by MIT Technology Review (2014) and in the Brilliant 10 by Popular Science (2014). Born in Meerut, India, Prakash earned a BTech in computer science and engineering from the Indian Institute of Technology in Kanpur before moving to the United States. He did his master’s and PhD at MIT before founding the Prakash Lab at Stanford.

Manu Prakash Assistant Professor of Bioengineering Stanford University
Seminars
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Abstract: The interactions between biological and cultural processes are critical determinants of human health. Successful public health programs must therefore be based on a synthesis of biological and anthropological research. By disentangling the impacts of behavior and biology on human health, we can update health care objectives and practices. Human movements and shifts in settlements across short and long time scales can result in misallocated health care resources and inefficient response to crises. I develop methods to quantify changing human population sizes and distributions to improve resource allocation in both routine health care settings and crisis response. This ranges from assessing health care system capacity for stable populations to outbreak control through vaccination and rapid response following population-scale disruptions due to natural disasters or political instability. This approach is also valuable in informing predictive mathematical models of human interactions and demographics to provide insight into a broader spectrum of human health issues. Here, I demonstrate these concepts specifically for the transmission and prevention of infectious diseases and access to health care in low-income settings ranging from rural Africa to urban America. 

 

About the Speaker: Nita Bharti is a Branco Weiss Society in Science fellow with an interdisciplinary background in Biology (PhD) and Anthropology (MA). She is a visiting scholar at Stanford’s Woods Institute of the Environment with a research associate appointment in the Biology Department and Center for Infectious Disease Dynamics at Penn State University. Her research integrates methods across social and natural sciences to identify and solve problems in human health, often in low-income settings. In addition to academic researchers across a wide variety of disciplines, her collaborators frequently include outreach and non-profit organizations as well as local authorities on public health and safety.

Nita Bharti Stanford Woods Institute for the Environment
Seminars
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Why has Korean pop music (K-Pop) become so popular overseas? A wide variety of explanations have been proposed by academics, journalists and the fans themselves, ranging from superior training and product quality to the strategic usage of social media. Although some of these explanations have become widely-cited especially in the Korean media, whether or not they are actually correct remains largely unknown. To demystify why K-Pop has gained a following overseas, this study examines data on K-Pop concert booking overseas, from 2011 through 2014. The findings highlight the importance of cultural proximity, while casting doubt upon several other widely-cited explanations.

Joon Nak Choi is the 2015-2016 Koret Fellow in the Korea Program at Stanford's Shorenstein Asia-Pacific Research Center (APARC). A Stanford graduate and sociologist by training, Choi is an assistant professor at Hong Kong University of Science and Technology. His research and teaching areas include economic development, social networks, organizational theory, and global and transnational sociology, within the Korean context. He recently coauthored Global Talent: Skilled Labor as Social Capital in Korea which he developed the manuscript from 2010-11 while he was a William Perry postdoctoral fellow at APARC.

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

Shorenstein APARC
Encina Hall
Stanford University
Stanford, CA 94305-6055

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Joon Nak Choi is the 2015-2016 Koret Fellow in the Korea Program at Stanford University's Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC). A sociologist by training, Choi is an assistant professor at Hong Kong University of Science and Technology. His research and teaching areas include economic development, social networks, organizational theory, and global and transnational sociology, within the Korean context.

Choi, a Stanford graduate, has worked jointly with professor Gi-Wook Shin to analyze the transnational bridges linking Asia and the United States. The research project explores how economic development links to foreign skilled workers and diaspora communities.

Most recently, Choi coauthored Global Talent: Skilled Labor as Social Capital in Korea with Shin, who is also the director of the Korea Program. From 2010-11, Choi developed the manuscript while he was a William Perry postdoctoral fellow at Shorenstein APARC.

During his fellowship, Choi will study the challenges of diversity in South Korea and teach a class for Stanford students. Choi’s research will buttress efforts to understand the shifting social and economic patterns in Korea, a now democratic nation seeking to join the ranks of the world’s most advanced countries.
 
Supported by the Koret Foundation, the Koret Fellowship brings leading professionals to Stanford to conduct research on contemporary Korean affairs with the broad aim of strengthening ties between the United States and Korea. The fellowship has expanded its focus to include social, cultural and educational issues in Korea, and aims to identify young promising scholars working on these areas.

 

2015-2016 Koret Fellow
Visiting Scholar
2015 Koret Fellow 2015 Koret Fellow, Korea Program, APARC, Stanford
Seminars
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In 2006, the Chinese Government introduced a massive block grant program for rural compulsory education, similar to that of Title I grant in the United States. Central government provided block grants with add-on requirement to provincial governments based on total number of pupils, average per pupil spending in that province, and a cost-sharing plan that favors the economically backward provinces. Provincial governments then distributed the grants along with its own share to county government using a similar formula to cover school operating expenditures, free tuitions, and conditional cash transfers for boarding students.

 

While there have been plenty research on whether the program has buttressed the financing of rural education or crowded out local financing, little is known about its effects on the enrollment and education attainment of rural children after a decade  (Shi, 2012; Chyi & Zhou, 2014; Lü, 2014). This paper fills this glaring gap by using matched household survey data and county school expenditure data between 2000-2011 that were made available to researchers for the first time.

 

Our identification strategies are composed of three parts. First, we take advantage of the exogenous variation in the rates of cost-sharing in the two-step allocation process of the block grants to estimate “Intention to Treatment” effects of the whole program. Secondly, we compare counties receiving different proportion of subsidies from central government in a difference-in-difference framework. Thirdly, we use the IV-DID strategy that instruments the county-level education spending with the exogenous variation in the planned allocation of the grants.

 

Dr. Wei HA is currently Research Professor in Education Policy and Leadership at the Graduate School of Education and a faculty associate at the Institute of Education Economics at Peking University. Prior to joining the Peking University, he worked as policy specialists at UNICEF and UNDP for seven years in the United States and Africa. During his doctoral study at the Harvard University, he also served as a consultant at the World Bank. He has conducted research in a wide-range of fields including education economics, public health, migration, and development economics. His current research focuses on the impact evaluation of key national education policies in China such as the Rural Compulsory Education Finance Reform, and China’s efforts to build “World Class Universities” through the 211 and 985 Projects. He also examines the interaction between education and major social transformations in China such as the massive labor retrenchments at State-Owned Enterprises in the late 1990s and rising housing prices in urban China. Dr. Ha received a dual BA in Economics and Political Science and MA in Education Economics from Peking University and his PhD in Public Policy from Harvard University.

 

This event is cosponsored by the Rural Education Action Program (REAP).

Does Money Matter? The Effects of Block Grants on Education Enrollment and Attainment in Rural China
Wei HA Education Policy and Leadership at the Graduate School of Education and Institute of Education Economics at Peking University
Seminars
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