Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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In this session of the Corporate Affiliates Research Presentations, the following will be presented:

Wataru Fukuda, Shizuoka Prefectural Government, "Software Solutions of Tourism Promotion"

In his research, Fukuda investigates the possibilities of expanding the inbound tourism market in Japan, especially in the Shizuoka prefecture, a local area of Japan.  He provides an overview of the online travel industry and how they are expanding their market with new technologies and innovations.  After reviewing how software services for international travelers is currently being used in Japan, he focuses on specific applications with the highest potential to make Shizuoka more accessible and attractive for international travelers.  Additionally, he reviews regulations and obstacles that could prevent these new technologies and innovations from being implemented.  As a result, Fukuda suggests that the suppliers of local tourism provide their services with a holistic utilization of the applications.

 

Catherine Huang, Beijing Shanghe Shiji Investment Company, "How the U.S. Capital Market Helps Enterprises Grow From the Infant State to Mature Businesses"

China is slowing down its pace for development, facing the so-called “middle income trap”.  While the attention to the macroeconomic picture is necessary, it is not sufficient.  Extraordinary monetary policies buy time, but they do not solve the fundamental problem.  The focus needs to be on the structural reforms – the microeconomic entities, to which the capital market acts like a lifeline, will drive future growth.  The productivity, competition and innovation in all sectors – all of which are largely fueled by an efficient, healthy and accessible capital market – ensure a productive supply-side growth.  In her research, Huang explores the culture, participants and regulatory system of the U.S. capital market and tries to figure out what China’s capital market development can learn from this system.

 

Yuichiro Muramatsu, Mitsubishi Electric, "Manufacturing Industry with Big Data Analysis on IoT"

The Internet of Things (IoT) is major technology that connects devices and cloud service.  Cloud service computes device data and returns meaningful results for abnormal detection, performance improvement and prediction.  One key component of IoT is big data analysis.  Japan’s Ministry of Economy, Trade and Industry’s 2015 Whitepaper states that innovation in the manufacturing industry by using IoT and big data analysis is about to launch, but few cases exist in Japan.  Innovative companies like Netflix, Uber and AirBnB are data driven companies and the manufacturing industry is also expected to have smart factories with big data analysis.  In his research, Muramatsu investigates the use of big data analysis on IoT and identifies useful cases of business efficiency and the methodology that supports big data analysis.

 

Fred Yang, MissionCare, "Private Hospitals in Taiwan and the Implications"

In most East Asian countries, including Japan, South Korea and Taiwan, private hospitals are the majority in the market.  In China, even though private hospitals have been in fast growth for the past 10 years, their size remains small and the market is still dominated by large public hospitals.  In the most recent move of healthcare reform in China, the government emphasized and encouraged the entry of private-non-profit hospitals into the market. 

In the National Health Insurance Administration’s (NHIA) Open Information System, a set of quality indicators is computed based on hospitals’ reimbursement data.  A committee comprised of representatives from government, academia and hospitals select these indicators and the data is published to the general public on a quarterly basis. 

By using statistical tools such as descriptive analysis, univariate analysis, and multivariable analysis, Yang focused on the comparison of hospital performance by ownership in Taiwan.  The results revealed limited differences among three types of hospitals by ownership, which is consistent with findings of most studies.  Based on his findings, Yang provides policy implications to the market and policy makers that include 1) hospital ownership might not be a key determinant of a hospital’s quality and 2) the real challenge to the government may be creating an environment where hospitals are committee to improve the quality of care.

 

Shizuoka Prefectural Government
Beijing Shanghe Shiji Investment Company
Mitsubishi Electric
MissionCare
Seminars
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In this session of the Corporate Affiliates Research Presentations, the following will be presented:

Yuta Aikawa, Ministry of Economy, Trade & Industry, Japan, "A Study About a Government Policy to Develop Defense Industry"

In April 2014, under consideration of the recent situation of international cooperation and developing defense equipment in the world, the government of Japan decided on the “Three Principles on Transfer of Defense Equipment and Technology”.  Additionally, the Acquisition, Technology and Logistics Agency was newly established in the Ministry of Defense (MOD) in October 2015, consolidating and reorganizing acquisition-related organization in the MOD to address the new age and duties.  These recent changes could have a big impact on the defense industry in Japan.  In his research, Aikawa tries to figure out how to develop the defense industry by looking at the situation in South Korea, whose government recently developed to export defense equipment to other countries.  Aikawa uses this example to illustrate implications for the government of Japan on the future of the defense industry.

 

Tsuzuri Sakamaki, MInistry of Finance, Japan, "What Impact Would the Ongoing Basel III Implementation Procedure Have on Banks' Value Creation and Risk Management?"

Basel III has been developed in response to the financial crisis that started in 2007 and reached one of its many peaks with the Lehman Brothers bankruptcy in September 2008.  The aim of the Basel Committee on Banking Supervision (BCBS) implementing Basel III is to make the banking system more resilient to market stress, but this new regulation inevitably limits the ability of banks to take deposits and lend money to the real economy.  Banks are also under constant pressure from their own shareholders who are providing them with equity capital to maximize the usage of the capital in order to achieve high returns for them.  With all these regulatory policy intensions and market economic constraints taken into account, Sakamaki has researched into whether the Basel III would indeed lead to increased stability of the banking system, or what possibly unintended negative consequences could develop in its implementation process.

 

Ravishankar Shivani, Reliance Life Sciences, "Pharmaceutical Process Validation — A Science and Risk-Based Approach to Evaluate Impact of Changes on Regulatory Filings"

Regional differences in regulatory oversight of post-approval changes exists in the ICH regions and there is an urgent need for clarification of current expectations and how best to optimize the use of relevant regulatory tools in place in the different regions.  The key aspects considered are 1) inclusion of risk-based regulatory commitment approach to enable post-approval changes and continual improvement,  2) establishing criteria for an harmonized risk-based change management system, and 3) introducing the concept of post-approval change management plan for regulatory overview. 

Shivani has researched the possibilities of changes to the attributes of a product over the life cycle that are necessary to maintain product quality and efficacy.  His research identifies the methodology for inclusion of the proposed changes during the development phase as commitments in dossiers to facilitate regulatory assessment. 

 


 

Ministry of Economy, Trade & Industry, Japan
Ministry of Finance, Japan
Reliance Life Sciences
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:

The past two decades have witnessed an unprecedented expansion of investment in healthcare in developing countries with corresponding widespread improvement in health indicators, though there still remain a billion people without basic access to primary care. Though there is a growing emphasis on integrating international donor funds with broad-based health system strengthening (HSS) efforts, very little is known about the process in which healthcare systems improve at the point of service, and how that, in turn, impacts population health.   Unlike the role of randomized trials on individual interventions, there is no gold standard for health systems research.  As global health expands its scope to the new field of planetary health broadly associated with the SDGs, the gaps in knowledge and research grow even further. Here, we present a framework for adaptive district-level HSS in Madagascar.  The program simultaneously strengthens the WHO’s six building blocks of HSS at all levels of the health system within a government district, while pioneering a rigorous system for policy and implementation research that includes 1) strengthening the district’s health management information systems (HMIS); 2) a prospective longitudinal cohort demographic and health study of over 1500 households; and 3) selected qualitative and biomedical research projects.  The research platform allows for the evaluation of system output indicators as well as population-level impact indicators, such as mortality rates.  Moreover, it provides a platform for scientific research on socio-economic and environmental determinants of health that are fundamental to the new field of planetary health.

Matthew Bonds Harvard University
Seminars
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All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract:

The Vaccine Confidence Project (VCP) is a research group, led by Dr. Heidi Larson. The VCP studies the diverse sociocultural, political and psychological influences which affect confidence in vaccines and immunisation programmes in local settings worldwide, as well as examining trans-national influences. The VCP has developed multiple metrics to measure population confidence in vaccines and immunization programmes, from a survey-based Vaccine Confidence Index to temporal analysis of media and social media monitoring of vaccine sentiment  and local qualitative research to understand the drivers of vaccine reluctance and refusal. Together, these diverse metrics  generate a rich picture of the drivers of vaccine confidence to hep inform interventions.

While all the evidence points to the importance of understanding locally nuanced drivers of vaccine reluctance to inform interventions, Dr. Larson will talk about the equally important transnational impacts of local vaccine events and emotions through global cases studies on HPV, Polio, Flu and Ebola, and the implications for vaccine preparedness around newly introduced vaccines and programmes as well as pandemic preparedness.

Bio:

Heidi J. Larson, PhD,  is an anthropologist and Senior Lecturer, Department of Infectious Disease Epidemiology, LSHTM, an Associate Clinical Professor, Institute of Health Metrics and Evaluation, University of Washington, Seattle, and a Fellow at the Chatham House Centre on Global Health Security. Dr. Larson previously headed Global Communication for Immunisation at UNICEF and chaired the Advocacy Task Force for GAVI (Global Alliance for Vaccines and Immunisation). She was also a  member of the WHO SAGE working group dealing with vaccine hesitancy.   Dr. Larson’s research focuses on the analysis of the social and political factors that can affect uptake on health interventions, particularly vaccines, and the implications for policies and programmes. Her particular interest is on risk and rumour management from clinical trials to delivery – and building public trust. Dr. Larson is currently the Principle Investigator for a large European Union grant (EBODAC) on the deployment, acceptance and compliance of an Ebola prime-boost vaccine trial in Sierra Leone.

*This seminar is co-sponsored with the Stanford Center for Innovation in Global Health*

Heidi J. Larson
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:

Quantitative evaluation of environmental, health, and safety policies requires a metric for the value of changes in health risk. This metric should be consistent with both the preferences of the affected individuals and social preferences for distribution of health risks in the population. There are two classes of metrics widely used in practice: monetary measures (e.g., compensating and equivalent variations, willingness to pay and willingness to accept compensation) and health-utility measures (e.g., quality-adjusted life years (QALYs), disability-adjusted life years (DALYs)), both of which are summed across the population. Health-utility measures impose more structure on individual preferences than monetary measures, with the result that individuals’ preferences often appear inconsistent with these measures; for the same reason, health-utility measures help protect against cognitive errors and other sources of incoherence in estimates of the values of monetary measures obtained from revealed- and stated-preference studies. This paper presents theoretical and empirical evidence comparing these metrics and examining how they co-vary.

James Hammitt Harvard University
Seminars
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Founded in 1996, Asian Liver Center at Stanford and Peking Universities (ALC) are devoted to the elimination of transmission, stigma, and deaths associated with chronic hepatitis B and liver cancer.  On April 22, 2016, ALC will co-host the JoinJade for China Summit: Building Inclusive Workplaces at the Stanford Center at Peking University. 28 leading multinational employers in China will be recognized for their commitment to the JoinJade for China initiative to build healthy, inclusive workplaces free from hepatitis B discrimination.

Summit Agenda

9:00                 Reception

9:30                 Welcome

                          Emcee: Dong Qian, CCTV anchorwoman

9:35                 Opening remarks

                          Dr. Samuel So, Director, Asian Liver Center

                          Jayne Lux, Vice President, Global Business Group on Health

9:50                 Keynote speeches

                          Dr. Bernhard Schwartländer, WHO Representative in China

                          Dr. Fuqiang Cui, Deputy Director, China CDC National Immunization Program

10:05               Tea break

10:20               Panel discussion

                          Dr. Samuel So, Director, Asian Liver Center

  Dr. Tong Chen, Consulting Occupational Physician, Integrated Health Services, IBM Greater China

                          Dr. Jean Wu, Medical Director, GE China

                          Mr. Chuang Lei, Founder, Yiyou Charity

                          Q & A

10:55              Launching Ceremony

11:05              JoinJade for China Awards Ceremony

11:25              Group picture

11:40              Lunch

 

For questions, please contact:

Email: xiaojuny@stanford.edu

Phone: +86 (10) 62744167

5 Yiheyuan Road

Haidian District, Beijing

China

 

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Nearly 100 health economists from across the United States signed a pledge urging U.S. presidential candidates to make chronic disease a policy priority. Karen Eggleston, a scholar of comparative healthcare systems and director of Stanford’s Asia Health Policy Program, is one of the signatories. 

The pledge calls upon the candidates to reset the national healthcare agenda to better address chronic disease, which causes seven out of 10 deaths in America and affects the economy through lost productivity and disability.

Read the pledge below.

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"What do I do about the chickens?"

When assistant professor of medicine Eran Bendavid began a study on livestock in African households to determine impact on childhood health, he'd already anticipated common field problems like poorly captured or intentionally misreported data, difficulty getting to work sites, or problems with training local volunteers.

But he'd never gotten that particular question from a fieldworker before. It didn't occur to him that participating families, in reporting their livestock holdings, would completely omit the chickens running around at their feet, thereby skewing the data.

"They didn't consider chickens to be livestock," recalled Bendavid. Along with Scott Rozelle, the Helen F. Farnsworth Senior Fellow at FSI, and associate professor of political science and FSI senior fellow Beatriz Magaloni, Bendavid spoke to a full house last week on lessons learned from fieldwork gone awry. The return engagement of FSI's popular seminar, "Everything that can go wrong in a field experiment” was introduced by Jesper Sørensen, executive director of Stanford Seed, and moderated by Katherine Casey, assistant professor of political economy at the GSB. The seminar is a product of FSI and Seed’s joint Global Development and Poverty (GDP) Initiative, which to date has awarded nearly $7 million in faculty research funding to promote research on poverty alleviation and economic development worldwide.

Rozelle, co-director of the Rural Education Action Program, spoke of the obstacles to accurate data gathering, especially in rural areas where record-keeping is inaccurate and participants' trust is low. Arriving in a Chinese village to carry out child nutrition studies, said Rozelle, "we found Grandma running out the back door with the baby." The researchers had worked with the local family planning council to find the names of children to study, but the families thought the authorities were coming to penalize them for violation of the one-child policy.

Cultural differences make for entertaining and illuminating (if frustrating) lessons, but Beatriz Magaloni, director of FSI's Program on Poverty and Governance at the Center on Democracy, Development and the Rule of Law had a different story to tell. Over the course of three years, her GDP-funded work to investigate and reduce police violence in Brazil - a phenomenon resulting in more than 22,000 deaths since 2005 - has encountered obstacle after obstacle. Her work to pilot body-worn cameras on police in Rio has faced a change in police leadership, setting back cooperation; a yearlong struggle to decouple a study of TASER International’s body worn cameras from its electrical weapons in the same population; a work site initially lacking electricity to charge the cameras or Internet to view the feeds; and noncompliance among the officers. "It's discouraging at times," admitted Magaloni, who has finally gotten the cameras onto the officers' uniforms and must now experiment with ways to incentivize their use. "We are learning a lot about how institutional behavior becomes so entrenched and why it's so hard to change."

Experimentation is a powerful tool to understand cause and effect, said Casey, but a tool only works if it's implemented properly. Learning from failure makes for an interesting panel discussion. The speakers' hope is that it also makes for better research in the future.

The Global Development and Poverty Initiative is a University-wide initiative of the Stanford Institute for Innovation in Developing Economies (Seed) in partnership with the Freeman Spogli Institute (FSI). GDP was established in 2013 to stimulate transformative research ideas and new approaches to economic development and poverty alleviation worldwide. GDP supports groundbreaking research at the intersection of traditional academic disciplines and practical application. GDP uses a venture-funding model to pursue compelling interdisciplinary research on the causes and consequences of global poverty. Initial funding allows GDP awardees to conduct high-quality research in developing countries where there is a lack of data and infrastructure.

 

 

 

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The Walter H. Shorenstein Asia-Pacific Research Center (APARC), in pursuit of training the next generation of scholars on contemporary Asia, has selected three postdoctoral fellows for the 2016-17 academic year. The cohort includes two Shorenstein Postdoctoral Fellows and one Developing Asia Health Policy Fellow; they carry a broad range of interests from hospital reform to the economic consequences of elite politics in Asia.

The fellows will begin their year of academic study and research at Stanford this fall.

Shorenstein APARC has for more than a decade sponsored numerous junior scholars who come to the university to work closely with Stanford faculty, develop their dissertations for publication, participate in workshops and seminars, and present their research to the broader community. In 2007, the Asia Health Policy Program began its fellowship program to specifically support scholars undertaking comparative research on Asia health and healthcare policy.

The 2016-17 fellows’ bios and their research plans are listed below:


Shorenstein Postdoctoral Fellows

 

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Aditya "Adi" Dasgupta is completing his doctorate in the Department of Government at Harvard University. At Stanford, he will work on converting his dissertation on the historical decline of single-party dominance and transformation of distributive politics in India into a book manuscript. More broadly, his research interests include the comparative economic history of democratization and distributive politics in emerging welfare states, which he studies utilizing formal models and natural experiments. He received a Bachelor of Arts from Cambridge University and a Master of Science from Oxford University and has worked at the Public Defender Service in Washington D.C., his hometown.

 

 

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Dong Zhang is a political scientist whose research interests include political economy of development, with focus on the economic consequences of elite politics, and on the historical origins of long-run economic development. His dissertation examines the political logic of sustaining state capitalism model in weakly institutionalized countries with a primary focus on China. At Stanford, Zhang will develop his dissertation into a book manuscript and pursue other research projects on comparative political economy and authoritarian politics. He will receive his doctorate in political science from Northwestern University in 2016. Zhang holds bachelor’s degrees in public policy and economics, and a master’s degree in public policy from Peking University, Beijing.


Developing Asia Health Policy Postdoctoral Fellow

 

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Ngan Do is strongly interested in health system related issues, especially health financing, human resources for health, and health care service delivery. Do implemented comparison studies at regional level as well as participated in fieldwork in Cambodia, Lao, the Philippines, Korea and Vietnam. At Stanford, she will work on the public hospital reforms in Asia, focusing on dual practice of public hospital physicians and provider payment reforms. Do achieved her doctorate in health policy and management at the College of Medicine, Seoul National University. She earned her master’s degree in public policy at the KDI School of Public Policy and Management in Seoul, and her bachelor’s degree in international relations at the Diplomacy Academy of Vietnam (previously the Institute for International Relations).


 

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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:

The Norwegian universal health care system is built on the fundamental principle of equal access to high quality health services regardless of socioeconomic status, ethnicity and geographical residence. Norway (approx. 5 Million people) is recognized for being an overall top performer among OECD countries on various health measures. However, the aging population has led to substantial cost increases as well as long waiting times for elective surgery, due to insufficient ability of hospitals to absorb patient inflows. These were some of the main motivations for Norway’s Hospital Reform and the implementation of the Free Choice System in the early years following the millennium. The responsibility for financing and providing specialized health services was transferred to four Regional Health Authorities (Central State), which in turn were given the right to contract (usually by tendering competition) with Private For-Profit Hospitals (PFPs). In the Free Choice System, patients holding a referral from their general practitioner (GP) can choose any hospital, both PFPs and Non-Profit Hospitals, for the same out of pocket cost. We have previously found that PFPs deliver the same procedures at a substantially lower cost (down to 50.6% of the National DRG-price). However, due to relatively large variations in waiting times between PFPs and Non-Profit Hospitals, we hypothesized that some groups may be better at navigating in this new system and achieve lower waiting times. We were particularly interested in whether the reform, aimed to contain costs and reduce waiting time for elective surgery, has compromised the fundamental principle equal access to care. Patients who underwent day surgery during the period 2009 – 2014 were identified through the Norwegian Patient Register and linked with socioeconomic data using the Norwegian Tax Register and the Norwegian Education Register. Preliminary findings suggest that otherwise similar younger patients, poorer patients, and those with more comorbidities are less likely to use PFPs, using Non-profit Hospitals instead. Higher educated patients go more frequently to PFPs and the difference between lower educated and higher educated patients is increasing with longer waiting times. We also find an overall increasing secular trend to use PFPs.

BIO:

Geir H. Holom, MD, is a Visiting Scholar at Stanford School of Medicine (CHP/PCOR) from the University of Oslo. His research focuses on the expansion of private for-profit hospitals in the Nordic countries and its effect on prices, quality of care and selection of patients. He received a BSc in Economics and Business Administration from the Norwegian School of Economics and an MD from the University of Bergen. While in medical school, he conducted research on patients diagnosed with head and neck cancer who underwent head and neck reconstruction using microsurgery. Since receiving his MD, he has worked as a physician in both primary care and specialized health services. Prior to entering the field of medicine, he worked in the business and finance sector. Dr. Holom volunteers for the Children's Program at Oslo University Hospital.

Geir Holom
Seminars
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