Health Outcomes

Shorenstein APARC
Encina Hall C331
616 Serra Street
Stanford, CA 94305-6055

(650) 724-5656 (650) 723-6530
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2013-2014 Asia Health Policy Postdoctoral Fellow
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PhD

Margaret (Maggie) Triyana’s main research interests are inequality and human capital investments in developing countries. In particular, she is interested in the effects social policy changes on children’s health outcomes. As a Postdoctoral Fellow, she will analyze the effects of rural-urban migration in Indonesia and China, as well as the impact of health insurance expansion in Indonesia and Vietnam.

Triyana received a PhD in Public Policy from the University of Chicago in 2013.

 

Working Papers

“Do Health Care Providers Respond to Demand-Side Incentives? Evidence from Indonesia“

“The Effects of Community and Household Interventions on Birth Outcomes: Evidence from Indonesia”

“The Longer Term Effects of the ‘Midwife in the Village’ Program in Indonesia”

“The Sources of Wage Growth in a Developing Country” (with Ioana Marinescu)

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A tremendous amount of radioactive products were discharged as a result of the accident at the Fukushima nuclear power plant in March 2011, which resulted in radioactive contamination of the plant and surrounding areas. While geographical distribution of radioactive iodine, tellurium, and cesium in the surface soils was smoothly (but not always systematically) widespread all over the region, health risk information by the government, media, and other organizations is most likely to be given in terms of administrative boundaries (cf. prefectures, municipalities, etc.) and/or distance from the radiation source.

This paper estimates the effect of such health risk information rather than the actual health risks of radiation on land and other prices in different locations. We find that the prefecture and municipality border effects – but not the distance effect from the nuclear power plant – are significantly related to a reduction in land and other prices after the accident. This shows that people responded to health risk information based on administrative boundaries rather than the actual health risk of radiation after the disaster. Although health risk information based on prefecture and municipality boundaries has an obvious advantage of distilling large and complex risk information into a simple one, the government, media, and other organizations need to recognize and carefully examine the potential of misclassifying non-contaminated areas into contaminated prefectures. Doing so will avoid unintentional consequences to the region’s economy.

Hiroaki Matsuura is currently Departmental Lecturer in the Economy of Japan in the School of Interdisciplinary Area Studies, University of Oxford and a Junior Research Fellow of St. Antony’s College. His main interests are health economics and demography, with a special interest in the relation between laws and population health. Hiroaki received his B.A. in Economics from Keio University, M.A. in Social Science from the University of Chicago, M.S. in Project Management from Northwestern University’s McCormick School of Engineering and Applied Science, and Sc.D. in Global Health and Population (Economics track) from Harvard University’s School of Public Health. In the past, he was affiliated with Institute of Quantitative Social Sciences, Human Rights in Development, and Takemi Program in International Health at Harvard University. He also worked as a research assistant at the National Bureau of Economic Research. His doctoral dissertation research explores a right to health or to health care in national constitutions of 157 countries and state constitutions of the 50 U.S. states and estimates the impact of introducing (or removing) a right to health or to health care into national and state constitutions on health system and population health outcomes. His most recent article, “The Right to Health in Japan: Challenges of a Super Aging Society and Implication from Its 2011 Public Health Emergency” (with Eriko Sase) will be appeared on “Advancing the Human Right to Health”, edited by José M. Zuniga, Stephen P. Marks, and Lawrence O. Gostin, Oxford University Press, 2013. 

Daniel and Nancy Okimoto Conference Room

Hiroaki Matsuura Departmental Lecturer in the Economy of Japan in the School of Interdisciplinary Area Studies Speaker University of Oxford
Seminars
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Abstract: Dr. Wang will be discussing some of the formal governmental and non-governmental collaborative mechanisms between Taiwan, China, Hong Kong, and other countries (including the US) on survaillance and reporting for flu. He will also discuss lessons learned from SARS, including the development of specific policies, protocols, or procedures, and new technologies deployed for public health preparedness.

 

C. Jason Wang, M.D., Ph.D. is an Associate Professor of Pediatrics at the Center for Policy, Outcomes, and Prevention at Stanford University.  He received his B.S. from MIT, M.D. from Harvard, and Ph.D. in policy analysis from RAND.  After completing his pediatric residency training at UCSF, he worked in Greater China with McKinsey and Company, during which time he performed multiple studies in the Asian healthcare market. In 2000, he was recruited to serve as the project manager for the Taskforce on Reforming Taiwan's National Health Insurance System. His fellowship training in health services research included the Robert Wood Johnson Clinical Scholars Program and the National Research Service Award Fellowship at UCLA. Prior to coming to Stanford in 2011, he was an Assistant Professor of Pediatrics and Public Health (2006-2010) and Associate Professor (2010-2011) at Boston University and Boston Medical Center. 

Among his accomplishments, he was selected as the student speaker for Harvard Medical School Commencement (1996).  He received the Overseas Chinese Outstanding Achievement Medal (1996), the Robert Wood Johnson Physician Faculty Scholars Career Development Award (2007), the CIMIT Young Clinician Research Award for Transformative Innovation in Healthcare Research (2010), and the NIH Director’s New Innovator Award (2011). He was recently named a “Viewpoints” editor and a regular contributor for theJournal of the American Medical Association (JAMA).  He served as an external reviewer for the 2011 IOM Report “Child and Adolescent Health and Health Care Quality: Measuring What Matters” and as a reviewer for AHRQ study sections.

Dr. Wang has written two bestselling Chinese books published in Taiwan and co-authored an English book “Analysis of Healthcare Interventions that Change Patient Trajectories”.  His essay, "Time is Ripe for Increased U.S.-China Cooperation in Health," was selected as the first-place American essay in the 2003 A. Doak Barnett Memorial Essay Contest sponsored by the National Committee on United States-China Relations.

Currently he is the principal investigator on a number of quality improvement and quality assessment projects funded by the Robert Wood Johnson Foundation, the National Institutes of Health (USA), Health Resources and Services Administration (HRSA), and the Andrew T. Huang Medical Education Promotion Fund (Taiwan).

Dr. Wang’s research interests include: 1) developing tools for assessing and improving the quality of healthcare; 2) facilitating the use of innovative consumer technology in improving quality of care and health outcomes; 3) studying competency-based medical education curriculum, and 4) improving health systems performance.

CISAC Conference Room

Encina Commons Room 180,
615 Crothers Way,
Stanford, CA 94305-6006

(650) 736-0403 (650) 723-1919
0
LCY: Tan Lan Lee Professor
Professor, Health Policy
Professor Pediatrics (General Pediatrics)
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MD, PhD

C. Jason Wang, M.D., Ph.D. is a Professor of Pediatrics and Health Policy and director of the Center for Policy, Outcomes, and Prevention at Stanford University.  He received his B.S. from MIT, M.D. from Harvard, and Ph.D. in policy analysis from RAND.  After completing his pediatric residency training at UCSF, he worked in Greater China with McKinsey and Company, during which time he performed multiple studies in the Asian healthcare market. In 2000, he was recruited to serve as the project manager for the Taskforce on Reforming Taiwan's National Health Insurance System. His fellowship training in health services research included the Robert Wood Johnson Clinical Scholars Program and the National Research Service Award Fellowship at UCLA. Prior to coming to Stanford in 2011, he was an Assistant Professor of Pediatrics and Public Health (2006-2010) and Associate Professor (2010-2011) at Boston University and Boston Medical Center. 

Among his accomplishments, he was selected as the student speaker for Harvard Medical School Commencement (1996).  He received the Overseas Chinese Outstanding Achievement Medal (1996), the Robert Wood Johnson Physician Faculty Scholars Career Development Award (2007), the CIMIT Young Clinician Research Award for Transformative Innovation in Healthcare Research (2010), and the NIH Director’s New Innovator Award (2011). He was recently named a “Viewpoints” editor and a regular contributor for the Journal of the American Medical Association (JAMA).  He served as an external reviewer for the 2011 IOM Report “Child and Adolescent Health and Health Care Quality: Measuring What Matters” and as a reviewer for AHRQ study sections.

Dr. Wang has written two bestselling Chinese books published in Taiwan and co-authored an English book “Analysis of Healthcare Interventions that Change Patient Trajectories”.  His essay, "Time is Ripe for Increased U.S.-China Cooperation in Health," was selected as the first-place American essay in the 2003 A. Doak Barnett Memorial Essay Contest sponsored by the National Committee on United States-China Relations.

Currently he is the principal investigator on a number of quality improvement and quality assessment projects funded by the Robert Wood Johnson Foundation, the National Institutes of Health (USA), Health Resources and Services Administration (HRSA), and the Andrew T. Huang Medical Education Promotion Fund (Taiwan).

Dr. Wang’s research interests include: 1) developing tools for assessing and improving the quality of healthcare; 2) facilitating the use of innovative consumer technology in improving quality of care and health outcomes; 3) studying competency-based medical education curriculum, and 4) improving health systems performance.

Director, Center for Policy, Outcomes & Prevention (CPOP)
Co-Director, PCHA-UHA Research & Learning Collaborative
Co-Chair, Mobile Health & Other Technologies, Stanford Center for Population Health Sciences
Co-Director, Academic General Pediatrics Fellowship
C. Jason Wang Speaker
Seminars
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Abstract:

The levels of violence in Mexico have dramatically increased in the last few years due to structural changes in the drug trafficking business. The increase in the number of drug trafficking organizations (DTOs) fighting over the control of territory and trafficking routes has resulted in a substantial increase in the rates of homicides and other crimes. This study evaluates the economic costs of drug-related violence. We propose electricity consumption as an indicator of the level of municipal economic activity and use two different empirical strategies to test this. To estimate the marginal effect of violence in the rate of homicides (per 100,000 inhabitants) we use an instrumental variable regression created by Mejía, Castillo and Restrepo (2012). For the average municipality, the marginal negative effect of the increase in homicides rates is substantive for earned income and the proportion of business owners, but not for energy consumption. Although negative and statistically significant, the effects are mild for labor participation. We also employ the methodology of synthetic controls to evaluate the effect that inter-narco wars have on local economies. The analysis indicates that the drug wars in those municipalities that saw dramatic increases in violence between 2006 and 2010 significantly reduced their energy consumption in the years after the change occurred, which is interpreted as a significant reduction in GDP per capita for these municipalities.

Speaker Bio:

Gabriela Calderon holds a Ph.D. in Economics from Stanford University. Her research interests include policies that affect gender differences in developing countries, policy evaluation, violence in Latin America and the effect of institutions and governance on the provision of public goods and health/education outcomes. She did her master's degree in economic theory and bachelor's degree in economics at the Instituto Tecnológico Autónomo de México. Currently, in the Program on Poverty and Governance, her research analyzes the way institutions and democracy affect the provision of public goods, and the impact they have on health outcomes like infant mortality trends. She is also studying the effects of government interventions that combat drug-trafficking organizations over violence in Mexico.

Her research has focused on the topics of development, public finance, and the evaluation of public policy programs in Mexico. For example, during the summers of 2009/2010, she conducted a field experiment in Zacatecas, Mexico with Giacomo de Giorgi, an assistant professor from Stanford University, and Jesse Cuhna, a former Stanford student. The main task was to evaluate the impact of financial literacy classes on underprivileged women entrepreneurs in the region. To successfully complete an evaluation in an untreated region, they proposed collaborating with the Mexican NGO CREA on a joint project. They contacted local interviewers, trained them, and identified all women entrepreneurs in the 17 communities, in which we conducted the experiment. Preliminary results suggest that the female entrepreneurs who were randomly assigned to treatment earned higher profits, had larger revenues, and served a greater number of clients. They also found that they were more likely to implement formal accounting techniques.

She has also studied programs that are not randomly assigned as an experiment. For example, she has analyzed the effects of a national policy in Mexico of child care services, called Estancias Infantiles para apoyar a Madres Trabajadoras (EI), using administrative, census and household data. Her empirical research strategy identifies the effects of the program on both the men and women who were eligible for the program. She used time, location and eligibility variation, and considered a major threat to identification of the actual effects: for example, a manufacturer who moves into a municipality at approximately the same time as the EI program and who happens to disproportionately demand the skills of women who were eligible to the program happened to have. To ensure that such scenarios do not affect her results, she chose not triple difference strategy, in which all ineligible people are treated as “controls” for the EI-eligible families. Instead, she employs Synthetic Control Methods, using the same methodology as Abadie and Gardeazabal (2003) and Abadie, Diamond and Hainmueller (2010) to ensure that her control group has the same mix of skills and preferences as the EI-eligible group. She adapted the Synthetic Control Method to analyze repeated cross-sectional household data, which are data that are typically available in developing countries

Encina Ground Floor Conference Room

Encina Hall
616 Serra Street
Stanford, CA 94305-6055

(650) 724-2996
0
CDDRL Postdoctoral Fellow 2012-13
Calderon_HS.jpg
PhD

Gabriela Calderon holds a Ph.D. in Economics from Stanford University. Her research interests include policies that affect gender differences in developing countries, policy evaluation, violence in Latin America and the effect of institutions and governance on the provision of public goods and health/education outcomes. She did her master's degree in economic theory and bachelor's degree in economics at the Instituto Tecnológico Autónomo de México. Currently, in the Program on Poverty and Governance, her research analyzes the way institutions and democracy affect the provision of public goods, and the impact they have on health outcomes like infant mortality trends. She is also studying the effects of government interventions that combat  drug-trafficking organizations over violence in Mexico. 

Her research has focused on the topics of development, public finance, and the evaluation of public policy programs in Mexico. For example, during the summers of 2009/2010, she conducted a field experiment in Zacatecas, Mexico with Giacomo de Giorgi, an assistant professor from Stanford University, and Jesse Cuhna, a former Stanford student. The main task was to evaluate the impact of financial literacy classes on underprivileged women entrepreneurs in the region. To successfully complete an evaluation in an untreated region, they proposed collaborating with the Mexican NGO CREA on a joint project. They contacted local interviewers, trained them, and identified all women entrepreneurs in the 17 communities, in which we conducted the experiment.  Preliminary results suggest that the female entrepreneurs who were randomly assigned to treatment earned higher profits, had larger revenues, and served a greater number of clients. They also found that they were more likely to implement formal accounting techniques.

She has also studied  programs that are not randomly assigned as an experiment. For example, she has analyzed the effects of a national policy in Mexico of child care services, called Estancias Infantiles para apoyar a Madres Trabajadoras (EI), using administrative, census and household data.  Her empirical research strategy identifies the effects of the program on both the men and women who were eligible for the program. She used time, location and eligibility variation, and considered a major threat to identification of the actual effects: for example, a manufacturer who moves into a municipality at approximately the same time as the EI program and who happens to disproportionately demand the skills of women who were eligible to the program happened to have. To ensure that such scenarios do not affect her results, she chose not triple difference strategy, in which all ineligible people are treated as “controls” for the EI-eligible families. Instead, she employs Synthetic Control Methods, using the same methodology as Abadie and Gardeazabal (2003) and Abadie, Diamond and Hainmueller (2010) to ensure that her control group has the same mix of skills and preferences as the EI-eligible group. She adapted the Synthetic Control Method to analyze repeated cross-sectional household data, which are data that are typically available in developing countries

Gabriela Calderón CDDRL Postdoctoral Fellow 2012-13 Speaker
Seminars
Paragraphs

OBJECTIVE: To determine whether children in rural areas have worse health than children in urban areas after liver transplantation (LT). STUDY DESIGN: We used urban influence codes published by the US Department of Agriculture to categorize 3307 pediatric patients undergoing LT in the United Network of Organ Sharing database between 2004 and 2009 as urban or rural. Allograft rejection, patient death, and graft failure were used as primary outcome measures of post-LT health. Pediatric end-stage liver disease/model of end-stage liver disease scores >20 was used to measure worse pre-LT health. RESULTS: In a multivariate analysis, we found greater rates of allograft rejection within 6 months of LT (OR 1.27; 95% CI 1.05-1.53) and a lower occurrence of posttransplantation lymphoproliferative disorder (OR 0.64; 95% CI 0.41-0.99) in patients in rural areas. The difference in allograft rejection was eliminated at 1 year of LT (OR 1.18; 95% CI 0.98-1.42). Rural location did not impact other outcome measures. CONCLUSION: We conclude that rural location makes a negative impact on patient health within the first 6 months of LT by increasing the risk for allograft rejection, although patients in rural areas may have lower rates of developing posttransplantation lymphoproliferative disorder. Long-term adverse health effects were not seen.

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J Pediatr
Authors
KT Park
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Currently, more than two-thirds of the population in Africa must leave their home to fetch water for drinking and domestic use. The time burden of water fetching has been suggested to influence the volume of water collected by households as well as time spent on income generating activities and child care. However, little is known about the potential health benefits of reducing water fetching distances. Data from almost 200 000 Demographic and Health Surveys carried out in 26 countries were used to assess the relationship between household walk time to water source and child health outcomes. To estimate the causal effect of decreased water fetching time on health, geographic variation in freshwater availability was employed as an instrumental variable for one-way walk time to water source in a two-stage regression model. Time spent walking to a household’s main water source was found to be a significant determinant of under-five child health. A 15-min decrease in one-way walk time to water source is associated with a 41% average relative reduction in diarrhea prevalence, improved anthropometric indicators of child nutritional status, and a 11% relative reduction in under-five child mortality. These results suggest that reducing the time cost of fetching water should be a priority for water infrastructure investments in Africa.

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Environmental Science and Technology
Authors
Jenna Davis
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In this paper we report the results of a randomized controlled trial designed to measure the impact of a parental training program on the nutritional status of primary school students in rural Shaanxi Province, in Northwest China. Using hemoglobin (Hb) levels as the outcome variable, we first measure the overall impact of a nutritional training program, then measure the impact separately by gender. We use both descriptive and multivariate analyses.

The results for the descriptive and econometric results were robust and consistent with the literature. Overall, we find no impact on students’ Hb levels when we trained their parents about undernutrition and anemia. In both the descriptive and multivariate results, there was no difference in the change of Hb levels between control and treatment students. Parents in the treatment group did learn more about anemia than parents in the control group, but this increased knowledge did not lead to sharp changes in behavior, in general. We did find, however, that there was a measurable impact of parental training on the Hb levels of female students. In both the descriptive and econometric results we found that the Hb levels of female students rose more than that of male students, and that this difference was statistically significant. We conjecture that the parents of female students may have recognized from the training that they were not providing their daughters with sufficient nutrition. Our data show that parents in the treatment group responded by increasing the daily provision of meat, fish, eggs and beans, relative to parents of girls in the control group.

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China Agricultural Economic Review
Authors
Scott Rozelle
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