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Breastfeeding self-efficacy (BSE), defined as a mother’s confidence in her ability to breastfeed, has been confirmed to predict the uptake of exclusive breastfeeding (EBF). Early experiences during the birth hospital stay, especially in-hospital formula feeding (IHFF), can impact both EBF and maternal breastfeeding confidence. Therefore, our objective was to examine the association between IHFF and EBF outcomes and investigate whether this association is influenced by BSE. The study included 778 infants from a larger cohort study conducted in 2021, with a one-year follow-up in rural areas of Sichuan Province, China. We used a causal mediation analysis to estimate the total effect (TE), natural direct (NDE), and nature indirect effects (NIE) using the paramed command in Stata. Causal mediation analyses revealed that IHFF was negatively associated with EBF (TE odds ratio = 0.47; 95% CI, 0.29 to 0.76); 28% of this association was mediated by BSE. In the subgroup analysis, there were no significant differences in the effects between parity subgroups, as well as between infant delivery subgroups. Our study found that IHFF hindered later EBF and that BSE mediated this association. Limiting the occurrence of in-hospital formula feeding or improving maternal breastfeeding self-efficacy is likely to improve exclusive breastfeeding outcomes.

Journal Publisher
Nutrients
Authors
Lu Liu
Yuju Wu
Xiannan Xian
Jieyuan Feng
Yuping Mao
Siva Balakrishnan
Ann Weber
Gary Darmstadt
Yunwei Chen
Sean Sylvia
Huan Zhou
Scott Rozelle
Scott Rozelle
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George Krompacky
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On October 18, as part of its autumn 2023 seminar series on APEC in advance of the organization's meeting in San Francisco in November, Shorenstein APARC and its Asia Health Policy Program (AHPP) presented the series' second event, Asia-Pacific Digital Health Innovation: Technology, Trust, and the Role of APEC. The featured panelists were Kiran Gopal Vaska, Director of the National Health Authority of India, and CK Cheruvettolil, the Senior Strategy Officer, Digital Health and Artificial Intelligence, at the Bill & Melinda Gates Foundation. Siyan Yi, the Director of the Integrated Research Program at the National University of Singapore and a former AHPP fellow, moderated the conversation.

While India is not an APEC member, Indian initiatives are examples of leveraging technology to better the health of the most vulnerable citizens in low- and middle-income countries (LMICs). Kiran Gopal Vaska gave an overview of the Ayushman Bharat Digital Mission (ABDM), India's latest health initiative that focuses on the interoperability of health records, services, and health claims. He stressed that ABDM was built on previous digital infrastructure, like Aadhaar, the national digital identity system, and Digilocker, a digital storage scheme for citizens' health and other records.

In ABDM, we do just three things: interoperability of health records, interoperability of services, and interoperability of health claims.
Kiran Gopal Vaska
Director of the National Health Authority of India

The approach India has taken is for the government to build the rails—the infrastructure of the system—and create a space where the private sector can develop applications integrated with that space through application programming interfaces (APIs), avoiding the siloing that can hamper the interoperability of data.

Regarding health data, privacy is a crucial concern at the patient level. ABDM addresses this concern through the use of a consent artifact. Individuals decide whether hospitals or other medical service providers have access to their data, and this access has levels of granularity: you can share specific portions of 7 different data types, like immunizations or prescriptions. You can limit that sharing to a particular period, like one day.

Also participating on the panel was CK Cheruvettolil, who discussed strategies by the Bill & Melinda Gates Foundation in leveraging the power of mobile phones to augment the work of Accredited Social Health Activists (ASHAs), the more than one million female frontline health workers in India. ASHAs can use mobile phone cameras, sensors, and streaming data to better care for low-birth-weight babies and other patients. 

If [software] is developed in isolation without understanding that social context, you would lose a huge portion of the population, you'd lose that effectiveness.
CK Cheruvettolil
Senior Strategy Officer, Digital Health and Artificial Intelligence, Bill & Melinda Gates Foundation

He explained the critical role of taking local context into account when developing software by using the example of pregnant Indian women in their third trimesters. The custom for Indian mothers, especially in rural areas, is for the child to be born in the maternal grandparents' home. If software were to store only the mother's address, healthcare workers in the grandparents' jurisdiction would not know that a pregnant woman in the critical third trimester would soon be giving birth at a local address.

Kiran Gopal Vaska noted that India had solved the technological issues, and now the task was to push for adoption. He emphasized that the technologies underlying India's digital health stack were created as public goods for the world, and for LMICs to support each other in advancing digital health technologies, the key was interoperability, "using standards that are accessible and acceptable worldwide."

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Panelists gather to discuss APEC
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Trade Experts Gather to Discuss APEC’s Role and Relevance

Ahead of the 2023 Asia-Pacific Economic Cooperation (APEC) convening in San Francisco, APARC kicked off its fall seminar series, Exploring APEC’s Role in Facilitating Regional Cooperation, with a panel discussion that examined APEC’s role and continued relevance in a rapidly-evolving Asia-Pacific region.
Trade Experts Gather to Discuss APEC’s Role and Relevance
A man holding a pill case consults on his computer with a female doctor.
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How South Koreans Feel About Telemedicine as an Alternative to In-Person Medical Consultations

A new study, co-authored by Asia Health Policy Director Karen Eggleston, investigated preferences for telemedicine services for chronic disease care in South Korea during the COVID-19 pandemic and found that preferences differed according to patient demographics.
How South Koreans Feel About Telemedicine as an Alternative to In-Person Medical Consultations
The Future of Health Policy: Reflections and Contributions from the Field
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Health Policy Scholars and Practitioners Examine the Future of the Field

In the third installment of a series recognizing the 40th anniversary of Stanford’s Walter H. Shorenstein Asia-Pacific Research Center, the Asia Health Policy Program gathered alumni to reflect on their time at APARC and offer their assessments of some of the largest challenges facing healthcare practitioners.
Health Policy Scholars and Practitioners Examine the Future of the Field
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Shorenstein APARC continued its APEC seminar series with the second installment, Asia-Pacific Digital Health Innovation: Technology, Trust, and the Role of APEC, a panel discussion that focused on how India’s digital health strategy has evolved and its lessons for other countries creating their own.

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Objective
To test the feasibility and effectiveness of a mindfulness-based intervention in rural-to-urban migrant Chinese children using trained community volunteers.

Method
Migrant students ages 9 to 16 from 5 schools in Shanghai (N = 653) were randomly assigned to a mindfulness only group (n = 167), a mindfulness plus life skills group (n = 118), or a waitlist control group (n = 368). The first 2 groups received an 8-week mindfulness intervention delivered 1 hour weekly by trained community volunteers. The mindfulness plus life skills group received 8 additional hours of skills-based mentorship. Measurements on mindfulness, resilience, and anxiety and depression symptoms were collected before and after intervention. Multivariable regression analyses compared the intervention vs control groups.

Results
Before intervention, there were no significant demographic or outcome measure differences between groups except that students in the intervention groups were slightly older. Students had relatively low levels of mindfulness and prosociality difficulties and similar degrees of depression and anxiety symptoms compared with prior studies. After intervention, no statistically significant differences were found in mean scores for mindfulness, resilience, anxiety, or depression in the intervention vs control groups.

Conclusion
A volunteer-led mindfulness intervention did not significantly benefit migrant Chinese children after 8 weeks. More implementation research is needed for low-cost, scalable, and contextually effective mental health prevention programs.

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JAACAP Open
Authors
Lian Tong
Huan Wang
Luwan Lan
Min Wang
Cody Abbey
Scott Rozelle
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George Krompacky
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This story was updated on September 18, 2023, to reflect the passing of Victor Fuchs.


It is hardly news that America’s health care system is complicated, expensive, and, in many ways, dysfunctional and that the nation’s health care outcomes are falling behind those of other, even sometimes poorer, countries. The problems of rising costs and disparities in access and outcomes were already well established in 1974, when Victor Fuchs, the late Henry J. Kaiser, Jr., Professor of Economics and of Health Research and Policy at Stanford, first published his seminal book Who Shall Live? Health, Economics and Social Choice. In what turned out to be the first edition of the book, Fuchs applied fundamental concepts from economic theory to health and medical care in an innovative manner that hadn't been attempted previously, presenting an economic framework for addressing health and medical care challenges and emphasizing the importance of choice at both individual and societal levels. The publication became a classic introduction to health economics and is recognized for pioneering the field.

Now a third edition of Who Shall Live? has been released by World Scientific Publishing, co-authored by Karen Eggleston, director of Shorenstein APARC’s Asia Health Policy Program. This edition adds supplemental research and an all-new section that focuses on the decade 2012–21, specifically looking at the Affordable Care Act, the COVID-19 pandemic, the intersection of health and politics, and the state of expenditures and outcomes during that period.

Eggleston was honored to be able to work with Fuchs, who had also been a senior fellow emeritus at the Freeman Spogli Institute for International Studies and the Stanford Institute for Economic Policy Research, but noted that “it was a little depressing to hear him conclude that the pandemic would not be the 'wake-up call’ for systemic reforms that he has spent a lifetime showing the United States needs.” Fuchs passed away peacefully in his longtime home on Stanford’s campus on September 16, 2023. He was 99.

Between 2012 and 2019 (pre-pandemic), life expectancy at birth did not increase at all in the United States, while it increased 0.18 years per annum in Japan, and 0.16 years per annum across 10 other high-spending OECD countries.
Karen Eggleston

Part of the story of U.S. health care is its poor showing compared to other, often less-affluent nations. Japan is one of the comparison countries in the updated section on the last decade; in one example, Eggleston describes, “between 2012 and 2019 (pre-pandemic), life expectancy at birth did not increase at all in the United States, while it increased 0.18 years per annum in Japan, and 0.16 years per annum across 10 other high-spending OECD countries.” This is despite the fact that “in 2019, Japan spent only 63% of what the United States spends on healthcare (as a share of GDP)… Why can’t we do better for Americans?” 

This question is precisely the one that Who Shall Live? aims to answer—that the state of any health care system is a result of “the necessity of choice at both the individual and social levels.” To shrink the costs of health care in the United States and improve outcomes, different choices have to be made—by patients (in their personal lifestyles and behavior), by physicians, by hospitals, and by the U.S. government.

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A figure dressed as a medical personnel holding a stethoscope and a blurry image of the South Korean flag in the background.
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How South Korea Can Become a Global Pioneer in Productivity of Health Spending

Research by Stanford health economist Karen Eggleston, the director of APARC's Asia Health Policy Program, offers evidence on the link between medical spending and health outcomes in South Korea, showing how the country can benefit from developing a “satellite account for health” to promote high-value innovations for longer, healthier lives.
How South Korea Can Become a Global Pioneer in Productivity of Health Spending
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Asia Health Policy Program Director Karen Eggleston has coauthored the new third edition of Victor Fuch's 'Who Shall Live: Health, Economics, and Social Choice,' an authoritative book considering the great health challenges of our time.

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SCCEI Seminar Series (Fall 2023)



Friday, November 17, 2023 | 12:00 pm -1:20 pm Pacific Time
Goldman Room E409, Encina Hall, 616 Jane Stanford Way


How Digital Surveillance Justifies Massive Lockdowns in China During COVID-19
 

China’s draconian response to COVID-19 drew considerable criticism, with many suggesting that intense digital surveillance and harsh lockdowns triggered the unusual public dissent seen in China in late 2022. However, we argue that rather than backfiring, digital surveillance may have legitimized the government’s overreaction by making uncertain threats appear certain. We collected data on daily counts of lockdown communities and COVID cases from 2020 to 2023. Using a difference-in-differences approach with World Value Surveys (China 2012, 2018) and a nationwide online survey in 2023, we show that real-world lockdowns significantly reduced public perception of respect for human rights and trust in the government; however, these effects are moderated by the pervasiveness of COVID surveillance, proxied by cellphone usage. To establish causality, we use a survey experiment to show that digital surveillance indeed increases support for COVID lockdowns by making citizens more likely to believe they are close contacts. In contrast, surveillance cannot justify protest crackdowns. Our findings suggest that uncertainty in threats to public safety may foster support for state surveillance and coercion.

Please register for the event to receive email updates and add it to your calendar. Lunch will be provided.


About the Speaker 
 

Xu Xu headshot

Xu Xu is Assistant Professor of Politics and International Affairs at Princeton University. Xu studies digital authoritarianism, political repression, and the political economy of development, with a regional focus on China. He is currently working on a book entitled Authoritarian Control in the Age of Digital Surveillance. His other ongoing projects examine the political aspects of artificial intelligence, social media propaganda, public opinion on state repression, and state-society relations in China. His work has appeared in the American Journal of Political Science, the Journal of Politics, and the Journal of Law, Economics, and Organization, among other peer-reviewed journals.

He received his Ph.D. in political science from Pennsylvania State University in 2019, and was a postdoctoral fellow at Stanford University from 2020 to 2021.
 


A NOTE ON LOCATION

Please join us in-person in the Goldman Conference Room located within Encina Hall on the 4th floor of the East wing.



Questions? Contact Xinmin Zhao at xinminzhao@stanford.edu
 


Goldman Room E409, Encina Hall

Xu Xu, Assistant Professor of Politics and International Affairs, Princeton University
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Please join us in congratulating Didi Kuo, Center Fellow at the Freeman Spogli Institute for International Studies (FS), and co-author Andrew S. Kelly, Assistant Professor in the Department of Health Sciences at California State University, East Bay, on being awarded the 2023 Leonard S. Robins Award for the Best Paper on Health Politics and Policy by the American Political Science Association (APSA)!

The Robins Award is named in honor of Leonard S. Robins, who, through his presence and gentle questioning at virtually every health politics panel, graciously nurtured the scholarship of both junior and senior scholars. The award recognizes the best paper on any subject that fits under the rubric of Health Politics and Policy presented at the previous annual APSA meeting.

Kuo and Kelly's award-winning paper, "State Capacity and Public Health: California and COVID-19," investigates the comparative COVID-19 policy response across counties and regions within California. In the description of the 2022 APSA panel "The Politics of Pandemic Response and the Opportunities for Health Policy Reform," during which they presented their paper, it notes that "In moving beyond a consideration of formal state and public health capacity, Kuo and Kelly argue that the more robust policy response of the Bay Area was, in part, a product of partnerships between state and community-based actors. Drawing on the concept of 'embedded autonomy,' Kuo and Kelly reconceptualize public health capacity and consider it within broader issues of state capacity and democracy."

An abstract of the paper can be found below:
 

On March 17, 2020, six counties in the Bay Area jointly issued the nation’s first shelter-in-place orders in response to the COVID-19 crisis. Cities and states across the United States quickly followed suit, with varying degrees of success. Public health officials have been critical in setting policies, enforcing behavioral and non-pharmaceutical interventions, and communicating with the public. This paper explores the determinants of public health capacity, distinguishing between formal institutional capacity (ie budget, staff) and informal embedded capacity (ie community ties, insulation from political pressures). It argues that informal embedded capacity is critical to public health capacity, but difficult to measure empirically. It concludes by relating public health capacity to broader issues of state capacity and democracy.

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Didi Kuo, FSI Center Fellow
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Didi Kuo, Expert on Comparative and American Politics, Announced as FSI’s Newest Center Fellow

As a Center Fellow, Kuo will continue to advance her research agenda at the Center on Democracy, Development and the Rule of Law, exploring both the challenges facing American democracy today and their roots.
Didi Kuo, Expert on Comparative and American Politics, Announced as FSI’s Newest Center Fellow
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The award recognizes Kuo and Kelly's paper, “State Capacity and Public Health: California and COVID-19,” as the best paper on health politics and policy presented at the 2022 American Political Science Association (APSA) conference.

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Background
Mothers’ perception of infant hunger cues is a critical content of responsive feeding, which is central to the promotion of early childhood development. However, only a few studies have examined responsive feeding in China, especially lacking the studies on perceptions of infant hunger cues. Consider the cultural differences, the aim of this study was to describe the perceptions of infant hunger cues of Chinese mothers for infants aged 3 months, and explore the relationship between maternal perceptions of infant hunger cues and different feeding methods.

Methods
A cross-sectional study was conducted with a sample of 326 mothers of healthy 3-month-old infants, including 188 exclusive breastfeeding (EBF) mothers and 138 formula feeding (FF) mothers. It was implemented in four provincial and municipal maternal and child health hospitals. The mothers’ perceptions of infant hunger cues were surveyed by self-reporting questionnaires. Chi-square tests and logistic analysis were applied to analyze the differences in maternal perceptions of infant hunger cues, including the number of hunger cues and the specific cues, between EBF group and FF group by controlling sociodemographic variables and the daily nursing indicators.

Results
We found that a higher proportion of EBF mothers could perceive multiple hunger cues (≥ 2) than FF mothers (66.5% vs.55.1%). For specific cues, the EBF mothers had higher perceptions of infant’s “hand sucking” (67.6% vs. 53.6%) and “moving head frantically from side to side” (34.6% vs. 23.9%), all p < 0.05. Regression analysis revealed that EBF might support mothers to perceive infant hunger cues than FF mothers, with the number of infant hunger cues (OR = 1.70, 95% CI: 1.01–2.85), “hand sucking” (OR = 1.72, 95% CI: 1.04–2.87), “moving head frantically from side to side” (OR = 2.07, 95% CI: 1.19–3.62). The number of infant hunger cues perceived by mothers was also associated with their educational level and family structure.

Conclusion
EBF mothers of 3-month-old infants may be more likely to perceive infant hunger cues than FF mothers in China. It is necessary to increase the health education about infant hunger and satiety cues to caregivers in China, especially among mothers with lower education levels, mothers living in nuclear families, and FF mothers.

Journal Publisher
BMC Public Health
Authors
Fenghua Zhao
Yijie Sun
Yue Zhang
Tao Xu
Nianrong Wong
Shaungqin Yan
Ting Zeng
Fenghua Zhang
Jie Gao
Qing Yue
Scott Rozelle
Scott Rozelle
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SCCEI Fall Seminar Series 


Tuesday, November 29, 2022      11:00 am -12:15 pm Pacific Time

Goldman Room E401, Encina Hall, 616 Jane Stanford Way | Zoom Meeting 


Cost-Sharing in Medical Care Can Increase Adult Mortality in Lower-Income Countries


About the Speaker

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Grant Miller

As a health and development economist based at the Stanford School of Medicine, Dr. Grant Miller's overarching focus is research and teaching aimed at developing more effective health improvement strategies for developing countries.

His agenda addresses three major interrelated themes: First, what are the major causes of population health improvement around the world and over time? His projects addressing this question are retrospective observational studies that focus both on historical health improvement and the determinants of population health in developing countries today. Second, what are the behavioral underpinnings of the major determinants of population health improvement? Policy relevance and generalizability require knowing not only which factors have contributed most to population health gains, but also why. Third, how can programs and policies use these behavioral insights to improve population health more effectively? The ultimate test of policy relevance is the ability to help formulate new strategies using these insights that are effective.


Seminar Series Moderators

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Headshot of Dr. Scott Rozelle

Scott Rozelle is the Helen F. Farnsworth Senior Fellow and the co-director of Stanford Center on China's Economy and Institutions in the Freeman Spogli Institute for International Studies and Stanford Institute for Economic Policy Research at Stanford University.  For the past 30 years, he has worked on the economics of poverty reduction. Currently, his work on poverty has its full focus on human capital, including issues of rural health, nutrition and education. For the past 20 year, Rozelle has been the chair of the International Advisory Board of the Center for Chinese Agricultural Policy, Chinese Academy of Sciences (CAS). Most recently, Rozelle's research focuses on the economics of poverty and inequality, with an emphasis on rural education, health and nutrition in China. In recognition of this work, Dr. Rozelle has received numerous honors and awards. Among them, he became a Yangtse Scholar (Changjiang Xuezhe) in Renmin University of China in 2008. In 2008 he also was awarded the Friendship Award by Premiere Wen Jiabao, the highest honor that can be bestowed on a foreigner. 

 

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hongbin li headshot

Hongbin Li is the Co-director of Stanford Center on China's Economy and Institutions, and a Senior Fellow of Stanford Institute for Economic Policy Research (SIEPR) and the Freeman Spogli Institute for International Studies (FSI). Hongbin obtained his Ph.D. in economics from Stanford University in 2001 and joined the economics department of the Chinese University of Hong Kong (CUHK), where he became full professor in 2007. He was also one of the two founding directors of the Institute of Economics and Finance at the CUHK. He taught at Tsinghua University in Beijing 2007-2016 and was C.V. Starr Chair Professor of Economics in the School of Economics and Management. He founded the Chinese College Student Survey (CCSS) in 2009 and the China Employer-Employee Survey (CEES) in 2014.

Hongbin’s research has been focused on the transition and development of the Chinese economy, and the evidence-based research results have been both widely covered by media outlets and well read by policy makers around the world. He is currently the co-editor of the Journal of Comparative Economics.


A NOTE ON LOCATION

This seminar is a hybrid event. Please join us in person in the Goldman Conference Room located within Encina Hall on the 4th floor of the East wing, or join remotely via Zoom.

Questions? Contact Heather Rahimi at hrahimi@stanford.edu


 

Scott Rozelle
Hongbin Li

Hybrid Event: Goldman Room E409, Encina Hall | Zoom Meeting

Encina Commons Room 101,
615 Crothers Way,
Stanford, CA 94305-6006

(650) 723-2714 (650) 723-1919
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Henry J. Kaiser, Jr. Professor
Professor, Health Policy
Senior Fellow at the Freeman Spogli Institute for International Studies
Senior Fellow at the Stanford Institute for Economic Policy Research
Professor, Economics (by courtesy)
grant_miller_vert.jpeg
PhD, MPP

As a health and development economist based at the Stanford School of Medicine, Dr. Miller's overarching focus is research and teaching aimed at developing more effective health improvement strategies for developing countries.

His agenda addresses three major interrelated themes: First, what are the major causes of population health improvement around the world and over time? His projects addressing this question are retrospective observational studies that focus both on historical health improvement and the determinants of population health in developing countries today. Second, what are the behavioral underpinnings of the major determinants of population health improvement? Policy relevance and generalizability require knowing not only which factors have contributed most to population health gains, but also why. Third, how can programs and policies use these behavioral insights to improve population health more effectively? The ultimate test of policy relevance is the ability to help formulate new strategies using these insights that are effective.

Faculty Fellow, Stanford Center on Global Poverty and Development
Faculty Affiliate, Stanford Center for Latin American Studies
Faculty Affiliate, Woods Institute for the Environment
Faculty Affiliate, Interdisciplinary Program in Environment & Resources
Faculty Affiliate, Stanford Center on China's Economy and Institutions
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Asia Health Policy Postdoctoral Fellow, 2022-23
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Ph.D.

Jianan Yang joined the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) as the 2022-2023 Developing Asia Health Policy Postdoctoral Fellow. She recently obtained her Ph.D. in Economics at the University of California San Diego. She holds B.A. in Economics and Mathematics from the Renmin University of China. Her research lies in the intersection of development and health economics and revolves around what drives the sub-optimal healthcare-seeking behaviors in developing countries and how they can be improved by leveraging price or non-price mechanisms.

Yang views health as a fundamental part of human development. People in developing countries usually face additional barriers to accessing healthcare resources because of underqualified providers on the one side, lower income levels, insufficient insurance coverages, and a lack of information on the other side. Because markets in healthcare settings are usually characterized by imperfect competition and government regulations, Yang thinks it is important to evaluate the policies’ impacts on various aspects of the healthcare system. Through understanding the underlying constraints, we can think about how the policy can be designed more efficiently.

Yang’s dissertation studied how patients’ chronic condition drug utilization responds to price reductions in China. By documenting a larger increase in utilization and a meaningful reduction in underuse among the uninsured, the study suggests that the price elasticities would be higher in developing countries and there will be larger welfare benefits from such price reductions resulting from squeezing out the price markups of the pharmaceutical companies due to market power. The finding suggests that cost is a barrier to both drug take-up and adherence, especially among the lower-income population who meanwhile are more likely to not have insurance coverage.

At APARC, Yang further accessed the underlying factors affecting people’s healthcare-seeking behaviors including the role of cost, information, and behavioral bias. She also extended her research agenda to the other sectors of the healthcare system. 

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Although eyeglasses have been considered a cost-effective way to combat myopia, the empirical evidence of its impacts on improving learning outcomes is inconsistent. This paper provides empirical evidence examining the effect of providing eyeglasses on academic performance between provinces with a different economic level in western China. Overall, we find a significant impact in Intention-to-Treat analysis and a large and significant local average treatment effect of providing free eyeglasses to students in the poor province but not in the other. The difference in impact between the two provinces is not a matter of experimental design, implementation, or partial compliance. Instead, we find that the lack of impact in the wealthier provinces is mainly due to less blackboard usage in class and wealthier households. Our study found that providing free eyeglasses to disadvantaged groups boosted their academic performance more than to their counterparts.

Authors
Kang Du
Huan Wang
Huan Wang
Yue Ma
Yue Ma
Hongyu Guan
Scott Rozelle
Scott Rozelle
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