Pascal Geldsetzer, PhD
Assistant Professor of Medicine in the Division of Primary Care and Population Health
Title: Regression Discontinuity in Electronic Health Record Data
Abstract: Regression discontinuity in electronic health record (EHR) data combines the main advantage of randomized controlled trials (causal inference without needing to adjust for confounders) with the large size, low cost, and representativeness of observational studies in routinely collected medical data. Regression discontinuity could be an important tool to help clinical medicine move away from a “one size fits all” approach because, along with the increasing size and availability of EHR data, it would allow for a rigorous examination of how treatment effects vary across highly granular patient subgroups. In addition, given the broad range of health outcomes recorded in EHR data, this design could be used to systematically test for a wide range of unexpected beneficial and adverse health effects of different treatments. I will talk about the broad motivation for this research and discuss examples from some of our ongoing work in this area. If there is time, I will also discuss some of my ongoing research on improving healthcare services for chronic conditions in low- and middle-income country settings.
Zoom Meeting
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Alyce S. Adams, PhD
Professor of Medicine, Stanford's Center for Health Policy & Center for Primary Care and Outcomes Research
Professor of Epidemiology and Population Health in the Stanford School of Medicine
Associate Director for Health Equity and Community Engagement in the Stanford Cancer Institute
Title: Health Policy and the Fight for Equitable Healthcare Outcomes: Why Access Isn’t Enough
Abstract: Using evidence from evaluations of natural experiments, Alyce Adams will discuss the intended and unintended consequences of changes in prescription drug policy at the state and federal level of low income and minority individuals with multiple chronic conditions. We will explore the potential for policy effects to have an immediate and dramatic increase in access to clinically essential treatments. However, she will also discuss where such policies can widen, rather than reduce disparities in treatment. We concluded that increasing access (while critical) is not sufficient to address inequities in treatment use and outcomes among high risk populations. Importantly, new strategies are needed to inform the design of policy interventions that promote access, while simultaneously advancing health equity.
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Alyce Adams is a Professor of Epidemiology and Population Health in the Stanford School of Medicine, as well as Associate Director for Health Equity and Community Engagement in the Stanford Cancer Institute. Focusing on racial and socioeconomic disparities in chronic disease treatment outcomes, Dr. Adams' interdisciplinary research seeks to evaluate the impact of changes in drug coverage policy on access to essential medications, understand the drivers of disparities in treatment adherence among insured populations, and test strategies for maximizing the benefits of treatment outcomes while minimizing harms through informed decision-making. Prior to joining Stanford School of Medicine, Dr. Adams was Associate Director for Health Care Delivery and Policy and a Research Scientist at the Kaiser Permanente Division of Research, as well as a Professor at the Bernard J. Tyson Kaiser Permanente School of Medicine. From 2000 to 2008, she was an Assistant Professor in the Department of Population Medicine (formerly Ambulatory Care and Prevention) at Harvard Medical School and Harvard Pilgrim Health care. She received her PhD in Health Policy and an MPP in Social Policy from Harvard University. She is Vice Chair of the Board of Directors for AcademyHealth and a former recipient of the John M. Eisenberg Excellence in Mentoring Award from Agency for Healthcare Research and Quality and an invited lecturer on racial disparities in health care in the 2014/2015 National Institute of Mental Health Director’s Innovation Speaker Series.
"At a time when every other major economy is shrinking, China announced in late January that its GDP grew 2.3 percent in 2020. Beneath that impressive achievement, however, lies a very unbalanced recovery: As in the past, Beijing relied heavily on state investment and a state-led push for higher industrial production, while private investment and consumer spending remained weak. Easy credit to fuel growth has likely formed even more so-called zombie companies with little prospect of future profitability and filled the books of Chinese banks with even more bad loans.
That much is familiar to many who have taken a closer look at China’s skewed model for economic growth. What’s much less well known is the disproportionate burden of the COVID-19-induced downturn that has fallen on rural Chinese, including the 290 million migrant workers with rural hukou (household registrations) who work in cities throughout China. Lockdowns forced by the pandemic paralyzed economic sectors where many migrants work, such as services and retail. According to one estimate, Chinese migrant workers lost about $100 billion in wages that they are unlikely ever to recover.
Among migrant workers and the underdeveloped rural communities that depend on the wages they send home, a quiet crisis is taking place—with potentially dramatic consequences for China’s future growth. Despite what the GDP number suggests about the country’s successful handling of the pandemic, China’s longer-term economic risks have only grown—and are a direct result of the crisis in rural China. As Stanford University researchers Scott Rozelle and Natalie Hell document in their meticulously researched book, Invisible China: How the Urban-Rural Divide Threatens China’s Rise, hundreds of millions of rural Chinese face a dangerous lack of human capital and suffer from pervasive health problems, including widespread iron-deficiency anemia, uncorrected myopia, and parasitic intestinal worms. Exacerbated by the pandemic, China’s rural crisis remains largely invisible to outside observers, and even to many Chinese."
Chorzempa & Huang write on China's rural human capital crisis stating that "no country with China's vast education and public health problems has ever broken out of the ranks of middle-income countries." The article references FSI Senior Fellow and SCCEI Director Scott Rozelle's book "Invisible China: How the Urban-Rural Divide Threatens China’s Rise" throughout.
Background: China issued strict nationwide guidelines to combat the COVID-19 outbreak in January 2020 and gradually loosened the restrictions on movement in early March. Little is known about how these disease control measures affected the 600 million people who live in rural China. The goal of this paper is to document the quarantine measures implemented in rural China outside the epicenter of Hubei Province and to assess the socioeconomic effect of the measures on rural communities over time.
Methods: We conducted three rounds of interviews with informants from 726 villages in seven provinces, accounting for over 25% of China’s overall rural population. The survey collected data on rural quarantine implementation; COVID-19 infections and deaths in the survey villages; and effects of the quarantine on employment, income, education, health care, and government policies to address any negative impacts. The empirical findings of the work established that strict quarantine measures were implemented in rural villages throughout China in February.
Results: There was little spread of COVID-19 in rural communities: an infection rate of 0.001% and zero deaths reported in our sample. However, there were negative social and economic outcomes, including high rates of unemployment, falling household income, rising prices, and disrupted student learning. Health care was generally accessible, but many delayed their non-COVID-19 health care due to the quarantine measures. Only 20% of villagers received any form of local government aid, and only 11% of villages received financial subsidies. There were no reports of national government aid programs that targeted rural villagers in the sample areas.
Conclusions: By examining the economic and social effects of the COVID-19 restrictions in rural communities, this study will help to guide other middle- and low-income countries in their containment and restorative processes. Without consideration for economically vulnerable populations, economic hardships and poverty will likely continue to have a negative impact on the most susceptible communities.
John A. and Cynthia Fry Gunn Building, 366 Galvez Street
Stanford, CA 94305-6015
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 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 also founded and served as the Executive Associate Director of the China Social and Economic Data Center at Tsinghua University. 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.