Abstract:

One of the key objectives of introducing a compulsory health insurance is to provide citizens, regardless of socioeconomic status, with financial risk protection against unexpected catastrophic expenditures in the face of illness.  South Korea and Taiwan achieved universal health coverage (UHC) through mandatory social insurance schemes in 1989 and 1995, respectively.  Despite both countries' efforts to achieve the goal of financial risk protection for more than two decades, past research has demonstrated that household out-of-pocket (OOP) payment still accounts for more than one-third of total health expenditures in both countries.  When OOP payment represents a significant share of financial sources for health care, one should be particularly concerned about the distribution of such payments, in particular, catastrophic health expenditures, across households of differing economic levels.  This talk sets out to examine the change in the incidence and distribution of catastrophic health expenditures before and after the introduction of the National Health Insurance programs in South Korea and Taiwan.

Given similarity in the health and National Health Insurance (NHI) system characteristics observed in South Korea and Taiwan, substantial variation in the distribution of catastrophic payment among households was noted. The rich are more likely to incur catastrophic payment in South Korea, but the opposite trend is noted in Taiwan.  Further assessment on the impact of universal health coverage (UHC) on reducing catastrophic headcount (defined as the proportion of households incurring catastrophic health payment) is observed in Taiwan, but not in South Korea.  We found that when South Korea introduced the NHI program with a limited benefit package and high copayment, it produced little effect (if not none) in reducing financial burden in terms of proportion of catastrophic headcount. On the contrary, the impact of universal health coverage on catastrophic headcount ranged from -1.82% to -4.08% for Taiwan, due to the provision of a rather comprehensive benefit package with modest copayment. While UHC is a well-lauded policy goal and may be a magic word for many countries striving for the achievement, it is definitely not a panacea to resolve the incidence of catastrophic payment and potential medical impoverishment.  To provide sufficient financial protection against unexpected medical expenses, the design of the benefit coverage and risk sharing mechanism is key to the success of effectively achieving UHC. 

Bio

Jui-fen Rachel Lu, Sc.D., is the Fulbright Visiting Scholar at Center for East Asian Studies, Stanford University, and a Professor at Chang Gung University (CGU) in Taiwan, where she teaches comparative health systems, health economics, and health care financing and has served as department chair (2000-2004), Associate Dean (2009-2010) and Dean of College of Management (2010-2013).  She earned her B.S. from National Taiwan University, and her M.S. and Sc.D. from Harvard University, and she was also a Takemi Fellow at Harvard (2004-2005).  Prof. Lu is currently the President of Taiwan Society of Health Economics (TaiSHE) and an Honorary Professor at Hong Kong University (2007-2017).  Dr. Lu was also the recipient of IBM Faculty Award in 2009.   

Her research focuses on 1) the equity issues of the health care system; 2) impact of the NHI program on health care market and household consumption patterns; 3) comparative health systems in Asia-Pacific region.  She is a long-time and active member of Equitap (Equity in Asia-Pacific Health Systems) research network and was the coordinator for the catastrophic payment component of Equitap II research project which involved 21 country teams and was jointly funded by IDRC, AusAID, and ADB.  Professor Lu has also been appointed to serve as a member on various government committees dealing with health care issues in Taiwan.  

Abstract:

The United States spends over 17 percent of GDP on health care; the next six highest countries spend over 11 percent. This six percent differential indicates an excess spending of approximately one trillion dollars per year. Depending on the benefit from the extra spending, this suggests the possibility of a huge misallocation of resources. Also, because the federal government funds almost half of total health care spending, there are significant effects on the deficit and the debt. The main reasons for the excess are (1) the U.S. pays higher prices for drugs, devices, and equipment and higher fees to specialists and sub-specialists; (2) higher administrative costs; and (3) a more expensive mix of medical care. The seminar will focus on institutional and political explanations for the three proximate reasons.

Speaker Bio:

Victor R. Fuchs is the Henry J. Kaiser Jr Professor Emeritus at Stanford University, in the Departments of Economics and Health Research and Policy.  He is also a Research Associate of the National Bureau of Economic Research and a Senior Fellow at SIEPR.  He applies economic analysis to social problems of national concern, with special emphasis on health and medical care.  He is author of nine books, the editor of six others, and has published over two hundred papers and shorter pieces.  His current research focuses on male-female differences in mortality, reform of medical education, and the future of U.S. health care.

His best known work, Who Shall Live?  Health, Economics, and Social Choice (1974; expanded edition 1998, 2^nd expanded edition 2011), helps health professionals and policy makers to understand the economic and policy problems in health that have emerged in recent decades.  Other books include The Service Economy (1968), How We Live (1983), The Health Economy (1986), Women’s Quest For Economic Equality (1988), and The Future of Health Policy (1993).  He is the editor of Individual and Social Responsibility: Child Care, Education, Medical Care, and Long-term Care in America (1996).

Professor Fuchs was elected president of the American Economic Association in 1995.  He has also been elected to the American Philosophical Society, the American Academy of Arts and Sciences, the Institute of Medicine of the National Academy of Sciences, and is an Honorary Member of Alpha Omega Alpha.  He has received the John R. Commons Award, Emily Mumford Medal for Distinguished Contributions to Social Science in Medicine, Distinguished Investigator Award (Association for Health Services Research), Baxter Foundation Health Services Research Prize, and Madden Distinguished Alumni Award (New York University).  ASHE’s (American Society of Health Economists) Career Award for Lifetime Contributions to the Field of Health Economics and the RAND Corporation prize for the Best Paper published in the Forum for Health Economics and Policy are named and awarded in honor of Professor Fuchs.

This event is sponsored by the Stanford Center on Democracy, Development and the Rule of Law and the Center for Health Policy/Center for Primary Care and Outcomes Research.

The event will be a dialogue with Justice Sachs about contemporary human rights challenges in South Sfrica and the role South Africa plays in the region. It will be moderated by David Palumbo- Liu, professor of Comparative Literature at Stanford University and Tim Stanton, director of the Overses Studies Program at Stanford University will be a discussant.

Sachs will also be offering guest lectures in Professor Helen Stacy’s course, INTNLREL 144: New Global Human Rights, and ANTHRO 125S: International Criminal Courts and the Question of Global Justice with Professor Ron Jennings. Sachs is further available – and eager – to speak with interested students and faculty throughout his visit. Interested parties should contact Jessica Matthews at jess.matthews@stanford.edu. 

Albert Sachs’s career in human rights activism started when he was 17 years old, continuing through college and into his law practice in Cape Town. In defending people charged under the state’s racist statutes, he attracted the displeasure of authorities and was initially subjected to “banning laws” restricting his activities, then arrested, and finally put into solitary confinement. Upon release from prison, he went into voluntary exile but never discontinued his human rights work. In 1988 in Mozambique, Sachs lost his arm and the sight of one eye when a bomb placed under his car by South African security agents exploded, but emerged from the ordeal with renewed idealism for his cause and what he describes as simple joy at being alive.

In 1990, Sachs returned to South Africa, where he worked to draft the constitution for the newly democratic country. In 1994, he was appointed by Nelson Mandela to the Constitutional Court, where he served as judge until 2009, writing decisions that changed the face of human rights in South Africa, including a decision against the death penalty in 1995, a decision in favor of same-sex marriage in 2005, and several significant decisions about health care, access to clean water, housing and infrastructure.

He is the author of Soft Vengence of a Freedom Fighter, wich chronicles his response tothe 1988 car bombing, and five other books including The Jail Diary of Albie Sachs, which was dramatized for the Royal Shakespeare Company and broadcast by the BBC.

Justice Sachs will deliver the keynote address for Summer Session's Human Rights Intensive in CEMEX Auditorium on Wednesday, June 26 at 7:30 p.m. A courageous anti-apartheid campaigner in South Africa, Justice Sachs's talk is entitled: HEALTH AND HUMAN RIGHTS IN SOUTH AFRICA TODAY. 

Albert Sachs’s career in human rights activism started when he was 17 years old, continuing through college and into his law practice in Cape Town. In defending people charged under the state’s racist statutes, he attracted the displeasure of authorities and was initially subjected to “banning laws” restricting his activities, then arrested, and finally put into solitary confinement. Upon release from prison, he went into voluntary exile but never discontinued his human rights work. In 1988 in Mozambique, Sachs lost his arm and the sight of one eye when a bomb placed under his car by South African security agents exploded, but emerged from the ordeal with renewed idealism for his cause and what he describes as simple joy at being alive.

In 1990, Sachs returned to South Africa, where he worked to draft the constitution for the newly democratic country. In 1994, he was appointed by Nelson Mandela to the Constitutional Court, where he served as judge until 2009, writing decisions that changed the face of human rights in South Africa, including a decision against the death penalty in 1995, a decision in favor of same-sex marriage in 2005, and several significant decisions about health care, access to clean water, housing and infrastructure.

He is the author of Soft Vengence of a Freedom Fighter, wich chronicles his response tothe 1988 car bombing, and five other books including The Jail Diary of Albie Sachs, which was dramatized for the Royal Shakespeare Company and broadcast by the BBC.

This event is free and open to the public

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.

Abstract
In 1989 more than 700 South African political prisoners went on indefinite hunger strike to protest their detention. The unprecedented scale forced the South Africian government to release hundreds of incapacitated prisoners into public hospitals and enabled the active intevention of progressive medical professionals, social workers and human rights lawyers.

The presentation explores the widespread impact of these events in galvanizing the anti-apartheid struggle, energizing international human rights organizations and propelling the new international medical protocols on the ethical care of political prisoners on hunger strike.

Nayan Shah is Professor and chair of the Department of American Studies and Ethnicity at the University of Southern california. He is the author of Contagious Divides,Epidemics and Race in San Francisco's Chinatown (Universty of California Press, 2001) and Stranger Intimacy Contesting Race Sexuality and Law in the North American West (University of California Press 2011) which was awarded the Norris and Carol Hundley Prize by the American Historical Association PAcific Branch for the most distinguished book on any historical subject. Since 2011 Shah is co-editor with Beth Freeman of GLO, The Journal of Lesbian and Gay Studies.

Co-sponsored by: American Studies, Comparative Literature. Modern Thought and Literature, History,Theater Arts and Performance Studies