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Dr. Brian Chen's research has examined the tradeoffs between moral hazard and efficiencies in the integration of physician and non-physician medical services in the presence of asymmetric information. He has looked at a policy intervention in Taiwan that prohibited self-referrals of patients to physician-owned pharmacies unless the physician group integrated pharmacy services into the clinic by hiring an onsite pharmacist. He found that the policy reduced drug expenditures by close to thirty percent among physicians that did not have an onsite pharmacist. However, these physicians responded by increasing the overprovision of diagnostic services not covered by the policy, thereby reducing the effectiveness of the policy. Forty-five percent of the clinics that did not have an onsite pharmacist prior to the policy hired one subsequent to the implementation of the policy. Overall, after integration, the policy applied to only seventeen percent of clinics, and only reduced average discretionary expenditures by about two-point-five percent. Chen's research also shows that despite the reduction in drug utilization, patients treated at clinics without an onsite pharmacist did not have greater observable adverse health events than patients treated at integrated clinics. His results show that moral hazard costs of self-referral incentives are large, that the “safe harbor” exemption severely reduces the effectiveness of the policy, and that the exemption explains much of the recent integration of ancillary services into physician offices.

Dr. Brian Chen recently completed his Ph.D. in business administration in the Business and Public Policy Group at the Haas School of Business, University of California at Berkeley. He received a Juris Doctor from Stanford Law School in 1997, and graduated summa cum laude from Harvard College in 1992.

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Brian Chen 2011 AHPP/CEAS Visiting Scholar Speaker Stanford University
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Professor Li Liang Dong of the Central Party School's Politics and Law Department advises directly senior officials in the Chinese Communist Party.  Professor Li received his doctorate from the Central Party School in Law.  His main research areas are:  democratic perspective, Western political thought, and political theory. 

Some of his key works include: "Contemporary Chinese Studies of Public Opinion" (Central Party School Press, 1996), "Mao Zedong and Chinese farmers" (China Farmers Press, 1993), "Contemporary Chinese Democracy Studies" (Contemporary World Press, 2001 edition) and "Third Wave and the Chinese Democracy" (Central Party School Press, 2001 edition).  He has published over 300 articiles.  Professor Li has hosted discussions on topics including "Public Discussion in China",  "Societal Transitions", and "Study of Political Stability".

Co-sponsored by The Center for Deliberative Democracy at Stanford University

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Li Liang Dong Professor, Department of Politics and Law Speaker Central Party School, Beijing, China
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After the peaceful mass uprising that toppled one of the world's oldest autocracies, it is now possible to imagine the emergence of a genuine democracy in Egypt-the most important country in the Arab world. The very possibility of it marks an historic turning point for the entire region. However, there is a long and often treacherous distance between the demise of an authoritarian regime and the rise of a democracy.

With no experience of democracy in recent decades, and no apparent government leadership that is committed to bringing it about, Egypt's transition faces more formidable challenges than the transitions that led to democracy in recent decades in countries like Spain, Greece, Argentina, Brazil, Chile, the Philippines, Poland, South Africa, Indonesia, and Ukraine. (Which isn't to say these were easy: We forget how difficult each of these transitions seemed at the time, and how fraught they were with dangers and uncertainties.) With an energized civil society and deep resources of youthful talent, creativity, and mobilizing skill, Egypt has a real chance to get to democracy in the next few years. But doing so will require a keen analysis of the numerous potential traps that could sandbag the process.

The first trap is the Machiavellian opaqueness of the aging generals who are now running the country. Beginning with the Defense Minister (and now junta leader) Mohamed Tantawi, until a few days ago a close ally of the deposed President Mubarak, Egypt's new military rulers cannot be trusted to structure the political process and emergent rules in a way that will favor genuine democracy. Their principal goal, it appears, is to preserve as much of the old order as possible-Mubarakism without Mubarak (the father or the son). This means another round of the old shell game of Arab regimes-what Daniel Brumberg has called "liberalized autocracy." The process of liberalization-which runs in cycles, and which countries like Morocco and Jordan have seen many iterations of-institutes just enough change in the rules and faces to give the appearance of movement toward democracy without any of the dangers (for the ruling elite). But the changes, imposed from above, stop well short of the sweeping institutional transformations that would open wide the political arena (and the functioning of government) while leveling the playing field.

In their initial "communiqués," Egypt's ruling generals show signs of treading down this duplicitous path. Their initial choices have evinced the seductive veneer of democratic change but the closure and control of authoritarian continuity. To begin with, there appears so far to be little consultation with democratic forces in determining the character and pace of transition. Despite opposition demands, emergency rule remains in place, and so do many political prisoners. The military's initial decisions have been unilateral and preemptory. We learn there will be a constitution drafted within two months, followed by a referendum. A respected retired judge will head the process. This will produce "amendments" to the now-suspended authoritarian constitution. But what will be the role for Egyptian opposition and civil society in this process? What will be the scope down the road to draft a completely new, more democratic and legitimate constitution with broad popular participation and support? Will the president to be elected later this year serve another imperial six-year term, or be a caretaker heading a neutral government until a new constitution can be adopted and fresh elections held? At this point, if anyone knows the answers to these questions, it is only the junta.

The military is talking about early presidential and legislative elections, within six months. What could be more democratic than that? But, in fact, after the fall of a longstanding autocracy, it typically takes a lot longer than six months to organize competitive, free, and fair elections. Think of the steps. A neutral and independent electoral administration must be established. This requires not just legal authorization but also new leadership, and recruitment, training, funding, and deployment of new staff and equipment. If Egypt's generals intend to have elections administered by the same Ministry of Interior that shamelessly rigged the vote for Mubarak and his ruling National Democratic Party (NDP), that will be a sure sign that they do not intend to deliver democracy-or are too incompetent and cavalier to care. Then, the next step must be to produce a new register of voters. Experts believe only a quarter of eligible Egyptians are registered to vote today. The exclusion was very useful to perpetuating autocracy but could be deadly for an emerging democracy. That will take months, money, and far-reaching organization to do even reasonably well.

It will be one thing to elect a new president and quite another to choose a new parliament in Egypt's transitional flux. The military now suggests the two elections can be held together within six months. But they will have very different logics and requirements. A presidential election will be much simpler. The old order will no doubt throw up a somewhat more palatable face, perhaps the former Foreign Minister Amr Moussa. The democratic opposition may well rally behind a single candidate (though the regime, no longer able to exclude a democratic alternative, will probably try to fragment the field with as many opposition candidates as possible). Still, voters will be faced with a few principal choices for national leadership, and it won't matter where people vote, so long as they are of voting age and only vote once. This kind of election can be done more roughly and quickly, tossing aside the voter register and just dipping every forefinger in indelible ink after it has marked a ballot for one presidential candidate or another. It will be important in this election-and every future one-to ensure transparency and citizen monitoring of the vote, as well as to have Egypt's judiciary oversee the balloting (as it did in previous elections until the judges got too good at it and Mubarak cut them out). But, otherwise, a presidential election won't be a complicated affair.

By contrast, new parliamentary elections present formidable challenges. First, Egyptians (and hopefully not just the military) must decide what electoral system will be used. This choice can invoke arcane debate, but it may be one of the most important that Egypt makes in pursuit of democracy. If the electoral rules are "majoritarian," in that they make it hard for small minorities to get elected, they will work to the disadvantage of not just small ideological tendencies but also the welter of new, emerging parties and political forces-many of them liberal and secular-that will just be taking shape and starting to test their strength. This will inflate the strength of the only two political forces that now have effective political organizations on the ground-the old ruling party and the Muslim Brotherhood (with a smattering of some of the other older opposition parties). If Egypt retains the current electoral system of two-member districts (with each voter getting two votes), these two established political forces could sweep most of the seats between them, marginalizing the moderates, polarizing the parliament and political system, and dooming democracy from the start. Creating a liberal center in democratic politics requires more than moral and technical support for these parties to function; it also requires rules that enable them to get traction.

A much better-and fairer-alternative would be to elect the new parliament using some form of proportional representation, so that parties would win seats roughly in proportion to their vote shares. That way, new parties could begin to gain a foothold in the political process. Perhaps ironically, the best way to do this might be the way Iraq now does, by using the existing governorates (29 in Egypt) as multimember districts, and having each district then elect a share of seats equivalent to its share of the population. This would allow for very proportional results, with districts generally containing ten to 25 seats, while still enabling some accountability and candidate familiarity at the local level.

A truly democratic parliamentary election in Egypt cannot be pulled off in six months. In fact, it might require well over a year to prepare. But the alternative would be to rush to a vote with a flawed system that would leave Egypt's new democratic forces on the margins not just of legislating but of constitution-making as well.

How a new permanent constitution will be drafted-if it is even intended by the military-also remains a mystery at this point. The worst option would be to have a closed and hurried process dominated from above by the military. But that seems to be what the junta intends for the transitional period. Successful democratic transitions either use an expert but broadly representative constitutional drafting commission, and then a popular referendum to confirm the draft, or an elected constitutional assembly (often acting simultaneously as a parliament), possibly followed also by a popular referendum (as in Iraq). Some have used all of these methods combined. Experience of recent decades underscores the importance for future democratic legitimacy and stability of eliciting extensive public dialogue and broad popular participation in the constitution-making process, with adequate preparation and civic education and widespread media exposure, as in South Africa. A thorough, inclusive, and deliberate process of constitutional drafting and debate can also help to breed a more democratic culture at both the elite and mass levels. A rushed and closed process perpetuates authoritarian mentalities (and, often, authoritarian rules as well).

Prior to all of this is the most basic question of who writes the rules, the timetable, and the mode of transition. Egypt has now entered a classic transition game where the authoritarian regime and the democratic opposition have sharply different interests and little basis for cooperation and trust. As an institution, Egypt's military may not be hated the way Mubarak and his cronies were, but many of the generals were Mubarak's cronies. And the military's core interests are not freedom and democracy for the people, but preserving their own power, wealth, privilege, and impunity. The core lesson of numerous prior transitions is the need for a negotiated way out of this potentially fatal impasse. Democrats want democracy with no guarantees to autocrats. Autocrats want guarantees, with no real democracy.

There is an obvious generic compromise, and every successful negotiated transition-from Spain and Brazil to Poland, South Africa, and Indonesia-has settled on a version of it. The old order gets to hang on to most of its wealth and privilege, along with military autonomy at least for a time. Few, if any, henchmen of the old order are prosecuted for their past crimes, unless it is for the last, desperate excesses of a few diehards trying to hang on during the transition. Real accountability waits for a later day. Democrats get democracy. Autocrats (mostly) retain their wealth and influence, but they cannot bid for power unless they play the democratic game. The Yale political scientist Robert Dahl coined a term for this type of bargain. He called it "mutual security." From the Spanish transition on, the generic bargain became known as a political pact.

Only a negotiated pact between Egypt's surviving authoritarian regime and its emergent democratic forces can steer the transition through the current treacherous straits to calmer and freer waters. For that to happen, Egypt's disparate democratic forces must unify in a broad negotiating front that unites the "outside" opposition of the youthful movements with the "inside" opposition of the "wise persons" and established parties who have so far dominated, on an ad hoc basis, the discussions with the old order.

Opposition unity will give Egypt's democrats strategic leverage; if negotiations stall due to regime intransigence, then the unified opposition can more credibly threaten to turn out people by the millions again in protest. But, if negotiations move forward to ensure the essential conditions for a democratic transition-an end to emergency rule; freedom of organization, expression, and assembly; judicial independence; and new and fair electoral administration-then a unified opposition can guarantee social peace and political stability. Opposition coherence enables clear negotiating priorities to level the playing field and ensure a democratic transition. It will also give the old order a clear set of interlocutors who can credibly commit to deliver popular support behind a difficult compromise agreement. No condition is more important for a successful transition.

The role for the United States and other international actors is not to dictate terms for the transition or structures for the new political order. That is not our place, and Egyptians of every political stripe will resent it. But international actors should offer training to political parties and technical and financial assistance to the new civil society organizations and state institutions needed to make democracy work. For the United States., this will mean millions of dollars in new assistance for democracy in Egypt-but that is a trifle compared to the $68 billion we have invested in dictatorship (even if it was to buy peace). No less importantly, other democracies (including leaders of recent democratic transitions) can encourage Egypt's opposition groups to coalesce and share lessons of the strategies and choices that have led to democratic outcomes. And the Obama administration can make it clear to Egypt's military rulers that nothing less than a real transition to democracy-with broad consultation, serious negotiations, and a new climate of freedom-will return Egypt to stability and a lasting partnership with the United States.

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Stanford University’s Center on Democracy, Development, and the Rule of Law in partnership with the Canadian Foreign Affairs and International Trade department are hosting a symposium, Addressing the Accountability Gap in Statebuilding: The Case of Afghanistan, on February 25, 2011. The distinguished Ashraf Ghani, former Afghan Minister of Finance and 2009 Presidential Candidate, will be delivering the keynote address. This event will bring together practitioners, experts, and diplomats from Afghanistan and beyond, to share experiences and explore options to improve the contemporary practice of state-building. This conference and keynote address is open to the public.
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On January 1, 2010, China and the ten-member Association of Southeast Asian Nations (ASEAN) finally, formally launched a China-ASEAN Free Trade Agreement (CAFTA) that encompasses nearly two billion people engaged in trade worth some $200 billion. For China the agreement is a way of securing supplies of raw materials, while the ASEAN countries hope the agreement will open opportunities in China's huge domestic market. When CAFTA  was first signed in November 2002, Beijing promised that Southeast Asia would reap an “early harvest” of its benefits. Yet the Southeast Asian response to CAFTA in the agreement’s first year has been less than enthusiastic, especially in the Philippines and Indonesia. Is CAFTA a bonanza? A blunder? Something in between? Prof. Mendoza will assess the agreement, its implementation, and the implications for China’s role and image in Southeast Asia going forward.

Amado M. Mendoza, Jr. is a leading policy scholar in the Philippines, where he also serves as the treasurer of Economic, Social, and Cultural Rights (ESCR) Asia, Inc., an NGO dedicated to the promotion of socio-economic and cultural rights. He is the Philippines’ lead contributor to the soon-to-be-released 2010 Global Integrity Report on governance and corruption. Other subjects of his current research include Asian regional integration; Asian summitry and economic crisis management; Philippine economic diplomacy; and China-Taiwan relations within a regional context. In addition to his academic career, he has a background in journalism, banking, and development.

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Amado M. Mendoza, Jr. Professor of Political Science and International Studies Speaker University of the Philippines, Diliman, Quezon City
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Bandwidth connectivity is extremely low in many parts of the world, often delaying or even preventing people from accessing information. Although connectivity has increased by a factor of 10 or 15 over the last decade, average webpage size and number of objects has simultaneously increased by a factor of 60. This has resulted in what Subramanian terms an "unusable web"; the addition of video, audio and images has created huge web pages that take minutes or even hours to load in low connectivity worlds.

In his talk, Subramanian describes a range of techniques that he and his colleagues are developing to enhance information access in three scenarios of poor connectivity. These techniques illustrate the type of technologies being devised by a new group in Computer Science termed "Computing for Development." The focus of this group is on the design, implementation and evaluation of new computing innovations that enable global social and economic development. Since first world technology can often be a bad fit, this group instead seeks technologies that are locally appropriate, cost-effective, and easy to use.

The first low-connectivity scenario Subramanian discusses is that facing rural mobile users, who rely on low-end mobile devices and can thus only access voice and SMS services. To address the massive need for SMS services for this scenario, Subramanian and his colleagues have developed an SMS-based protocol stack for mobile applications that makes it possible to compress large quantities of information. The so-called UjU stack enables the compression of information into a 140-byte stack, while an affiliated UjU Create App interface enables anyone to create their own apps and forms. These forms are essentially turned into structured records (tables) that can be filled out and transmitted through a short message on a mobile phone. To date, UjU has already been used for microfinance applications in Mexico, mobile health data collection in India, and other applications in Ghana. Subramanian and his colleagues are also rolling out a live SMS search engine in Kenya and a data-over-GSM voice stack to support data connectivity over cellular voice.

Shared low bandwidth networks present a second low-connectivity scenario. In this scenario, an example of which might be a school where 2 Mbps of connectivity is used by 400 students, Subramanian suggests that a completely new Web architecture is needed. He and his colleagues have deployed an early version of such a system called Rural Café User Interface. Typically, a web browser sends dozens of requests when it is loading a particular page, since each site draws content from various sources and advertisers. Rather than being able to attempt to load as many windows and pages as possible, which results in even slower access, every user in Rural Café has a queue of what their search requests are. Users can search for anything at any point, but the interface acts as a planning tool by reporting how long (in seconds or minutes) the user would have to wait to load any particular site. The queue is persistent, so it doesn't change depending on how many new windows users try to open. This system is already being deployed in a few schools and universities in Kenya and India.

The third scenario is that of schools that have computer access, but no connectivity. To address this problem, Subramanian proposes the use of "vertical search engines" or contextual information portals that deliver a vertical slice of the Web in a hard-disk and provide an offline searchable and browse-able Internet. The portals are locally searchable and composed of many web-based services. Since the portals allow the user to search the local cache for the information they need rather than the URLs themselves, many local requests can be handled without browsing, supposing the local cache is strong and based on local interests and content. This is a good tool for either improving download times for people who have limited connectivity, or for enabling access for information for people without any connectivity at all. So far, the system has been piloted as an information tool for students and teachers in five schools with computers but no connectivity around Nairobi, Kenya.

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The central premise underlying Bussell's discussion this week is the reality that public service provision is often flawed in the developing world. Reforming public services entails significant efforts to increase the quality of public service, and there have been two important recent trends in this space: privatization and public-private partnerships and increased use of information and communication technologies (ICTs). The one-stop services model (which has been adopted globally in various forms, from Singapore's eCitizen Centre to Germany's Buergerbuero or "Citizen's Bureau"), exemplifies current trends.

In her research, which focuses primarily on the case of India, Bussell asks the following questions: why do or don't governments reform public service delivery? And when governments decide to implement reforms, why do they or don't they employ ICTs in these reforms?

The Indian strategy to public service reform has been to create stand-alone, one-stop citizen service centers. These centers are computerized and frequently have private-sector participation. Aside from these typical characteristics, there is significant state-level variation on several points, including timing of policy adoption, quantity and type of services, degree of automation, and ownership and management models.

Bussell discusses a variety of hypotheses that offer insight into the potential factors influencing the character of Indian reforms. First, she notes that politicians faced mixed electoral incentives for and against reforms. After all, there is evidence that eServices can improve service characteristics and reduce corruption. On the other hand, reforms may also reduce politicians' opportunities to amass funds to run for re-election. After all, bureaucratic discretion and opaque processes enable the siphoning of funds and bribe taking in service delivery. Politicians use "transfer authority" over bureaucrats to access bribes. More transparent services, due the implementation of reforms, threaten this access to bribes. At the same time, reform may also offer new opportunity for rents. Private partnerships to run centers entail new contracting processes. Larger-scale bribes may be available from ownership and management negotiation.

Based on these mixed direct and indirect incentives, Bussell predicts that reform will require expected net benefits to ruling politicians. States with higher petty corruption should implement policy reforms later. Meanwhile, states with higher grand corruption might lead to more partnerships with private sector.

So what factors actually explain variation in when different Indian states adopted reform? According to Bussell's research, the level of corruption was the most statistically significant variable affecting the timing of reform adoption. However, whether or not there was a coalition government in power was also significant. This means that an increase of 1 point out of 10 in the state's corruption level led to a 63% decrease in the chance of a reform being adopted in a given year. The quantity of services covered varied widely in the sample of states from less than 10 to more than 40 services. On average, moving from a state with below average corruption to a state with above average corruption causes a drop of 14 in the number of services covered.

In addition to examining the variation in reform adoption across Indian states, Bussell also looks at the consequences of reform. Despite reforms in the state of Karnataka, to give one example, demand for services continues to outstrip supply. Visitors to Nemmadi (privately-run computerized centers) were able to access services faster, while paying less money, making less visits, spending less time waiting at each visit, and seeing a reduction (on average) in the number of days before receiving the service. Despite quantitative improvements in average efficiency, however, perceived efficiency actually declined. Now, there is a 7-day minimum for service delivery and a 21-day maximum. Although average has declined as a consequence of these new requirements, it is now impossible to bribe officials in order to achieve service delivery in one day.

According to Bussell, these results bring up some interesting policy implications. First, it is important to consider the institutional incentives underlying the established model in order to ensure that reforms are effective. The incentives faced by both top politicians and street level officials must be taken into account. Second, it may be best to design policies that establish a strong, if narrow, initial model. After all, growing citizen demand affects electoral benefits and the calculations of politicians. Third, more research must be done regarding the various factors that influence policy outcomes. According to cases in South Africa and Brazil, there is some evidence that differences in electoral competition can affect policy outcomes. In South Africa, for instance, less electoral competition has led to less incentive to reform. More research will help to clarify the factors of importance in public service reform implementation.

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