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Journal Article

Comparing the Quality of Primary Care between Public and Private Providers in Urban China: A Standardized Patient Study

Min Su, Zhongliang Zhou, Yafei Si, Sean Sylvia, Gang Chen, Yanfang Su, Scott Rozelle, Xiaolin Wei
International Journal of Environmental Research and Public Health , 2021
Previous studies have been limited by not directly comparing the quality of public and private CHCs using a standardized patient method (SP). This study aims to evaluate and compare the quality of the primary care provided by public and private CHCs using a standardized patient method in urban China. We recruited 12 standardized patients from the local community presenting fixed cases (unstable angina and asthma), including 492 interactions between physicians and standardized patients across 63 CHCs in Xi’an, China. We measured the quality of primary care on seven criteria: (1) adherence to checklists, (2) correct diagnosis, (3) correct treatment, (4) number of unnecessary exams and drugs, (5) diagnosis time, (6) expense of visit, (7) patient-centered communication. Significant quality differences were observed between public CHCs and private CHCs. Private CHC physicians performed 4.73 percentage points lower of recommended questions and exams in the checklist. Compared with private CHCs, public CHC providers were more likely to give a higher proportion of correct diagnosis and correct treatment. Private CHCs provided 1.42 fewer items of unnecessary exams and provided 0.32 more items of unnecessary drugs. Private CHC physicians received a 9.31 lower score in patient-centered communication. There is significant quality inequality in different primary care models. Public CHC physicians might provide a higher quality of service. Creating a comprehensive, flexible, and integrated health care system should be considered an effective approach towards optimizing the management of CHC models.
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Journal Article

Health, Economic, and Social Implications of COVID-19 for China's Rural Population

Huan Wang, Sarah-Eve Dill, Huan Zhou, Yue Ma, Hao Xue, Sean Sylvia, Kumi Smith, Matthew Boswell, Alexis Medina, Prashant Loyalka, Cody Abbey, Dimitris Friesen, Nathan Rose, Yian Guo, Scott Rozelle
The Journal of the International Association of Agricultural Economists , 2021
This study examines the effects of local and nationwide COVID‐19 disease control measures on the health and economy of China's rural population. We conducted phone surveys with 726 randomly selected village informants across seven rural Chinese provinces in February 2020. Four villages (0.55%) reported infections, and none reported deaths. Disease control measures had been universally implemented in all sample villages. About 74% of informants reported that villagers with wage‐earning jobs outside the village had stopped working due to workplace closures. A higher percentage of rural individuals could not work due to transportation, housing, and other constraints. Local governments had taken measures to reduce the impact of COVID‐19. Although schools in all surveyed villages were closed, 71% of village informants reported that students were attending classes online. Overall, measures to control COVID‐19 appear to have been successful in limiting disease transmission in rural communities outside the main epidemic area. Rural Chinese citizens, however, have experienced significant economic consequences from the disease control measures.
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White Paper

One Face, Many Names: An Investigation into Fake NGOs and Media Outlets Linked to Harouna Douamba on and off Facebook (TAKEDOWN)

Lindsay Hundley, Renee DiResta, Josh A. Goldstein, Shelby Grossman, Cooper Reed, Adriana Stephan, Julia Thompson
2021
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Journal Article

Trajectories of Child Cognitive Development During Ages 0-3 in Rural Western China: Prevalence, Risk Factors and Links to Preschool-Age Cognition

Lei Wang, Yifei Chen, Sean Sylvia, Sarah-Eve Dill, Scott Rozelle
BMC Pediatrics , 2021
Background: Cognitive development after age three tends to be stable and can therefore predict cognitive skills in later childhood. However, there is evidence that cognitive development is less stable before age three. In rural China, research has found large shares of children under age three are developmentally delayed, yet little is known about the trajectories of cognitive development between 0 and 3 years of age or how developmental trajectories predict later cognitive skills. This study seeks to describe the trajectories of child cognitive development between the ages of 0–3 years and examine how different trajectories predict cognitive development at preschool age. Methods: We collected three waves of longitudinal panel data from 1245 children in rural Western China. Child cognitive development was measured by the Bayley Scales of Infant Development when the child was 6–12 months and 22–30 months, and by the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition when the child was 49–65 months. We used the two measures of cognitive development before age three to determine the trajectories of child cognitive development. Results: Of the children, 39% were never cognitively delayed; 13% were persistently delayed; 7% experienced improving cognitive development; and 41% experienced deteriorating development before age 3. Compared to children who had never experienced cognitive delay, children with persistent cognitive delay and those with deteriorating development before age 3 had significantly lower cognitive scores at preschool age. Children with improving development before age 3 showed similar levels of cognition at preschool age as children who had never experienced cognitive delay. Conclusions: Large shares of children under age 3 in rural Western China show deteriorating cognitive development from infancy to toddlerhood, which predict lower levels of cognition at preschool age. Policymakers should invest in improving cognitive development before age 3 to prevent long-term poor cognition among China’s rural children.
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Book

Patterns of Impunity

Robert R. King
2021
Human Rights in North Korea and the Role of the U.S. Special Envoy
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White Paper

Reversing the Tide: Towards a New US Strategy to Support Democracy and Counter Authoritarianism

Task Force on US Strategy to Support Democracy and Counter Authoritarianism
2021
Report of the Task Force on US Strategy to Support Democracy and Counter Authoritarianism
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Journal Article

Making the Internet Safe for Democracy

Francis Fukuyama
2021
Journal of Democracy from Volume 32, Number 2, April 2021 | Johns Hopkins University Press
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Journal Article

Health, Psychosocial, and Economic Impacts of the COVID-19 Pandemic on People With Chronic Conditions in India

Kavita (Singh), Dimple Kondal, Sailesh Mohan, Suganthi Jaganathan, Mohan Deepa, Nikhil Srinivasapura Venkateshmurthy, Prashant Jarhyan, Ranjit Mohan Anjana, K. M. Venkat Narayan, Viswanathan Mohan, Nikhil Tandon, Mohammed K. Ali, Dorairaj Prabhakaran, Karen Eggleston
BMC Public Health , 2021
A Mixed Methods Study
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White Paper

Self-harm Policies and Internet Platforms

Shelby Perkins, Elena Cryst, Shelby Grossman
2021
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Book

Blood and Diamonds

Steven Press
2021
Germany’s Imperial Ambitions in Africa
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Journal Article

Publishing and Assessing the Research of Economists: Lessons from Public Health

Sean Sylvia, Scott Rozelle
China Economic Review , 2021
We highlight a growing concern in the economics profession that young scholars face incentives that are misaligned with conducting research that furthers knowledge and addresses pressing policy problems. The premium given to publication in top journals leads to an emphasis on exhaustive treatment of narrow questions. Detailed, robustly identified studies of novel questions are of undeniable value; however, the opportunity cost of producing such studies is large in terms of research quantity and policy relevance. For economists who aim to achieve what we view as the ultimate goals of academic research (enhancing understanding of the world, solving social problems, and building foundational knowledge to enable future breakthroughs), we offer some insights from publication philosophy in the field of public health. We discuss how public health has developed norms around publishing that are more successful in meeting these ultimate goals. We then offer thoughts on potential lessons for young economists in China and the economics discipline.
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Policy Brief

Tracking China's Economic Path

Hongbin Li, Scott Rozelle
2021
Stanford scholars are setting and expanding research agendas to analyze China’s economic development and its impact on the world. The newly launched Stanford Center on China’s Economy and Institutions — co-directed by SIEPR senior fellows Hongbin Li and Scott Rozelle — is supporting their work. In this SIEPR Policy Brief, Li and Rozelle outline the research underway by the new center's affiliates.
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Book

From Mandate to Blueprint

Thomas Fingar
2021
Lessons from Intelligence Reform
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Commentary

Why federal regulation is not the answer

Frank Wolak
Austin American Statesman , 2021
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Journal Article

Variations in the Home Language Environment and Early Language Development in Rural China

Yue Ma, Laura Jonsson, Tianli Feng, Tyler Weisberg, Teresa Shao, Zixin Yao, Dongming Zhang, Sarah-Eve Dill, Yian Guo, Yue Zhang, Dimitris Friesen, Scott Rozelle
International Journal of Environmental Research and Public Health , 2021
The home language environment is critical to early language development and subsequent skills. However, few studies have quantitatively measured the home language environment in low-income, developing settings. This study explores variations in the home language environment and child language skills among households in poor rural villages in northwestern China. Audio recordings were collected for 38 children aged 20–28 months and analyzed using Language Environment Analysis (LENA) software; language skills were measured using the MacArthur–Bates Mandarin Communicative Developmental Inventories expressive vocabulary scale. The results revealed large variability in both child language skills and home language environment measures (adult words, conversational turns, and child vocalizations) with 5- to 6-fold differences between the highest and lowest scores. Despite variation, however, the average number of adult words and conversational turns were lower than found among urban Chinese children. Correlation analyses did not identify significant correlations between demographic characteristics and the home language environment. However, the results do indicate significant correlations between the home language environment and child language skills, with conversational turns showing the strongest correlation. The results point to a need for further research on language engagement and ways to increase parent–child interactions to improve early language development among young children in rural China.
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Journal Article

Choices In a Crisis - Individual Preferences Among SARS-CoV-2 Vaccines

Daniel B. Kremer, Douglas J. Opel, Efthimios Parasidis , Michelle Mello
The New England Journal of Medicine , 2021
Now that a third COVID-19 vaccine has been given emergency-use authorization, Michelle Mello and colleagues ask whether individuals should be able to choose which vaccine they receive.
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Journal Article

It All Starts at Home: 'Home Reading Environment and Reading Outcomes in Rural China'

Quifeng Gao, Yang Zhang, Wei Nie, Han Liu, Huan Wang, Yaojiang Shi
Journal of Research in Reading , 2021
Background: The educational resources that parents provide at home are crucial to their children’s development. In this study, we focused on home reading environment, a key contributor to success rates regarding the mastery of reading skills. We aimed to investigate students’ home reading environments and examine its effect on the reading development of primary school students in rural China. Methods: We draw on a dataset composed of 10,740 randomly selected primary school students and their households in rural areas of Jiangxi province in China. Surveys were administered by trained enumerators in May 2015. Results: The results show that students exhibited quite poor reading environments and reading outcomes. Specifically, we found the majority of the rural students lacked reading and learning resources in the context of their families and their parents did not enjoy reading or support their children’s reading. Moreover, our regression analysis documented students with poorer home reading environments are more likely to have worse reading performance. Conclusion: Our study supports the significance of the home reading environment in the reading development of students in the upper elementary grades in rural China. Furthermore, the results suggest that the home reading environments of rural Chinese students must be improved.
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Journal Article

Skill Levels and Gains in University STEM Education in China, India, Russia, and the United States

Prashant Loyalka, Ou Lydia Liu, Guirong Li, Elena Kardanova, Igor Chirikov, Shangfeng Hu, Ningning Yu, Liping Ma, Fei Guo, Tara Beteille, Namrata Tognatta, Lin Gu, Guangming Ling, Denis Federiakin, Huan Wang, Saurabh Khanna, Ashutosh Bhuradia, Zhaolei Shi, Yanyan Li
Nature Human Behavior , 2021
Universities contribute to economic growth and national competitiveness by equipping students with higher-order thinking and academic skills. Despite large investments in university science, technology, engineering and mathematics (STEM) education, little is known about how the skills of STEM undergraduates compare across countries and by institutional selectivity. Here, we provide direct evidence on these issues by collecting and analysing longitudinal data on tens of thousands of computer science and electrical engineering students in China, India, Russia and the United States. We find stark differences in skill levels and gains among countries and by institutional selectivity. Compared with the United States, students in China, India and Russia do not gain critical thinking skills over four years. Furthermore, while students in India and Russia gain academic skills during the first two years, students in China do not. These gaps in skill levels and gains provide insights into the global competitiveness of STEM university students across nations and institutional types.
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Journal Article

Improving Learning by Improving Vision: Evidence from Two Randomized Controlled Trials of Providing Vision Care in China

Xiaochen Ma, Huan Wang, Yaojiang Shi, Sean Sylvia, Lei Wang, Yiwei Qian, Scott Rozelle
Journal of Development Effectiveness , 2021
This paper examines the external validity of health intervention by comparing the impacts of providing free eyeglasses on the educational performance of nearsighted children in two settings: rural public schools in Western China and urban private migrant schools in Eastern China. The intervention significantly improves educational outcomes by 0.14 standard deviations in math in rural public schools but not in private migrant schools. The difference in measured impacts is due in part to lower quality schooling in migrant schools in Eastern China. Our findings show that only when school is providing a quality education, health interventions might increase student learnings.
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