The Republic of the Philippines began on the path to universal coverage with the passage of the National Health Insurance Act of 1995 (Republic Act 7875) which established the Philippine Health Insurance Corporation (PhilHealth) . Building on the Philippine Medicare program which began in 1971, PhilHealth has expanded coverage to more than 80% of the population with basic benefits, but accounts for only 10% of total health financing—wide population coverage with thin public benefits. An extensive system of private insurance provides additional benefits for high-income Filipino households. While the Philippines is pursuing a public insurance approach with private add-ons, Hawaii has mandated private employment-based coverage through the Pre-paid Health Care Act of 1974 and operates under a Congressionally granted ERISA exemption as well as an exemption from the Affordable Care Act of 2010. Combining the employer mandate with generous Medicaid and SCHIP programs, Hawaii has achieved a coverage rate exceeding 90% of the resident population with extensive benefit packages. The presenter will provide an overview of the two systems and present original research on the labor market effects and public insurance effects of the Hawaii system.

A class was given in the dSchool last spring. In this class small interdisciplinary teams focused on a term-long design project, taking advantage of the design process structures and methods that have been developed in the d.school. The course developed as a collaboration between Stanford, the University of Nairobi and Nokia Africa Research Center.  The focus area was finding ICT solutions to the healthcare needs of people living in Kibera slum outside Nairobi.

Under the guidance of Jussi Impiö at Nokia and the Computer Science faculty, 27 students from the University of Nairobi Computer Science department conducted need finding studies at a number of health-related sites, including clinics, hospitals, community health workers, community leaders, and government offices. They read background materials, made observations, and talked with a wide variety of stakeholders. Their reports became the basis of the Stanford teams' initial understanding of users and needs. Communication with the group in Nairobi was also maintained throughout the course, using a Facebook group to facilitate discussions, as well as several teleconference sessions.

Working in small teams, 20 Stanford students from a wide range of disciplines worked over 10 weeks to develop initial design concepts to respond to some of the needs that had been identified. Click on the title of each project to view their final presentations:

• mNote: an online archive for community health worker notes. This application empowers community health workers by preserving the flexibility and control they appreciate in their current paper notebooks, but adding digital knowledge management capabilities.
• M-MAJI ("mobile water"): an electronic information system that allows people to use their mobile phones to identify clean water sources in their community. The application seeks to decrease the time and money spent searching for water, improve water quality, and foster vendor accountability by providing a mechanism for user feedback.
• Babybank: a dedicated savings plan designed specifically for pregnant women in the slums of Nairobi. By leveraging a popular cell phone payment system, M-Pesa, the application aims to make savings easier, so that expecting mothers can afford the services that will keep themselves and their babies healthy.
• Mazanick: an application to provide support and advice to pregnant women via SMS, with the aim of helping motivate them to attend prenatal appointments.
• PillCheck (Kifaa cha Tenbe): a mobile application to help people in Kibera find information on the availability and pricing of malaria drugs quickly.
• PatientMap :a system to make the waiting process in clinics more transparent, and to increase patient trust in the medical system.

This summer, two follow up trips are planned, with Nairobi students due to spend several weeks at Stanford, while a number of students from the Stanford group will visit Nairobi to explore possibilities for developing their projects further. Building on the success and lessons learnt so far, the Designing Liberation Technologies course will be open to a new set of students next academic year. 

The Chinese health care system has experienced profound changes like retrenchment of state financial support in the past decades. These changes have prompted the Chinese media and some academics to suggest that patients have a relatively low level of trust in physicians in today's China. In this colloquium, Dr. Tam reports the results of his survey of patient trust in physicians in Beijing's public hospitals. The survey was conducted by Horizon Research Group between November 2009 and January 2010, and 434 patients were interviewed.
 
The survey asked the respondents their degree of trust regarding the following three dimensions: physician agency, competence, and information provision. The survey finds a relatively high level of patient trust in physicians in Beijing public hospitals. Additionally, the survey data highlight three major determinants of patient trust in physicians, namely exposure to negative media reports about physicians and hospitals; the patient's self-assessed health status; and the patient’s level of education and income.
 
Waikeung Tam received his Ph.D. in political science at the University of Chicago in 2009. He is currently a Research Fellow at the LKY School of Public Policy at the National University of Singapore. His research focuses on public policy, political development, law and society, with special reference to China and Hong Kong. His research has been published in China Review, Asian Perspective, Journal of Contemporary Asia, and Law & Social Inquiry.