Health Care
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After the Sichuan 5.12 earthquake, many people in the disaster area suffered from mental health problems. To decrease morbidity from mental disease, the Sichuan authorities worked with diverse hospitals to establish a “three-level network of psychiatric prevention and treatment.” The goal was to disseminate knowledge about prevention and treatment for psychiatric conditions from doctors to recipients, especially regarding symptoms. How to disseminate such knowledge effectively and efficiently deserves study. Based on a sample of 146 doctor-recipient pairs from 52 hospitals in diverse areas of China (including Sichuan, Beijing, and Guangzhou), this study examines the impact of knowledge characteristics, the network status of the doctor, the network status of the hospital with which the doctor is affiliated, and the relationship quality between doctor and recipient on the effectiveness and efficiency of knowledge transfer from the doctor to patient. Findings indicate that high-status doctors are more effective in knowledge transfer. In addition, low-status hospitals were found to have a positive effect on knowledge transfer efficiency. In particular, results highlight the strong positive impact that the quality of the relationship between the doctor and patient has on both the efficiency and effectiveness of knowledge transfer. Finally, findings suggest that the relationship between knowledge characteristics and knowledge transfer is partially mediated by the relationship quality between the doctor and the recipient.

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Shorenstein APARC
Stanford University
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Stanford, CA 94305-6055

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Visiting Scholar, 2009-2011
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Zhe Zhang is an assistant professor of organization management at the School of Management, Xi'an Jiaotong University, China, where she also received her PhD. Her research focuses on public-private partnerships, corporate governance, and corporate social responsibility. She has published in the Journal of High Technology Management Research, International Journal of Health Care Finance & Economics, Management and Organization Review, and the International Journal of Networking and Virtual Organizations.

(Amy) Zhe Zhang Visiting Scholar, 2009-2011 Speaker Shorenstein APARC
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Martin Connor is presently a Harkness Fellow in Health Care Policy and Practice.  These fellowships are delivered by the Commonwealth Fund and support mid-career physicians and health service managers and researchers to study in the US.  During his time at CHP/PCOR Martin will be studying integrated care and its potential to contribute to the delivery system aspects of Health Reform as well as maintaining long standing interests in policy developments in the UK and developments in physician leadership and accountability.

Prior to starting the fellowship, Martin was Director of the Trafford Integrated Care Organisation Programme in the UK NHS, as the follow on to his role as Deputy Chief Executive at Trafford PCT in Manchester, England.

Before this, he worked from 2005-08 as special policy adviser to the Department of Health in Northern Ireland, leading the development of national policy at Permanent Secretary and ministerial level.  He went on to lead the reform programme and established the Service Delivery Unit in Northern Ireland.  This transformed waiting times for elective assessment and treatment, increased the involvement of clinical professionals in decision making and the developed a novel, high frequency, patient level information base to support strategic decision making.

Between 2002 - 2005, he was Associate Director (Health Reform) for the Greater Manchester Strategic Health Authority.  He co-authored the strategy for GMSHA, which led to the area moving from 'special measures' to 'high performing' within 2 years.  This strategy included the first health authority-wide demand management system in the NHS that was commended by the Audit Commission.

In his twenties, he studied classical and linguistic philosophy following the award of a studentship from Durham University where he received his doctorate in 2001.  He joined the NHS on the graduate management training programme in 1999.

Adjunct Affiliate at the Center for Health Policy and the Department of Health Policy
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Objectives: To determine whether China's New Rural Cooperative Medical Scheme (NCMS), which aims to provide health insurance to 800 million rural citizens and to correct distortions in rural primary care, and the individual policy attributes have affected the operation and use of village health clinics.

Design: We performed a difference-in-difference analysis using multivariate linear regressions, controlling for clinic and individual attributes as well as village and year effects.

Setting: 100 villages within 25 rural counties across five Chinese provinces in 2004 and 2007.

Participants: 160 village primary care clinics and 8339 individuals.

Main outcome measures: Clinic outcomes were log average weekly patient flow, log average monthly gross income, log total annual net income, and the proportion of monthly gross income from medicine sales. Individual outcomes were probability of seeking medical care, log annual "out of pocket" health expenditure, and two measures of exposure to financial risk (probability of incurring out of pocket health expenditure above the 90th percentile of spending among the uninsured and probability of financing medical care by borrowing or selling assets).

Results: For village clinics, we found that NCMS was associated with a 26% increase in weekly patient flow and a 29% increase in monthly gross income, but no change in annual net revenue or the proportion of monthly income from drug revenue. For individuals, participation in NCMS was associated with a 5% increase in village clinic use, but no change in overall medical care use. Also, out of pocket medical spending fell by 19% and the two measures of exposure to financial risk declined by 24-63%. These changes occurred across heterogeneous county programmes, even in those with minimal benefit packages.

Conclusions: NCMS provides some financial risk protection for individuals in rural China and has partly corrected distortions in Chinese rural healthcare (reducing the oversupply of specialty services and prescription drugs). However, the scheme may have also shifted uncompensated new responsibilities to village clinics. Given renewed interest among Chinese policy makers in strengthening primary care, the effect of NCMS deserves greater attention.

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BMJ
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Grant Miller
Scott Rozelle
Kim Babiarz
Grant Miller
Scott Rozelle
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The major expansion of federal comparative effectiveness research launched in 2009 held the potential to supply the information needed to help slow health spending growth while improving the outcomes of care. However, when Congress passed the Patient Protection and Affordable Care Act one year later, it limited the role of cost analysis in the work sponsored by the Patient-Centered Outcomes Research Institute. Despite this restriction, cost-effectiveness analysis meets important needs and is likely to play a larger role in the future. Under the terms of the Affordable Care Act, the institute can avoid commissioning cost-effectiveness analyses and still provide information bearing on the use and costs of health care interventions. This information will enable others to investigate the comparative value of these interventions. We argue that doing so is necessary to decision makers who are attempting to raise the quality of care while reining in health spending.

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Health Affairs
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Karen Eggleston
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Karen Eggleston, Director of the Asia Health Policy Program, seeks to hire two research assistants at the advanced undergraduate or graduate social science level to assist with several projects, including an international comparative study of government financing for health service provision and provider payment. The RA should have a solid background in microeconomics; some background in health economics and comparative health policy; and near-native fluency in English. Knowledge of another European or Asian language (especially Chinese, Japanese, or Korean) would be an advantage. Ideally the RA would be a student whose own studies are related to the topic of health care financing and payment incentives in developing and/or transitional economies, or more generally in public economics, the government sector, and social protection policies. The work would be for autumn quarter, with possibility of extension to winter quarter. Compensation is competitive and commensurate with RA experience. Please send CV and brief statement of interest and related qualifications to Karen Eggleston at karene@stanford.edu by September 24th.

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Dr. Katzenstein completed his undergraduate and medical degrees as well as a residency in Internal Medicine and Fellowship training in Infectious Diseases at the University of California San Diego. He continued fellowship training in virology and Infectious Diseases with Dr. Colin Jordan at U.C. Davis, moving to the University of Minnesota to a faculty position in Infectious Disease in 1984. He was a visiting lecturer for two years in the Departments of Medical Microbiology and Medicine at the University University of Zimbabwe as the AIDS epidemic was first recognized in Southern Africa. In 1987, he returned to the U.S. to take up a senior research fellowship at the Center for Biologics Evaluation and Research (CBER) at the Food and Drug Administration in the Vaccine Branch, evaluating early candidate HIV Vaccines and diagnostics. Dr. Katzenstein returned to California in 1989 to work with Dr. Thomas Merigan and the AIDS Clinical Trials Group. He continues an active collaboration with his colleagues in Zimbabwe and Southern Africa in prevention, perinatal transmission and vaccine research. At Stanford, Dr. Katzenstein participates in studies of multiple drugs and drug combinations in Clinical Trials in the U.S. and Europe and is the principal investigator for Stanford's Virology Service Laboratory in the center for AIDS Research. At Stanford he teaches an undergraduate course in Global AIDS, attends on the Infectious Disease service and supervises both laboratory and clinical fellows conducting AIDS Research. He remains actively involved in studies of HIV infection in Zimbabwe, spending 2-3 months a year in Southern Africa.

Professor Katzenstein's research interests include treatment and evaluation of HIV infection in the United States and Europe through the AIDS Clinical Trials Group (ACTG). His international HIV pathogenesis work includes studies in Zimbabwe, South Africa. The lab currently is focused on drug resistance, envelope tropism and the pathogenesis of HIV.

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Helen Stacy Moderator
David Katzenstein Professor (Research), Medicine - Infectious Diseases; Member, Bio-X Speaker Stanford University
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