Clear evidence suggests the importance of health service provider payment incentives for achieving efficiency, equal access, and quality, including attention to primary, secondary, and tertiary prevention. “Pay for performance” may be on the cusp of significant expansion in Asia, and reform away from fee-for-service has been underway for several years in several economies. Yet despite the policy relevance, the evidence base for evaluating payment reforms in Asia is still very limited.

China in particular has been undertaking significant reforms to its health care system in both rural and urban areas. With the expansion of insurance coverage and need to resolve incentive problems like “supporting medical care through drug sales,” there is an urgent need for evaluating alternative ways of paying health service providers. Evidence from policy reforms in specific regions of China, as well as other economies of the Asia-Pacific, can provide valuable evidence to help inform policy decisions about how to align provider incentives with policy goals of quality care at reasonable cost.

To illuminate these questions, the Asia Health Policy Program and several collaborating institutions are planning to convene a conference on health care provider payment incentives on November 7-8, 2008 in Beijing. The conference will highlight and seek to distill “best-practice” lessons from rigorous and policy-relevant evaluations of recent reforms in China and elsewhere in the Asia Pacific.

The organizing committee – including health economists from Shorenstein APARC, Peking University, Tsinghua University, and Seoul National University – reviewed submissions in June 2008 and accepted sixteen. The conference papers cover payment issues in Korea, Japan, China, Taiwan, Thailand, Tajikistan, the Philippines, and the US, and the disciplines of economics, health services research/health policy, public health, medicine, and ethics. Topics include institutionalized informal payments; the impact of global budget policies on high-cost patients; public-private partnerships; public-sector physicians owning private pharmacies; evidence-informed case payment rates; payment and hospital quality; bonuses and physician satisfaction; physician prescription choice between brand-name and generic drugs; and differences in pharmaceutical utilization across insurance plans that pay providers differently (fee-for-service versus capitation).

Policymakers from China’s National Development and Reform Commission and Ministry of Health will also speak at the conference. Selected research papers will be published through the Shorenstein Asia-Pacific Research Center either in a special volume or in a special issue of an English-language health policy journal.

On May 1, 2003, President Bush publicly declared an end to combat in Iraq. Four years later, the conflict had only intensified, fueled by a violent insurgency, sectarian strife, and a resurgent al-Qaeda in Iraq. More than 3,000 American servicemen and servicewomen had been killed and 790,000 Iraqi civilians were dead. What had gone so disastrously wrong? Charles Ferguson, an MIT-trained political scientist, determined to find out.

Drawing on shockingly frank interviews with U.S. government officials, military personnel, diplomats, journalists and Iraqi leaders and citizens, his first film, No End in Sight: The American Occupation of Iraq, examines comprehensively how the Bush administration constructed the Iraq war and subsequent occupation. The film won the Special Jury Prize, documentary competition, at the 2007 Sundance Film Festival, as a “timely work that clearly illuminates the misguided policy decisions that have led to the catastrophic quagmire of the U.S. invasion and occupation of Iraq.”

“Overnight rendered unemployed and infuriated are 500,000 armed men,” one of many ill-advised moves that ignited resentment, desperation, and a still-raging insurgency.On May 23, the Freeman Spogli Institute hosted a special screening of the film, followed by a distinguished panel of experts. Among the film’s central themes was the failure to commit sufficient troops to maintain order, secure the borders, or protect government ministries, historic sites, or ammunition depots. The destruction of national treasures, depicted vividly, was heartbreaking.

Soon after one watershed—the toppling of Saddam Hussein and the defeat of the military—there was another watershed, characterized by widespread looting, lawlessness, and a growing feeling among Iraqis that Americans could not protect them. The film chronicles three especially fateful decisions: to halt the formation of an Iraqi interim government (as Iraqi opposition leaders felt they had been promised) and impose an American occupation instead; a wide-ranging campaign of de-Baathification—the purging of higher-level Baath Party officials who ran the civil service and even staffed many schools and hospitals; and the hasty decision to disband the Iraqi military and intelligence services.

Said Col. Paul Hughes (Ret.), “We could have used Iraqi units to clean up, build roads, and rebuild their country.” Instead, the military were told they were going to be out of work, leaving millions of Iraqis suddenly without support. The film recounts, “Overnight rendered unemployed and infuriated are 500,000 armed men,” one of many ill-advised moves that ignited resentment, desperation, and a still-raging insurgency. Ambassador Barbara Bodine recalled, “When we were first starting the reconstruction, we used to joke that there were 500 ways to do it wrong and two to three ways to do it right. What we didn’t understand is that we were going to go through all 500.”

The riveting documentary was followed by a lively panel discussion among Stanford political scientists, historians, and experts on the war in Iraq. Moderating the panel was Larry Diamond, Hoover Institution senior fellow and coordinator of the Democracy Program at FSI’s Center on Democracy, Development, and the Rule of Law, who called the war “one of the greatest policy tragedies in American history.” Diamond served as an advisor to the Coalition Provisional Authority and wrote a book about the experience, titled %publication1%.

Writer and director Charles Ferguson noted that the shooting to inclusion ratio was 100:1 and said he will release more than 100 hours of film and 3,000 pages of transcripts as a public archive for the historical record. Col. Christopher Gibson, a 2006–07 National Security Affairs fellow at the Hoover Institution, who served in both the Gulf and Iraq wars, observed in his opening remarks, “For this to work in a republic, soldiers have to be there to take the tough questions.” Drawing on his experience during two tours of duty supervising national elections, he underscored the Iraqi people’s desire for freedom and “their deep and sincere desire for democracy.”

David Kennedy, Stanford’s Donald J. McLachlan Professor of History and a 2000 Pulitzer-Prize winner, commended the film for making an important contribution to the historical record. Future historians will have to consider a number of major questions, Kennedy said, including these two: “What was the deep strategic rationale for this war and how was that rationale related to the declared reasons for going to war,” namely the now discredited claims that the regime possessed weapons of mass destruction and had verifiable links to al-Qaeda.

In a lively discussion among panelists, it was agreed that the calculus was complex and many factors converged—an Iraq believed both to be a menace and weakened by many years of sanctions under a brutal leader; a son wishing to redress the policy of the father and avenge a near assassination attempt. But the ideological factor was significant—the belief that we had the ability to effect political change in a country that would transform the character of an entire region.

The debate addressed other critical issues—could the outcome have been better had policy been better informed and more skillfully implemented? Could anything change the outcome now? Said Diamond, the only thing that could materially change the outcome now “would be to combine a military surge with a diplomatic surge,” involving the United Nations, the European Union, the United States, and a cooperative Iraqi leadership. The United States should let Iraq know we’ll leave, he stated, if Iraqi leaders fail to undertake the requisite political reconciliation and compromise. As the lively debate and discussion with more than 300 audience members ended, there was little doubt that all these questions would be debated for some time to come.