Stanford University

Testifying on Capitol Hill will be a unique experience for Toyota execs, according to Shorenstein APARC scholar

Authors
Daniel C. Sneider
News Type
News
Date
Paragraphs
In his testimony before the House Oversight Committee about Toyota's massive recall efforts, Akio Toyota will learn that you can't win such an encounter. But you can lose. Shorenstein APARC Associate Director for Research Daniel C. Sneider comments on a Japanese CEO learning the lessons of American business the hard way.
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Dealing with North Korea: A Current Snapshot

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Ambassador Bosworth will share his off-the-record thoughts with us.  No quotes or cameras of any kind please.

Stephen W. Bosworth is the Dean of The Fletcher School of Law and Diplomacy at Tufts University, a position he assumed in February 2001. Prior to his appointment at The Fletcher School, he served as the United States Ambassador to the Republic of Korea from November 1997 to February 2001.

From 1995-1997, Dean Bosworth was the Executive Director of the Korean Peninsula Energy Development Organization [KEDO], an inter-governmental organization established by the United States, the Republic of Korea, and Japan to deal with North Korea. Before joining KEDO, he served seven years as President of the United States Japan Foundation, a private American grant-making institution. During that period, he co-authored several studies on public policy issues for the Carnegie Endowment and the Century Fund. He also taught International Relations as an Adjunct Professor at Columbia University's School of International and Public Affairs from 1990 to 1994. In 1993, he was the Sol Linowitz Visiting Professor at Hamilton College.

Dean Bosworth has had an extensive career in the United States Foreign Service, including service as Ambassador to Tunisia from 1979-1981 and Ambassador to the Philippines from 1984-1987. He also served in a number of senior positions in the Department of State, including Director of Policy Planning, Principal Deputy Assistant Secretary of State for Inter-American Affairs, and Deputy Assistant Secretary for Economic Affairs. He is currently serving as Special Representative for North Korea Policy.

Dean Bosworth is the recipient of several awards, including the American Academy of Diplomacy's Diplomat of the Year Award in 1987, the Department of State's Distinguished Service Award in 1976 and 1986, and the Department of Energy's Distinguished Service Award in 1979. In 2005, the Government of Japan presented him with the Order of the Rising Sun, Gold and Silver Star.

Bosworth is a former member of the Board of Directors of the Council on Foreign Relations and currently serves as a member of the Board of Directors of the Japan Society of Boston. He is also a member of the Trilateral Commission.

Bosworth is a graduate of Dartmouth College where he was a member of the Board of Trustees from 1992 to 2002 and served as Board Chair from 1996 to 2000.

Philippines Conference Room

Stephen W. Bosworth Dean of The Fletcher School of Law and Diplomacy Speaker Tufts University
Seminars

The Question of Ethnic & Mass Violence

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President Barack Obama is reading What Is the What and has recommended that all his staff read it as well.

Valentino Achak Deng's life has been described by The New York Times as a testament "to human resilience over tragedy and disaster." Born in the village of Marial Bai, in Southern Sudan, he was forced to flee in the 1980s, at the age of seven, when civil war erupted. As one of the so-called Lost Boys, he trekked hundreds of miles, pursued by animals and government militias, and lived for years in refugee camps in Kenya and Ethiopia. He eventually resettled in America, to a new set of challenges. Deng's life is the basis of Dave Eggers' epic book What Is the What, which Francine Prose calls "an extraordinary work of witness, and of art." In 2009, as part of his Valentino Achak Deng Foundation, he opened the Marial Bai Secondary School, the region's first proper high school. Read Nicolas Kristof's glowing New York Times Op-ed about the Marial Bai School in Sudan.

Valentino Deng spent his formative years in refugee camps, where he worked as a social advocate and reproductive health educator for the UN High Commission for Refugees. He has toured the United States and Europe, telling his story and becoming an advocate for social justice and the universal right to education. In 2006, Deng collaborated with Dave Eggers on What Is the What, an international bestseller that is now required reading on college campuses across America. With Eggers, Deng is co-founder of the Valentino Achak Deng Foundation, which helps rebuild Sudanese communities by providing educational opportunities and facilities.

Professor Anne Bartlett received her Ph.D. from the Sociology Department at the University of Chicago. She is a director of the Darfur Centre for Human Rights and Development based in London. Since 2002, Bartlett has worked with tribes and rebel groups from Darfur as part of a research project on insurgent politics. At the invitation of the Darfur delegation, Bartlett was the chair of the United Nations hearing on the Darfur crisis, UN commission on Human Rights, 60th Session, Geneva, Switzerland, April 2004. She was also a guest speaker at "The Human Rights and Humanitarian Crisis in Darfur (Western Sudan): Challenges to the International Community," UN Commission on Human Rights, 61st session, April 2005, Geneva, Switzerland. Bartlett has published extensively on the crisis and has given numerous talks on the Darfur crisis worldwide. She is currently working on a project that examines the effect of humanitarian intervention in the region.

Co-Sponsored by

The Billie Achilles Fund and the Bechtel International Center, Programs in International Relations, SAGE, Six Degrees & Human Rights Forum, STAND, Stanford Amnesty International, UNICEF, Program on Human Rights: CDDRL, Center for African Studies, & The Black Community Services Center

Annenberg Auditorium
Stanford, CA

Valentino Deng co-founder, Valentino Achak Deng Foundation Speaker
Anee Bartlett Speaker Darfur Centre for Human Rights and Development based in London
Conferences

The Long Shadow of Vietnam

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Please join Marvin Kalb to discuss the impact of the Vietnam War on presidential/strategic decisions about national security issues. 

Marvin Kalb is also a contributing news analyst for National Public Radio and Fox News Channel. In addition, he is frequently called upon to comment on major issues of the day by many of the nation's other leading news organizations.

Kalb had a distinguished 30-year broadcast career, working for both CBS News and NBC News, where he served as Chief Diplomatic Correspondent, Moscow Bureau Chief, and moderator of Meet the Press. Among his many honors are two Peabody Awards, the DuPont Prize from Columbia University, the 2006 Fourth Estate Award from the National Press Club and more than a half-dozen Overseas Press Club awards. He has lectured at many universities, here and abroad. Kalb was the founding director of the Joan Shorenstein Center on the Press, Politics, and Public Policy at the Kennedy School of Government at Harvard University.

A graduate of the City College of New York, Kalb has an M.A. from Harvard and was zeroing in on his Ph.D. in Russian history when he left Cambridge in 1956 for a Moscow assignment with the State Department. The following year, he joined CBS News, the last correspondent hired by Edward R. Murrow. Kalb has authored or co-authored 10 nonfiction books and two best-selling novels. His latest book, The Media and the War on Terrorism (co-edited with Stephen Hess), was the recipient of the 2004 Arthur Rowse Award for Press Criticism. He is currently engaged in research for a book on U.S. involvement in the Vietnam War and its impact on American politics and foreign policy.

Daniel and Nancy Okimoto Conference Room

Marvin Kalb James Clark Welling Presidential Fellow at The George Washington University and Edward R. Murrow Professor Emeritus at Harvard's Kennedy School of Government Speaker
Seminars

The Cost of the Bomb, The Cost of Slave Labor: Mutual Apology and Compensation as a Way to Address U.S. and Japanese Atrocities from World War II

February 2010 Dispatch - Strict Liability for Medical Injuries? The Impact of Increasing Malpractice Liability on Obstetrician Behavior in Taiwan

Authors
Brian Chen
News Type
News
Date
Paragraphs

Malpractice liability, along with medical technology and payment system distortions, regularly figures among the most-cited reasons for escalating health-care spending in the United States. On the one hand, Harvard economist Amitabh Chandra conservatively estimates that upwards of $60 billion, or 3 percent of total health care costs ($1.8 trillion), is spent annually as a result of direct litigation and indirect defensive medicine costs. On the other hand, tort reform advocates place the figure at $200 billion by extrapolating, to the entire U.S. population, the results of research conducted by Stanford professor Dan Kessler and Mark McClellan. Their 1996 study shows that tort reforms reduced provider liability costs for Medicare heart patients by 5 to 9 percent.

At the heart of these debates is the following question. Does medical malpractice liability achieve its dual goal of compensating victims of medical injuries and deterring medical errors, or does it merely encourage wasteful defensive medicine without improving patient health? Despite considerable empirical research, there is little evidence that malpractice litigation deters medical negligence. The evidence is much stronger—though still hotly debated—that malpractice fears actually encourage physicians to engage in defensive medicine. My work at Shorenstein APARC explores whether malpractice pressures affect physician behavior, patient health, and health care costs in Asia. Studying physicians’ response to legal changes in Taiwan, I find that greater malpractice liability may, under certain circumstances, prompt physicians to perform more services without necessarily improving patient health.

In particular, I focus on how increased medical malpractice liability affects physicians in Taiwan who provide treatment to pregnant women. I have studied how a series of court rulings as well as an amendment to Taiwanese law between 1997 and 2004 impacted physicians’ test-ordering behavior and decisions to perform Caesarian sections. Traditionally, Taiwanese doctors are held accountable for medical malpractice under two bodies of law: tort law in the Civil Code, and criminal law for harm resulting from negligent acts in the course of professional operations. The latter, prosecutorial approach is rare among industrialized nations.

In January 1998, a Taipei District Court decision in favor of plaintiffs in a civil suit for damages sent shockwaves through the medical community. The district court judge disregarded the traditional tort requirement of proving the defendant’s negligence (or fault), and applied the “strict liability” doctrine of the Consumer Protection Law to impose liability on a medical provider without any showing of wrongdoing. The court decision—subsequently affirmed by the Taipei High Court on September 1, 1999 and by the Supreme Court on May 10, 2001—sparked resentment among medical professionals. Passions flared in heated debates between medical and legal scholars about whether medical services should be considered a covered “service” under the Consumer Protection Law. Economists and legal academics questioned whether the traditional justifications for imposing strict liability apply in the highly unpredictable practice of medicine, especially in obstetrics. The saga concluded in April 2004, when the legislature amended the Medical Law to require negligence or fault in medical malpractice cases.

My research considers the effect of these court rulings and legal amendments on physicians’ test-ordering behavior and their propensity to perform Caesarean sections. I identify two sources of variation in perceived risks of malpractice liability: (1) the differences between the level of exposure to malpractice risks due to the ownership structure and size of the physicians’ place of practice; and (2) the differences in perceived risks based on the physicians’ geographical location.

My results are consistent with the existence of defensive medicine. First, with respect to their propensity to increase laboratory tests and reduce Caesarean sections, physicians who own their clinics (“physician-owners”) in Taiwan reacted more strongly to the legal changes than did physicians who are salaried employees at larger hospitals (“nonowners”). Physician-owners’ behavior did not change, however, in discretionary expenditures that were not associated with defensive medicine. Second, physician-owners working in areas under the jurisdiction of the Taipei District Court reacted more strongly to legal change than did those practicing in Kaohsiung, Taiwan’s second largest city, at the opposite end of the island.

The negative connection between the likelihood of Caesarean deliveries and increased malpractice liability deserves special mention, since most published studies find a positive association between malpractice liability risks and Caesarean rates. However, economists Janet Currie and Bentley MacLeod at Columbia University suggest that reforms in which liability is closely aligned with defendant’s actual levels of care may produce the opposite effect. In the Taiwan context, increased medical malpractice liability accrues directly to the physician-owners. Since Caesarean sections are generally riskier than natural deliveries, it seems logical that higher tort liability in Taiwan may actually decrease the likelihood of deliveries by Caesarean sections. In this sense, my study confirms Currie and MacLeod’s predictions and empirical results.

My work contributes to our understanding of health law and policy in several concrete ways. First, I add support to the existence of defensive medicine, even in a non-Common Law jurisdiction. Since I focus on Taiwan—an environment that lacks malpractice insurance, in which physicians are either owners or employees at providers of varying sizes—my research isolates the pure effect of malpractice liability to a greater extent than do many current studies. Second, I show that interaction between the payment and legal systems may either enhance or mitigate the hypothetical pure effects of legal policies. In a fee-for-service system, physicians subject to higher malpractice risks appear much more willing to increase laboratory tests than to reduce profitable Caesarean sections. Third, my research indicates that, by altering physicians’ exposure to risks, different organizational forms and ownership structures of health care provision may affect defensive medicine at differing rates.

In sum, the practice of “defensive medicine” appears not to be a uniquely American phenomenon. Indeed, it may also play a role in health care cost escalations in Asia, especially under heightened physician liability regimes.

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Shorenstein APARC Dispatches are regular bulletins designed exclusively for our friends and supporters. Written by center faculty and scholars, Shorenstein APARC Dispatches deliver timely, succinct analysis on current events and trends in Asia, often discussing their potential implications for business.

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Koreans as Japanese Soldiers: Reflections on Inclusionary Racism in WWII

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Professor Fujitani’s presentation will be drawn from his forthcoming book, Race for Empire: Koreans as Japanese and Japanese as Americans in WWII. The book is a comparative and transnational study of ethnic and colonial soldiers during the Asia-Pacific War (or the Second World War in the Asia-Pacific) that focuses specifically on Japanese Americans mobilized to serve in the United States army and Koreans who were recruited or drafted into the Japanese military. His research utilizes the two sites of soldiering as optics through which to examine the larger operations and structures of the changing U.S. and Japanese national empires as they struggled to manage racialized populations within the larger demands of conducting total war. He seeks to show how discussions about, policies, and representations of these two sets of soldiers tell us a great deal about the changing characteristics of wartime racism, nationalism, imperialism, colonialism, capitalism, gender politics, the family, and some other related issues on both sides of the Pacific that go well beyond the soldiers themselves, and whose repercussions remain with us today. The seminar will focus on the Korean Japanese side of his research.

Takashi Fujitani is Professor of History at the University of California, San Diego. His primary areas of research are modern and contemporary Japanese history, East Asian history, and transnational history (primarily U.S./Japan and Asia-Pacific). His publications include: Splendid Monarchy: Power and Pageantry in Modern Japan (UC Press, 1996; Japanese version, 1994; Korean translation, 2003);  Perilous Memories: The Asia Pacific War(s) (co-editor, Duke, 2001); and  Race for Empire: Koreans as Japanese and Japanese as Americans in WWII (forthcoming, UC Press; Japanese version, Iwanami Shoten); as well as numerous book chapters and articles published in Korean, Japanese and English. His recent research has been funded by the John. S. Guggenheim Foundation, American Council of Learned Societies, National Endowment for the Humanities, and Social Science Research Council.

This seminar is supported by a generous grant from Koret Foundation.

Philippines Conference Room

Takashi Fujitani Professor of History, University of California, San Diego Speaker
Seminars
Korean Studies Colloquium Series
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