Strict Liability for Medical Malpractice? The Impact of Increasing Malpractice Liability on Obstetrician Behavior in Taiwan
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The extent and existence of "defensive medicine" -- excessive medical care to defend a physician against malpractice claims -- is a perennial subject of both policy and academic debate. For example, malpractice liability and associated defensive medicine are among the most-cited reasons for escalating health-care spending in the United States.
In this colloquium, Dr. Brian Chen will present results from his research investigating the extent of defensive medicine in Taiwan. He studies the impact of a series of court rulings in Taiwan that increased physicians’ liability risks, and a subsequent amendment to the law that reversed the courts’ rulings, on physicians’ test-ordering behavior and propensity to perform Caesarean sections. He finds that physicians faced with higher malpractice pressure increased laboratory tests as expected, but unexpectedly reduced Caesarean sections. (The reduction in Caesarean deliveries may be due to the fact that liability risks were more closely aligned with physicians’ standard of care after the court rulings.) After the law was amended to negate the court decisions, physicians reversed their previous behavior by reducing laboratory tests and increasing Caesarean deliveries.
This pattern of behavior is highly suggestive of the existence of defensive medicine among physicians in Taiwan. In other words, by studying physicians' response to legal changes in Taiwan, we find that greater malpractice liability may, under certain circumstances, prompt physicians to perform more services without necessarily improving patient health.
Dr. Brian Chen recently completed his Ph.D. in Business Administration in the Business and Public Policy Group at the Haas School of Business, University of California at Berkeley. He received a Juris Doctor from Stanford Law School in 1997, and graduated summa cum laude from Harvard College in 1992.
Philippines Conference Room
Brian Chen
Shorenstein APARC
Stanford University
Encina Hall, Room E-301
Stanford, CA 94305-6055
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chenbk@stanford.edu
2011 AHPP/CEAS Visiting Scholar
Dr. Brian Chen is currently a visiting scholar with the Asia Health Policy Program and Center for East Asian Studies at Stanford University. He was recently Shorenstein Asia-Pacific Research Center's 2009-2010 postdoctoral fellow in Comparative Health Policy. As a visiting scholar, Dr. Chen will conduct collaborative research about health of the elderly and chronic disease in China.
As an applied economist, Chen’s research focuses on the impact of incentives in health care organizations on provider and patient behavior. For his dissertation, Chen empirically examined how vertical integration and prohibition against self-referrals affected physician prescribing behavior. His job market paper was selected for presentation at the American Law and Economics Association’s Annual Meeting, the Academy of Management, the Canadian Law and Economics Association, the Conference on Empirical Legal Studies, and the First Annual Conference on Empirical Health Law and Policy at Georgetown Law Center in 2009. The paper was also nominated for best paper based on a dissertation at the Academy of Management.
Chen comes to the Shorenstein Asia-Pacific Research Center not only with a multidisciplinary law and economics background, but also with an international perspective from having lived and worked in Taiwan, Japan, and France. He has a particularly intimate knowledge of the Taiwanese health care system from his experience as an assistant to the hospital administrator at a medical college in Taiwan.
During his past residence as a postdoctoral fellow with the Asia Health Policy Program, Chen conducted empirical research on cost containment policies in Taiwan and Japan and how those policies impacted provider behavior. His work also contributed to the program’s research activities on comparative health systems and health service delivery in the Asia-Pacific, a theme that encompasses the historical evolution of health policies; the role of the private sector and public-private partnerships; payment incentives and their impact on patients and providers; organizational innovation, contracting, and soft budget constraints; and chronic disease management and service coordination for aging populations.
Dr. Brian Chen recently completed his Ph.D. in Business Administration in the Business and Public Policy Group at the Haas School of Business, University of California at Berkeley. He received a Juris Doctor from Stanford Law School in 1997, and graduated summa cum laude from Harvard College in 1992.
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CDDRL visiting scholar named Young Global Leader
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Each year, the World Economic Forum recognizes and acknowledges up to 200 outstanding young leaders from around the world for their professional accomplishments, commitment to society and potential to contribute to shaping the future of the world. For 2010, the Forum has selected 197 Young Global Leaders (YGLs) from 72 countries and all stakeholders of society (business, civil society, social entrepreneurs, politics and government, arts and culture, and opinion and media).
One honoree is Abebe Gellaw, CDDRL visiting scholar, who is recognized for his long standing work for freedom of expression, justice, democracy, and dignity in Ethiopia. He came to Stanford in 2009 as a Knight/Yahoo! International Fellow.
"I am not only thrilled but also humbled to be included in this year's YGL list of honorees," Gellaw remarked after the names of the honorees were announced, "I started mixing journalism and advocacy in 1993 as the government fired 42 respected professors from Addis Ababa University, where I was a student leader organizing protests against the misguided and destructive policies of the regime that has hijacked Ethiopia's hope for a democratic transition and decent future."
"The World Economic Forum is a true multistakeholder community of global decision-makers in which the Young Global Leaders represent the voice for the future and the hopes of the next generation. The diversity of the YGL community and its commitment to shaping a better future through action-oriented initiatives of public interest is even more important at a time when the world is in need of new energy to solve intractable challenges," said Klaus Schwab, Founder and Executive Chairman of the World Economic Forum.
The Young Global Leaders 2010 were chosen from a pool of almost 5,000 candidates by a selection committee, chaired by H.M. Queen Rania Al Abdullah of the Hashemite Kingdom of Jordan and comprised of eminent international media leaders including Steve Forbes, CEO of Forbes Media, James Murdoch, CEO of News Corporation (Europe and Asia), Arthur Sulzgerber, Chairman and Publisher of the New York Times, Tom Glocer, CEO of Thomson Reuters and Elizabeth Weymouth, Editor-at-Large and Special Diplomatic Correspondent of Newsweek.
The 2010 honourees will become part of the broader Forum of Young Global Leaders community that currently comprises 660 outstanding individuals. The YGLs convene at an annual summit - this year it will be in Dar es Salaam, Tanzania, 2-7 May 2010, the first time in Africa and the largest ever gathering of YGLs - as well as at Forum events and meetings throughout the year, according to a press release issued by the World Economic Forum.
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The Rise of the New Global Economic Powers: How the United States Should Meet the Challenge
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Robert D. Hormats is the Under Secretary of State for Economic, Energy, and Agricultural Affairs.
Formerly, Mr. Hormats was the Vice Chairman of Goldman Sachs International from 1982 to 2009.
Mr. Hormats served as Assistant Secretary of State for Economic and Business Affairs from 1981 to 1982, as Ambassador and Deputy U.S. Trade Representative from 1979 to 1981, and as Senior Deputy Assistant Secretary for Economic and Business Affairs at the Department of State from 1977 to 1979. He served as a Senior Staff Member for International Economic Affairs on the National Security Council from 1969 to 1977, where he was Senior Economic Advisor to Dr. Henry Kissinger, General Brent Scowcroft, and Dr. Zbigniew Brzezinski. Mr. Hormats was a recipient of the French Legion of Honor in 1982 and Arthur Fleming Award in 1974.
Mr. Hormats has been a visiting lecturer at Princeton University and is a member of the Board of Visitors of the Fletcher School of Law and Diplomacy and the Dean's Council of the John F. Kennedy School of Government at Harvard University. He is a member of the Council on Foreign Relations and a board member of the Irvington Institute for Immunological Research, Engelhard Hanovia, Inc., The Economic Club of New York, and Freedom House.
Mr. Hormats' publications include The Price of Liberty: Paying for America's Wars from the Revolution to the War on Terror; Abraham Lincoln and the Global Economy; American Albatross: The Foreign Debt Dilemma; and Reforming the International Monetary System. Mr. Hormats' articles have appeared in Foreign Affairs, Foreign Policy, The New York Times, The Washington Post, The Wall Street Journal, American Banker, and The Financial Times.
Mr. Hormats earned a B.A. from Tufts University in 1965 with a concentration in economics and political science. In 1966 he earned an M.A. and, in 1970, a Ph.D. in international economics from the Fletcher School of Law and Diplomacy.
CISAC Conference Room
Robert Hormats
Under Secretary of State for Economic, Energy, and Agricultural Affairs
Speaker
Seminars
Making Carbon Offsets Work in the Developing World: Lessons from the Chinese Wind Controversy
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The Clean Development Mechanism (CDM) is the leading international carbon market and a driving force for sustainable development globally. But the eruption of controversy over offsets from Chinese wind power has exposed cracks at the core of how carbon credits are verified in developing economies. It has become almost impossible to determine whether offsets from Chinese wind are "additional" and that they in fact represent "real" reductions beyond business as usual. Unless this problem can be resolved, it threatens to spread beyond wind in China and could threaten the ability of carbon markets to deliver the mitigation demanded by international climate policy.
In 2009 the CDM Executive Board (EB) shocked the carbon market by forcing an unprecedented review of whether multiple Chinese wind projects satisfied UNFCCC additionality requirements. CDM investors reeled as the safest CDM bet became the riskiest; the Chinese government publicly criticized the UN's oversight of carbon markets; and the CDM EB prepared itself for an unprecedented fight over how carbon offsets could be verified in the world's largest CDM market.
At the center of the controversy is the Chinese power tariff for wind.
When the EB observed decreases over time in power tariffs granted by China's National Development and Reform Commission (NDRC) to wind projects, it became concerned that China might be manipulating power tariffs in order to guarantee additionality and subsidize its domestic wind development with international finance. If the Chinese government were controlling additionality, then the CDM's ability to validate carbon offsets would be dealt a near‐lethal blow because the problems posed by Chinese wind extend to nearly all power sector projects in almost every developing country. If offsets cannot be credibly verified, then the integrity of emissions caps set by the Kyoto Protocol is directly threatened.
The Chinese wind controversy therefore has direct implications for the design and negotiation of any successor to the Kyoto Protocol. Despite largely failed negotiations in Copenhagen, the design of reliable, efficient carbon markets remains the world's most serious prospect for international cooperation. The developed world has committed USD 30 billion in climate aid by 2012, but the majority of these funds will likely have to be private capital delivered through markets. In order for carbon markets to avoid controversy and function effectively, the lessons from the Chinese wind controversy must be used to implement key reforms.
This report examines the application of additionality in the Chinese wind power market and draws implications for the design of effective global carbon offset policy. It demonstrates the causes of the wind power controversy, highlights underlying structural flaws in how additionality is applied in China, and charts a reform path that can strengthen the credibility of global carbon markets.
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Program on Energy and Sustainable Development Working Paper #90
Testifying on Capitol Hill will be a unique experience for Toyota execs, according to Shorenstein APARC scholar
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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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The Recent Subtraction and Prospects of Addition of Democracy in Russia - Can They at Last Get Right What We All First Got Wrong?
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Exploring The Myths Of Japanese Entrepreneurship
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Long before the current global economic crisis, Japan adopted important reforms in commerce, corporate governance, finance, and education. These changes stemming from the 1990s "lost decade" have created new opportunities for entrepreneurial activity.
Following a presentation of new cross-sectional data on 60,000 operating Japanese corporations started in the last decade, the panel will discuss the state of Japanese entrepreneurship. What companies are forming? Who is behind them? What are their potential fates?
This discussion is part of continuing research being undertaken by SPRIE's Stanford Project on Japanese Entrepreneurship and is presented in conjunction with Entrepreneurship Week at Stanford.
About the Panelists
Richard Dasher
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Kenji E. Kushida is a Graduate Researcher at the Berkeley Roundtable on the International Economy (BRIE) and a PhD candidate in the Department of Political Science at University of California Berkeley.
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Bechtel Conference Center
Richard Dasher
U.S.-Asia Technology Management Center
School of Engineering
Stanford, CA
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Consulting Professor
At Stanford University, Dr. Dasher has directed the US-Asia Technology Management Center since 1994, and he has been Executive Director of the Center for Integrated Systems since 1998. He holds Consulting Professor appointments at Stanford in the Departments of Electrical Engineering (technology management), Asian Languages and Cultures (Japanese business), and at the Asia-Pacific Research Center for his work with the Stanford Program on Regions of Innovation and Entrepreneurship. He is also faculty adviser to student-run organizations such as the Asia-Pacific Student Entrepreneurship Society and the Forum for American/Chinese Exchange at Stanford.
From 2004, Dr. Dasher became the first non-Japanese person ever asked to join the governance of a Japanese national university, serving a term as a Board Director (理事) of Tohoku University . He continued as a member of the Management Council (経営協議会) until March 2010, and he now serves as Senior Advisor to the President (総長顧問) of Tohoku University. Dr. Dasher has been a member of the high-profile Program Committee of the World Premier International Research Center Initiative (WPI) of the Japanese Ministry of Education (MEXT) since 2007. He has served on the Multidisciplinary Assessment Committee of the C$500 million Canada Foundation for Innovation Leading Edge Fund in 2007 and again in 2010, and as a member of the Phase I and Phase II Review Panels of the C$200 million Canada Excellence Research Chairs Program in 2008 and again in 2010. He was a distinguished reviewer of the Hong Kong S.A.R. study on innovation in 2008–09, and since 2007 he has been a member of the Foresight Panel of the German Ministry of Education and Research. From 2001–03, Dr. Dasher was on the International Planning Committee advising the Japanese Minister of State for Science and Technology Policy in regard to the formation of the Okinawa Institute of Science and Technology.
As allowed by Stanford policy, Dr. Dasher maintains an active management consulting practice, through which he is an advisor to start-up companies and large firms in the U.S., Japan, and China. He has been a board director of Tokyo-based ZyCube Inc. since 2006, and he is founder and chairman of Pearl Executive Shuttle in Valdosta, Georgia, U.S.A. In the non-profit sector, he is a Board Director of the Japan Society of Northern California and the Keizai Society U.S. – Japan Business Forum, and he is an advisor to organizations such as the Chinese Information and Networking Association, the Silicon Valley – China Wireless Technology Association, and the International Foundation for Entrepreneurship in Science and Technology (iFEST). In 2010 he served as a consultant to The Indus Entrepreneurs (TiE) in regard to their establishment of a worldwide remote mentoring program for entrepreneurs. Dr. Dasher frequently gives speeches and seminars throughout Japan and Asia, as well as in the U.S. Recent appearances include the Nikkei Shimbun Business Innovation Forum, the Foreign Correspondents Club of Japan, speaking tours of Japan co-sponsored by METI and the U.S. Embassy in Tokyo, and guest lectures at Chubu University, Kochi University of Technology, Ritsumeikan Asia Pacific University, and the University of Tokyo.
From 1990–93, Dr. Dasher was a board director of two privately-held Japanese companies in Tokyo, at which he developed new business in international licensing of media rights packages and other intellectual properties. From 1986–90, he was Director of the U.S. State Department’s Foreign Service Institute advanced field schools in Japan and Korea, which provide full-time language and area training to U.S. and select Commonwealth country diplomats assigned to those countries. He received M.A. and Ph.D. degrees in Linguistics from Stanford University and, along with Prof. Elizabeth Closs Traugott, he is co-author of the often-cited book Regularity in Semantic Change (Cambridge University Press, 2002). He received the Bachelor of Music degree in clarinet and orchestra conducting from the San Francisco Conservatory of Music, where he served on the faculty from 1978-85.
Robert Eberhart
Panelist
Shigeo Kagami
Professor and General Manager
Panelist
Science Entrepreneurship and Enterprise Development, University of Tokyo
Kenji Kushida
BRIE Fellow
Panelist
UC Berkeley
William F. Miller
Panelist
Allen Miner
Founder and General Partner
Panelist
Sunbridge Partners
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