Note: This talk is also offered as a virtual webinar on April 4 at 6 p.m.

International procurement institutions have played an important role in drug supply. This paper studies price, delivery, and procurement lead time of drug supply for major infectious diseases (antiretrovirals, antimalarials, antituberculosis, and antibiotics) in 106 developing countries from 2007-2017 across four procurement institution types. We find that pooled procurement institutions lower prices: pooling internationally is most effective for small buyers and more concentrated markets, and pooling within-country is most effective for large buyers and less concentrated markets. Pooling can reduce delays, but at the cost of longer anticipated procurement lead times. Finally, pooled procurement is more effective for older-generation drugs, compared to intellectual property licensing institutions that focus on newer, patented drugs. We corroborate the findings using multiple identification strategies, including an instrumental variable strategy, the Altonji-Elder-Taber-Oster method, and reduced-form demand estimation. Our results suggest that the optimal mixture of procurement institutions depends on the trade-off between costs and urgency of need, with pooled international procurement institutions particularly valuable when countries can plan well ahead of time.

Coauthor: Nahim Bin Zahur (Queen’s University).

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Dr. Lucy Xiaolu Wang is a tenure-track Assistant Professor at University of Massachusetts Amherst, a Faculty Research Fellow at the Max Planck Institute for Innovation and Competition, Germany, and a Faculty Associate at the Canadian Centre for Health Economics. Her research focuses on the economics of innovation & digitization in health care markets (national and global), particularly in the biopharmaceutical and digital health industries. Dr. Wang earned her PhD in economics from Cornell University, her master’s degree in economics from Duke University, and her bachelor’s degree in applied economics (specialty: insurance) from Central University of Finance and Economics in Beijing, China. 

Note: This talk is also offered as an in-person seminar on April 5 at 12 p.m.

International procurement institutions have played an important role in drug supply. This paper studies price, delivery, and procurement lead time of drug supply for major infectious diseases (antiretrovirals, antimalarials, antituberculosis, and antibiotics) in 106 developing countries from 2007-2017 across four procurement institution types. We find that pooled procurement institutions lower prices: pooling internationally is most effective for small buyers and more concentrated markets, and pooling within-country is most effective for large buyers and less concentrated markets. Pooling can reduce delays, but at the cost of longer anticipated procurement lead times. Finally, pooled procurement is more effective for older-generation drugs, compared to intellectual property licensing institutions that focus on newer, patented drugs. We corroborate the findings using multiple identification strategies, including an instrumental variable strategy, the Altonji-Elder-Taber-Oster method, and reduced-form demand estimation. Our results suggest that the optimal mixture of procurement institutions depends on the trade-off between costs and urgency of need, with pooled international procurement institutions particularly valuable when countries can plan well ahead of time.

Coauthor: Nahim Bin Zahur (Queen’s University).

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Dr. Lucy Xiaolu Wang is a tenure-track Assistant Professor at University of Massachusetts Amherst, a Faculty Research Fellow at the Max Planck Institute for Innovation and Competition, Germany, and a Faculty Associate at the Canadian Centre for Health Economics. Her research focuses on the economics of innovation & digitization in health care markets (national and global), particularly in the biopharmaceutical and digital health industries. Dr. Wang earned her PhD in economics from Cornell University, her master’s degree in economics from Duke University, and her bachelor’s degree in applied economics (specialty: insurance) from Central University of Finance and Economics in Beijing, China. 

The Center on Democracy, Development and the Rule of Law and the Freeman Spogli Institute for International Studies at Stanford University are pleased to welcome social justice and environmental activist Kumi Naidoo to deliver the 2024 Payne Distinguished Lecture Series in International Relations Theory and Practice.

As we veer ever closer to a global climate catastrophe, it has become clear that incremental tinkering with our systems — including political, environmental, social, and economic systems — will not be an adequate solution. Drawing on Martin Luther King’s idea of Creative Maladjustment, this lecture will argue that rather than responding to the polycrisis with an approach of system recovery, maintenance, and protection, what is urgently needed now is system innovation, redesign, and transformation.

It is imperative that we change the trajectory we are on as a species. Yet activism is failing to win at the scale and speed necessary to do so. The communications deficit that must be addressed by those seeking transformative change will likely need to be multilayered and imbued with intersectionality. This lecture posits the power of artivism — a fusion of art and activism — as a vital force capable of resonating with diverse audiences, instilling a sense of urgency, and fostering various pathways for participation. At this critical juncture, pessimism is a luxury we simply cannot afford. The pessimism that flows from our analysis, observations, and lived realities can best be overcome by the optimism of our thoughts, actions, and creative responses.

The Payne Lectureship is named for Frank E. Payne and Arthur W. Payne, brothers who gained an appreciation for global problems through their international business operations. Their descendants endowed the annual lecture series at the Freeman Spogli Institute for International Studies in order to raise public understanding of the complex policy issues facing the global community today and to increase support for informed international cooperation.

The Payne Distinguished Lecturer is chosen for his or her international reputation as a leader, with an emphasis on visionary thinking; a broad, practical grasp of a given field; and the capacity to clearly articulate an important perspective on the global community and its challenges.

ABOUT THE SPEAKER

Kumi Naidoo is a prominent South African human rights and environmental justice activist. At the age of fifteen, he organized school boycotts against the apartheid educational system in South Africa. His courageous actions made him a target for the Security Police, leading to his exile in the United Kingdom, where he remained until 1990. Upon his return to South Africa, Kumi played a pivotal role in the legalization of the African National Congress in his home province of KwaZulu Natal.

Kumi also served as the official spokesperson for the Independent Electoral Commission (IEC), responsible for overseeing the country's first democratic elections in April 1994. His dedication to democracy and justice led to notable international roles, including being the first person from the global South to lead Greenpeace International as Executive Director from 2009 to 2016. He later served as the Secretary General of Amnesty International from 2018 to 2020.

In the realm of education, Kumi has shared his expertise, lecturing at Fossil Free University and holding a Richard von Weizsäcker Fellowship at the Robert Bosch Academy until early 2022.

Currently, Kumi serves as a Senior Advisor for the Community Arts Network (CAN). He holds the position of Distinguished visiting lecturer at Stanford University’s Center on Democracy, Development and the Rule of Law, and is a Professor of Practice at the Thunderbird School of Global Management at Arizona State University. Additionally, he continues to represent global interests as a Global Ambassador for Africans Rising for Justice, Peace, and Dignity. He also holds positions as a Visiting Fellow at Oxford University and an Honorary Fellow at Magdalen College.

In a testament to his family's commitment to positive change, they have established the Riky Rick Foundation for the Promotion of Artivism, honoring the legacy of their son and brother, the now late South African rapper Rikhado “Riky Rick” Makhado through a commitment to supporting artivism and mental health in South Africa.

Kumi has authored and co-authored numerous books, the most recent being Letters To My Mother (2022), a personal and professional memoir that won the HSS 2023 non-fiction award by the National Institute Humanities and Social Sciences.

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Dan Zeltzer is currently a Koret Visiting Assistant Professor at the Department of Economics and SIEPR, Stanford University (2023-2024), and a Senior Lecturer with tenure at The Berglas School of Economics, Tel Aviv University. Zeltzer's research explores the intersections of Health Economics, Networks, and Machine Learning. His scholarly contributions include telemedicine, digital health technologies, end-of-life spending, and physician networks as moderators of technology diffusion and gender homophily in patient referrals. Zeltzer received his BSc in Mathematics from Tel Aviv University and completed his PhD in Economics at Princeton University.

Talk Abstract: This seminar will feature three papers examining the impacts of enhanced access to health care through telemedicine and urgent care centers. Utilizing Israeli data, the first two papers explore how the adoption of telemedicine and its augmentation with digital devices affect healthcare utilization and cost. The third paper investigates how the entry of urgent care centers into local markets influences primary care utilization and antibiotics prescribing for Medicare beneficiaries. Together, these studies provide insights into the impacts of healthcare delivery innovations on care provision, utilization, and costs.

Here are links to the first two papers (the third paper, Urgent Care Center Entry and Antibiotics Prescribing is still in draft:

The Impact of Increased Access to Telemedicine

Adoption and Utilization of Device-Assisted Telemedicine

Co-sponsored by Peking University Institute for Global Health and Development, and the Asia Health Policy Program

Pakistan followed the example of many large Asian countries and started introducing publicly financed health insurance under the so-called "Sehat Sahulat Program" (SSP) from 2015 onwards. The SSP initially covered hospitalization expenses for poor households in selected districts and by now covers millions of households all over Pakistan. This talk explains the recent reforms, focusing on information barriers to utilizing the SSP. In particular awareness about coverage seems to be a key issue, making the system not easy to navigate for poor households. A first study shows that education plays an important role for successfully utilizing health care under the scheme in this context. Information and awareness about financial protection, however, is only one element of health care decisions. Even if beneficiaries know which household members are covered under which condition in which facility, they might still be unsure about where treatment is most appropriate given their medical condition. A second study thus provides theoretical and empirical evidence on how incomplete financial and medical information jointly affect health provider choices, and how this might explain limited health service utilization under the SSP.

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Andreas Landmann is a Full Professor of Development Economics at the Friedrich-Alexander University (FAU) Erlangen-Nürnberg where he uses applied econometrics and behavioral research in the area of development economics. A lot of his work investigates insurance in low-income countries, with a special focus on health. In particular, he analyzes different impact evaluations on health insurance provision in Pakistan. Additionally, he is interested in decisions under risk and uncertainty, as well as prosocial preferences. He conducted several large-scale impact evaluations, randomized control trials, and behavioral experiments in the Philippines, Germany, Vietnam, China, and Pakistan, all of them including primary data collection. Prior to joining the FAU, he held research positions at the University of Göttingen, the Paris School of Economics, and the University of Mannheim, from where he also holds a PhD.