Internship experience at the Milken Institute, Asia Center

LKYSPP Internship Program – Written Article

Name: Jansen Tham

The Milken Institute is a global non-profit, nonpartisan economic think tank that aims to enhance global prosperity and advance affordable healthcare for all. Other than the Asia Center based in Singapore, the Institute has seven other centers, namely: California Center, FasterCures, Center for Financial Markets, Center for the Future of Aging, Center for Jobs and Human Capital, Center for Public Health and Center for Strategic Philanthropy.

Each center has its own domain expertise and focuses on different key issues. For example, the Center for the Future of Aging looks at aging preparedness in developed (e.g. US) and developing (e.g. China) nations. By conducting research and gathering demographic data on these nations, the Centre charts the future of aging and how nations/states can implement policies that would mitigate the economic impact of aging, while allowing elders to age gracefully and reduce the burden on healthcare systems. As a non-profit think tank, it does not lobby governments to pursue the policies or strategies it has laid out, but actively engages state and private sector actors to hear from them the potential challenges and impediments to change. The Institute’s role, as a convener allowing organizations from different sectors to come together and discuss complex issues, is valuable as a platform for no-holds-barred conversations among people that would not have met if not for the Institute.

Another example is the Center for Strategic Philanthropy, whom I worked closely with during my internship (see Section 4 below). This Center develops plans to use philanthropic funds more efficiently toward specific causes such as finding potential cures to cystic fibrosis or melanoma. Instead of the conventional aims of philanthropy, which is that donors give money to organizations or people to help them foot the medical bill for illnesses, the Center thinks of strategies to move funding upstream by incentivizing private investment in high-potential drugs that lack the funding to make it to the clinical trial phase. In essence, the Center conducts research on ways to make a greater philanthropic impact on healthcare than simply donating money to charities or foundations.

The Asia Center, where my internship was, is the outpost of the Institute in Asia. It operates out of Singapore to other Southeast and Northeast Asian countries. It has conducted and is conducting research projects on healthcare and infrastructure financing in Philippines, Vietnam, China and Indonesia, and takes a keen interest in the development of capital markets in Myanmar after the lifting of US sanctions following Myanmar’s shift to democratic rule. Other than these research projects, the Asia Center holds an annual flagship conference named the Asia Summit, inviting speakers and participants from many fields and industries including fintech, artificial intelligence, aging, health technology and cybersecurity to speak at the conference. About 5,000 private and public sector leaders attend the summit, which is scheduled on 13-15 September this year.

I was given three core tasks during my four-month internship at the Asia Centre. My primary responsibility was to lead the research and manage the administration for a project aimed at mitigating China’s skyrocketing lung cancer mortality rate. The end goal was to develop implementation strategies and financing mechanisms to improve uptake of lung cancer screening and allow patients to have better and more affordable access to lung cancer treatment.

The work included:

1. Conducting desktop research on the state of lung cancer in China, and on existing programs that help to improve screening uptake, and treatment affordability and accessibility;
2. Searching for Chinese stakeholders knowledgeable about lung cancer and who are in positions to make changes to government policy or private sector practices to improve financing of lung cancer screening and treatment. This involves collating lists of stakeholders, contacting them for tele-conversations or face-to-face meetings, and translating our research into Chinese to explain what the Institute is aiming to do in China;
3. Identifying a specific Chinese city to act as a test-bed for the strategies we have developed. This involves speaking with senior Chinese government officials who are often skeptical about non-profit organizations and persuading them of the need to explore solutions to this public health crisis, and coming up with criteria to determine the city where the test-bed should be conducted;
4. Managing the administration for study trips to China to meet stakeholders, culminating in a Financial Innovations Lab in April 2018 that brings together key stakeholders to discuss the problem of lung cancer and ways to mitigate the high mortality rates using innovative finance mechanisms. Stakeholders include Chinese government officials, charity foundations, capital and institutional investors, banks, insurance companies, international organizations (World Health Organization, World Bank and International Finance Corporation), healthcare academics and practicing healthcare professionals/administrators;
5. Developing innovative financing mechanisms from literature research, and modifying them to suit the Chinese context. These form background knowledge prior to the Institute’s engagement with stakeholders to understand the feasibility of implementing them in China;
6. Managing relations with project sponsors and subject matter experts from the other Centers in Milken Institute, such as the Center for Strategic Philanthropy and Center for Financial Markets. As the other Centers are based in the US and none of the other research staff understood Chinese, I was the main point of contact between the Institute and our Chinese stakeholders, responsible for explaining our research objectives and what the Institute was keen to accomplish in China.

My second task was to work on the project administration for a recently completed Financial Innovations Lab on infrastructure financing in Manila, Philippines. When I entered the Institute, the project was at its tail end of the research phase and I took over engagement with key stakeholders (e.g. senior management from banks, institutional investors, infrastructure firms, government agencies like the Department of Finance and Department of Transport, consultancy companies, World Bank and its investment arm the International Finance Corporation) as well as reviewing the presentation slides that were to lead the discussion between these stakeholders. The project was about how to leverage innovative finance mechanisms to resolve the problems with infrastructure financing in Manila, as there were insufficient public funds available to build important infrastructure like roads, pipelines, ports and airports that would stimulate investment and growth in the Philippines. The project revolved around the pros and cons of Public-Private Partnerships against Overseas Development Assistance from foreign nations such as China and Japan. I worked closely with the other Milken Institute Centers and key stakeholders in ensuring the success of the Financial Innovations Lab and gaining buy-in for the financing recommendations from the Lab.

My third task was to assist the Business Development and Communications teams of the Asia Center in organizing the annual Asia Summit held in Singapore in September. This involved developing the content for the conference panel discussions (e.g. discussions on fintech, cybersecurity, China’s Belt and Road initiative, the rise of South Asia as an economic powerhouse etc), suggesting speakers for the Executive Director’s approval, inviting approved speakers, and liaising with the US Institute staff to invite speakers from the US and Europe. This work was nowhere near mundane although largely administrative; I had to read through very interesting articles on fintech and cybersecurity companies, and analyze the profiles of C-suite executives to assess their suitability to speak at the invite-only conference. I must say I learnt a fair bit about industries that I would otherwise not have researched into, and it was an eye-opener to learn about the blossoming future industries that would soon drive the global economy, such as artificial intelligence and fintech.

3. Internship program offered by Asia Centre

Other than the research work I undertook in Section 2, the Institute also developed a very robust and broad-based internship program for all interns, including myself. The program included:

1. Exposure talks with the Institute’s Young Leaders’ Circle (YLC)
   The Institute engages and periodically invites young professionals below 40 working in key appointments and slated for higher appointments in the private sector to fireside chats and discussions. For the internship program, some of these leaders were invited to give the interns an introduction into several topics; among others, how capital markets work, how should social enterprises seek seed funding for their ideas, how strategic philanthropy should be adopted to maximize the money that has been donated, the role of gold in investment markets, and so on. There were about 10 of such lunch-time exposure talks that shed light on some industries and sectors that I never knew existed prior to my internship at the Institute. Some of the prominent names who delivered these talks included: Ambassador Curtis Chin, former US Ambassador to the Asian Development Bank (ADB); Mr Don Lacey, Managing Director of Citibank and Head of Insurance Asia-Pacific; and Mr Steve Okun, Board of Directors for the American Chamber of Commerce (AmCham) in Singapore. These talks were useful from the exposure perspective, as they offered insights into a sphere beyond public policy that I was unaware of.
2. Opportunities to speak with renowned private sector C-suite management
   These were more formal occasions the Milken Institute organized, bringing together their YLC members with senior C-suite management from the private sector. I had the pleasure of meeting and hearing from Mr Gregory Gibb, the CEO of the largest fintech company in China valued at US$18 billion. It is owned mainly by Ping An Insurance, the largest private insurance company in China. These opportunities allowed me to ask questions freely about the matter closest to my heart – how can the private and public sectors collaborate to bring about greater societal good for the public? Contrary to popular belief, private sector corporations are not only concerned with the bottom-line of profit-making, but also about investing in the public good. The Institute works on bridging this public-private collaboration gap by bringing in private capital to try and solve public problems, such as healthcare, aging and unemployment.
3. Fireside chats with Milken Institute global senior management
   In the time I was with the Institute, I had the opportunity to meet and engage many of its global senior management team. This included the President and Chief Operating Officer, Mr Richard Ditizio; Chief Executive Officer, Mr Michael Klowden, Executive Director for the Centre of Strategic Philanthropy, Ms Melissa Stevens and Managing Director for Research, Mr Perry Wong. I was personally interested in the strategic direction of the Institute in Asia and whether it was intending to do more in Asia, since this was the part of the world where many countries still lack access to capital markets, have poor healthcare systems and yet are facing aging populations. Some of my learning points from having fireside chats with them are in the following Section 4.
4. Representing the Institute at public and closed-door forums
   I also represented the Institute at several events organized by NUS and AmCham, primarily due to my interest in geopolitics and the Singapore government. These included fireside chats and lectures with the Chairman and CEO of The Asia Group and former Assistant Secretary of State for East Asian and Pacific Affairs, Mr Kurt Campbell, a closed-door lecture by Visiting Professor for Political Science Lowell Dittmer, and a talk on cyber-security and government communications by Permanent Secretary of the Ministry of Communications and Information, Mr Gabriel Lim. I also attended a working lunch organized by AmCham with a delegation of senior US Congressional staffers discussing US-Singapore trade relations and policy, and ways to further strengthen economic relations with Singapore and the region. These were often paid and/or exclusive events and I was fortunate to be sponsored by the Institute to attend.
5. Meetings with and reaching out to key stakeholders
   In the course of my work, my direct supervisor, Ms Belinda Chng, also brought me to meetings with key healthcare stakeholders based in Singapore, among them senior management of the National Cancer Centre and locally-based pharmaceutical companies like Johnson and Johnson and Merck. These were important in my understanding of how the healthcare ecosystem worked in Singapore beyond a government-focused view, which was admittedly very narrow. In fact, there are many people and organizations working silently behind the scenes to ensure that people get top-quality healthcare when they visit clinics and hospitals, and that pharmacies are always stocked with subsidized drugs. Beyond the government, the non-profit sector and the pharmaceutical companies are working to support the healthcare system and make sure prices are kept low and affordable for patients.
6. Team-building
   Other than the research work and participating in the internship events drawn up for us, interns were also invited to participate in team-building events. As a small economic thinktank in Singapore, the Institute actively builds cohesiveness and encourages sharing of ideas, no matter how silly it may seem at first glance. Bureaucracy is non-existent with a very flat reporting structure from intern to the Executive Director. The whole Center participated in a cook-off team-building event in July, where we were divided into teams to cook pre-arranged dishes taught by a professional cook. It was interesting and rather fun to see how foreigners (since several of the team members were Americans, Chinese and Filipino) cooked Singaporean dishes, and the interaction added a layer of familiarity with each other when the event ended (photos in Section 6).
4. Key lessons gleaned

The following summarizes my key learnings from this internship at the Milken Institute, Asia Center:

1. Role of public-private partnerships (PPP) in healthcare and infrastructure financing: In many countries, Singapore included, the demands of the population are so large that it is very difficult for public funds to keep up with diverse needs such as healthcare and infrastructure. This problem is particularly pertinent in Southeast Asia, since tax collection methods are not robust and this leads to a significant loss in public funds that are used to create such public goods. For example, in the Philippines, the government has set up a PPP Center to oversee PPP infrastructure projects, with investors coming in with billions of dollars to fund the building of infrastructure critical to enhance economic growth. However, the PPP method poses several challenges – the key of which is the structuring of private finance to incentivize investors to fund these projects, and projecting rates of return attractive to them. The failure to align incentives across the private and public sectors is arguably the largest impediment to further partnership. The current Philippine administration is now trying to reverse the trend of awarding more PPP contracts, by turning to Overseas Development Assistance (ODA) money from China and Japan instead. The latter poses geopolitical challenges considering that part of the ODA must be returned at some stage in future, and could be used as a card against the Philippines in bilateral negotiations over sensitive issues such as sovereignty.

   There is great potential for PPP in healthcare and infrastructure financing in Southeast Asia, especially with strained public budgets. There are innovative financing mechanisms out there that help to align incentives achieving a triple-win situation: investors get their investment back with a handsome return, governments deliver on their promise for better healthcare and infrastructure, and the public benefits from the public goods created. The problem appears to be a strong inertia to work with each other that is holding back collaboration due to a lack of trust between people from different organizations. Bringing them together to explain the advantages of PPP is the first step to enhancing cooperation, and a sustained effort is required to ensure continuity of PPP initiatives – a role the Institute tries to fulfil.

2. Role of non-profit organizations in delivering public good and potential for greater tri-sector partnership

   The Milken Institute is an example of a non-profit organization keen to deliver public good through its convening ability and research. There is a need for more research organizations and thinktanks to come to Asia, because there is a great deal of work that needs to be done to improve standards of living in Southeast Asia nations to the level of the developed nations. For example, Indonesia does not have a national vaccination program for basic vaccines that reduce disease among children, Myanmar does not yet have a credible capital market system although it has the potential to develop into an economic powerhouse for growth in Southeast Asia, and Vietnam and China are aging before they get rich. Given the diversity of cultures and problems here, there is no one-size-fit-all policy solution to issues, and solutions must be thought through carefully considering the context of the country in question. In summary, there is a lot of work left to be done and non-profit organizations can help in this process by delivering public good in a manner that governments cannot because of political pressures and realities.

   There is also great potential for tri-sector partnership in Southeast Asia. A very truncated partnership model is that the private sector provides the funding capital through investment and philanthropy, the public sector regulates and monitors capital flows while overseeing private investment and the implementation of projects, while thinktanks provide an unbiased, evidencebased view on issues that the government has no capacity to research on. This is certainly an oversimplification of the actual landscape, but it is clear from my internship at the Institute that each sector has a distinct role to play and should work together to cover each other’s weaknesses. The primary problem is the lack of trust and mutual suspicion on each other’s intentions - an issue prevalent in Asia. It takes time and a lot of effort to get governments to buy into the philosophy of tri-sector partnerships, and this process needs to be expedited. On the other hand, governments should understand the intentions of the private sector and thinktanks, and be more open to work with them.

3. Research in thinktanks versus research in an academic setting

   My last key learning is the difference between research in a thinktank and research in an academic setting. The former is a lot more application-based and focuses more on how to implement solutions and get things done, while the latter is more of assessing ideas that appear to work on paper based on models and paper analysis. One of the most common lines I heard at the Institute when I presented my collated desktop research from academics was: ‘Yes, but are these proposals implementable and realistic?’ Policy research needs to be more than analyzing datasets; a concerted effort must be made to understand the viewpoints of the people actually affected by the policy. For example, one of the surprising concerns of Indonesians when it came to taking vaccines was not whether they were affordable, but whether they were haram or halal. Similarly, one of the key concerns of people going for free lung cancer screening in China was that the screening centers were an entire day’s journey from the resident’s home, and he/she would lose both the day of income and pay for transportation and housing just to get screened in the city for free. These are observations and insights that would not have been discovered through desktop research. Just like government policy-makers cannot be making policy in an ivory tower, neither can academic research be done without interviewing people and understanding the real problems faced.

5. Conclusion

In all, I had a very productive summer at the Institute, although it is unfortunate that I will not be able to see through the China lung cancer project that I was spearheading to its completion. It afforded me a wider perspective on how NGOs and thinktanks form part of the ecosystem of policy-making, and how they contribute to the public good in their own way, quite distinct from the public or private sector. NGOs and thinktanks also face restrictions in the way they work, although they are quite different from the constraints the public and private sector face. Thinktanks cannot implement their policy recommendations; they can only advise governments and the private sector based on evidence, and this restricts their overall impact. Nonetheless, the Milken Institute seeks to be a convener of stakeholders and through their conferences and events, sensitize government and private sector leaders of their research and proposed solutions.

In conclusion, the most important takeaway for me from this internship is the need for greater collaboration across the three sectors. In Singapore, the NGO and thinktank landscape is not fully developed and there is insufficient collaboration – the public sector dominates in policy-making, sidelining the efforts of the private and NGO sectors in areas like social welfare and efficient financing structures. Greater cooperation would see the covering of each other’s deficiencies and ultimately lead to greater public good, which is the eventual goal of policy-making.

6. Internship photograph collection