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Over the post-Mao period, the Chinese state has radically cut back its role in funding health services and insuring its citizens against the costs of ill health. Using an analytical framework drawn from studies of state retrenchment in industrialized democracies and in post-communist Eastern Europe, Jane Duckett argues that the state’s retreat from health in China was not a simple consequence of economic policies and market reform. Just as important were the influences of health policies, reform era political institutions, communist party ideology, and bureaucratic stakeholders. Through her analysis, Duckett maintains that by studying retrenchment in China, the world’s most populous nation and now a major global economic power, we can better understand international transformations in the role of the state, and the politics that shape that role. The Chinese State’s Retreat from Health both extends research on retrenchment politics to a major authoritarian state and contributes to piecing together understanding of the Chinese state’s changing role across the economy and other social policies, including housing and education. It will be of interest to students and scholars of Chinese politics, social policy and the Chinese health care system, as well as to those with a comparative interest in health, welfare states and the politics of retrenchment. Jane Duckett is Professor of Chinese and Comparative Politics at the University of Glasgow, UK.
The eminent China scholar delivers a landmark study of Chinese culture’s relationship to the natural environment across thousands of years of history. Spanning the three millennia for which there are written records, The Retreat of the Elephants is the first comprehensive environmental history of China. It is also a treasure trove of literary, political, aesthetic, scientific, and religious sources, which allow the reader direct access to the views and feelings of Chinese people toward their environment and their landscape. China scholar and historian Mark Elvin chronicles the spread of the Chinese style of farming that eliminated elephant habitats; the destruction of most of the forests; the impacts of war on the landscape; and the re-engineering of the countryside through gigantic water-control systems. He documents the histories of three contrasting localities within China to show how ecological dynamics defined the lives of the inhabitants. And he shows that China in the eighteenth century was probably more environmentally degraded than northwestern Europe around this time. Indispensable for its new perspective on long-term Chinese history and its explanation of the roots of China’s present-day environmental crisis, this book opens a door into the Chinese past.
This multifaceted book examines the free market reform of the Chinese healthcare system in the 1980s and the more collectivist or socialist counter-reforms that have been implemented since 2009 to remedy some of the problems introduced by marketization. The book is based on an ethnographical study in a Chinese county from 2011 to 2012, which investigated local people’s experience of healthcare reforms and the various ways in which they have adapted their own behavior to the constraints and opportunities introduced by these reforms. It provides a vivid depiction of the morality and emotionality of people’s experiences of the Chinese healthcare system and the myriad frustrations and sometimes desperation it induces not only among patients with significant health problems and their families, but also healthcare practitioners caught between their desire to do right by their patients and the penalties they personally incur if they do not adhere to institutionalized cost-saving measures. The people’s experiences within China’s health sector presented reflect many similar experiences in the wider Chinese society. The book is thus a valuable resource for researchers and graduate students interested in China’s healthcare reforms and scholars concerned with issues of contemporary Chinese society.
This comprehensive volume reviews recent scholarship regarding the role of the state in economic development. With a wide range of case studies of both successful and failed state-led development, the authors push the analysis of the developmental state beyond its original limitations and into the 21st century. New policies, institutional configurations, and state-market relations are emerging outside of East Asia, as new developmental states move beyond the historical experience of East Asian development. The authors argue for the continued relevance of the ‘developmental state’ and for understanding globalization and structural transformation through the lens of this approach. They further this concept by applying it to analyses of China, Latin America, and Africa, as well as to new frontiers of state-led development in Japan and the East Asian developmental states. This book expands the scope of research on state-led development to encompass new theoretical and methodological innovations and new topics such as governance, institution building, industrial policy, and the role of extractive industries. This book was originally published as a special issue of the journal Third World Quarterly.
This book looks at how NGOs, social organizations, business associations, trade unions, and religious associations interact with the state, and explore how social actors have negotiated the influence of the state at both national and local levels, and examines how a corporatist understanding of state-society relations can be reformulated, as old and new social stakeholders play a greater role in managing contemporary social issues. In turn, the book goes on to chart the differences in how the state behaves locally and centrally, and finally discusses the future direction of the corporatist state.
Especially since the 2003 SARS crisis, China’s healthcare system has become a growing source of concern, both for citizens and the Chinese government. China’s once praised public health services have deteriorated into a system driven by economic constraints, in which poor people often fail to get access, and middle-income households risk to be dragged into poverty by the rising costs of care. The New Rural Co-operative Medical System (NRCMS) was introduced to counter these tendencies and constitutes the main system of public health insurance in China today. This book outlines the nature of the system, traces the processes of its enactment and implementation, and discusses its strengths and weaknesses. It argues that the contested nature of the fields of health policy and social security has long been overlooked, and reinterprets the NRCMS as a compromise between opposing political interests. Furthermore, it argues that structural institutional misfits facilitate fiscal imbalances and a culture of non-compliance in local health policy, which distort the outcomes of the implementation and limit the effectiveness of insurance. These dynamics also raise fundamental questions regarding the effectiveness of other areas of the comprehensive New Health Reform, which China has initiated to overhaul its healthcare system.
This book examines the introduction and ongoing development of public medical care insurance in contemporary China. Based on extensive field investigations, residents’ surveys and analyses by local policy experts and practitioners it provides a comparative analysis of the marketization of public policy in China in contrast to those in other countries, such as the United Kingdom and Germany. The book highlights system-specific issues of the centrally planned economy (CPE) during economic reform, such as alienation of entitlements from funding and historically rooted obligations in the realm of public policy, and as such fills the gap in research on the Chinese government’s public financial management. Public Policy and Health Care in China will appeal to students, academics and researchers interested in public policy and health care in China, as well as Chinese society and economics more broadly.
China’s current social medical insurance system has nominally covered more than 95 per cent of 1.4 billion population in China and is moving towards the ambitious goal of universal health insurance coverage. Challenges posed by a rapidly ageing population, an inherently discriminatory design of the health insurance system, the disorder of drug distribution system and an immature legal system constrain the Chinese government from realizing its goal of universal health insurance coverage in the long run. This book uses a refined version of historical institutionalism to critically examine China's pathway to universal health insurance coverage since the mid-1980s. It pays crucial attention to the processes of transforming China's healthcare financing system into the basic social medical insurance system alongside rapid socio-economic changes. Financing Healthcare in China will interest researchers and government and think-tank officials interested in the state of healthcare reforms in China. Healthcare specialists outside of East Asia may also be interested in its general study of healthcare in developing countries. Scholars and students interested in the healthcare field will also find this useful.
Presenting a comprehensive examination of China’s medical care system, this book tackles issues of policymaking, organization, management and financing in the context of the provision of affordable care in China. Making use of extensive field investigations, interviews and a thorough analysis of documents, this book examines the re-structuring of the medical care system, spanning more than three and half decades from 1979 to the present day. Assessing the difficulties of regulatory control in the health care sector, it also explores theoretical alternatives, including post-Weberian constructs of uncertainty and control, as well as franchise and asymmetric information in market transactions. Ultimately, it argues that patient medical care has become less and less affordable amid shrinking government subsidies, breakdowns of public insurances and increases in user charges, especially between the mid-1990s and mid-2000s. Whilst the government took decades to re-organize the public hospital system and rebuild public insurances, it faced a dilemma of enforcing both low-cost medical care and maintaining revenue flow to public hospitals through marketization. Re-engineering Affordable Care Policy in China provides extensive discussion of the policymaking process as well as detailed analysis of policy contents. As such, it will be invaluable to students and scholars of Chinese social policy and public administration, as well as Chinese Studies more generally.
This book empirically examines health care financing reforms and popular responses in three major cities in East Asia: Shanghai, Singapore, and Hong Kong. It adopts a new revised version of the theory of historical institutionalism to compare and explain the divergent reform paths in these three places over the past three decades. It also examines forces that propel institutional change. The book provides three detailed case studies on the development of health care financing reforms and the politics of implementing them. It shows that health care systems in Shanghai, Singapore, and Hong Kong were the products of Western presence in the nineteenth century. It illustrates how greater attention is paid to the roles played by ideas, actors, and environmental triggers without abandoning the core assumptions that political institutions and policy feedback remain central to impact health care financing reforms. It shows that health care financing reform is shaped by a complex interplay of forces over time. It also provides the most updated material about health care financing reforms in Shanghai, Singapore, and Hong Kong. The central argument of this book is that health care financing reform is both an evolving process responding to changing circumstances and a political process revealing an intricate interplay of power relationships and diverse interests. It shows that institutional changes in health care financing system can be incremental but transformative in nature. It argues that social policies will continue to develop and welfare states will continue to adapt and evolve in order to cope with new risks and needs. This book sheds new lights on understanding the politics of health care financing reform and sources and modes of institutional change.