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Four Worlds of Welfare: Understanding Subnational Variation in Chinese Social Health Insurance

Published online by Cambridge University Press:  23 April 2015

Xian Huang
Xian Huang*
Affiliation:
Political Science Department of Columbia University. Email address: xh2128@columbia.edu.
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Abstract

China's social health insurance has expanded dramatically over the past decade. The increasing number of beneficiaries and benefits, however, has aggravated rather than mitigated regional disparities in health care. How can the regional variation in Chinese social health insurance be explained? This paper argues that the subnational variation in China's social health insurance results from the policy choices of central and local states. The central leadership, which is concerned about regime stability, delegates substantial discretionary authority to local state agents to accommodate diverse social needs and local circumstances. Local officials, who care about their political careers in the centralized personnel system, proactively design and implement social health insurance policy according to local situations such as fiscal resources and social risk. In specifying the rationale, conditions and patterns of regional variation in Chinese social health insurance, this paper addresses the general issue of how political leaders in an authoritarian regime respond to social needs.

摘要

中国社会医疗保险在过去的十二年里迅速发展, 取得了显著的进步。但是, 医疗保险覆盖面的迅速扩大和医疗保险项目的增加并没有减轻, 反而增大了医疗保险地区间的差异。这些地区差异体现在哪些方面, 是由什么因素造成的? 本文指出, 中国社会医疗保险的地区差异可以通过中央与地方互动的角度来解释: 中央政府出于维护社会稳定和因地制宜的目的将医疗保险政策的决策权下放给地方政府; 尽职尽责的地方官员会根据地方具体情况, 尤其是地方政府财政能力和地方人口风险结构, 并结合中央的政策框架或建议来制定医疗保险政策; 所以, 不同的地方社会经济条件引起了中国社会医疗保险政策明显的地区差异。本文通过阐释和实证中国社会医疗保险背后的政治经济逻辑, 也反映了威权政府如何在政策制定中响应社会的需要

Keywords

social welfareChinahealth insurancesubnational variation社会福利医疗保险地区差异
Type
Articles
Information
The China Quarterly , Volume 222 , June 2015 , pp. 449 - 474
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Copyright © The China Quarterly 2015 

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