Jane Duckett

Bureaucrats in Business, Chinese-Style: The Lessons of Market Reform and State Entrepreneurialism in the People's Republic of China

In the 1990s, parts of the state bureaucracy in China have been setting up new profit-seeking, risk-taking businesses. Some of these businesses are entrepreneurial rather than rent-seeking, and are an unplanned and unanticipated development in Chinas market-oriented economic reforms. What are the lessons of this phenomenon for the developing world? State entrepreneurialism may create problems such as reduced government control over departmental finance, loss of state assets, and uneven provision of services. It is nevertheless an innovative solution to the politically difficult problem of bureaucratic restructuring, and confounds the development orthodoxy, fostered by neoliberalism, that states will resist market reform. It also demonstrates that to understand fully the politics of market reform we must research the activities of subcentral state bureaucrats as well as central leaders and policymakers.

Political interests and the implementation of China's urban health insurance reform

During the 1980s and 1990s China has been experimenting with reform of its health insurance system. Based on a study of experimental schemes in several cities in eastern China in the late 1990s, this paper shows that the schemes’ main problems are due to the vested interests of enterprises, hospitals, officials, and other beneficiaries of the pre-reform system. Reform policy has been implemented slowly, and local health insurance schemes have (1) suffered from poor participation rates, and (2) had difficulties balancing contributions into local government-run pooled funds with expenditures needed for medical treatment. These problems threaten the viability of the national programme announced in late 1998. The solution lies in improving local government capacity through effective legislation and training, but this will be difficult to achieve.

The emergence of the entrepreneurial state in contemporary China

Abstract As market reform has progressed in China, state bureaux have adapted and become entrepreneurial. This contradicts expectations that states will either simply retreat in the face of encroaching markets to play a minimal role in the economy, or obstruct market‐oriented change through bureaucratic conservatism or rent‐seeking. This paper describes the state entrepreneurialism that has appeared in the Chinese city of Tianjin in the early 1990s and explains its emergence as the consequence of both market‐induced structural transformation and the resultant changing incentives and demands on officials. It proposes the ‘entrepreneurial state’ as a model of state adaptation to marketization and assesses its implications for both our conception of the developmental state and for anticipation of rent‐seeking and resistance to market reform.

Challenging the Economic Reform Paradigm: Policy and Politics in the Early 1980s' Collapse of the Rural Co-operative Medical System

Over the last two decades an economic reform paradigm has dominated social security and health research: economic reform policies have defined its parameters, established its premises, generated its questions and even furnished its answers. This paradigm has been particularly influential in accounts of the early 1980s collapse of China’s rural cooperative medical system (CMS), which is depicted almost exclusively as the outcome of the post-Mao economic policies that decollectivized agriculture. This paper draws primarily on government documents and newspaper reports from the late 1970s and early 1980s to argue that CMS collapse is better explained by a change in health policy. It shows that this policy change was in turn shaped both by post-Mao elite politics and by CMS institutions dating back to the late 1960s. The paper concludes by discussing how an explanation of CMS collapse that is centred on health policy and politics reveals the limitations of the economic reform paradigm and contributes to a fuller understanding of the post-Mao period.

China's social security reforms and the comparative politics of market transition

China has undergone market transition like the countries of central Europe, but under continued one-party rule rather than democratic politics. What have been the consequences for its social security system? Like the post-communist central European states, China has introduced unemployment insurance and new means-tested poverty assistance, and has reduced state enterprises’ role in delivering social security. It has also reformed pensions and health insurance in the direction of mandatory, contributory social insurance. However, there is greater urban bias in China’s social security, benefits have been more eroded, and unemployment insurance and means-tested poverty assistance have been introduced relatively late in a more protracted reform process. There are similarities between China and post-communist central Europe due to the common experiences and constraints of market transition, demography, vested interests and ideology. The differences lie in China’s distinctive rural, agricultural starting-point, lower per capita GDP, pre-reform system of enterprise-based social security provision, continued one-party rule and decentralized fiscal system. Although only one among a range of influences, political systems have been an important shaper of social policy. Paradoxically, however, pre-transition social security provisions may have been better preserved under post-communist governments than under continued communist party rule.

Extending political participation in China: new opportunities for citizens in the policy process

Authoritarian political systems are portrayed as offering few opportunities for citizens to participate in politics – particularly in the policy process. This paper’s contribution is to set out new mechanisms that enable Chinese citizens to evaluate government performance, contribute to decision-making, shape policy agendas and feed back on implementation. Based on fieldwork in the city of Hangzhou, we argue that the local party-state orchestrates citizen participation in the policy process, but members of the public nevertheless do have influence. Political participation is widening in China, but it is still controlled. It is not yet clearly part of a process of democratization, but it does establish the principle of citizen rights to oversee the government.

Does distrust in providers affect health-care utilization in China?

How trust affects health-care utilization is not well-understood, especially in low- and middle-income countries. This article focuses on China, a middle-income country where low trust in health-care settings has become a prominent issue, but actual levels of distrust and their implications for utilization are unknown. We conducted a nationally representative survey of the Chinese population (November 2012 to January 2013), which resulted in a sample of 3680 adult men and women. Respondents rated their trust in different types of health-care providers. Using multivariate logistic and negative binomial regression models, we estimated the association between distrust in clinics and respondents’ hospital visits in the last year; whether they had sought hospital treatment first for two common symptoms (headache, cold) in the last 2 months; and whether they said they would go first to a hospital if they had a minor or major illness. We analysed these associations before and after adjusting for performance evaluations of clinics and hospitals, controlling for sex, age, education, income, insurance status, household registration and self-assessed health. We found that distrust in hospitals is low, but distrust in clinics is high and strongly associated with increased hospital utilization, especially for minor symptoms and illnesses. Further research is needed to understand the reasons for distrust in clinics because its effects are not fully accounted for by poor evaluations of their competence.

Why do Authoritarian Regimes Provide Public Goods? Policy Communities, External Shocks and Ideas in China’s Rural Social Policy Making

Abstract Recent research on authoritarian regimes argues that they provide public goods in order to prevent rebellion. This essay shows that the ‘threat of rebellion’ alone cannot explain Chinese party-state policies to extend public goods to rural residents in the first decade of the twenty-first century. Drawing on theories of policy making, it argues that China’s one-party regime extended public goods to the rural population under the influence of ideas and policy options generated by policy communities of officials, researchers, international organisations and other actors. The party-state centre adopted and implemented these ideas and policy options when they provided solutions to external shocks and supported economic development goals. Explanations of policies and their outcomes in authoritarian political systems need to include not only ‘dictators’ but also other actors, and the ideas they generate.

Explaining public satisfaction with health‐care systems: findings from a nationwide survey in China

To identify factors associated with health‐care system satisfaction in China.

Populism versus neo-liberalism: diversity and ideology in the Chinese media's reporting of health system reform

Research on the Chinese media has concentrated on understanding party-state control over an increasingly commercialized industry. And it has usually focused on reporting issues over which the central party-state has a clear and unified position. This article explores how the Chinese media reported a domestic policy issue—health reform—on which the party-state had no unified position. It examines three print publications during a major health care system review and consultation between 2005 and 2009 to see how much diversity there was in the reporting, what the principal narratives were, and which actors had voice. It finds the media took diverse positions, with narratives centering on market and state roles in health, but a vocal minority of pro-market articles challenged the dominant pro-state reporting. But pro-state positions were populist and paternalist, speaking for “the people” rather than giving them a direct voice. The neoliberal, pro-market challenge, meanwhile, was elitist, with the media venturing only at the margins to demand rights for vulnerable people and greater public participation in policy making.Research on the Chinese media has concentrated on understanding party-state control over an increasingly commercialized industry. And it has usually focused on reporting issues over which the central party-state has a clear and unified position. This article explores how the Chinese media reported a domestic policy issue—health reform—on which the party-state had no unified position. It examines three print publications during a major health care system review and consultation between 2005 and 2009 to see how much diversity there was in the reporting, what the principal narratives were, and which actors had voice. It finds the media took diverse positions, with narratives centering on market and state roles in health, but a vocal minority of pro-market articles challenged the dominant pro-state reporting. But pro-state positions were populist and paternalist, speaking for “the people” rather than giving them a direct voice. The neoliberal, pro-market challenge, meanwhile, was elitist, with the media venturing only at the margins to demand rights for vulnerable people and greater public participation in policy making.