Jiwei Qian

Explaining medical disputes in Chinese public hospitals: the doctor–patient relationship and its implications for health policy reforms

In recent years China has witnessed a surge in medical disputes, including many widely reported violent riots, attacks, and protests in hospitals. This is the result of a confluence of inappropriate incentives in the health system, the consequent distorted behaviors of physicians, mounting social distrust of the medical profession, and institutional failures of the legal framework. The detrimental effects of the damaged doctor-patient relationship have begun to emerge, calling for rigorous study and serious policy intervention. Using a sequential exploratory design, this article seeks to explain medical disputes in Chinese public hospitals with primary data collected from Shenzhen City. The analysis finds that medical disputes of various forms are disturbingly widespread and reveals that inappropriate internal incentives in hospitals and the heavy workload of physicians undermine the quality of clinical encounters, which easily triggers disputes. Empirically, a heavy workload is associated with a larger number of disputes. A greater number of disputes are associated with higher-level hospitals, which can afford larger financial settlements. The resolution of disputes via the legal channel appears to be unpopular. This article argues that restoring a healthy doctor-patient relationship is no less important than other institutional aspects of health care reform.

HEALTH SYSTEM REFORM IN CHINA: AN ASSESSMENT OF RECENT TRENDS

In this paper, we first briefly review the changes that the Chinese health care system has undergone since the early 1980s. We then describe the major current health policy initiatives in urban and rural areas and discuss likely scenarios for their evolution over time. Using comparisons with international experience regarding different institutional arrangements in the health care sector, we also discuss whether the approaches taken in China are likely to strengthen the health care system in terms of efficiency and equity. Our conclusion is that in order to predict how effectively Chinas future health care system will perform in the future, one must have more information about what role the state (central government) will play, as regulator, partial funder and direct provider in the system. We believe that the best strategy at present is to allow the development of a mixed model with significant roles for both the state and the private sector, in both the supply of health care services and the provision of health insurance.

Reallocating authority in the Chinese health system: an institutional perspective

Affordability of health care is still a serious concern in China after the health reform in 2009. According to the literature of the economics of organization, allocation of authority in hospitals and social insurance is extremely important for improving affordability. The information structure and the degree of conflicts in tasks within an organization determine the optimal allocation of authority. However, the progress of the governance reform to reallocate the authority is relatively slow during the reform period. This article argues that the slow progress is associated with ineffective coordination among government departments in China. Two institutional reasons are illustrated in this article. First, there is no institutional arrangement to facilitate the horizontal coordination among ministries and bureaus. Second, the performance evaluation system for officials, which mainly addresses the vertical coordination between upper and lower level governments, has unintended consequences for horizontal coordination among local government departments. Future reforms should take into account these institutional aspects.

Massification of higher education and youth transition: skills mismatch, informal sector jobs and implications for China

ABSTRACT This study adopts a nationwide survey data set between 2005 and 2013 (Chinese General Social Survey) to explore the influence of the massification of higher education on the transition of Chinese youth into the labour market. Data analysis reveals two major findings. First, the economic returns to college education of recent cohorts of university graduates (those who have graduated from universities not more than 3 years ago) are lower than the cohorts who graduated in 2005 and 2006. Second, recent cohorts of college graduates are likely to work in the urban informal sector, unlike their senior counterparts. These findings could partially be explained by skills mismatch in the labour market but a comprehensive understanding of graduate unemployment in China could be obtained by bringing the broader political economy perspective into the analysis.

Social protection for the informal sector in urban China : institutional constraints and self-selection behaviour

The Chinese government has recently expanded the scope of urban social insurance programmes. However, social protection for the labour force of the urban informal sector, which reaches about half the number of urban workers, lags significantly behind. This under-coverage may be due to institutional constraints, particularly the household registration system hukou , and self-selection behaviour related to the limited benefits of social insurance. Drawing on a recent nationwide individual-level survey and city-level statistics, this study examines these two explanations for the under-enrolment on the social insurance programme. First, results suggest that hukou and the intergovernmental fiscal system are major institutional constraints. Second, self-selection behaviour in programme enrolment is verified. Employers in the informal sector are likely to opt out of social insurance. More importantly, employers in the informal sector, with rural or non-local hukou , are likely to opt out of social insurance, which suggests that self-selection behaviour is constrained by institutions. Such findings have important implications for broad theoretical and policy debates on universal social protection.

Logrolling Under Fragmented Authoritarianism: Theory and Evidence from China

This paper provides a rigorous theoretical and empirical analysis of the effect of logrolling between interest groups on social welfare in a non-democratic political system. In particular, we focus on China, where bureaucratic interest groups are separate vertical organizations reaching down from Beijing to the provinces and cities. The key question in this paper is: what are the effects of the logrolling of parochial interest groups on state policies and social welfare in autocracies? We address this question both theoretically and empirically. The theory predicts a specific distortion in resource allocation because of logrolling, while the empirical results confirm the theoretical prediction. We find policy outcomes under logrolling are characterized by excessive spending on all the interest groups’ preferred goods and insufficient spending on public goods. We test the existence of logrolling between the Ministry of Civil Affairs and Ministry of Health in China. Our result shows logrolling between the two ministries lead to inefficiencies in social security and health care policies.

Social Protection for the Informal Sector in Urban China_stamped.pdf

The Chinese government has recently expanded the scope of urban social insurance programmes. However, social protection for the labour force of the urban informal sector, which reaches about half the number of urban workers, lags significantly behind. This under-coverage may be due to institutional constraints, particularly the household registration system hukou , and self-selection behaviour related to the limited benefits of social insurance. Drawing on a recent nationwide individual-level survey and city-level statistics, this study examines these two explanations for the under-enrolment on the social insurance programme. First, results suggest that hukou and the intergovernmental fiscal system are major institutional constraints. Second, self-selection behaviour in programme enrolment is verified. Employers in the informal sector are likely to opt out of social insurance. More importantly, employers in the informal sector, with rural or non-local hukou , are likely to opt out of social insurance, which suggests that self-selection behaviour is constrained by institutions. Such findings have important implications for broad theoretical and policy debates on universal social protection.

A New Welfare Regime in the Making? Paternalistic Welfare Pragmatism in China

Since 2003, the Chinese government has been increasing its social expenditure and initiated new social welfare programmes to provide universal social protection and meet citizens’ welfare needs. This article uses the wider socio-economic and socio-political contexts to critically examine whether there is a new welfare regime on the rise in China, with a particular reference to whether the increase in social expenditure has really marked a new welfare philosophy or prompted the transformation of China into a protective welfare regime. By analysing prefecture-level data for government expenditures in education, health, social security and assistance programmes between 2003 and 2012, we show a continuation of the Chinese welfare regime in ‘paternalistic welfare pragmatism’ for two reasons. First, government social expenditures are set on the basis of the prefecture-level government’s fiscal capacity. Second, variations of welfare programmes are associated with the dichotomy between the urban formal and informal sectors.

Social Protection for the Labour Force of Informal Sector in Urban China: Institutional Constraints and Self-selection Behaviour

The Chinese government has recently expanded the scope of urban social insurance programmes. However, social protection for the labour force of the urban informal sector, which reaches about half the number of urban workers, lags significantly behind. This under-coverage may be due to institutional constraints, particularly the household registration system hukou , and self-selection behaviour related to the limited benefits of social insurance. Drawing on a recent nationwide individual-level survey and city-level statistics, this study examines these two explanations for the under-enrolment on the social insurance programme. First, results suggest that hukou and the intergovernmental fiscal system are major institutional constraints. Second, self-selection behaviour in programme enrolment is verified. Employers in the informal sector are likely to opt out of social insurance. More importantly, employers in the informal sector, with rural or non-local hukou , are likely to opt out of social insurance, which suggests that self-selection behaviour is constrained by institutions. Such findings have important implications for broad theoretical and policy debates on universal social protection.

Social Protection for the Informal Sector in Urban China

The Chinese government has recently expanded the scope of urban social insurance programmes. However, social protection for the labour force of the urban informal sector, which reaches about half the number of urban workers, lags significantly behind. This under-coverage may be due to institutional constraints, particularly the household registration system hukou , and self-selection behaviour related to the limited benefits of social insurance. Drawing on a recent nationwide individual-level survey and city-level statistics, this study examines these two explanations for the under-enrolment on the social insurance programme. First, results suggest that hukou and the intergovernmental fiscal system are major institutional constraints. Second, self-selection behaviour in programme enrolment is verified. Employers in the informal sector are likely to opt out of social insurance. More importantly, employers in the informal sector, with rural or non-local hukou , are likely to opt out of social insurance, which suggests that self-selection behaviour is constrained by institutions. Such findings have important implications for broad theoretical and policy debates on universal social protection.