Bureaucratic institutions and interests in the making of China's social policy

Abstract

Explanations of China’s post-Mao social policy have concentrated on the political, social, fiscal, and economic goals of the state and its governing elite. In a study of urban health insurance policy, this article argues that bureaucratic interests and institutions within the Chinese state are also influenced. This article first shows how bureaucratic interests within the central government have influenced the adoption of a new national social health insurance framework. It then shows how that framework has been modified following local implementation experiences that have allowed other bureaucratic and non-bureaucratic interests to be expressed. This examination of both central and local interests helps explain the adoption of a basic social health insurance system that provides for only the urban working population, subsidizes civil servants, and is administered locally. The article also shows the policy process in this sector to have been particularly protracted and incremental and argues that further incremental policy changes are likely