Social Protection under Authoritarianism: Health Politics and Policy in China

Social Protection under Authoritarianism: Health Politics and Policy in China

by Xian Huang
Social Protection under Authoritarianism: Health Politics and Policy in China

Social Protection under Authoritarianism: Health Politics and Policy in China

by Xian Huang


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Why would an authoritarian regime expand social welfare provision in the absence of democratization? Yet China, the world's largest and most powerful authoritarian state, has expanded its social health insurance system at an unprecedented rate, increasing enrollment from 20 percent of its population in 2000 to 95 percent in 2012. Significantly, people who were uninsured, such as peasants and the urban poor, are now covered, but their insurance is less comprehensive than that of China's elite. With the wellbeing of 1.4 billion people and the stability of the regime at stake, social health insurance is now a major political issue for Chinese leadership and ordinary citizens.

In Social Protection under Authoritarianism, Xian Huang analyzes the transformation of China's social health insurance in the first decade of the 2000s, addressing its expansion and how it is distributed. Drawing from government documents, filed interviews, survey data, and government statistics, she reveals that Chinese leaders have a strategy of "stratified expansion," perpetuating a particularly privileged program for the elites while developing an essentially modest health provision for the masses. She contends that this strategy effectively balances between elites and masses to maximize the regime's prospects of stability.

In China's multilevel governance, both centralized and decentralized structures are involved in the distribution of social health insurance. When local leaders implement the stratified expansion of social health insurance, they respond to varied local conditions. As a result, China's health insurance policies differ dramatically across subnational regions as well as socioeconomic groups. Providing an in-depth look into China's health insurance system, this book sheds light not only on Chinese politics, but also on how social benefits function in authoritarian regimes and decentralized multilevel governance settings.

Product Details

ISBN-13: 9780190073640
Publisher: Oxford University Press
Publication date: 08/31/2020
Pages: 280
Product dimensions: 9.49(w) x 6.49(h) x 0.91(d)

About the Author

Xian Huang is an assistant professor of political science at Rutgers University. Her research has focused on the politics of social inequality and redistribution with a regional focus on China. Her research has appeared in Governance, Social Science Research, The China Quarterly, Journal of Contemporary China, Journal of Chinese Political Science, and China: An International Journal.

Table of Contents

Chapter 1. Introduction
Chapter 2. Theory of Stratified Expansion of Social Welfare
Chapter 3. Overview of China's Social Health Insurance
Chapter 4. The Center's Distributive Strategy and Fund Allocation
Chapter 5. Local Motivation and Distributive Choices
Chapter 6. Understanding Subnational Variation in Chinese Social Health Insurance
Chapter 7. Who Gets What, When and How from Chinese Social Health Insurance Expansion?
Chapter 8. Conclusion
Appendix A
Appendix B
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