Health sector reforms in contemporary China: a political perspective
Introduction Since the mid-1980s, when it became clear that policies of reform and opening up were the dawn of a new, distinct phase in China’s long pursuit of modernization, many scholars have attempted to provide a coherent explanation of the political processes characterizing policy making in transitional China. Although debate is still occasionally heated regarding the possible outcomes of China’s transformation-ranging from elective democracy to the continuation of an authoritarian system dominated by the Party through a revival of either Confucian or revolutionary virtues-a broad consensus has finally emerged over the role played by market-oriented reforms in shaping a polity that is increasingly open to interaction between the private sphere and the political system (Zheng 2002: 64; Kennedy 2005: 160-186; Perry 2007). A useful theoretical framework on which to develop the analysis of China’s transitional system is that which focuses on the role played by interest groups, based on the assumption that an interest-based social order has emerged in the People’s Republic. Applied to the study of US politics in the 1950s by David Truman, by the late 1960s the concept of interest group had already been widely utilized for analysing communist polities, with special reference to the Soviet Union.2 While early works applying this approach to the study of communist regimes dealt primarily with the interests and conflicts within the bureaucracy, analyses focused on post-Mao China have described a context where the ‘pursuit of economic expansion has led to the emergence of an interest-based social order’ (Zheng 2002: 64) and a polity where the ‘largest and most active interest groups are economically driven and have a great impact on . . . political and social affairs’ (Yang 2007: 2). Despite the profound influence of market-oriented reforms in the health care sector, this paradigm of increasing complexity and
interaction has so far not been extensively applied to the study of health politics. Decision making in this area is still commonly considered the result of political processes taking place within a state’s bureaucracy which is mainly concerned, at least at the centre, with national development priorities. Most efforts made by China scholars in investigating health care have focused on policy outputs, overlooking inputs from economically driven interests-in particular those of medical providers and pharmaceutical producers-to the political power, either in the form of resistance to the existing regulatory framework, or through the articulation of specific demands (on common narratives of health system change in China, see Bloom 2011: 1303-1305. Among the few studies focusing on relevant political processes, see Lampton 1977: 250-267; Huang 2006). This paper attempts to investigate the processes which have led to the constitution of economically driven interests in post-Mao China’s health care sector, how they have exerted their influence on the commitments made by the Hu-Wen leadership towards a more ‘harmonious’ pattern of socio-economic development, and which avenues they might follow in articulating demands upon the political system. Finally, we will introduce the coordinates of the most recent developments in health policies and the relevant debate involving the central leadership, health care providers and pharmaceutical producers.