ABSTRACT
Introduction During the proceedings of the 2010 Chinese People’s Political Consultative Conference (CPPCC), delegate Zong Licheng overtly criticised government measures aimed at curbing health care costs, but his words didn’t garner much attention among China’s health policy observers (Nanfang Zhoumo 2010b). The debate over health reform had been raging for over a decade, since a de facto privatisation of the health care system had shown its disastrous consequences. Many views over the reform had been aired publicly, and one more voice joining the choir of criticism did not constitute, after all, something worthy of comment. What many probably failed to recognise, however, was the political value of Mr Zong’s words: as a manager of a pharmaceutical company, he was clearly taking advantage of his role as a CPPCC delegate to represent the interests of China’s health industry. This episode can be taken as an indicator of the increasing complexity in the interactions between the private sphere and the political system in China. Although the country’s polity remains essentially authoritarian, economic and institutional reforms have increased the capacity of diverse actors to pursue their interests by influencing policy formulation and implementation. An increasingly large corpus of literature deals with these processes through the analysis of recent developments in Chinese politics. In the volume The Business of Lobbying in China, Scott Kennedy maintains that the notion ‘that bureaucracy controls the scene no longer captures critical elements of the political process’, showing how in the late 1990s private interests already ‘yielded victories on scores of issues’ (Kennedy 2005: 160). Andrew Walder similarly finds that SOEs have considerable bargaining leverage within the halls of government, while Barry Naughton highlights ‘the rising influence of powerful corporate groupings in China’ (Walder 2011: 171-2; Naughton 2008: 1). In political terms, these actors possess the characteristics of interest groups, i.e. groups ‘of individuals who are linked by particular bonds of concern or advantage, and who have some awareness of these bonds’ (Almond and Powell 1966: 75). Such groups produce and convey inputs into the political system, both supporting or resisting the implementation of policies and articulating demands
upon the policy-maker (Almond and Powell 1966: 75; Easton 1957: 384). In mapping China’s interest groups, Yang Guangbin provides a tentative distinction in four categories, based on their components and organisational structure: (a) institutional interest groups, composed of bureaucratic and para-bureaucratic elements organised in government departments and affiliated agencies; (b) associational interest groups, composed of individuals and/or institutions organised in sectorial associations; (c) corporate interest groups, made up of individuals operating in large companies; and (d) anomic interest groups, composed of the public, often not formally organised (Yang 2007: 3-11). Analysing these groups from a political perspective requires charting the routes they follow in crossing the border between the pursuit of particular interests and the attempt to influence political processes whose outcomes regulate policy development. The analytical framework provided by fragmented authoritarianism (FA) is an instrument particularly adept at capturing the main features of these dynamics. FA was originally devised to describe the bargaining occurring within the Chinese bureaucracy. According to the proponents of FA, analysing these bargaining processes – involving bureaucracies with competing interests and/or diverging views of how to best serve national interests – can prove extremely useful in explaining variations in policy outcomes (Lieberthal and Oksenberg 1988: 9-31; Lieberthal and Lampton 1992). More recently, FA has been adopted as a framework to analyse relations between the public and the private sphere, in a context whereby ‘the process of policy making has become increasingly pluralized . . . [and] barriers to entry have been lowered’ (Mertha 2009: 995). In this context, actors previously excluded from the policy-making arena can act as ‘policy entrepreneurs’, exploiting bureaucratic fragmentation to propose reframed views of issues present in the policy agenda (Mertha 2009: 995-1012). By not focusing on formal political features, the FA approach enables the observer to capture political processes characterising an evolving system which, although it conserves authoritarian features, is nonetheless showing increasing responsiveness to the demands of different sectors of society. The health care sector provides an interesting case study upon which to apply FA as an analytical framework to investigate the development of China’s political system. In fact, its evolution can be considered representative of wider tendencies from institutional, socio-economic and governance perspectives. To start with, the same bureaucratic fragmentation found in other sectors of public interest also applies to health care, where planning, financing and provision functions are traditionally plagued with the overlapping of competencies and conflicts of attribution (See Lampton 1977; Wang and Fan 2013). The penetration of economically driven interests, and the subsequent conflict between private interests and public utility, is another element that renders the health care sector representative of larger transformations in Chinese political, social and economic life (Yang 2007). Finally, the health care system crisis is linked to wider governance challenges, tied to social imbalances caused by the reforms of the 1980s and 1990s.
