ABSTRACT
This chapter endeavors to discuss, in theoretical terms, how top Chinese policymakers apply state or markets or a combination of the both in order to provide affordable medical care to all during the reform era. Treating the state and markets as two systems of coordination on a territorial scale, the study tries to answer the question concerning which functional area either the state or markets can work more effectively as public policy tools, and thus most likely to consolidate. The chapter starts with a critical assessment on how the policymaking within the Party-state hierarchy differs from that in the realm of business/industrial management. The study then makes an attempt to dwell conceptually on the notion of marketization of medical care services through franchising and user charges, coupled with an analysis of three types of markets (free markets, regulated markets and quasi-markets) adopted in the re-engineering affordable care policy. While underscoring the usefulness of marketization as a policy tool in revenue raising and resource management, it also examines such unanticipated policy outcomes of marketization as “exorbitant” charges, over-provision, abuses of prescription drugs, weakening of public and preventive care, and inequality in health care resource allocation. The chapter highlights several theoretical alternatives on unanticipated policy outcomes in the existing literature, that will be discussed further in the empirical cases of medical care reforms in the remaining of the book.
