Oscillating between Mao and Deng? The Domestic-Global Nexus of China's Public Health Reform

World Scientific Publishing
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China at 60: Global-Local Interactions, 2011, 1, pp. 255 - 281
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Deng's China inherited a Maoist cradle-to-grave health-care system that emphasised wide entitlement and access to medical care that was backed up by the state or collective financing. However, the economic reforms since the late 19705 have sadly left the country with a failing public health system. From the turn of this century onwards, the Chinese government has gone to great lengths to revert its health-care system partially back to the Maoist universal one in different ways. Previous studies have largely ignored the external factors that contribute to the recent health reform in China. This chapter has demonstrated that what motivates the Chinese leadership to press ahead with public health reform in the country are not only internal demands, but also external factors, such as the pressures to make improvements exerted by intergovernmental organisations and international opprobrium over its rickety health-care situation. Owing to the powerful force of globalisation, it has now become a global norm that all states are obliged to cooperate with each other under a global institution to prevent a global spread of contagious diseases. First, the normative pressure from the global community, particularly the pressure that emerged during the SARS outbreak in 2003, has heightened China's awareness of the need to remedy its ailing health system and shoulder greater responsibility for providing public goods for health to its own citizens as well as the global community. Second, using 'naming and shaming' tactics, the WHO fairly succeeds in prodding countries into complying with its health regime. The global discourse on disease transmission creates a situation in which states can no longer afford to evade WHO advice. Third, due to the recent global economic downturn, the Chinese government increased its investment in its health system as part of an economic stimulus package to promote domestic consumption. Overall, China's increasing participation in globa health governance in the last two decades has been conducive to China's learning and acceptance of international norms. However, China has yet to fully internalise the norms of the global health regime. An advantage of China's politicoadministrative system is that it can readily mobilise local governments to tackle pandemic crises promptly as soon as the central government perceives the diseases as threats to national security. However, mobilisation is often a one-off incidence and depends on the leaders' preferences and interests. There is a sign of incipient norm change. In February 2009, for the first time, Premier Wen Jiabao referred to health care as a 'public good' when he said that the principle of the current reform is that 'public medical service must have public good as its goal'. At present, it is uncertain whether this goal can be achieved or not.
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