A Study of China's Health Reform——Features, Underlying Reasons and Future Trend
Author
Fei, HAN
Term
4. term
Publication year
2013
Submitted on
2013-05-30
Abstract
Denne afhandling undersøger Kinas sundhedsreform siden 1985 med fokus på driften af statsejede hospitaler og behandler reformen som et institutionelt skifte i en postsocialistisk stat. Den stiller spørgsmålene: hvilke problemer er opstået sammen med de opnåede resultater, hvad kendetegner reformen, hvilke underliggende årsager driver udviklingen, og hvad kan fremtidige tendenser blive. Metodisk kombinerer studiet en gennemgang af reformens forløb og sektorens tilstand (herunder ideologi og finanssystem, finansiering, kompensationsmekanismer samt personale- og ledelsesforhold) med en teoretisk ramme om overgangsstater og institutionel forandring, særligt forholdet mellem ideologi og interesser. På dette grundlag identificeres som et hovedtræk, at staten ikke fuldt ud har ændret sin rolle, idet den både er juridisk ejer af statshospitaler og samtidig tilsynsmyndighed, hvilket svækker uafhængigt tilsyn og forsinker problemløsning; dette er også ideologisk betinget af overgangens politiske logik. Fremvæksten af privatejede medicinske aktører ændrer interessefordelingen og kan sætte nye institutionelle skift i gang. Afhandlingen peger på, at fremtiden vil afhænge af konkurrencen mellem kræfter, der søger at konsolidere autoritære ordninger, og dem, der drager fordel af velfungerende markedsmekanismer. Da sundhedsreformen omfatter flere delområder, afgrænser undersøgelsen sig primært til hospitalernes reform som en repræsentativ indgang til feltet.
This thesis examines China’s health reform since 1985 with a primary focus on the operation of state-owned hospitals, treating the reform as an institutional shift in a post-socialist state. It asks what problems have emerged alongside achievements, what characterizes the reform, which underlying forces have shaped it, and where it may be heading. Methodologically, the study combines a review of the reform’s trajectory and the sector’s status (including ideology and the fiscal system, financing, compensation mechanisms, and personnel and managerial arrangements) with a theoretical framework on transitional states and institutional change, especially the interplay of ideology and interests. On this basis, it identifies a key feature: the government has not fully transitioned its role, acting both as the legal owner of state hospitals and as the sector’s regulator, which weakens independent oversight and delays problem correction; this pattern is also reinforced by the ideological context of transition. The rise of privately owned medical providers introduces new interest constellations that may drive further institutional shifts. The thesis argues that future directions will be shaped by competition between forces that consolidate authoritarian arrangements and those that benefit from well-functioning market mechanisms. Recognizing the breadth of health reform, the study primarily delimits itself to hospital reform as a representative window into the sector.
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