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Social Protection under Authoritarianism - Health Politics and Policy in China (Hardcover)
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Social Protection under Authoritarianism - Health Politics and Policy in China (Hardcover)
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Why would an authoritarian regime expand social welfare provision
in the absence of democratization? Yet China, the world's largest
and most powerful authoritarian state, has expanded its social
health insurance system at an unprecedented rate, increasing
enrollment from 20 percent of its population in 2000 to 95 percent
in 2012. Significantly, people who were uninsured, such as peasants
and the urban poor, are now covered, but their insurance is less
comprehensive than that of China's elite. With the wellbeing of 1.4
billion people and the stability of the regime at stake, social
health insurance is now a major political issue for Chinese
leadership and ordinary citizens. In Social Protection under
Authoritarianism, Xian Huang analyzes the transformation of China's
social health insurance in the first decade of the 2000s,
addressing its expansion and how it is distributed. Drawing from
government documents, filed interviews, survey data, and government
statistics, she reveals that Chinese leaders have a strategy of
"stratified expansion," perpetuating a particularly privileged
program for the elites while developing an essentially modest
health provision for the masses. She contends that this strategy
effectively balances between elites and masses to maximize the
regime's prospects of stability. In China's multilevel governance,
both centralized and decentralized structures are involved in the
distribution of social health insurance. When local leaders
implement the stratified expansion of social health insurance, they
respond to varied local conditions. As a result, China's health
insurance policies differ dramatically across subnational regions
as well as socioeconomic groups. Providing an in-depth look into
China's health insurance system, this book sheds light not only on
Chinese politics, but also on how social benefits function in
authoritarian regimes and decentralized multilevel governance
settings.
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