Transformative state capacity in post-collective China: The introduction of the new rural cooperative medical system in two counties of Western China, 2006-2008

European Journal of East Asian Studies

Volumn 8, Issue 1, 2009, Pages 61-89

  Klotzbücher, Sascha ^a   Lässig, Peter ^a  

^a UNIVERSITY OF VIENNA   (Austria)

Author keywords

China; Public sector reform; Rural cooperative medical system

Indexed keywords

EID: 72449172062     PISSN: 15680584     EISSN: 15700615     Source Type: Journal    
DOI: 10.1163/156805809X439895     Document Type: Article

References (111)

1. We would like to acknowledge financial support from the Austrian Science Fund (FWF, Project 194433-G4) and grants from the Eurasia Pacific Uninet and the universities of Vienna and Shihezi.
2. See NRCMS in Wu Ming, 'Fen baogao zhiyi: Xinxing nongcun hezuoyiliao shishi zhuang-kuangjiqiyingxiangyinsu de dingxingyanjiii (Third report: Qualitative study on the implementation of the New Rural Cooperative Medical Scheme and its impact factors), in Weisheng tongji xinxi zhongxin (eds), Zhongguo xinxing nongcun hezuo yiliao jinzhan jiqi xiaoguo yanjiu (Beijing: Zhongguo Xiehe Yiyuan Daxue Chubanshe, 2005), pp. 96-148;
3. Liu Yuanli, 'Development of the rural health insurance system in rural China', Health Policy and Planning, Vol.19, No.3 (2004), pp. 159-165;
4. Wang Hong, Zhang Licheng, Winnie Yip and William Hsiao, 'Adverse selection in a voluntary rural mutual health care health insurance scheme in China', Social Science & Medicine, Vol.63, No.5 (2006), pp. 1236-1245;
5. Sukhan Jackson, Adrian C. Sleigh, Li Peng and Liu Xi-Li, 'Health finance in rural Henan: low premium insurance compared to the out-of-pocket system', The China Quarterly, Vol.181 (2005), pp. 137-152;
6. Sascha Klotzbiicher, Peter Lassig, Qin Jiangmei and Susanne Weigelin-Schwiedrzik, 'What is new in the "New Rural Cooperative Medical System"? An assessment in a Kazak county of Xinjiang', forthcoming in The China Quarterly.
7. Qingnianbao, Weishengbu: xinnonghe fugai quyu chaoguo 85 % (Health Ministry: coverage of NRCMS exceeds 85 per cent) (13 November 2007), http://zqb.cyol.com/content/2007-n/13/content-1953246.htm (accessed 27 December 2007). The national coverage rate (fugailu) in this context means the availability of a scheme in a county; the participation rate (canjialu) indicates the percentages of enrolment of a defined population.
8. See Jane Duckett, 'Local governance, health financing, and changing patterns of inequality in access to health care', in Vivienne Shue and Christine Wong (eds), Paying for Progress in China: Public Finance, Human Welfare and Changing Patterns of Inequality (London: Routledge, 2007), pp. 46-68.
9. Concepts in Oliver Treib, Holger Bahr and Gerda Falkner, 'Modes of governance: towards a conceptual clarification', Journal of European Public Policy, Vol.14, No.1 (2007), pp. 1-20, pp. 5-11.
10. Examples for this top-down orientation in Dali Yang, Remaking the Chinese Leviathan: Market Transition and the Politics of Governance in China (Stanford: Stanford University Press, 2004);
11. Susan Whiting, 'The cadre evaluation at the grass roots. The paradox of party rule', in Barry Naughton and Dali Yang (eds), Holding China Together. Diversity and National Integration in the Post-Deng Era (Cambridge: Cambridge University Press, 2004), pp. 101-119.
12. Linda Weiss, The Myth of the Powerless State. Governing the Economy in a Global Era (Cambridge: Polity Press, 1998).
13. Sebastian Heilmann, 'Policy experimentation in Chinas economic rise', Studies in Comparative International Development, Vol.43, No.1 (2008), pp. 1-26, p. 19.
14. Based on Alma De Silva, A Framework for Measuring Responsiveness, GPE Discussion Paper Series No.32 (no year), http://www.who.int/responsiveness/ papers/paper32.pdf (accessed 6 November 2007)
15. and Gunnar Folke Schuppert, ' Governance im Spiegel der Wissenschaftsdisziplinen (Governance in the mirror of the science disciplines), in Gunnar Folke Schuppert (ed.) Governance-Forschung. Vergewisserungen über Stand und Entwicklungslinien (Governance Research. Verifications on State and Development Lines) (Berlin: Nomos, 2005), pp. 371-469, p. 412.
16. Responsiveness, originally developed in economics (Ian Ayres and John Braithwaite, Responsive Regulation: Transcending the Deregulation Debate (Oxford: Oxford University Press, 2002), p. 4), is used for the relationship between central and local state agencies;
17. see Sascha Klotzbücher, Das ländliche Gesundheitswesen der VR China. Strukturen-Akteure-Dynamik (The Rural Health Service of the PR China. Structures-Actors-Dynamics) (Frankfurt am Main: Peter Lang, 2006), pp. 151, 169 ff. Further, it is defined in the WHO Health 2000 report as 'to assess, monitor and raise awareness of how people are treated and the environment in which they are treated when seeking health care'; WHO, Health System Responsiveness (2000), http://www.who.int/responsiveness/en/ (accessed 23 October 2007).
18. This article does not discuss the minority population aspects, and how they might affect the 'responsiveness' of the administrators.
19. Guobanfa 2001-39, Guanyu nongcun weisheng gaige yu fazhan de zhidao yijian (Suggestions Concerning the Reform and Development of Rural Health Care) (8 May 2001), http://www.moh.gov.cn/newhtml/8065.htm (accessed 30 July 2007).
20. See discussion of the 'Health For All by the Year 2000' programme in Huang Yongchang, Zhongguo weisheng guoqing (Situation of Health Care in China) (Shanghai: Shanghai Yike Daxue Chubanshe, 1994).
21. Examples in Klotzbiicher, Gesundheitswesen, p. 257 ff.
22. Guofa 1997-18, 'Guanyu fazhan he wanshan nongcun hezuo yiliao de ruogan yijian (Suggestions on the development and perfection of rural cooperative medicine), Henan Zhengbao, No.7 (1999), pp. 15-16, p. 16;
23. for more on CMS, see Liu Yuanli, Keqin Rao and Shanlian Hu, People's Republic of China. Toward Establishing a Rural Health Protection System (Manila: Asian Developing Bank, 2002), http://www.adb.org/ documents/reports/RC-rural- health-protection-system/prc-rural-health.pdf (accessed 26 November 2004).
24. Zhongfa 2002-13, Zhonggong zhongyangguowuyuan guanyu jin yibu jiaqiang nongcun weisheng gongzuo de jueding (Decision of the Central Committee of Chinas Communist Party (CCP) and the State Council to Strengthen Health Work in Rural Areas) (30 October 2002), http://www.agri.gov.cn/zcfg/t20021107-22649.htm (accessed 3 April 2003).
25. Guobanfa 2003-31 Guanyu jianli xinxing nongcun hezuo yiliaoz hidu yijian (Suggestions for the Introduction of NRCMS) (16 January 2003), http://www.jswst.gov.cn/dfnewsdis-play.php?newsid=43 6 (accessed 13 May 2006).
26. Guofa 1997-2018.
27. Caizhengbu,' Guanyu gonggu da jiancha chengguo jinyibu zuohao jianqing nongmin fudan gongzuo de baogao' (Report on the consolidation of the success of the wide inspection and how to cause further decrease in the farmers' burden), Guowuyuan gongbao, No.20 (2000), pp. 18-21.
28. 'Ciwai, daolu zijin, hezuo yiliao zijin zai yixie difang rengwei jinzhi' ('in addition, tolls and the premiums for the CMS are still not forbidden in some places'); Caizheng, Guanyu gonggu, p. 20.
29. Hu Shanlian, 'Zhongguo nongcun pinkun diqu hezuo yiliao shishi zhong zhengfu shilinghe shichang shiling de biaoxian (Government failure and market failure on the implementation of CMS in impoverished areas of rural China), Zhongguo weisheng jingji, Vol.21, No.1 (2002), pp. 38-41.
30. Guobanfa 2003-3.
31. Zhongfa, 2002-2013.
32. Zhongfa, 2002-2013;
33. Guobanfa, 2003-3.
34. Weinongweifa 2007-23 5, Weishengbu, caizhengbu, guojia zhongyiyao guanliju guanyu wanshan xinxing nongcun hezuoyiliao buchangfang'an de zhidaoyijian (Guiding Suggestions of the Ministry of Health, Ministry of Finance, and the State Administration of Traditional Chinese Medicine for the Completion of the Subsidy Scheme for the NRCMS), http://www.moh.gov.cn/newshtml/ 20180.htm (accessed 30 September 2007).
35. See Heilmann, Policy experimentation.
36. See discussion and examples in Klotzbücher, Gesundheitswesen, p. 111 ff.
37. Case study in Fang Xiaoping, 'Zhongguo nongcun de chijiao yishengyu hezuo yiliao zhidu-Zhejiang sheng Fuyang xian gean yanjiu (1968-1983)' (Chinese rural barefoot doctor and the Cooperative Medical System-case study of Fuyang County in Zhejiang Province (1968-1983)), Ershiyi shiji, Vol.10 (2003), pp. 42-54.
38. Fang Xiaoping, Zhongguo nongcun.
39. Susanne Weigelin-Schwiedrzik, 'The distance between state and rural society in the PRC. Reading Document No. 1 (February 2004)', Journal of Environmental Management, Vol.87, No.2 (2008), pp. 216-225.
40. Compare the model suggested by Heilmann, Policy experimentation.
41. Minfa 2003-158, Minzhengbu, weishengbu, caizhengbu guanyu shishi nongcun yiliao.
42. jiuzhu deyijian (Suggestions of the Ministries of Civil Affairs, Health and of Finance about the Implementation of the Subsidies for Rural Cooperative Health Care) (26 July 2004), http://www.moh.gov.cn/public/open.aspx?n-id=8365 (accessed 12 May 2006).
43. Weinongweifa 200 5-319: Weishengbu, caizhengbu guanyu zuohao xinxing nongcun hezuo yiliao shidian youguan gongzuode tongzhi (Circular of the MoF and MoH about the Related Work of the NRCMS Pilots) (16 August 2005), http://www.moh.gov.cn/uploadfile/20058 1213145560.doc (accessed 12 May 2006).
44. Interview 02/07.
45. Zhongfa 2002-2013.
46. Weinongweifa 2006-13, Weishengbu dengy buweiju lianhe xiafa guanyu jiakuai tuijin xinxing nongcun hezuo yiliao shidian gongzuode tongzhi (The MoH and Seven More Committees Promulgate the 'Circular for Accelerating the Work in Pilots for the NRCMS') (19 January 2006), http://www.moh.gov.cn/public/open. aspx?n-id=11283 (accessed 12 May 2006).
47. Weinongweifa 2008-17, Weishengbu caizhengbu yifa guanyu zuohao 2008 nian xinxingnongcun hezuo yiliao gongzuo de tongzhi (The Ministries of Health and Finance Distributethe Circular about the Work for the NRCMS in 2008) (13 March 2008), http://202.96.155.170/publicfiles/business/htmlfiles/mohncwsgls/s6476/ 20o8o4/19389.htm (accessed 1 July2008).
48. Guobanfa 2003-3.
49. Davidson R. Gwatkin, 'Health care for China's rural poor', a Health Policy Programme occasional paper with support from the International Health Policy programme, unpublished paper (1999).
50. Zhu Ling, 'Zhengfuyu nongcun jiben yiliao baojian zhidu xuanze (The government and the selection of the rural basic health protection system), Zhongguo shehui kexue, No.4 (2000), pp. 89-99, p. 91.
51. Zhongfa 1997-3, 'Zhonggong zhongyang, guowuyuanguanyu weisheng gaige yu fazhan de jueding' (Decision of the Central Committee of the CCP and the State Council about the development and reform of health care), Guangming ribao (18 February 1997), pp. 1-2, p. 2.
52. Guobanfa 2003-3.
53. Caishe 2003-112, Caizhengbu, weishengbu guanyu zhongyang caizheng zizhu zhongxibu diqu nongmin canjia xinxing hezuoyiliao zhidu buzhu zijin bofu youguan wenti de tongzhi (Circular of the MoF and MoH about the Appropriation of Sums from the Central Budget as Subsidies for the Enrolled Farmers in Western and Central Regions) (25 August 2003), http://www.moh.gov.cn/newshtml/8353.htm (accessed 30 September 2007).
54. Weinongweifa 2006-2013.
55. Zhongfa 2002-2013.
56. Caishefa 2007-5, Caizhengbu, weishengbu guanyu tiaozheng zhongyang caizheng xinxing nongcun hezuo yiliao zhidu buchang zijin bofu banfa youguan wenti de tongzhi (Circular of the MoF and MoH about the Problems of Adjusting Earmarked Subsidy Funds of the Central Coffer for NRCMS) (3 March 2007), http://www.moh.gov.cn/newshtml/18022.htm (accessed 21 September 2007).
57. Weinongweifa 2006-2013.
58. Weinongweifa 2008-2017. The individual contribution is reduced to 10 yuan per household member in the poorer southern part of Xinjiang (populated mostly by Uyghurs).
59. Xinjiang zhengfu (Government of Xinjiang), Xinjiang Weiwuerzu zizhiqu renmin zhengfu guanyu quanmian jiaqiang xinxing nongmuqu hezuo yiliao zhidu jianshe deyijian (Suggestions of the People's Government of Xinjiang Uyghur Autonomous Region about How to Strengthen the Construction of the New Cooperative Medical System in Agricultural and Pastoralist Areas) (18 April 2008), http://www.xj.cei.gov.cn/e/DoPrint/?classid=20id =3975 (accessed 8 July 2008).
60. Guobanfa 2003-3.
61. Interview 01/07.
62. Interview 16/07.
63. Yili hasake zizhizhou tongjiju (Statistical Bureau of Yili Kazak Autonomous Prefecture)(ed.) Yili hasake zizhizhou tongji nianjian 2006 (2006 Statistical Yearbook of the Yili KazakAutonomous Prefecture) (Wulumuqi: Yili Hasake Zizhizhou Tongjiju, 2006), p. 63.
64. Interview 01/07.
65. Interviews 16/07, 18/07.
66. Interview 05/07.
67. Shihezi/Vienna Universities, 'Xinyuan xian muqu jumin weisheng fuwu xianzhuang ji muye yiyuan fazhan qianjingyanjiu' (Health service survey of pastoralists of Xinyuan County and perspectives for pastoral clinics), unpublished report (2007), p. 59.
68. Xinyuan xian (Xinyuan County), Xinyuan xian xinxing nongmuqu hezuoyiliao shishi xice (shixing) (Concrete (provisional) NRCMS implementation guidelines for agricultural and pastoral regions in Xinyuan County), document (2007).
69. Xinyuan xian, Shishi xice, para 18.4.
70. Interview 02/07.
71. Xunzhengfa 2007-4, Xundian zhengfu huizu yizu zizhixian 2007 nian xinxing nongcun hezuoyiliao shishi fang'an (shixing) ((Provisional) implementation programme for NRCMS in 2007 of the Xundian Hui and Yi Autonomous County), leaflet (2007).
72. Interview 16/07.
73. Xinyuan xian, Shishi xice, Art. 2 5-28.
74. Xunzhengfa 2007-4;
75. Xinyuan xian, Shishi xice.
76. Interview 16/07.
77. Xunzhengfa 2007-4, p. 7.
78. Han Jun and Luo Dan, Zhongguo nongcun weisheng diaocha (Survey on China's Rural Medical and Health Reality [sic!]) (Shanghai: Yuandong Chubanshe, 2007), p. 397.
79. See also 'Second, the county and township cadres' guarantee for the county and townships, and the cadres' guarantee from the townships, villages and households' ..." Qinghai sheng weishengting" (Health Office of Qinghai Province), Xinxing nongcun hezuo yiliao zhidu fugai quan sheng (The Whole Province is Covered by NRCMS) (8 November 2005), http://www.qhwst.gov.cn/ Get/xinwen/xwgs/161237601.htm (accessed 7 August 2008).
80. Interview 16/07.
81. Interview 16/07.
82. Xunzhengfa 2007-4, p. 2.
83. Xinyuan xian (Xinyuan County), Xinyuan xian nongmumin canjia xinxing nongmu qu hezuo yiliao xieyishu (NRCMS participation agreement of farmers and herders in Xinyuan County), leaflet (2007).
84. Xunzhengfa 2007-4, p. 2.
85. Xinyuan xian, Xieyishu, para. 7;
86. Shihezi/Vienna Universities, Xinyuan xian, p. 59.
87. Weinongweifa 2008-2017.
88. Shihezi/Vienna Universities, Xinyuan Xian, pp. 66, 31.
89. Interviews 01/07, 05/07.
90. Interview 05/07.
91. Interviews 05/07, 16/07.
92. E.g. X-rays 11-28 yuan, ultrasound and ECG 6-30 yuan, injections 1-4 yuan, blood/ urine analysis 5-13 yuan, registration and examination fees 0.3 and 0.5 yuan; Interview 08/06.
93. Interview 01/07.
94. Xunzhengfa 2007-4.
95. Xinjiang zhengxie (Xinjiang's Political Consultative Conference), Di 519 hao guanyu jinyibu zuohao woqu xinxing nongmuqu hezuo yiliao shidian gongzuo de jidian jianyi (Doc. No. 519 about Suggestions to Finish the Pilot NRCMS in Agricultural and Pastoral Regions) (30 May 2006), http://www.xjzx.gov.cn/ showcontent.asp?id=4263Nclassid=191 (accessed 8 July 2008).
96. Klotzbücher, Gesundheitswesen, pp. 205-224.
97. See example of rural finance in Christian Göbel, 'Intergovernmental relations and policy failure in China: the case of the rural tax and fee reform', working paper prepared for ASC conference, November 2008.
98. Thomas Bossert, 'Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance', Social Science and Medicine, Vol.47, No.10 (1998), pp. 1513-1527;
99. Klotzbücher, Gesundheitswesen, p. 55 ff.
100. Heilmann, Policy experimentation.
101. One of the principles is that income restricts expenses (shou dingzhi), Guobanfa 2003-2013.
102. Dali Yang, Remaking the Chinese Leviathan (Stanford: Stanford University Press, 2004), p. 231 ff.;
103. and S.H. Whiting, The Cadre Evaluation System at the Grass Roots (New York: Cambridge University Press, 2004).
104. Caishe 2004-24, Caizhengbu, weishengbu guanyuyinfa 'zhongyang buzhu difang weisheng shiye zhuanxiang zijin guanli zanxing banfa'de tongzhi (Circular of the MoF and MoH about the 'Provisional Regulation Concerning the Management of the Earmarked Funds for the Subsidy of Local Health Care Institutions of the Central Government') (2 May 2004), http://www.mof.gov.cn/news/20050228-1506- 4265.htm (accessed 30 September 2007);
105. Caiku 2008-33, Xinxing nongcun hezuoyiliao buzhu zijin guoku jizhong zhifu guanli zanxing banfa (Provisional Regulation for the Administration and Central Payments of Subsidies for NRCMS from the State Treasury) (14 April 2008), http://www.mof.gov.cn/news/20080520-3483-32873.htm (accessed 8 July 2008).
106. Kevin O'Brien and Li Lianjiang, Rightful Resistance in Rural China (Cambridge: Cambridge University Press, 2006). p. 11.
107. Xinyuan xian, Shishi xice, para. 8.
108. Interview 18/07.
109. Compare Heilmann, Policy experimentation, p. 1.
110. Heilmann, Policy experimentation.
111. Lily L. Tsai, 'The struggle for village public goods provision: informal institutions of accountability in rural China', in Elizabeth J. Perry and Merle Goldman (eds), Grassroots Political Reform in Contemporary China (Cambridge, MA: Harvard University Press, 2007), pp. 117-148.