Legacies and incentives: Explaining local healthcare expenditure variation in post-Mao China.

摘要

Inequality characterizes health care in China, especially in terms of utilization, outcomes, expenditures, and financing. This dissertation focuses on variation in local healthcare expenditure by asking the following question: How and why does local government healthcare spending in China vary across time and space? Previous researchers have centered primarily on economic determination, arguing that the local economy is the main factor behind variation in local healthcare expenditures; however, when one sets this argument against the background of an era of reforms and a complicated central–regional relationship, it becomes clear that scholars have missed important factors beyond the local economy. The writer of this dissertation relies on a typical political–economic approach to explain variation in China’s local healthcare expenditures. Drawing upon studies of healthcare policies across nations as well as studies of China’s local government, the author proposes two dimensions to explain local healthcare expenditure. The first dimension explains variation by focusing on the influences of the privatization of state-owned enterprises and the inequality between urban and rural areas. The second dimension emphasizes the incentives of individuals, including governmental bureaucrats. These explanations are tested in quantitative comparisons across localities and in a single-region case study. This project contributes to studies of health care in China as well as our understanding of the central–local relationship in this country.