The paradox of state power: Political institutions, policy process, and public health in post-Mao China.

摘要

Contrary to the pessimistic predictions, post-Mao China has not witnessed a measurable decline in its overall public health status. Using a methodology combining game theory, statistical analysis, and case studies, this study demonstrates that the key to the continuous public health progress reflects both sustained and effective state engagement in public health sector. The main arguments of this dissertation have been threefold. First, despite the initial state withdrawal from public healthcare and the attempts to marketize the health sector, the Maoist health policy structure made a strong comeback in the 1990s. Second, despite the erosion of their formal power and status in the wake of fiscal and bureaucratic decentralization, health bureaucrats proved capable of expanding their resource bases to pursue effective policy implementation. Finally, despite decollectivization, marketization and the primary focus on economic development, the capacities of local Chinese state to undertake public health provision on a collective basis did not simply collapse in post-Mao era. The state effectiveness in public health provision was made possible by the institutional interaction and interpenetration in four domains: formal institutional structure, administrative capacities, state-society relations, and the pre-reform health policy structure. Such institutional dynamics established a strategic context for the actions of various state actors that not only rendered further state withdrawal an increasingly infeasible policy alternative, but also determined the outcome of health policy implementation.