HEALTH CARE REFORM IN CHINA: AN ANALYSIS OF DEVELOPMENT TRENDS AND LACK OF IMPLEMENTATION

摘要

China's health care system, under the direction of the central government, has undergone continuous reform in recent decades. Many problems have been encountered, with successive measures attempting to deal with shortcomings and failings of previous reforms. To what extent can implementation failures account for the recurring problems, and what explains these failures? The analysis adopts the theoretical lens of structural-instrumental and cultural-institutional perspectives, respectively, and draws also on recent developments in implementation theory. The historical trajectory of health reform is described, with particular reference to why health policies formulated by the central government during different periods repeatedly failed to achieve their objectives. The empirical analysis finds that structural factors, such as departmentalism and regional separation resulting in complex, overlapping horizontal and vertical actor patterns, have been a primary reason for implementation failures and suggests that they will continue to dog future reform efforts.