Political Economy of Health: Integration of China's Social Health Insurance.

Chinese social health insurance has been characterized as fragmented. The fragmentation of the Chinese social health insurance system occurs in two primary areas: horizontal segmentation and vertical decentralization. First, the social health insurance system is segmented between rural and urban population and between labor market insiders and outsiders. Second, Chinese social health insurance is decentralized to county-level units (including district in prefecture). In other words, the social health insurance funds and health risks are pooled within individual counties. This seriously impairs the social insurance's sustainability and equity. In 2009, the Chinese government announced a comprehensive health reform with the prime goal of establishing a universal (quan min) social health insurance system. This reform is to integrate the fragmented social health insurance to make health care accessible and affordable to all people. This paper will explore two main aspects of the integration process: horizontal integration of the social health insurance programs of different social groups and vertical integration of social health insurance to prefectural level. Through examining local implementation of the integration, this paper finds that China's recent health reform is encountering tremendous institutional drawbacks and political backlashes in various regions. Ironically, the political economic system that promoted rapid economic growth and establishment of social insurance in the past few decades creates substantial obstacles to reform and development. This paper will draw empirical evidences from the author's recent interviews with labor and social welfare officials at various administrative levels and health insurance beneficiaries in twelve Chinese provinces between 2009 and 2012. [ABSTRACT FROM AUTHOR]