Social protection under authoritarianism: health politics and policy in China

In: Oxford scholarship online

Abstract

Why would authoritarian leaders expand social welfare provision in the absence of democratization? How do authoritarian leaders design and enforce social welfare expansion in a decentralized multilevel governance setting? This book identifies the trade-off authoritarian leaders face in social welfare provision: effectively balancing coverage and benefits between elites and masses in order to maximize the regime's survival prospects. Using government documents, field interviews, survey data, and government statistics about Chinese social health insurance, this book reveals that Chinese authoritarian leaders attempt to manage the distributive trade-off by a "stratified expansion" strategy, establishing an expansive yet stratified social health insurance system to perpetuate a particularly privileged program for the elites while building an essentially modest health provision for the masses.