Suchergebnisse

SUMMARYThis article defies the traditional notion that cost inflation in healthcare could hardly be curbed without the significant revision of economic incentive scheme, but demonstrates the possibility of containing cost inflation with concerted administrative actions in the Chinese context. It examines the case of Fujian Province that embarked on a health bureaucracy‐led policy reform without an alteration of economic levers but mainly using administrative tools to combat cost escalation. Through clearly defined, well designed, targeted and concerted administrative measures, effective cost containment is attainable in China's healthcare sector, at least in the short run. If combined well with the powerful economic instruments, administrative tools would be able to augment their effects in cost containment, provided with the government's possession of hospital ownership. At the heart of Fujian's case are the reassertion of the government stewardship, the reconstruction of the collapsed accountability mechanisms, the reconfiguration of policy instruments, and the revision of administrative incentives, rather than the decreased costs per se. Copyright © 2011 John Wiley & Sons, Ltd.

This study seeks to investigate whether welfare chauvinism exists in a large country with tremendous regional disparities and massive internal migration. Set in the context of coastal Guangdong Province, it examines Chinese people's attitudes toward welfare entitlements for rural-to-urban immigrants. The study finds that chauvinistic attitude does not fracture along the lines of intergroup competition in the labor market; instead, it stems primarily from perceived competition over scarce welfare resources. Normative values and generalized trust powerfully mitigate welfare chauvinism. The larger relative number of migrants in the local community substantially increases the appeal of chauvinism, thus suggesting the occurrence of negative intergroup interactions. The empirical evidence is discussed against the broader context of rural-to-urban immigration in China and the developmental logic of its social policies. (J Contemp China/GIGA)

Policy entrepreneurs play a pivotal role in policy changes in both electoral democracies and authoritarian systems. By investigating the case of healthcare reform in Sanming City, this article illustrates how the fragmented bureaucracy in China enables and constrains local policy entrepreneurs, and how entrepreneurial manoeuvring succeeds in realigning the old institutional structures while attacking the vested interests. Both structural conditions and individual attributes are of critical importance to the success of policy entrepreneurship. Four factors and their dynamic interactions are central to local policy entrepreneurship: behavioural traits, political capital, network position and institutional framework. This study furthers theoretical discussion on policy entrepreneurship by elucidating the fluidity of interactional patterns between agent and structure in authoritarian China. The malleability of rigid institutions can be considerably increased by the active manoeuvring of entrepreneurial agents. (China Q/GIGA)

The competency of the Chinese health bureaucracy has long been questioned in light of past healthcare reform failures. This article, however, by analysing the case of the Fujian Provincial Health Bureau and a policy intervention led by it aimed at curbing rampant cost inflation, demonstrates that with a conducive political environment and firm policy determination, it is possible to achieve effective cost containment without touching fundamental economic levers. The health bureaucracy is not inherently incapable. It still possesses essential authority and policy instruments to exercise strong stewardship. The reassertion of its legitimacy, reinforcement of government stewardship, restoration of the collapsed accountability mechanisms and realignment of government tools epitomise the experiences of Fujian's healthcare reforms. (CIJ/GIGA)

China has embarked on a systemic and holistic healthcare reform to provide universal coverage and affordable health services. Yet, the reform is likely to fail if the fundamental causes of the system failure such as perverse incentives are inappropriately tackled. The establishment of an essential national drug system, the experiments on clinical pathways and the public hospital sector reform are all aimed at addressing these issues. (East Asian Pol/GIGA)

The decline in popularity of New Public Management worldwide reinvigorated the search for a new paradigm in the field of public administration. Several alternatives to New Public Management, such as the New Governance and Public Value paradigms, have gained prominence in recent years. Despite tensions among these paradigms, exceptional challenges for public administration teaching programs exist. Xun Wu and Jingwei He of the National University of Singapore compiled data on public administration and management courses from 48 top master of public administration degree programs in China and the United States. This essay analyzes how competing paradigms influenced the selection of course content and pedagogical foci in professional training curricula. The authors conclude that in order to take advantage of an unprecedented opportunity provided by the rapid, global expansion of professional education in public administration, there is an urgent need to find a synthesized theoretical framework.

China's dizzying economic achievement is not mirrored in its labor rights protection record. Migrant workers in particular do not enjoy rights commensurate with their contribution to the economy. The pervasive infringement of labor rights and the failure of the official protective system have jointly created a niche for nongovernmental organizations (NGOs). This article investigates the grassroots migrant labor NGOs in the Pearl River Delta region, an area which has seen unprecedented increases in labor disputes both in terms of quantity and intensity. Making extensive use of in-depth interviews and participatory observations, it examines the strategies and tactics NGOs use for survival and growth in a hostile external environment. This article reveals that administrative illegitimacy and resource shortage have been the two key challenges for grassroots NGOs; in order to survive, they have developed a series of strategies to enhance legitimacy and explore resources. In the meantime, however, antagonistic thinking still drives the government's response to grassroots organizations unless the latter can skillfully balance political ideology and actual operation. Yet, overall, most NGOs still managed to survive despite various difficulties. Reciprocity and mutual trust are of critical importance to peaceful coexistence, if not cooperation, between the state and the grassroots. The building of long-term healthy labor relations in China necessitates more liberal thinking and collaborative governance. (J Contemp China/GIGA)

The patterns of hospitals' behavioural changes in response to different insurance systems and payment arrangements have been well documented in the literature on health economics and policy. To understand these changes, it is necessary to look at the shifts in fundamental economic incentives. Meanwhile, hospital practices are also subject to adjustment when administrative tools are realigned. This article examines the dynamics of a health policy campaign started in 2005 by a Chinese provincial health administration that was committed to containing health expenditures using administrative measures. Through a combination of qualitative in-depth interviews and quantitative panel data analysis comprising 30 public hospitals in the sample, this article finds that by revising the structure of administrative measures on the supply side, the Chinese health bureaucracy is able to curb rapid cost inflation in the short term. However, while having to meet the cost control mandate imposed by the health administration, Chinese public hospitals still managed to defend their economic interests by engaging in various unintended opportunistic behaviour. This article analyses a panel database from Fujian province and reveals the strategies adopted by public hospitals and considers their implications for China's ongoing national healthcare reform. (China Q/GIGA)