Social Protection under Authoritarianism: Politics and Policy of Social Health Insurance in China

Xian Huang
Does authoritarian regime provide social protection to its people? What is the purpose of social welfare provision in an authoritarian regime? How is social welfare policy designed and enforced in the authoritarian and multilevel governance setting? Who gets what, when and how from the social welfare provision in an authoritarian regime? My dissertation investigates these questions through a detailed study of Chinese social health insurance from 1998 to 2010. I argue and empirically show that
more » ... rically show that the Chinese social health insurance system is characterized by a nationwide stratification pattern as well as systematic regional differences in generosity and coverage of welfare benefits. I argue that the distribution of Chinese social welfare benefits is a strategic choice of the central leadership who intends to maintain particularly privileged provisions for the elites whom are considered important for social stability while pursuing broad and modest social welfare provisions for the masses. Provisions of the welfare benefits are put in practice, however, through an interaction between the central leaders who care most about regime stability and the local leaders who confront distinct constraints in local circumstances such as fiscal stringency and social risk. The dynamics of central-local interactions stands at the core of the politics of social welfare provision, and helps explain the remarkable subnational variation in social welfare under China's authoritarian yet decentralized system. This dissertation attempts to contribute to the studies of authoritarianism, decentralization and social welfare in the following aspects. First, in specifying the rationale, conditions and policy results of the interaction between Chinese central and local leaders in social welfare provision, the dissertation sheds light on how political leaders in an authoritarian regime with multilevel governance structure respond to social needs. The analysis of subnational politicians' incentive structure and policy choices in social welf [...]
doi:10.7916/d8mc8xn4 fatcat:hw2sbfl5and4legg7fpdw6t4mq