Doctoral Dissertation Research in Political Science: Understanding Chinese "Welfare States": Rural Health Policy and the New Cooperative Medical System

在没有选举或独立公民社会的压力下，是什么促使中国政府扩大社会福利供应？此外，中国在社会政策执行方面的地方差异是什么原因？通过对中国农村卫生服务的分析，该项目将解决非民主发展中国家的福利国家绩效这个更大的问题，这些国家占世界人口和民族的一半。尽管这一问题意义重大，但主流研究范式忽视或曲解了威权制度，转而关注民主力量的影响，如公民社会和选举竞争。当前文献中的另一个空白限制了其在寻求良好治理的政策分析方面的效用。对发展中国家福利制度的许多政策分析过于侧重于国家一级的政策采纳。在现实中，所有类型的政权都必须努力应对产生当地社区复杂现实的地理和区域多样性所固有的困难。如果不了解一国内部的差异，分析师就不能完全掌握推动政策成败的原因。本研究开始填补这些明显的空白。为此，本文将考察新型农村合作医疗制度在中国农村地区的采纳和实施情况。在现有文献的基础上，本项目将评估三大类假设：政治和历史背景、经济限制和社会力量。现有的关于发展中国家福利国家的文献考察了前两组国家层面的假设；本研究将检验这些因素是否会影响中国在地方层面实施新农合的差异。至于社会力量的影响，目前的文献通常强调民主和民主化的作用；本项目将审查社会力量是否以及如何影响在威权背景下通过和执行社会政策。为了对这些理论进行实证检验，论文将依靠定性研究，包括档案研究；对政府官员、医务人员和村民的半结构化访谈；以及对五个省的县级卫生官员的原始调查的分析。此外，本文还将通过在中国等发展中国家传播原始调查和展示结果来产生具体的、更广泛的影响。首先，原始调查将存档供公众使用。其次，合作研究员将与中国合作伙伴合作，并在中国大学展示她的中文研究成果。第三，这篇论文对发展中国家的社会政策有政策影响，并将包括一个关于其他发展中国家社会政策的比较章节。因此，这一结果将对中国及其以后关注社会福利提供的学术辩论和政策制定者产生影响。

Without the pressures of elections or independent civil society, what motivates the Chinese government to expand social welfare provision? Moreover, what accounts for local variation in implementation of social policy in China? Through an analysis of rural health delivery in China, this project will address the larger issue of welfare state performance in non-democratic developing countries, which comprise half of the world's people and nations. Despite the significance of this issue, the dominant research paradigms ignore or misrepresent authoritarian systems and instead focus on the impacts of democratic forces, such as civil society and electoral competition.Another gap in the current literature limits its utility for policy analysis in the quest for good governance. Much policy analysis of welfare regimes in developing countries is overly focused on policy adoption at the national level. In reality, all regime types have to grapple with the difficulties inherent to the geographic and regional diversity that produces the complex realities of local communities. Without understanding variation within a country, an analyst cannot fully grasp the causes driving policy successes and failures. This research begins to fill in these glaring lacunae.To this end, the dissertation will examine the adoption and variation in implementation of the New Cooperative Medical System (NCMS) in rural China. Building on the existing literature, this project will evaluate three broad categories of hypotheses: political and historical context, economic constraints, and social forces. The extant literature on the welfare state in developing countries examines the first two sets of hypotheses at the national level; this research will test whether these factors affect variation in implementation of the NCMS at the local level in China. As for the effect of social forces, the current literature typically emphasizes the role of democracy and democratization; this project will examine whether and how social forces affect the adoption and implementation of social policy in an authoritarian context. To test these theories empirically, the dissertation will rely on qualitative research, including archival research; semi-structured interviews with government officials, medical personnel, and villagers; and the analysis of an original survey of county-level Public Health officials in five provinces.In addition, this dissertation will have concrete broader impacts through the dissemination of an original survey and the presentation of results in China and other developing countries. First, the original survey will be archived for public use. Second, the co-investigator will collaborate with Chinese partners and present the results of her research in Chinese at Chinese universities. Third, the dissertation has policy implications for social policy in developing countries and will include a comparative chapter on social policy in other developing countries. Thus, the results will have implications for both academic debates and policymakers concerned with social welfare provision in China and beyond.