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

没有选举的压力，没有独立的公民社会，中国政府扩大社会福利的动机是什么？此外，是什么导致了中国社会政策执行的地方差异？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福利国家绩效的更大问题，这些国家占世界人口和国家的一半。尽管这一问题具有重要意义，但主流研究范式忽视或歪曲了威权制度，而是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它在寻求善治的政策分析中的效用。对发展中国家福利制度的许多政策分析过分侧重于国家一级的政策采纳。实际上，所有类型的政权都必须克服地理和区域多样性所固有的困难，这种多样性造成了地方社区的复杂现实。如果不了解一个国家内部的变化，分析人员就无法完全掌握推动政策成功和失败的原因。这项研究开始填补这些明显的空白。为此，本文将考察新型合作医疗制度在中国农村的采用和实施变化。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、经济约束和社会力量。现存的关于发展中国家福利国家的文献在国家层面上考察了前两组假设；本研究将检验这些因素是否会影响新农合在中国地方层面实施的差异。对于社会力量的作用，当前文献典型地强调民主和民主化的作用；这个项目将研究社会力量是否以及如何影响专制背景下社会政策的采用和实施。为了对这些理论进行实证检验，本文将依靠定性研究，包括档案研究；与政府官员、医务人员和村民进行半结构化访谈；以及对五个省县级公共卫生官员的原始调查的分析。此外，通过在中国和其他发展中国家传播原始调查和介绍结果，本文将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。第二，合作研究者将与中国合作伙伴合作，并在中国大学用中文展示她的研究成果。第三，本文对发展中国家的社会政策具有政策意义，并将包括其他发展中国家社会政策的比较章节。因此，研究结果将对中国及其他国家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.