Social Welfare and Public Services in Transforming China

2:00 pm – 3:45 pm
Room 3

  • Organised by Hua Wang
  • Hua Wang, “Elderly Care Provision in Urban Communities of China: Institutions, Actors, and Local Constraints”
  • Pia Eskelinen, “Hukou, Rural Women and Land Rights”
  • Diwen Xiao, Liao Liao, Yulin Wang, “Cross-Border Health Service Provision under ‘One Country, Two Systems’: The Evidence from University of Hong Kong-Shenzhen Hospital”
  • Jingyan Zhu, “The Perceptions of Marketisation in Health Care in China: Evidence from Chinese Local Health Facilities”

China’s welfare regime is undergoing tremendous transformation. With decades of reform and opening-up, China’s economic performance has achieved great success, yet issues like public services supply, social welfare provision and social inequalities have become more significant challenges facing Chinese government and society. This panel, consisting of four papers by authors from both European countries and China, seeks to inquire the existing problems of citizens’ welfare rights, eldercare provision, and cross-border public services supply in the transforming period of China. All papers on this panel are based upon solid empirical evidence collected from contemporary China. Pia Eskelinen’s paper focuses on rural women’s land rights and how the change of Hukou locations has generated gender inequalities in land contracts. Diwen Xiao’s paper argues that the political party (CCP) has played a significant role in influencing the cross-border supply of public services through its interaction with professional groups. Hua Wang’s paper looks into how the central initiatives on elderly care have been implemented in the local context and how the elderly care provision structure in urban communities has been shaped by various factors. Anthea Cain’s paper takes the specific populations who directly provide eldercare to the growing aged in China as a lens to understand the care chains among rural-to-urban migrant women and non-migrant urban women, thus to investigate the gender inequality in old age.

Hua Wang, “Elderly Care Provision in Urban Communities of China: Institutions, Actors, and Local Constraints”

As one of the most indispensable civil welfare schemes, elderly care in China has become a significant social issue. The Chinese government has recognised the need to strengthen formal elderly care provisions and expand access to services. Since 2013, Chinese central government has issued several policy documents to promote “Integrated Elderly Care” and “Long-term Care Insurance”. However, the local practice in implementing these initiatives has demonstrated distinct local characteristics and great variation. The policy deviation is partly due to the conflicting interests of local bureaucratic institutions. In the meantime, the interaction of public-private sectors, and the influence of the third sectors are also relevant. This article takes the implementation of “Integrated Elderly care” and “Long-term Care Insurance” as case studies, to illustrate the process of how the central initiative being implemented in the local context and most importantly, how the elderly care provision structure has been constructed in the urban communities. Based on case studies and interviews from 2019 to 2020 in several Chinese cities, this study tries to provide a clear picture of elderly care provision structure in the Chinese urban communities, and analyse how the structure has been shaped by central policy design and local policy implementation, the interaction of public-private actors and families, and other local constraints.

Pia Eskelinen, “Hukou, Rural Women and Land Rights”

The household registration system, hukou, was introduced by the People’s Republic of China in the 1950’s, even though hukou’s history in imperial China is thousands of years long. The hukou system does not only designate residents’ status as being either rural or urban based on their registered birthplace but it also controls (domestic) migration. In today’s China, the problem of the hukou system is not simply controlling migration, but the great inequality the hukou has created between the urban and rural population. However, there are inequalities and inconsistencies within the rural hukou holders as well. Most striking problem involves the land contracting in rural areas after hukou location has been changed. Particularly rural women suffer from the unequal policies surrounding the changing of hukou location and status compared with rural men. According to my interviews, there are different rules for men and women although the law is very clear: land should be redistributed if new residents move in the area and if they no longer have land at their old location. China cannot be analysed from a Western perspective but rather within the Marxist, Confucianist and Chinese feministic framework. This research is mainly based on formal interviews and informal discussions that will be analysed within the framework of the theories and philosophies grounding Chinese ideology.

Diwen Xiao, Liao Liao, Yulin Wang “Cross-border Health Service Provision under ‘One Country, Two Systems’: The Evidence from University of Hong Kong-Shenzhen Hospital”

It has become a universal public governance issue to achieve effective cross-border public service supply and ensure citizens’ social rights in the age of globalisation. Existing studies focus on the cross-border public service provisions between developed countries, emphasising the importance of coordination and supranational institutions to ensure the effective supply of public services. There are few studies on cross-regional practice within sovereign countries and little attention has been paid to the political parties. This study takes the development of the University of Hong Kong-Shenzhen Hospital as an example to show how the CCP influences the cross-border supply of public services in the context of “one country, two systems.” The study presents that the interactions between CCP and professional groups promote the settlement of cross-border medical and health services. On the one hand, CCP of Hospital plays a linking role in the communication between hospitals and local governments to ensure mutual trust. On the other hand, CCP also ensures that professional organisations can adapt to the new institutional environment and provide high-quality medical services under its consultation and supervision. Meanwhile, important plans of the hospital are formulated jointly by CCP, the board of directors, and experts or decided in a collaborative way. This study would shed light on both the cross-border public services provision under the “one country, two systems” regime, and the role of political power and the professionals in trans-system health cooperation.

Jingyan Zhu, “The Perceptions of Marketisation in Health Care in China: Evidence from Chinese Local Health Facilities”

Since the 2009 healthcare reform, the Chinese health system has undergone the transition with a series of government-funded programs ensuring the safety net and public health provision for the Chinese population. However, it is largely relying on the market in the delivery of hospital-centred services. The long-term marketisation for over three decades has significantly affected people’s understanding and behaviours of health care. The existing scholarship pays scant attention to how stakeholders view marketisation and how the marketisation impacts on the utilisation of health care. This study focuses on the perceptions of marketisation at the service delivery level through the various lens of stakeholders, including patients and their lay carers, health professionals, health board managers and local administrators.
This is qualitative research with a multiple case design. Four local health facilities are selected as case sites in Shandong Province, including two city hospitals, a county hospital and a long-term care facility between 2017 and 2019. Semi-structure interviews are conducted for data collection. Framework analysis is used for data analysis. Drawing upon the empirical evidence in selected Chinese local hospitals, I argue that the marketisation in health care leads to a variety of demands, expectations, and beliefs in health care. It also stimulates service users as consumers to exercise rights of choices in the market of health care. This study contributes to our understanding of marketisation and the impact on the utilisation of health services empirically and theoretically.

Event Timeslots (1)

Room 3