Health Care Transformation in Contemporary China: Moral Experience in a Socialist Neoliberal Polity
Author: Tu, Jiong , tujiongnk@gmail.com
Department: Department of Sociology
University: University of Cambridge, United Kingdom
Supervisor: Dr Peggy Watson
Year of completion: 2014
Language of dissertation: English
Keywords:
Healthcare Reform
, China
, Moral Experience
, Governmentality
Areas of Research:
Health
, Political Sociology
, Social Transformations and Sociology of Development
Abstract
Since the 1980s, when China began to adopt market reforms, its health system experienced a transition from fully state run and financed system towards more private financing and delivery of health care. These changes led to soaring medical fees, minimal medical insurance coverage, and poor access to affordable medical services. These negative consequences have undermined public perceptions of the Chinese government. In response, since 2009, China has been implementing a new round of healthcare reform that is attempting to reverse the market character of earlier trajectories. The change has been accompanied by the shifts in values, ideologies, and governance. Drawing on Foucault’s concept of governmentality and its critical use by other researchers, this research explores the configurations of governmental power, rationality, techniques, and subjectivity in the Chinese health sector.
From 2011 to 2012, I did fieldwork in Riverside (a pseudonym) County of Sichuan province. The research involved semi-structured interviews and conversations with patients, health professionals and administrators about their health care (medical practice) experiences. I took participant observation in medical clinics, community health centres, public and private hospitals to see how health care were carried out and talked about in daily practice setting. Local archives, county gazetteers, official regulations, and government reports about health care changes and administrations were searched and collected. This thesis supplies an ethnographic analysis of people’s moral experiences during healthcare transformation over the past decades, and outlines the complexity, messiness and contradictions within individual experiences, institutional practices, and government rationales.
Chinese health policy and governance are marked by an extreme form of hybridity with the collision and convergence of market values, neoliberal technologies, authoritarian rule, and a strong, state-led socialism. The combination of these seemly contradictory rationalities and techniques of governance enables the making of governable subjects in the health sector, but also creates increasingly resentful individuals with insufficiently protected rights. Health care functions as a biopower, maximising the energy and capacity of individuals and institutions while prohibiting certain acts, ensuring that certain members of the population are nurtured and have entitlement while others are marginalised and neglected. Health care is the site of contestation, rebuilding and legitimation of governance. It makes the government itself subject to the normative discourses of morality and modernity. The Chinese healthcare reform is an ongoing ideological and moral project in the party-state’s renewal and reinvention of itself, and is tackling unprecedented challenges as it progresses to actually improve people’s health care experience.
