Building a Welfare State:A Case Study of Rural Migrant Medical Insurance in Urban China.

China;Social Welfare System;Authoritarian States;Medical Insurance;Public Goods;Migration;Rural Migrants;Hukou System;Social Policy;Social Insurance;Healthcare;Shanghai;Guangzhou;Local Government Competition;Policy Diffusion;Labor;Fiscal Incentives;Pension;Policy Legacy;Political Science;Social Sciences;Political Science

Trieu, Huong T.Shipan, Charles R. ;

University of Michigan

关键词: China;    Social Welfare System;    Authoritarian States;    Medical Insurance;    Public Goods;    Migration;    Rural Migrants;    Hukou System;    Social Policy;    Social Insurance;    Healthcare;    Shanghai;    Guangzhou;    Local Government Competition;    Policy Diffusion;    Labor;    Fiscal Incentives;    Pension;    Policy Legacy;    Political Science;    Social Sciences;    Political Science;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/97906/htrieu_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

My dissertation explores the expansion of social insurance, specifically medical insurance, for migrants, who are neither urban nor rural residents, in urban China.I investigate the factors that account for the expansion of medical insurance to this group in some localities but not others.Building upon the literature on social welfare and the logic of social welfare provision in authoritarian states, I argue that the recent adoption of urban migrant medical insurance is primarily a state centered story about leaders’ political and fiscal incentives.Migrant medical insurance programs have been adopted as a result of three factors: policy legacy, political structure, and political and fiscal incentives.Using an inductive approach to derive theory from case studies in Shanghai and Guangzhou, I argue that policy legacies matter because past policies of the command economy, the danwei system and the hukou system have created a social welfare system based on employer contributions where there are two options for expanding social welfare to migrant workers, hukou conversion and ad hoc social program expansion.Moreover, the political structure, characterized by bureaucratic negotiation between central and local governments, has created a space for variation in local policy and promoted competition between local governments.However, these first two variables are static across all localities.While they explain the broad context of social insurance expansion in China, they cannot alone explain the variation at the local level.In this regard, I argue that the cadre evaluation system and the fiscal system have created political and fiscal incentives that motivated the expansion of medical insurance to migrants as a development and revenue raising strategy. I hypothesize that local governments have used medical insurance as a way to attract skilled labor to develop their local economies because government officials have been evaluated on their ability to generate economic growth.Additionally, fiscal deficit, not fiscal surplus, has been a key factor in social policy expansion because overstretched local governments can use migrant insurance funds as extrabudgetary revenue to meet current fiscal commitments.These hypotheses are tested in a dataset of 285 prefecture-level and provincial-level cities.