Social Protection under Authoritarianism: Politics and Policy of Social Health Insurance in China
Creators: Huang, Xian
Publisher: name: Columbia University
Year: 2014
Subjects: subject: Authoritarianism
subject: Public welfare--Political aspects
subject: Public welfare--Government policy
subject: Public welfare
subject: Political science
subject: FOS: Political science

description: Does authoritarian regime provide social protection to its people? What is the purpose of social welfare provision in an authoritarian regime? How is social welfare policy designed and enforced in the authoritarian and multilevel governance setting? Who gets what, when and how from the social welfare provision in an authoritarian regime? My dissertation investigates these questions through a detailed study of Chinese social health insurance from 1998 to 2010. I argue and empirically show that the Chinese social health insurance system is characterized by a nationwide stratification pattern as well as systematic regional differences in generosity and coverage of welfare benefits. I argue that the distribution of Chinese social welfare benefits is a strategic choice of the central leadership who intends to maintain particularly privileged provisions for the elites whom are considered important for social stability while pursuing broad and modest social welfare provisions for the masses. Provisions of the welfare benefits are put in practice, however, through an interaction between the central leaders who care most about regime stability and the local leaders who confront distinct constraints in local circumstances such as fiscal stringency and social risk. The dynamics of central-local interactions stands at the core of the politics of social welfare provision, and helps explain the remarkable subnational variation in social welfare under China's authoritarian yet decentralized system. 
      This dissertation attempts to contribute to the studies of authoritarianism, decentralization and social welfare in the following aspects. First, in specifying the rationale, conditions and policy results of the interaction between Chinese central and local leaders in social welfare provision, the dissertation sheds light on how political leaders in an authoritarian regime with multilevel governance structure respond to social needs. The analysis of subnational politicians' incentive structure and policy choices in social welfare provision, which are missing in most extant studies of authoritarianism and social welfare, demonstrates an "indirect accountability" built into the Chinese social welfare provision. This "indirect accountability", evidenced by local leaders' proactive accommodation of social and local needs through social policies, may partially account for the puzzling resilience and flexibility of Chinese authoritarian regime. Second, the dissertation demonstrates that social welfare expansion, in some cases, is not a result of democracy but of resilient authoritarianism. Social welfare is one tool employed by authoritarian leaders to maintain regime stability. The political motivation for social welfare provision is different in non-democracies--it is more directly from top-down pressure of maintaining order rather than from bottom-up demands as in democracies--but this does not mean that non-democracies provide less social welfare than democracies do. Furthermore, the dissertation highlights the multidimensionality of social welfare policy and the trade-offs that politicians face in distributing welfare benefits. It suggests that politicians, no matter in democracies or non-democracies, face similar policy trade-offs (e.g. coverage versus generosity) in social welfare provision and that they make policy choices on the different dimensions of social welfare -coverage, generosity and stratification- according to the specific institutional and socioeconomic constraints they encounter. It is the combination of these different choices that constitute the variation of social welfare provision observed cross countries and within countries.