Accountability Mechanisms for the Realisation of the Right to Health Care in China

Abstract

INTRODUCTION This chapter evaluates the extent to which right to health-based accountability can advance the right to health care within China's unique legal, political and social background. The purposes of such an assessment are threefold. First, as outlined in chapter 2, States undertake a core obligation to establish a range of effective, transparent, accessible and independent accountability mechanisms in relation to duties arising from the right to health (care). In his mission to China in 2017, Philip Alston, the UN Special Rapporteur on Extreme Poverty and Human Rights, observed the existence of top-down mechanisms in China to control public officials; however, he also noted that ‘it is extremely difficult to identify any effective mechanisms or avenues’ that provide ‘regularized avenues for citizens to complain and seek remedies for relevant abuses’, ‘despite the plethora of procedures that exist in theory’. In light of this, by identifying existing mechanisms for exerting accountability in the context of the right to health care chapter 7 first examines whether China has discharged its core obligation to establish appropriate accountability mechanisms. Second, previous (human rights or political science) scholarship addressing accountability has more or less focused on democratic countries with competitive, free and fair elections; relatively little attention has been paid to accountability in non-electoral regimes. This begs the question of whether the concept of accountability can be applied in the same fashion in non-electoral regimes. In fact, as explained in chapter 6, there is a considerable volume of literature and research criticising the effectiveness of elections for ensuring political accountability and aiming to identify other forms of accountability mechanisms to advance the right to health care. By taking China as a country study, this chapter can reach a greater understanding of accountability. States with similar legal and political settings can also draw lessons from China's experience. Third, through extensive case analyses, this chapter explores the role that accountability can play in reducing abuses of power, assuring compliance with right to health standards and redressing violations of the right to health care within the context of China's current legal and political system. By identifying examples of good practice and obstacles to improved accountability, this chapter offers several recommendations for the enhancement of accountability. The recommendations, if fed directly into China's new round of health care reform (NHR), would eventually advance the right to health care in China.