Bringing the local state back in: the political economy of public health in rural China

Abstract

Contrary to what most alarmist reports would imply, China has not witnessed a measurable decline in the overall public health status. What explains the continuous improvement in some important domains of public health despite the pertinacious pricing, financing and institutional‐behavioral problems in China's health system change? This study provides a political economy analysis of the role the local Chinese state played in rural public health provision during the reform era. Through comparative case studies, statistical analysis, and formal modeling, the study shows that state capacity is a principal factor setting the parameters for rural public health in China. It also suggests that the post‐Mao reforms, while generating strong disincentives for the provision of public services, unleashed forces that lay down the institutional bases for sustained state engagement in the health sector.