Expansion of Chinese Social Health Insurance: who gets what, when and how?

Abstract

This article asks ‘who gets what, when and how’ from China's recent social welfare expansion. Little research to date examines the overall landscape of China's social health insurance, which has changed dramatically since 2003, and the distributive consequences and implications thereof. Drawing on public survey data and fieldwork for empirical support, this article finds that China's recent social health insurance expansion does significantly expand people's access to social health insurance. However, the expansion, which entails health insurance fragmentation and increasing benefit disparities, not only reinforces existing social cleavages such as the rural–urban divide, but it also generates new divisions within urbanites and workforce. Moreover, multiple social cleavages that cross-cut class differences have been institutionalized into China's social health insurance system. This reflects authoritarian regimes' ‘divide and rule’ tactic in social welfare provision.