Health Insurance Regime as Differentiation and Discipline: The Chinese Health Insurance Reforms

Abstract

Health care in the Chinese official discourses is expressed as a right. At the First National Health Work Conference in 1950, soon after the founding of the People’s Republic of China (in 1949), health care was declared as a right. It laid down healthcare guidelines oriented towards ‘workers, peasants and soldiers’. 1 The constitution, first promulgated in 1954 and later revised many times, denoted that the state should develop various medical and health care facilities to protect people’s health (Article 21), that Chinese citizens should have the right to get material help from the state and society when they are old, sick, or lose their working ability, and that the state will develop social insurance, social aid, and medical and health care work to meet these rights of citizens (Article 45). In the collective era (from 1950s to 1970s), China had provided basic health care to most of its population. Health care then was consisted of health care for workers under the Labour Insurance Scheme (LIS, laobao yiliao), mainly funded by the welfare funds of enterprises, providing employees and their immediate family members with full or partial medical care coverage; public health care for government employees through the Government Insurance Scheme (GIS, gongfei yiliao), financed directly by governments at various levels, provided to people working in government and public institutions, including the staff of cultural, educational, health, and research institutes, and students at colleges and universities; and the rural Cooperative Medical Scheme (CMS, hezuo yiliao) for peasants, funded by contributions from participants and heavily subsidised by the rural collective welfare funds and government.