Want a Horse to Run but not Eat? Conflict Objectives and Policy Dilemmas in China’s Medical Reform

Abstract

Medical reform is not only closely related to the interests of the public, but it also reflects the interdependence of government, the market, and society. Within a country’s medical reform coexists the “big objective” of the government and the “small objective” of the governance object. Their interactions will affect the policy stream and the policy window. If the “big objective” is compatible with the “small objective”, then the “real policy window” will open. If the two are in conflict, they will grind together, enlarging the discretion of the governance object. The result will be the opening of an “illusory policy window” that will slow the policy reform or even hinder it. The multiple reforms of the Chinese medical industry are the result of the four competitive governance logics coexisting in public hospital governance. The first two-the country’s logic (public welfare dominant) and bureaucratic logic (executive order-led) -have shaped the “big objective” of public welfare. Enterprise logic (market-oriented) and the logic of professional organizations (led by experts) have shaped the “small objective” of effective operation. The conflict and balance between “big objective” and “small objective” have seriously affected the process of Chinese social policy reform.