Rural Reform In China Research Articles

The impact of welfare design on consumption patterns of the poor: Evidence from the recent Dibao reform in rural China

In the recent anti-poverty campaign, China's minimum livelihood guarantee program (called Dibao in Chinese) experienced significant changes in that it now includes both cash transfer and special assistances such as education and healthcare subsidies. Therefore, the current Dibao program in China is a composite cash transfer program containing the nature of both unconditional and conditional cash transfers. This paper is the first attempt to examine the impact of a composite cash transfer program on consumption patterns of the poor population by utilizing exogenous variation in the differential size of increases in Dibao subsidy lines across cities. We find that the Dibao reform has a significantly positive effect on total consumption of poor households. In particular, the generosity of this composite cash transfer program increased human capital expenditures to a large extent including expenditures on healthcare and children's education. The Dibao reform also generates positive spillovers such as increasing school enrollment and improving academic performance for children in Dibao families.

Improving access to primary health care through financial innovation in rural China: a quasi-experimental synthetic difference-in-differences approach

BackgroundInadequate financing constrains primary healthcare (PHC) capacity in many low- and middle-income countries, particularly in rural areas. This study evaluates an innovative PHC financing reform in rural China that aimed to improve access to healthcare services through supply-side integration and the establishment of a designated PHC fund.MethodsWe employed a quasi-experimental synthetic difference-in-differences (SDID) approach to analyze county-level panel data from Chongqing Province, China, spanning from 2009 to 2018. The study compared the impact of the reform on PHC access and per capita health expenditures in Pengshui County with 37 other control counties (districts). We assessed the reform’s impact on two key outcomes: the share of outpatient visits at PHC facilities and per capita total PHC expenditure.ResultsThe reform led to a significant increase in the share of outpatient visits at PHC facilities (14.92% points; 95% CI: 6.59–23.24) and an increase in per capita total PHC expenditure (87.30 CNY; 95% CI: 3.71-170.88) in Pengshui County compared to the synthetic control. These effects were robust across alternative model specifications and increased in magnitude over time, highlighting the effectiveness of the integrated financing model in enhancing PHC capacity and access in rural China.ConclusionsThis research presents compelling evidence demonstrating that horizontal integration in PHC financing significantly improved utilization and resource allocation in rural primary care settings in China. This reform serves as a pivotal model for resource-limited environments, demonstrating how supply-side financing integration can bolster PHC and facilitate progress toward universal health coverage. The findings underscore the importance of sustainable financing mechanisms and the need for policy commitment to achieve equitable healthcare access.

How new rural elites facilitate community-based homestead system reform in rural China: A perspective of village transformation

In line with China's rural transformation, the homestead system reform (HSR) pilots have been launched to rectify adverse land-related issues by formalising and capitalising land property rights. In contrast with a government-led model prevalent among most national HSR pilots, a community-based approach has been experimented with and proven efficient in Yujiang County, southern China. It highlights a pivotal role of the endogenous and public-spirited activists who are locally called ‘new rural elites’ (NREs). From the perspective of village transformation processes, this paper establishes a theoretical framework and employs a case study in Yujiang to interpret the underlying rationale for NREs' involvement in HSR. The findings indicate that HSR, aiming at multi-level space reshaping and ‘three rights separation’ reform, is in alignment with the triple processes of village transformation (i.e., systemic, communal, and living). The NREs represent a cultural force for facilitating village transformation, which is underpinned by the capacity, channel and carrier endowed by urban-rural linkages, interpersonal value transmission and community social solidarity, respectively. The benevolent dominance of the NREs is jointly shaped by governmental empowerment and accountability, egalitarian property rights design and strong social solidarity. To expand NREs' benevolent roles, this study recommends aligning community empowerment with the improvements of community-based action capacity.

A multi-case study of the vertically integrated health-care at county-level in rural China: towards holistic and dynamic governance.

In contrast to the Grading Diagnosis and Treatment System (GDTS), Vertically Integrated Health-care at County-level (VIHC) is a strategic policy in rural China. This research intends to analyze the shift in governance paradigm with regard to the adjustment of the power structure and interest relationships among various participants, using the building of VIHC as a cut-in point. We carry out a multi-case study to investigate the paradigms of health governance when building VIHC in three different rural counties in China. There were exchanges between government and other participants, vertical and horizontal collaborations among government divisions, and prompt responses to public requirements. County C's local administration, in particular, placed a strong emphasis on bureaucratic power and collaboration between various departments both within and outside of administrative boundaries. In contrast, County B's local administration emphasized the independence of healthcare practitioners and worked to win their support. In contrast to the previous two governments, County A encouraged social actors to participate and saw a little improvement in performance. In examining the health reform in rural China, this study paints a picture of the development of the health governance paradigm. In rural China, a comprehensive and dynamic governance paradigm was created through the integration of the health decision-making process, which was driven by the public's health needs, the operation mechanism, which featured both competition and cooperation, and the action logic of sharing responsibility.

How farmland circulation affects household financial vulnerability in China: The chain mediation effect of labor transfer and financial literacy

Financial vulnerability is an important issue in livelihood resilience research domain. In the context of the Farmland Property Rights Reform in rural China and the promotion of farmland circulation, this study aims to explore whether and how household financial vulnerability is affected by farmland circulation and whether its impact shows heterogeneous characteristics depending on differences in farm household characteristics and regional characteristics. To answer these questions, a theoretical and empirical study was conducted based on the latest available Chinese household survey data (N = 9,822) from 2015 to 2019, using a chain mediating effects model and group regressions. The findings showed that farmland circulation could significantly reduce household financial vulnerability (Coef.=−0.167, p<0.01) while labor transfer and financial literacy played a mediating role. That is to say, farmland circulation could indirectly reduce household financial vulnerability by affecting labor transfer and financial literacy. The heterogeneity analysis showed that farmland circulation had a stronger mitigating effect on the financial vulnerability of older “first-generation farmer” households (with heads born before the 1980's) and households in the eastern regions with higher levels of economic development, suggesting that despite the “better late than never” advantage of farmland circulation, it can lead to greater regional inequality. These findings not only advance our understanding of how farmland circulation is associated with financial vulnerability but also provide some implications for the government's continuous optimization of the Farmland Property Rights Reform to ensure the financial security of farming households.

Does Rural Operation System Reform Enhance Agricultural Output? Evidence from Sichuan Province

Rural operation system reform is vital in promoting rural revitalisation and agricultural and rural modernisation in China. Based on the sample data of 153 counties in Sichuan Province from 2012 to 2020, this paper constructs a PSM-DID evaluation model to analyse the effectiveness of rural operation system reform on agricultural development from the perspective of policy action mechanism, variable differentiation and other aspects. The results show that: (1) rural operation system reform has significantly boosted the economic development of the counties implementing the pilot reform of the rural operation system; (2) rural operation system reform mainly has two components: rural land system reform and agriculture organisation innovation; both have an impact on county economic and social development, but the degrees of impact are different; (3) the effectiveness of the rural operation system reform policy has a specific time lag. The results of this paper enrich the effectiveness evaluation of the reform policy on economic development and have policy implications for further promotion of agricultural and rural reform in China.

Taxation and Migration of Peasants: Evidence from the Tax-for-Fee Reform in Rural China

This paper studies the effect of rural taxation on Chinese peasants’ mobility towards urban areas. We find that the tax alleviation due to the tax-for-fee reform significantly reduces rural-to-urban migration, with a 10% decline in tax leading to a 10% reduction in migration. We provide compelling evidence that the result is not driven by unintended policy effects of the tax-for-fee reform in fostering rural non-agricultural job opportunities. The effect of taxation is more pronounced and precisely estimated on migration across provinces or at older ages. To the best of our knowledge this is the first study to identify the tax-induced migration among low-skilled and low-income laborers.

Land System Reform in Rural China: Path and Mechanism

Changes in land policy not only determine agricultural growth, but also have bearing on issues, such as peasants’ rights and interests, industrial development, and urbanization. On account of China’s singular history and culture, its land systems are somewhat unique. This paper analyzes the institutional changes that took place before and after 1978 to show the journey of land system reform in rural China in the 20th century. We look closely at the policy performance and drawbacks of the reform that occurred after 1978, and analyze a series of “Central First Documents” that concern rural issues. Based on this analysis, some prospective land policy reforms are predicated. We conclude that at present, rural land ownership is unlikely to be completely privatized in the short-term. Creating a new agricultural management system with special functions or a land shareholding system, could be suitable measures to overcome the disorder of the existing land policy system in China.

Comparison of inpatient distribution amongst different medical alliances in a county: a longitudinal study on a healthcare reform in rural China

BackgroundChina has launched the medical alliances (MAs) reform to drive the development of primary medical institutions and decrease health inequality in rural areas. Three different types of MAs were built to promote township hospitals in Y County. This study aims to evaluate the actual effect of China’s MAs reform in rural areas on inpatient distribution especially amongst different types of MAs.MethodsWe obtain 2008–2015 claims data from the New Cooperative Medical Scheme (NCMS) in Y County, Hubei Province of China. We consider January 2008–December 2010 as the pre-reform period and January 2011–December 2015 as the post-reform period.We use independent sample t-test and single-group interrupted time series analysis (ITSA) to compare the number of inpatients per month in the three MAs, including three county and 10 township hospitals before and after the reform. We use paired t-test and multiple-group ITSA between seven township hospitals within MAs and seven township hospitals outside MAs.ResultsThe MAs reform in Y County increased the number of inpatients in county and township hospitals within MAs. After the reform, the number of inpatients per month in county hospitals had an upward trend, with a slope of 31.01 person/month (P < 0.000). Approximately 19.99 new inpatients were admitted to township hospitals monthly after the reform (P < 0.000). Furthermore, township hospitals within MAs had a substantial increase in the number of inpatients (10.45 new inpatients monthly) compared with those outside MAs.ConclusionThe MAs reform in Y County significantly improved the capability of medical institutions within MAs. After the reform, township hospitals within MAs had greater development advantages than those outside MAs. However, it also caused further imbalance in the county region, which contained the new health inequality risk.

An answer from Marxist economics to Weber's hypothesis about China: a concurrent discussion of the direction of rural reform in China

PurposeWeber's hypothesis about China is the hypothesis forwarded by Weber that why capitalist production did not appear in eastern countries such as China in the first place. Weber considered that the reason may be Chinese Confucianism and Taoism lack protestant ethic like Western countries.Design/methodology/approachThe clarification has aroused wide discussion, meanwhile, East Asian capitalism belonging to the Chinese cultural circle has successfully refuted Weber's proposition. Chinese scholars have a broad debate around this topic while no agreement has been reached. This paper tries to explain Weber's hypothesis by Marx's theory of capital origin, which can be explained that the landlord economy caused by China's federal society under centralism leads to the result that the commodity of labor cannot exist in that environment.FindingsThe answer from Marxist economics has not only solved an enormous theoretical problem, but also it has vital practical significance. It easily clarifies the fact that the commodity of labor in full sense still cannot emerge in China nowadays, which is an important reason causing China to enter the New Normal and New Era.Originality/valueTherefore, it leaves China the only way of the socialist road with Chinese characteristics and revitalizing China's rural economy, which means China can only promote rural industrialization and urbanization under the principle of adhering to rural collective ownership, while implementing various forms of integrated agricultural and industrial business models based on local conditions.

Incentivising teachers? Evaluating the incentive effect of China’s teacher performance‐based compensation reform in rural China

In this paper, we evaluate the incentive role of a teacher performance‐based compensation reform in rural China. Using the value‐added model widely adopted in the education literature, we first estimated the teacher effects on student academic scores with panel data of a large number of students and teachers from rural and urban schools in one county in a south‐western province of China. The estimated teachers’ value‐add was then allowed us to examine the effectiveness of the 2009 teachers’ compensation reform. We find that despite the strong intent of the performance‐based compensation reform to improve student’s academic performance, teachers’ compensations are not closely tied to teachers’ value‐add to student academic achievement. This suggests that the performance‐based compensation reform is not able to provide strong incentives for teachers to raise students’ test scores and points towards the possible problems with the design and/or implementation of the reform.

Does free education help combat child labor? The effect of a free compulsory education reform in rural China

This paper evaluates the effect of a free compulsory education reform in rural China on the incidence of child labor. We exploit the cross-province variation in the rollout of the reform and apply a difference-in-differences strategy to identify the causal effects of the reform. We find that exposure to free compulsory education significantly reduces the incidence of child labor for boys, but has no significant effect on the likelihood of child labor for girls. Specifically, one additional semester of free compulsory education decreases the incidence of child labor for boys by 8.3 percentage points. Moreover, the negative effect of the reform on the likelihood of child labor is stronger for boys from households with lower socioeconomic status. Finally, the free compulsory education reform may induce parents to reallocate resources towards boys within a household and thus may enlarge the gender gap in human capital investment.

Free Education Helps Combat Child Labor? The Effect of a Free Compulsory Education Reform in Rural China

This paper evaluates the effect of a free compulsory education reform in rural China on the incidence of child labor. We exploit the cross-province variation in the roll-out of the reform and apply a difference-in-differences strategy to identify the causal effects of the reform. We find that the exposure to the free compulsory education significantly reduces the incidence of child labor for boys, but has no significant effect on the likelihood of child labor for girls. Specifically, one additional semester of free compulsory education decreases the incidence of child labor for boys by 8.3 percentage points. Moreover, the negative effect of the reform on the likelihood of child labor is stronger for boys from households with lower socioeconomic status. Finally, the free compulsory education reform may induce parents to reallocate resources towards boys within a household and thus may enlarge the gender gap in human capital investment.

Education on the cheap: The long-run effects of a free compulsory education reform in rural china

This paper evaluates the long-run effects of a free compulsory education reform in rural China on individuals’ educational attainment, cognitive achievement and health. We exploit the cross-province variation in the roll-out of the reform and apply a difference-in-differences strategy to identify the causal effects of the reform on the outcomes. We find that the reform exposure, measured by the number of semesters that an individual is supposed to be exposed to the free compulsory education, is positively associated with individuals’ educational attainment and cognitive achievement measured by math test scores in early adulthood. The reform effects on educational attainment become greater in the longer term. Moreover, the reform effect on educational attainment is stronger for individuals with less-educated fathers.

Hiroki Takeuchi, Tax Reform in Rural China: Revenue, Resistance, and Authoritarian Rule

Hiroki Takeuchi, Tax Reform in Rural China: Revenue, Resistance, and Authoritarian Rule

Effects of Public Hospital Reform on Inpatient Expenditures in Rural China.

Public hospital reform is one priority area in the healthcare system reform that China launched in 2009. The Chinese government invested over $10bn for pilot projects in public hospital reform in rural China. However, little evidence exists on their effects. Using a quasi-natural experiment design, we evaluated the effects of a public hospital pilot project in Hubei province on inpatient spending. We obtained inpatient claims data from 1/1/2011 through 6/30/2013 for enrollees in the New Cooperative Medical Scheme in two counties: Danjiangkou, one of the pilot counties selected for reform in September 2012, and Laohekou, a similar, adjacent county serving as the control group. Using a difference-in-differences approach with propensity score weighting, we found that total inpatient spending increased ¥1160 (95% CI 1155-1166), out-of-pocket spending increased ¥385 (95% CI 382-389), length of stay increased 0.51days (95% CI 0.50-0.52), but inpatient medication spending decreased ¥147 (95% CI 145-150), post-policy in Danjiangkou, relative to the control group. The overall reimbursement rate increased by 5.7 percentage points. One of the goals of the recent public hospital reform is to make inpatient services affordable to patients. We found that although patients spent less on inpatient medications, total out-of-pocket spending increased considerably after reform. Copyright © 2016 John Wiley & Sons, Ltd.

Old-Age Pension and Extended Families: How is Adult Children's Internal Migration Affected?

This paper makes use of the most recent social pension reform in rural China to examine whether receipt of the pension payment equips adult children of pensioners to migrate. Employing a regression discontinuity (hereafter RD) design to a primary longitudinal survey, this paper overcomes challenges in the literature that households eligible for pension payment might be systematically different from ineligible households and that it is difficult to separate the effect of pension from that of age or cohort heterogeneity. Around the pension eligibility age cut-off, results reveal large and significant increase among adult sons (but not daughters) to migrate out of their home county. Meanwhile, adult children are more likely to migrate out if their parents are healthy. Our Fuzzy RD estimations survive a standard set of key placebo tests and robustness checks.

OLD‐AGE PENSION AND EXTENDED FAMILIES: HOW IS ADULT CHILDREN'S INTERNAL MIGRATION AFFECTED?

This paper makes use of the most recent social pension reform in rural China to examine whether receipt of the pension payment equips adult children of pensioners to migrate. Employing a regression discontinuity (hereafter RD) design to a primary longitudinal survey, this paper overcomes challenges in the literature that households eligible for pension payment might be systematically different from ineligible households and that it is difficult to separate the effect of pension from that of age or cohort heterogeneity. Around the pension eligibility age cut-off, results reveal large and significant increase among adult sons (but not daughters) to migrate out of their home county. Meanwhile, adult children are more likely to migrate out if their parents are healthy. Our Fuzzy RD estimations survive a standard set of key placebo tests and robustness checks.

Too little, but not too late? Health reform in rural China and the limits of experimentalism

This article provides a preliminary evaluation of health care reforms in rural China, with particular focus on villagers’ perceptions of the quality of care and the rural health insurance programme. Based on semi-structured interviews and an original survey of villagers in three provinces, this study suggests that, although recent reforms may have somewhat reduced the out-of-pocket cost of catastrophic illness, rural health systems continue to suffer from serious deficiencies. By examining villagers’ perceptions of health care, this article argues that initial conditions and incentive structures interact with local policy styles to impede effective health care reform in rural China.

Health system reform in rural China: Voices of healthworkers and service-users

Like many other countries China is undergoing major health system reforms, with the aim of providing universal health coverage, and addressing problems of low efficiency and inequity. The first phase of the reforms has focused on strengthening primary care and improving health insurance coverage and benefits. The aim of the study was to explore the impacts of these reforms on healthworkers and service-users at township level, which has been the major target of the first phase of the reforms. From January to March 2013 we interviewed eight health officials, 80 township healthworkers and 80 service-users in eight counties in Zhejiang and Yunnan provinces, representing rich and poor provinces respectively. Thematic analysis identified key themes around the impacts of the health reforms. We found that some elements of the reforms may actually be undermining primary care. While the new health insurance system was popular among service-users, it was criticised for contributing to fast-growing medical costs, and for an imbalance of benefits between outpatient and inpatient services. Salary reform has guaranteed healthworkers' income, but greatly reduced their incentives. The essential drug list removed perverse incentives to overprescribe, but led to falls in income for healthworkers, and loss of autonomy for doctors. Serious problems with drug procurement also emerged. The unintended consequences have included a brain drain of experienced healthworkers from township hospitals, and patients have flowed to county hospitals at greater cost. In conclusion, in the short term resources must be found to ensure rural healthworkers feel appropriately remunerated and have more clinical autonomy, measures for containment of the medical costs must be taken, and drug procurement must show increased transparency and accountability. More importantly the study shows that all countries undergoing health reforms should elicit the views of stakeholders, including service-users, to avoid and address unintended consequences.