Asset‐based policy in rural China: an innovation in the retirement social insurance programme1

In response to growing rural–urban inequality, China is undertaking a series of policy initiatives to promote rural development. In addition to redistributive policy aiming at social protection, asset‐based policy, which integrates social protection and social investment, are a viable option for progressive rural development. In 1998, the Hutubi local government in Xinjiang, China, implemented an innovative retirement programme that allows account holders to use accounts as legal collateral to borrow small loans and invest in productive assets, education, and small businesses. Using the data gathered by the programme organizers and in‐depth interviews with programme participants, this case study closely examines the Hutubi programme. We examine the programme's key features, which have effectively encouraged asset building in a rural community, and identify the programme's strengths and weaknesses. The success of the Hutubi programme has implications for asset‐based policy development in rural China.

为了回应城乡日益扩大的不平等, 中国现正实施一系列新政策以鼓励农村发展。 除了以社会保护为目的的再分配政策外, 资产为本的政策综合了社会保护和社会投资, 是推进农村进步性发展的可行选择。 1998年, 中国新疆呼图壁地区政府实施了崭新的养老计划, 容许户口持有人利用保险户口作为法律担保, 借出小额贷款及投资在具有效益的资产、教育及小型企业上。

透过项目组织者所收集的数据, 以及与参与者进行的深入访谈, 本研究个案将详细剖析呼图壁项目。 我们检视了项目的主要特征, 这些特征有效地促成了农村社区资产的建立。 我们还分析了项目的优缺点。 呼图壁项目的成功对中国农村实行资产为本的政策发展有着深远的启示。     

A fistful of euros: Is the German one‐euro job workfare scheme effective for participants?

Hohmeyer K, Wolff J. A fistful of euros: is the German one‐euro job workfare scheme effective for participants? Welfare reforms have constituted a major policy issue in many OECD countries in recent decades. In Germany, a major reform in 2005 emphasised the activation of welfare recipients and introduced a workfare programme –‘One‐Euro Jobs’– on a large scale. In the present study, the impact of one‐euro jobs on the employment prospects of different groups of participants was estimated. The analysis was conducted on a large sample of welfare recipients using propensity score matching. The sample of one‐euro job participants and other welfare recipients was drawn from administrative records comprising all those who started their participation in the programme in early 2005. Our results showed that participation slightly improved the medium‐term employment prospects for women but not for men. Participation reduced the employment rate of participants younger than 25 years but raised it for some of the older participant groups. In conclusion, one‐euro jobs are effective for participants who have been jobless for several years but ineffective for participants who were recently employed.     

国家控制与医生临床自主性的滥用:对公立医院医生执业行为的分析

如何对医生的执业行为实施有效的社会控制是职业社会学的一个重要问题。本文通过对我国城市医生的执业环境与执业行为的分析,指出医生仍然依附于占据医疗服务市场垄断地位的公立医院,丧失法团自主性的他们无法与国家就收入与服务补偿进行协商。但也正是由于垄断地位,公立医院及其医生获得了对患者和医药厂商的双向支配地位,可以便利地将处方权转换为经济利益。但与此同时,医生对临床自主性的这种滥用意味着卫生行政部门的监管、职业规范内化后的自律等社会控制方式的失败。本文认为,医生这一职业群体在医疗卫生政策制定过程中的参与、逐步开放医生的执业自由以及给予非公立医疗机构平等的地位与待遇等措施会使这些问题得到改观。     

The aging of the Chinese population and the cost of health care

It is projected that by 2050 China could have a staggering 115 million elderly citizens over 80 years old. Serious planning is needed to cope with this demand. This is the direct and inevitable result of the one-child policy that came into effect in 1979, as an independent policy to the Comprehensive Economic Reform; but the complementary nature is unmistakable.In accordance with the objective of this special issue of the Social Science Journal, the modest objective of this paper presents a brief history of the health care reform which really only began in 2002. We borrow from a major pilot study (the CHARLS data set) to provide quantitative measures of the cost of medical insurance. CHARLS samples two provinces, the inland poorer Gangsu and the coastal prosperous Zhejiang. The premium was 13 and 27 Yuan for the rural populations Gansu and Zhejiang. For the urban population, the premium was 289 versus 337 for men versus women in urban Gansu. But for the urban areas of Zhejiang, the pattern is radically different; 324.3 Yuan for women and a much higher 608 Yuan for men.Urban residents have always enjoyed better health care. With the support of the central government, 90% of rural population now received some form of basic health coverage. The issue is the reimbursement rate. For outpatient care, the reimbursement rates max out at under 40% and 32% for the urban and rural patients, respectively. This is certainly not enough to cover catastrophic illness, and that is why many Chinese feel they are just one major illness away from utter poverty. Outpatient care is even worse. The reimbursement rates average around only 10%. As Chinese statistics on full medical cost (especially for the elderly) is lacking, we utilize statistics from Taiwan and try to estimate the health care cost of the aging population.We discuss potential issues observed in the Taiwan experience, and proposed an incentive scheme, Self-Motivated Health Maintenance (SMHM), to deal with moral hazards and to reduce the overall health care cost. We believe the SMHM is a win–win–win solution. China has the possibility of building this into their health insurance.     

The Hutubi Model: what have we learned?

Created to address some of the limitations in China's rural retirement insurance policy, the Hutubi Model represents an innovative approach to asset building. A key feature of the model, the Hutubi loan programme, operated in Hutubi County, Xinjiang, China, from 1998 to 2010. It allowed farmers in Hutubi to borrow against their rural retirement accounts, taking loans for investment in farming and other priorities. This study examines the institutional incentives and structures that enabled the programme to help farmers build assets. We also discuss the programme's implications for the development of asset-based social policy in rural China and consider recent policy developments there. Among these is a new rural retirement social insurance programme.     

BANGLADESH The Grameen Bank health programme

In May 1993 the Grameen Bank in Bangladesh - one of the most successful and internationally best-known self-help projects - launched a programme to provide poor people in rural areas with basic health care. The first four medical centres were followed by six more by July 1995. The organization and methods of operation of the Grameen Health Programme are based on the tried and tested self-help principles underlying the loan programme which has been in operation since 1976. The services offered include medical care at reduced fees and free counselling. Target groups are primarily poor women, to whom the programme's women field workers initially give information on simple preventive measures plus advice on avoidance of unwanted pregnancies. This article presents a provisional evaluation based on two primary inquiries conducted in 1994 and 1995. The overall conclusion was that the health programme has still far to go in order to attain the longer-term objective of becoming self-financing. Nevertheless, it demonstrates that decentralized access to health services, and preventive healthcare counselling in particular, can be of real assistance to poor people in rural areas.     

Healthcare financing reform and the new single payer system in the Republic of Korea: Social solidarity or efficiency?

In July 2000, national health insurance in the Republic of Korea was transformed into a single insurer system. This major reform in healthcare financing resulted from the merger of more than 350 health insurance societies. Inequity in healthcare financing and the chronic financial situation of the health insurance societies for self–employed workers in rural areas have been the driving forces leading to the unified health insurance system. The unique institutional context together with political change opened the window of policy change, and various stakeholders such as politicians, rural self–employed workers, trade unions and civic groups were involved in the healthcare reform process. Fair income assessment of the self–employed and the role of the single insurer as a prudent purchaser of medical care will be vital for the new system to achieve its intended goal and improve social solidarity and efficiency of healthcare.     

The sustainability of China’s Urban Employees’ Pension Programme: A case of getting old before getting rich?

This article examines the sustainability of China’s Urban Employees’ Pension Programme – the main component in China’s overall old‐age support system. It looks at the sustainability of the programme generally and, in particular, at case studies of two areas (Tianjin municipality and Guangxi province) to highlight both the extent of regional variations and the common challenges facing Chinese policy‐makers. It discusses a number of key issues that should assist policy‐makers to address the challenge of population ageing. It concludes that the challenge facing China is no more severe than that already faced by other countries in Europe and Asia. Moreover, the ageing of the population is not uniform across the regions of China. Consequently, those areas where the demographic shift is more advanced will provide some opportunity for policy experimentation. Given the experience to date of slow progress on various aspects of pension policy reform, the article suggests that it seems unlikely that paradigmatic change will be significant. Nonetheless, the study suggests a range of parametric policy measures that China should consider. The challenge facing China’s policy‐makers is to ensure that China gets old and rich at the same time.     

Political Interests and the Implementation of China's Urban Health Insurance Reform

During the 1980s and 1990s China has been experimenting with reform of its health insurance system. Based on a study of experimental schemes in several cities in eastern China in the late 1990s, this paper shows that the schemes' main problems are due to the vested interests of enterprises, hospitals, officials, and other beneficiaries of the pre-reform system. Reform policy has been implemented slowly, and local health insurance schemes have (1) suffered from poor participation rates, and (2) had difficulties balancing contributions into local government-run pooled funds with expenditures needed for medical treatment. These problems threaten the viability of the national programme announced in late 1998. The solution lies in improving local government capacity through effective legislation and training, but this will be difficult to achieve.     

Institutional rules for framing healthcare policy issues in national,financial, and specialized newspapers

By considering the role of institutional rules for news making, this study examines news frames embedded in 1162 stories from national, financial, and specialized newspapers with respect to four healthcare policy issues: “the decrease in pharmaceutical prices,” “the comprehensive medical payment system,” “swine flu,” and “humidifier-related lung disease.” Conflict, economy, crisis, and policy execution are dominant frames in stories about the policy issues, and these four frames are also major frames used by the newspapers. This phenomenon is understood as “concentration of healthcare frames.” We conducted in-depth interviews with 19 news reporters to identify institutional rules that might influence the formation of news frames. In-depth interviews revealed that similar types of frames resulted from institutional rules (e.g., journalist’s autonomy, news value, newspaper’s mission statement, and characteristics of readers). The findings suggest that health journalists follow institutional rules that govern the creation of news frames. To provide diverse perspectives on healthcare policy issues, newspapers need to reconsider their institutional rules.     

Managing professional identity within a changing market environment: New Zealand optometrists’ responses to the growth of corporate optometry

ABSTRACT

This research investigated the effects of changes in the market environment for optometry services and products on the professional identity of New Zealand optometrists. It explored three issues. First, ways participants’ location within either the independent or corporate sectors shaped their professional identities. Second, ways potential ethical conflicts between participants’ healthcare and retailing identities were resolved. Last, participants’ opinions concerning the future of their profession. Twelve male and fourteen female optometrists were interviewed. Nineteen participants worked within independent optometry practices. Seven worked within practices that were part of international optometry chains. Six participants were recent graduates, the rest experienced optometrists. All participants identified primarily as healthcare professionals. All recognised that practising optometry within a commercial market created the possibility of ethical conflicts between healthcare and business imperatives. There were differences in the ways participants managed this boundary, with participants working within corporate optometry seeming more comfortable with the business aspects of their profession. All participants thought the profession was changing and several suggested that the future of independent optometry was limited. The article concludes that recent changes within the market environment of optometry have heightened tensions between optometrists’ medical and entrepreneurial identities and contributed to changing work patterns within the profession.     

Social work practice in nursing homes: creativity,leadership, and program development

Housing policy in China has undergone profound changes ever since the dismantlement of the in-kind welfare housing system in 1998. A modern housing system has emerged in China in line with a rapidly growing real estate sector. Meanwhile, China is also plagued with similar housing problems that western governments faced during their industrialization and urbanization and are facing now. In response, the Chinese government has attempted to tackle housing problems by imposing strict regulations on the real estate sector, introducing new affordable housing schemes, and channelling and even limiting housing consumption behaviours. However, the outcome has proved to be meagre. The unsound outcome has driven further policy changes. This paper presents an updated trajectory of housing policy development in the post-reform era. It concludes by discussing implications of housing policy changes on social development and argues that housing policy in China is at a crossroads and is ready for a major overhaul.     

Discourse change and policy development in social assistance in China

Zhang H. Discourse change and policy development in social assistance in China Since the introduction of a new social assistance programme in urban China, the state was eventually able to expand the programme to rural areas as a further step towards integrating the development of social assistance in urban and rural areas. This article argues that the development of social assistance in China can be explained by the change of discourse among the officials and the elites in central government. The discourse on social assistance can be conceptualised in three periods: the urban‐first discourse (1999–2003); the discourse debate (2003–2007); and the urban–rural integration discourse (2007–present). Through scrutinising specific discourses and the policy development of social assistance in these three periods, it appears that in company with the change in the discourse process, rural social assistance was developed rapidly in order to construct an integrated social assistance system. The article concludes that discourse plays a significant role in Chinese social assistance policy development.     

医疗体制弊端与药品定价扭曲

通过对中国医疗体制和药价管制模式的分析,我们发现公立医疗机构在药品零售环节上的双向垄断地位是导致药价虚高的根本原因,医疗服务价格低估导致的“以药补医”机制赋予了医疗机构抬高药价的合法权力,而收益率管制政策进一步诱导医院进销高价药品。此外,单独定价政策加之宽松的新药审批制度为药厂提高药价、医院购销高价药提供了便利。所有这些问题的出现根源于政府管制措施的失当。因此,解决药价虚高的根本措施是减少政府管制,放开处方药零售权,改革公费医疗和医疗保险报销制度,打破公立医院垄断。     

Weight Prejudice and Medical Policy: Support for an Ambiguously Discriminatory Policy Is Influenced by Prejudice-Colored Glasses

This study examined the influence of affectively-based weight prejudice versus weight control beliefs on perceptions of and support for an ambiguously discriminatory medical policy: denying surgery to overweight patients. Participants read a news article describing a new policy in the United Kingdom of denying surgery to overweight patients, and reported their reactions to the policy. Results revealed that participants who scored higher on an affectively-based measure of weight prejudice that was completed 3–4 weeks before the main session were less likely to perceive the medical policy as discriminatory, more likely to agree with the policy and to support adoption of a similar policy in their own country, and recommended lower body mass index (BMI) cutoff values for denying surgery to overweight patients, whereas weight control beliefs had less of a role to play. In addition, perceptions of the policy as (non)discriminatory mediated the effects of weight prejudice on policy agreement, support, and recommended BMI cutoff. These results indicate that affective prejudice influences individuals' support for an ambiguously discriminatory medical policy, which has important implications for policy makers and researchers.     

Minimum income programme and welfare dependency in China

In the mid‐1990s China introduced a means‐test cash benefit called the Minimum Living Standard Guarantee System (dibao). Alongside the increases in both the number of beneficiaries and the budget, there is growing public concern that dibao is creating welfare dependency. Using survey data collected in three cities in China, we investigated to what extent dibao beneficiaries look for work. Focus group discussions were held with programme administrators and beneficiaries. While headline figures suggest that a considerable proportion of beneficiaries are of working‐age and able to work, their personal and household circumstances are important factors in determining their long‐term unemployment. There are also dibao design issues that have created financial disincentives to work. The specific origins of the policy of addressing the problem created by layoffs of inefficient state‐owned enterprises are still affecting the implementation of the programme and preventing it from playing a significant role in poverty reduction.     

Changing Healthcare System Types

This article classifies 32 Organisation for Economic Co‐operation and Development (OECD) healthcare systems based on data from 2001 and 2007. It shows that European countries are clustered in different types of healthcare systems and that traditional typologies are only partially represented in the four types of healthcare systems identified in this study. Type 1 represents countries with low total health expenditure (THE), high public financing, and low out‐of‐pocket payment (OOP). In‐patient healthcare is higher and out‐patient healthcare lower than the OECD average. General practitioners (GPs) are paid by capitation, and patients' access to healthcare is strictly regulated. Type 2 represents countries with an average level of THE, high public financing, above‐average OOP, and high in‐patient and out‐patient healthcare. GPs receive a salary, and access regulation is strict. Type 3 is characterized by very low THE, low public financing, and very high OOP. Both in‐patient and out‐patient healthcare is well below average, and GPs are paid a salary. Type 4 includes systems with the highest THE, the highest public financing, and the lowest direct payments by patients. In‐patient healthcare is below the OECD mean and out‐patient healthcare is well above it. GPs are paid by fee‐for‐service, and most countries offer free choice of medical doctors. The clusters for the years 2001 and 2007 are quite robust. During this time period, THE increased, and patients' access to medical doctors has since become more regulated.     

Why It Is Bad to Be Kind. Educating Refugees to Life in the Welfare State: A Case Study from Norway

In Norway, as elsewhere in Europe, the aim of policy‐making is to ensure the integration of immigrants into mainstream society. This paper focuses on one of the most concrete and practical measures Norwegian authorities have ever taken in this field, namely the recent establishment of a compulsory two‐year introduction programme for newly arrived refugees. This is an activation‐style programme involving both a financial and an educational component, where out‐payments depend on participation in a full‐time training programme aimed at enabling participants to become self‐sufficient members of Norwegian society. In the first part of the paper the establishment of this policy is located within a broader context of integration crisis, before it moves on to look more specifically at the background for the programme and the problems it is set up to address. The latter part of the paper addresses the implementation of the introduction programmes in one medium‐sized Norwegian city. The local discourse here is one of before and after, where the failings of previous policies have been overcome and new and productive practices have been established. Connections can be made between public and political discourses on integration crisis and the local discourses of implementation through the notion of kindness and the idea that kindness has hampered the integration efforts of the state. Herein lies a story not only about views on immigrants and diversity, but also about how immigration has challenged the Norwegian welfare state model.     

Between Activation and Supporting Women – Alternative Operation of Welfare‐to‐work Programmes

With the emergence of activation policies, researchers are intrigued by the extent to which welfare‐to‐work (WTW) programmes reflect the ideological orientation of policymakers, while leaving the ideological orientation of their operators unexamined. This aspect may be of particular importance when women's non‐governmental organizations operate non‐coercive WTW programmes. Directing attention to the contribution of the operator, we ask how women who operate these programmes distinguish between the feminist goal of increasing women's independent access to material resources, and the activation rhetoric of ‘work first’. Moreover, as not enough is known about how participants benefit from the incongruence between the feminist discourse and the activation one, scholarship contemplating women's resistance to WTW programmes remains focused on specific welfare histories, and this form of feminist work remains neglected. The importance of the specific operators and the policy implications of the benefits of feminist operation of WTW programmes receive attention in the study reported on herein. We used a non‐coercive activation programme operated by a feminist organization in Israel (among other operators) as an opportunity to deepen our understanding of how programme trainers voice their position between feminism and activation discourse, and how their form of speech enables participants to insist on decent employment as a policy issue. Implications for policy are discussed.     

Fiscal Policy and Urban and Rural Residents＇ Marginal Propensity to Consume

基于代表性家庭最优消费决策及其与财政政策的关系,估计中国财政政策对城乡居民边际消费倾向的影响,结果表明,自1998年至今,城乡居民边际消费倾向的下降幅度超过20％。城乡居民边际消费倾向下降,．除源于收入分配、经济发展程度、预期、消费结构等因素的影响外,与财政政策运用也有很大关系。其中,未预期到的财政政策冲击对居民边际消费倾向产生的综合效应显著为负。以未预期到的税收增加为融资工具的策略选择,大大抑制了结构调整的正面效应。因此,扩大居民消费,不仅要通过财政增收,提高居民消费能力,而且要通过调整财政收支策略,稳定居民消费预期,提升居民边际消费倾向。