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Public Services and Informal Profits: Governing Township Health Centres in a Context of Misfit Regulatory Institutions

Published online by Cambridge University Press:  06 December 2018

Armin Müller
Armin Müller*
Affiliation:
Collaborative Research Centre “Global Dynamics of Social Policy,” Jacobs University Bremen (Germany). Email: [email protected].
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Abstract

China's healthcare system is governed by institutions that are mutually incompatible. Although healthcare providers are supposed to offer affordable curative care services and engage in public health and administrative work, they receive insufficient financial support from the state and rely on generating informal profits and grey income. The “institutional misfit” between this public welfare mandate and medical service providers’ market orientation is particularly pronounced in the case of township health centres (THCs), a generalist type of healthcare provider with a key role in China's healthcare system. Based on fieldwork in four county-level jurisdictions, this study explores how local governments and THCs interact to cope with institutional misfit. It sheds light on a large variety of informal practices pertaining to human resources, healthcare services, drug procurement, health insurance and capital investment. Local governments deliberately neglect regulatory enforcement and collude with THCs to generate informal profits, behaviour which undermines service quality and increases healthcare costs. The study also shows that while the New Healthcare Reform altered the informal and collusive practices, it has failed to harmonize the underlying institutional misfit. To date, we see only a reconfiguration rather than an abandoning of informal practices resulting from recent healthcare reforms.

摘要

中国的医药卫生体制被相互矛盾的制度管理。虽然医疗卫生机构应该提供贱价的医疗服务并且参与公共卫生和行政管理工作，但是上述机构往往得不到充分的财政支持， 从而只能依靠非正式盈利和灰色收入。医疗卫生机构介于公益性和市场导向之间的 “制度性矛盾” 在乡镇卫生院中表现得尤为明显。乡镇卫生院是一种在中国医药卫生体制中发挥着关键作用的综合型医疗卫生机构。本研究基于四个县、区的实地调查和田野研究，探讨地方政府和乡镇卫生院如何互动配合、处理制度性矛盾。该研究揭示了与人力资源，医疗服务，药品采购，医疗保险和基本建设投资相关的各种非正式行为。地方政府会故意得忽视执行规定，甚至与乡镇卫生院勾结共谋，产生和获取非正式盈利，从而一方面降低服务质量，另一方面增加医疗成本。该研究还表明，虽然“新医改”再调整了非正式和勾结共谋的行为，但是它没有协调根本的制度性矛盾。迄今为止，非正式行为仍然被重新塑造，而非全盘放弃了。

Keywords

township health centreshealthcare policylocal governmentzero mark-upNew Healthcare ReformChina乡镇卫生院医药卫生政策地方政府零差价新医改中国
Type
Research Article
Information
The China Quarterly , Volume 237 , March 2019 , pp. 108 - 130
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Copyright
Copyright © SOAS University of London 2018 

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