Health Reform and De Facto Federalism in China (Report‪)‬

As part of its agenda "to construct a harmonious society", China approved sweeping health reforms that aim to achieve universal health coverage for its citizens by 2020. (1) In his report during the 17th Congress of the Communist Party of China (CPC), President Hu Jintao in 2007 declared that the guiding direction for reform would be the restoration of "public character and orientation" to the public health system. (2) However, specification of the steps necessary to such a restoration has been slow to emerge. Indeed, many experts and stakeholders in China disagree on the approach to this task, with one major rift having emerged between the so-called market and government factions. (3) The market approach faction (shichang zhudao pai) supports some measure of competitive purchasing of services in the health marketplace while the government approach faction (zhengfu zhudao pai) favours direct government organisation of services. (4) Yet it is unclear which course China has chosen in its health reform plans. This article attempts to explain China's health reform, arguing that just as it is possible to explain the history of the problems in the health sector as a story of the rise of de facto federalism, it is also possible to explain the health reform plan's specific features and China's future options as functions of de facto federalism.