Social Protection under Authoritarianism: Health Politics and Policy in China, August 2020, Oxford University Press

Why would an authoritarian regime expand social welfare provision in the absence of democratization? Yet China, the world’s largest and most powerful authoritarian state, has expanded its social health insurance system at an unprecedented rate, increasing enrollment from eight percent of its population in 2000 to 95 percent in 2012. Significantly, people who were uninsured, such as peasants and the urban poor, are now covered, but their insurance is less comprehensive than that of China’s elite. With the well-being of 1.4 billion people and the stability of the regime at stake, social health insurance is now a major political issue for Chinese leadership and ordinary citizens.

In Social Protection under Authoritarianism, Xian Huang analyzes the transformation of China’s social health insurance in the first decade of the 2000s, addressing its expansion and how it is distributed. Drawing from government documents, filed interviews, survey data, and government statistics, she reveals that Chinese leaders have a strategy of “stratified expansion,” perpetuating a particularly privileged program for the elites while developing an essentially modest health provision for the masses. She contends that this strategy effectively balances between elites and masses in order to maximize the regime’s prospects of stability.

In China’s multilevel governance, both centralized and decentralized structures are involved in the distribution of social health insurance. When local leaders implement the stratified expansion of social health insurance, they respond to varied local conditions. As a result, China’s health insurance policies differ dramatically across sub-national regions as well as socioeconomic groups. Providing an in-depth look into China’s health insurance system, this book sheds light not only on Chinese politics, but also on how social benefits function in authoritarian regimes and decentralized multilevel governance settings.

Journal Articles

Xian Huang, Sung Eun Kim, 2020, “When Top-Down Meets Bottom-Up: Local Adoption of Social Policy Reform in China,” Governance, 33(2):343-364. (URL)

Xian Huang, 2019, “Social Cleavages and Preferences for Government Redistribution in Contemporary China,” Studies in Comparative International Development, 54(3):415-450. (URL)

Xian Huang, Qin Gao, 2019, “Alleviating Poverty or Discontent: Impact of Social Assistance on Chinese Citizens’ Views of Government,” China: An International Journal, 17(1):76-95.(URL)

Xian Huang, Qin Gao, 2018, “Does Social Insurance Participation Improve Assessment of Government Performance? Evidence from China,” Social Science Research,70 (February):28-40.(URL)

Xian Huang, 2015, “Four Worlds of Welfare in China: Understanding Subnational Variation in Chinese Social Health Insurance,”The China Quarterly, Vol. 222 (June):449-474.(URL)

Xian Huang, 2014,  “Expansion of Chinese Social Health Insurance: Who Gets What, How and When?” Journal of Contemporary China, Vol.23 (89):923-951.(URL)

Xian Huang, 2013,”The Politics of Social Welfare Reform in China: Social Welfare Preferences and Reform Policies,” Journal of Chinese Political Science, Vol.18 (1): 61-85.(URL)

Book Chapters

Xian Huang, 2012, “Collective Wage Bargaining and State-Corporatism in Contemporary China”, in The Chinese Corporatist State: Past, Present and Future, eds. by Jennifer Hsu and Reza Hasmath, Routledge, pp. 50-65. (URL)