Explaining health policy change in China between 2003 and 2009: actors, contexts and institutionalisation

The health policy change in China between 2003 and 2009 was profound. In 2003, the Chinese government changed its response to the Severe Acute Respiratory Syndrome (SARS) outbreak from initial passivity to proactivity. Following the SARS outbreak, in 2005 the Chinese government started major healthcare reforms. During this process, the health policy direction then changed from marketisation towards being more government-led. Previous research has explained health policy change mainly from bureaucratic perspectives that considered the government playing the main role. This thesis explains how and why health policy changed by focusing on three actors outside the political system. I argue that, after the SARS outbreak, experts, the media, and international organisations influenced the health policies as a ‘Policy Entrepreneurial Coalition’ (PEC), the result of which was a combination of normal and paradigmatic policy changes between 2003 and 2009. This is a qualitative study. I conducted fieldwork in China involving semi-structured interviews of policy insiders and outsiders. The policy insiders are government officials in the Ministry of Health. The policy outsiders are: domestic Chinese experts in social science, health economics, and health; external (foreign) experts who were involved in China’s health policymaking; journalists in national media and other commercialised traditional media; and representatives of international organisations in China. I also did content analysis of both policy documents and media reports. I identified three cases: the health policy change during the SARS outbreak, the initiation of the healthcare reform, and the health policy change during the healthcare reform policymaking. This thesis makes three major contributions. First, it documents the health policy change between 2003 and 2009. Second, previous studies focused on bureaucratic bargaining during policymaking in China, but I examine roles of policy outsiders, who have conventionally been neglected in China’s policy process. Third, to explain the influence of the outsiders, I examine the policymaking process within the central government and how the policy outsiders interacted with the policy insiders. In doing so, this thesis contributes to the understanding of China’s politics and policy processes