State, collectivism and worker privilege: a study of urban health insurance reform

Since 1998, the central government has focused its attention on social security. Among other things, it has created a ministry for social security, pressed for the extension of health and unemployment insurance to larger numbers of the urban working population, and increased spending. Does this mean that the party-state is rebuilding the eroded urban social security system and re-asserting its role in ensuring collective provision? Do recent initiatives repair or damage the interests of urban workers? This article examines these questions through a study of urban health insurance reform. It argues the state has taken over from work units the responsibility for health insurance, that collectivism has been partially preserved through redistrib utory "risk-pooling" systems, and that the party-state is moving away from its traditional state enterprise-centred working-class base and widening participation to include workers in the private and rural industrial sectors. However, continued prioritization of economic growth means that the party-state's role is limited, while collectivist provision is restricted to the non-agricultural working population. In practice, government officials and workers in successful state enterprises are still the most likely to be insured