No abstract

Most migrant workers in mainland China are officially covered by the New Rural Cooperative Medical System (NRCMS), a rural health insurance system that operates in their home communities. The NRCMS and the system of household registration ([Formula: see text], hukou) are tightly linked and systemically interdependent institutions. Migrant workers have difficulties benefitting from this social protection because it remains spatially separated from them. Only a minority have access to urban health insurance systems. This paper sheds light on the institutional origins of the coverage problem of migrant workers and examines crucial policy initiatives that attempt to solve it. In the context of the ongoing hukou reforms, these policies aim to partially dissolve the systemic interdependence of hukou and health insurance. While the policies provide feasible, yet conflict-prone, solutions in short-distance and concentrated bilateral migration systems, covering migrants who cross provincial boundaries remains a challenge.

Quantitative studies of social policy diffusion face substantial challenges regarding their understanding of causal mechanisms. Knowledge of diffusion processes is particularly limited in authoritarian countries, in comparatively autonomous developing countries, and fields of social policy not characterized by hegemonic ideas and strong epistemic communities. This study focuses on technical and vocational education and training (TVET) in the People's Republic of China. The conceptual approach is based on the interaction‐oriented understanding of causal mechanisms in actor‐centred institutionalism, and the framework of lesson drawing. Methodologically, this study follows a process tracing approach, relying on semi‐structured interviews with Chinese experts, recently de‐classified project reports of the World Bank, and content analysis of Chinese legal and regulatory documents. Analysing why China introduced a system of vocational qualification certificates similar to English National Vocational Qualifications (NVQs), rather than German‐style dual vocational apprenticeships, it uncovers a mechanism of bureaucratic conflict between competing coalitions of domestic ministries and transnational actors from the UK and Germany in a context of organizational hierarchy with multiple principals. The World Bank here attempted to play the role of a neutral international principal, but could only do so in limited ways and insofar as its preferences were compatible with those of the leadership core of the Party‐state. The study illustrates how bureaucratic conflict mediates policy learning, explaining the diffusion and non‐diffusion of different policy options. Furthermore, it highlights doubts regarding the mechanism of coercion, which remained largely ineffective.

In late 2002, the Chinese government launched an initiative to extend the coverage of health insurance in rural China with the New Rural Cooperative Medical System (NRCMS). It covered all of rural China by 2008 and is being continuously adapted and developed. This study explores two conflicting goals in the policy design: universal coverage and voluntary enrolment. Local governments often faced the problem that only insufficient numbers of villagers were enrolling voluntarily. They developed different strategies to cope with it: Complementary outpatient reimbursement via medical savings accounts (MSAs) effectively transferred villagers’ premiums back to them, thus making the NRCMS more attractive. Adapting the premium-collection process to the local context or utilising collusive practices allowed them to pay premiums on behalf of the villagers from the insurance funds. These strategies undermine the effectiveness of the NRCMS as a risk-pooling mechanism, facilitate latent coverage gaps and turn it into a tax-funded service.

This study seeks to explain why China’s Urban Employees’ Social Insurance (UESI) features models that can be considered internationally mainstream in three of its branches (pensions, work accidents and unemployment), but fringe models in the other two (healthcare and maternity). Focusing on learning as a mechanism of diffusion, it compares the five insurance programmes of the UESI regarding the influence of domestic and international factors on the outcomes. Compared to previous work on Latin America, the study identifies new factors influencing learning processes, such as economic transition in the case of unemployment insurance. Furthermore, the study finds deviations from previously established connections between the complexity of policy subsystems and the synthesis of different policy options. Nevertheless, the results largely corroborate previous arguments about complexity: policy subsystems with a smaller number of international models are more conducive to adopting simple, neat policy models.