ObjectiveTo identify factors associated with health‐care system satisfaction in China.ContextRecent research suggests that socio‐demographic characteristics, self‐reported health, income and insurance, ideological beliefs, health‐care utilization, media use and perceptions of services may affect health‐care system satisfaction, but the relative importance of these factors is poorly understood. New data from China offer the opportunity to test theories about the sources of health‐care system satisfaction.DesignStratified nationwide survey sample analysed using multilevel logistic regression. Setting and participants: 3680 Chinese adults residing in family dwellings between 1 November 2012 and 17 January 2013.Main outcome measureSatisfaction with the way the health‐care system in China is run.ResultsWe find only weak associations between satisfaction and socio‐demographic characteristics, self‐reported health and income. We do, however, find that satisfaction is strongly associated with having insurance and belief in personal responsibility for meeting health‐care costs. We also find it is negatively associated with utilization, social media use, perceptions of access as unequal and perceptions of service providers as unethical.ConclusionsTo improve satisfaction, Chinese policymakers – and their counterparts in countries with similar health‐care system characteristics – should improve insurance coverage and the quality of health services, and tackle unethical medical practices.
How trust affects health-care utilization is not well-understood, especially in low- and middle-income countries. This article focuses on China, a middle-income country where low trust in health-care settings has become a prominent issue, but actual levels of distrust and their implications for utilization are unknown. We conducted a nationally representative survey of the Chinese population (November 2012 to January 2013), which resulted in a sample of 3680 adult men and women. Respondents rated their trust in different types of health-care providers. Using multivariate logistic and negative binomial regression models, we estimated the association between distrust in clinics and respondents’ hospital visits in the last year; whether they had sought hospital treatment first for two common symptoms (headache, cold) in the last 2 months; and whether they said they would go first to a hospital if they had a minor or major illness. We analysed these associations before and after adjusting for performance evaluations of clinics and hospitals, controlling for sex, age, education, income, insurance status, household registration and self-assessed health. We found that distrust in hospitals is low, but distrust in clinics is high and strongly associated with increased hospital utilization, especially for minor symptoms and illnesses. Further research is needed to understand the reasons for distrust in clinics because its effects are not fully accounted for by poor evaluations of their competence.
Many universities have developed teacher preparation programs online. This study explores online learning in a graduate school course on behavior management that is included in the special education teacher credential program at a large private university in California. A total of 140 adult students took the course, half of these online and the other half on-campus. Students self-selected the format in which they took the course. Learning and follow-up teaching performances were evaluated and compared across these two settings by first, measurement of learning as recorded on three periodic standard multiple-choice quizzes taken during the course and secondly, on performance in a follow-up measure of behavior management in student teaching as recorded by a master teacher and university supervisor. No significant differences between these two groups were found in the measurement of initial learning or follow-up performance. The absence of significant difference is reviewed along with the value of actual differences available in each learning experience.
During the s and s China has been experimenting with reform of its health insurance system. Based on a study of experimental schemes in several cities in eastern China in the late s, this paper shows that the schemes' main problems are due to the vested interests of enterprises, hospitals, officials, and other beneficiaries of the pre-reform system. Reform policy has been implemented slowly, and local health insurance schemes have () suffered from poor participation rates, and () had difficulties balancing contributions into local government-run pooled funds with expenditures needed for medical treatment. These problems threaten the viability of the national programme announced in late . The solution lies in improving local government capacity through effective legislation and training, but this will be difficult to achieve.
Recent research on authoritarian regimes argues that they provide public goods in order to prevent rebellion. This essay shows that the 'threat of rebellion' alone cannot explain Chinese party-state policies to extend public goods to rural residents in the first decade of the twenty-first century. Drawing on theories of policy making, it argues that China's one-party regime extended public goods to the rural population under the influence of ideas and policy options generated by policy communities of officials, researchers, international organisations and other actors. The party-state centre adopted and implemented these ideas and policy options when they provided solutions to external shocks and supported economic development goals. Explanations of policies and their outcomes in authoritarian political systems need to include not only 'dictators' but also other actors, and the ideas they generate. WHY DO AUTHORITARIAN REGIMES PROVIDE PUBLIC GOODS? MUCH research portrays autocrats as focussed on maximising their own revenues (Niskanen 1997; Acemoglu & Robinson 2000). It expects them to channel private goods to members of their support base in the 'selectorate', but to neglect the 'unenfranchised' majority (Bueno de Mesquita et al. 2003). 1 Other recent studies have found authoritarian regimes sometimes do extend provision beyond their immediate support base-but only to groups who threaten rebellion. Gandhi and Przeworski (2006), for example, argue that well institutionalised one-party regimes make policy concessions so as to co-opt those who might otherwise challenge them. Gallagher and Hanson (2009) similarly suggest authoritarian regimes sometimes try to reduce revolutionary 1 We do not have the space here to discuss the substantial literature categorising authoritarian regimes (Linz 2000), explaining their transitions to democracy (O'Donnell et al. 1986) and examining how they repress their opponents (Lichbach 1995; Wintrobe 1998).
This article explores the relationships among neoliberalism, social policy expansion and authoritarian politics in contemporary China. It argues that in the era of neoliberalism, rising new right and authoritarian governments, the Chinese Communist Party has sought to retain power by shifting politically to the right and promoting neoliberal‐looking economic policies. These policies have raised average living standards but also increased insecurity for most of the Chinese population, while new social policies have facilitated marketization. Social policy expansion includes minimal cash transfers as well as social old‐age and health insurance for hitherto excluded sections of the population. These policies have begun to erode long‐standing urban–rural segregation, but they have added new, underfunded, social programmes rather than widening participation in existing ones, re‐segregating provision so that urban elites and formal sector workers enjoy much more generous provisions than many people working informally and those without work. These social policies’ most significant dark sides thus include compounded income inequalities and the segmentation and stigmatization of the poorest. Authoritarian controls have enabled the Communist Party to avoid redistributive policies that would undermine its urban support, so that politics in China differ from the right‐wing populism of new, anti‐establishment authoritarian regimes.
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