The ‘medical city’ and China’s entrepreneurial state: Spatial production under rising consumerism in healthcare

Abstract

The role of hospitals has significantly changed over the past decades and the ‘medical city’ has emerged as a new urban phenomenon in China. However, research on the significance of the medical city to China’s urbanism is limited. This paper situates China’s medical city in the theory of state entrepreneurialism and rethinks consumerism in healthcare. Particularly focussing on the state–market and production–consumption dyads, the paper argues that the state has engineered the institutional and market legitimacy for the rise of consumerism in healthcare and allows the medical city to capitalise on the provision and consumption of high-end healthcare services to advance the healthcare reform and capture economic opportunities. This argument is substantiated by a case study on the Shanghai New Hongqiao International Medical Center, which focusses on the public–private partnerships in the medical city. It is found that while the production of the medical city is based on private sector participation, the state’s presence is diffused in the governance of the medical city through public–private partnerships, which reflect the characteristics of state entrepreneurialism. The findings add to the theory of China’s urbanism with new sets of materials and render important implications for the urban future in China.

Positioning China’s state entrepreneurialism in structural coherence and multiple logics

“…Many empirical studies reveal that the strategic goals of central and local states overlap but are not identical (Zhang, 2022, 2023; Zhang et al, 2023b), and local states may selectively implement the central state’s strategic goals (Chung and Xu, 2021), such as strategic industries (Pan et al, 2021) and infrastructure development (Shen et al, 2020), industrial structure upgrade (Li and Xiao, 2022), maintaining party-state legitimacy (Sum, 2019), and population control (Chan and Li, 2017; Immel, 2020; Ong, 2007). As the central state attaches increasing importance to extra-growth objectives (Luan and Li, 2022; Wu et al, 2022), such as ecological civilisation (Zhang and Wu, 2022; Zhang et al, 2022), food security, arable land conservation (Zhang et al, 2023b), social justice (Nie, 2023; Zhang, 2023), stability (Li and Jonas, 2022; Pan et al, 2017), indigenous technological innovation (Zhang and Wu, 2019), and national security, the local state still cares more about short-term growth (Chien and Woodworth, 2022; Wang et al, 2022), fiscal revenue (Luan and Li, 2022), and territorial competition (Zhang, 2022). However, the local state can also go beyond speculation and focus on long-term growth elements (Li and Xiao, 2022; Lin et al, 2022; Shen et al, 2020), including strategic space production (Chan and Li, 2017), striving for urban land development quota (Yang et al, 2019), attracting investors and taxpayers, and competing for young talents (Cheung, 2021).…”

“…A theoretical response to the ‘competing narratives’ in terms of intrastate relations and regional differences as aforementioned is also needed, beyond an investigation into the bureaucratic system (Wang et al, 2022; Zhang et al, 2023b). With growing market players nurtured by the party-state (Shen et al, 2020), are they agencies of capital logic subjected to political control (Nie, 2023; Zhang, 2022) or embedded in a party-state-centric accumulation system (Lauridsen and Zeuthen, 2022)? Is the growing influence of the party in private businesses a testimony towards a ‘CCP Inc.’ (Blanchette, 2020), or is it just hyperbole from the geopolitical imagination (Alami and Dixon, 2020)?…”