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South Africa has embarked on major health policy reform to deliver universal health coverage through the establishment of National Health Insurance (NHI). The aim is to improve access, remove financial barriers to care, and enhance care quality. Health technology assessment (HTA) is explicitly identified in the proposed NHI legislation and will have a prominent role in informing decisions about adoption and access to health interventions and technologies. The specific arrangements and approach to HTA in support of this legislation are yet to be determined. Although there is currently no formal national HTA institution in South Africa, there are several processes in both the public and private healthcare sectors that use elements of HTA to varying extents to inform access and resource allocation decisions. Institutions performing HTAs or related activities in South Africa include the National and Provincial Departments of Health, National Treasury, National Health Laboratory Service, Council for Medical Schemes, medical scheme administrators, managed care organizations, academic or research institutions, clinical societies and associations, pharmaceutical and devices companies, private consultancies, and private sector hospital groups. Existing fragmented HTA processes should coordinate and conform to a standardized, fit-for-purpose process and structure that can usefully inform priority setting under NHI and for other decision makers. This transformation will require comprehensive and inclusive planning with dedicated funding and regulation, and provision of strong oversight mechanisms and leadership.
The willingness of ordinary Chinese to take extraordinary risks to challenge their state is widely known. Just what kind of people they are, and what wellsprings of personality and events drive them to do so, is harder to fathom. Ian Johnson's Wild Grass provides three fascinating cases that illuminate the question. Moreover, it implicitly points to the power of law not just to shape protest, but to bring it about in the first place. It's also a great read.
His first protagonist is Ma Wenlin, the “peasant champion.” A pretty ordinary 1962 Xi'an university graduate who worked quietly in local government for decades, in the early 1990s he taught himself the law and became a “legal worker,” concentrating mainly on contract and civil cases. In 1997, during a visit to his ancestral home, local farmers, inspired by a successful case nearby, prevailed on him to file a class-action suit against their township government for excessive levies. He demurred, but the farmers pressured him backhandedly by starting rumours that he was bribed by local officials to stay out of the matter. Rather than turning against them, he felt he had to clear his good name. He took the case. The failure of his legal filing, combined with his stubborn personality, his moral sensibility, and the inoculation against authority provided by the Cultural Revolution, emboldened him to participate in a political fight for his beleaguered clients. He helped the farmers organize local demonstrations, all citing the law, and eventually found his way to the Petition and Appeals Office of the State Council in Beijing.
The Making of the Chinese Industrial Workplace opens a window on to the world of Chinese factories and the political institutions, policies, conflicts and crises that swirled in and around them from the early 20th century to the early 1960s (with tantalizing glimpses of the Cultural Revolution and the reform period). Here, managers struggle to make a profit or just to survive, shop floor bosses jockey for position, political officials endeavour to regulate and control, and workers struggle with them all.
Workers' protests in the 1980s and 1990s, numerous and widely distributed though they may be, remain spasmodic, spontaneous and unco-ordinated. While the reasons are numerous, this article focuses on the role of workers' hegemonic acceptance of the core values of the market and the state. Data from interviews in Tianjin from 1995 to 1999 are used to explicate the existence of this hegemony. Several of its sources, some general, some specific to China, are then discussed. The findings are situated within recent scholarship on labour politics in China, and the prospects are discussed.
Students of the local state in reform-era China behold a host of different forms. Scholarly research reports debate their defining characteristics, speculate about the political participatory and non-participatory possibilities each type seems to hold out for the future, scrutinize their implications for economic development or for income distribution, and ponder if the very plurality of local governance types now seen in play across the country will prove to be a durable or only a transitory state of affairs. In a recent, commendably lucid “state of the field” essay, Baum and Shevchenko grouped the many disparate observations and models to date into four main sorts: in their relationships to economic activity, local states have been found to be entrepreneurial, clientelist, predatory or developmental.In entrepreneurial states, state agents and bureaucrats, even whole government bureaus, may go into business independently or enter into partnerships for profit; in clientelist states, officials promote and participate in the benefits of profit-making activity through personalized and particularistic ties to entrepreneurs in their localities; in predatory states, officials do not engage in business either directly or indirectly but utilize their positions instead to extract unproductive rents from producers and entrepreneurs through exorbitant fees, levies and fines; while in developmental states, officials intervene indirectly in the economy, “helping to plan, finance, and co-ordinate local projects, investing in local infrastructure, and promoting co-operative economic relations with external agencies.” In developmental states, local officials create an environment conducive to growth while not, themselves, engaging in business for profit and while “avoiding the formation of particularistic ties to ‘preferred’ enterprises and clients.” See Richard Baum and Alexei Shevchenko, “The state of the state,” in Merle Goldman and Roderick MacFarquhar (eds.), The Paradox of China's Post-Mao Reforms (Cambridge, MA: Harvard University Press, 1999), pp. 344–45. The entrepreneurial state model has had its fullest elaboration in Jane Duckett, The Entrepreneurial State in China (London: Routledge, 1998), but see also Yimin Lin and Zhanxin Zhang, “Backyard profit centers: the private assets of public agencies,” in Jean C. Oi and Andrew G. Walder (eds.), Property Rights and Economic Reform in China (Stanford: Stanford University Press, 1999), pp. 203–225. Clientelist state forms have been very widely reported. For just two urban examples, see Margaret M. Pearson, China's New Business Elite (Berkeley: University of California Press, 1997), and David L. Wank, “Bureaucratic patronage and private business: changing networks of power in urban China,” in Andrew G. Walder (ed.), The Waning of the Communist State (Berkeley: University of California Press, 1995), pp. 153–183; and for a rural example, see Gregory A. Ruf, “Collective enterprise and property rights in a Sichuan village: the rise and decline of managerial corporatism,” in Oi and Walder, Property Rights, pp. 27–48. Predatory state forms have also been widely reported in the growing literature on corruption in China. They are often associated with poverty, the heavy tax and fee burden placed upon the peasantry and with peasant protest, as in Thomas P. Bernstein and Xiaobo Lu, “Taxation without representation: peasants, the central and the local states in reform China,” The China Quarterly, No. 163 (September 2000), pp. 742–763. But predatory abuses are found also in more prosperous localities, as reported in Nan Lin and Chih-Jou Jay Chen, “Local elites as officials and owners: shareholding and property rights in Daqiuzhuang,” in Oi and Walder, Property Rights, pp. 145–170. As for the developmental state model, note that Baum and Shevchenko correctly classify Jean Oi's concept of “local state corporatism” as a variant within the category of “developmental” states (p. 350). See Jean C. Oi, “The role of the local state in China's transitional economy,” The China Quarterly, No. 144 (December 1995), pp. 1132–49; Jean C. Oi, “The evolution of local state corporatism,” in Andrew G. Walder(ed.), Zouping in Transition: The Process of Reform in Rural North China (Cambridge, MA: Harvard University Press, 1998); and Jean C. Oi, Rural China Takes Off (Berkeley: University of California Press, 1999). For a recent critique and reassessment of the “local state corporatist” conception, see Sally Sargeson and Jian Zhang, “Reassessing the role of the local state: a case study of local government interventions in property rights reform in a Hangzhou district,” China Journal, No. 42 (July 1999), pp. 77–99. But new examples of developmental state forms also continue to be found, as reported in Jonathan Unger and Anita Chan, “Inheritors of the boom: private enterprise and the role of local government in a rural South China township,” China Journal, No. 42 (July 1999), pp. 45–74. Unger and Chan deal specifically, as we do here, with the relationship between local developmental states and the growing private sector.
Chinese state socialism has, for many years, politicized what crops the country's farmers plant. By doing so, it has transformed the agriculture radically and repeatedly. The state has adopted some strikingly different policy directions and modalities during both the Maoist and Dengist periods. Cleavages between the state and rural society have been opened, closed and re-opened more than once. The political importance and role of intermediate levels of the Chinese state – in particular, provincial and county governments – in affecting policy, mediating between society and the central state, and pursuing their own interests has long been sensed by scholars and Chinese politicians. But they remain largely unspecified.