The Hu Jintao era saw an unprecedented expansion in China's welfare state. Healthcare was one of the policy areas in which growth and reform were dramatic – access to healthcare insurance rose from 34 per cent of the population in 2004 to 90 per cent in 2010. The establishment of a new welfare state raises two intriguing puzzles. First, while existing literature finds a strong association between democratization and the establishment of a welfare state, it does not account for the logic of welfare state expansion in authoritarian countries such as China. Second, while the welfare state expanded, its patterns of growth varied across China's provinces both in terms of population coverage and generosity of government subsidies per capita. What factors account for this regional variation? Xian Huang's excellent and timely book tackles these two questions. Along with Kerry Ratigan's recent Local Politics and Social Policy in China (Cambridge University Press, 2022) and the work of Dorothy Solinger and Yiyang Hu (“Welfare, wealth and poverty in urban China: the dibao and its differential disbursement,” The China Quarterly 211, 2021, pp. 741–764), this book contributes to an important, yet understudied, topic: the politics of regional variation in China's welfare state.
To answer the first puzzle, the author develops a theory on a “stratified welfare state,” which builds on existing ideas about “masses and elites” (Daron Acemoglu and James A. Robinson, Economic Origins of Dictatorship and Democracy, Cambridge University Press, 2006; Milan W. Svolik, The Politics of Authoritarian Rule, Cambridge University Press, 2012) and the “selectorate” (Bruce Bueno de Mesquita et al. The Logic of Political Survival, MIT Press, 2005). Yet, the book goes beyond these theories, explaining how autocrats build a welfare state that balances between two different goals that are crucial for regime survival: to coopt the elites, who potentially pose the most acute threat to the autocrats, and appease the masses to pre-empt a rebellion. The result, as this book explains, is a welfare state that provides generous benefits to elites, yet is also inclusive, but less generous, towards the rest of the population, including marginalized and migrant populations. Interviews with 68 local officials from 16 provinces and an analysis of government documents uncovers the motivations underlying autocrats’ policies to preserve a stratified welfare state.
Social Protection under Authoritarianism argues that divergence in both the level of social risk (i.e. migrant outflow and old-age populations) and fiscal resources contribute to regional variation in coverage and generosity. High social risk will result in more inclusive enrolment to enlarge risk pooling, whereas high fiscal revenues will enhance the generosity of welfare programmes. Relying on cluster analysis, the author identifies four distinct types of provincial welfare states in China. The “dual type,” which combines both low social risk and high fiscal capacity, will result in both broad coverage and high generosity, whereas “status quo” provinces with low social risk and moderate resources will be both less inclusive and less generous. “Privileging” provinces with low risk and high fiscal capacities – primarily, the country's large metropolises with a high concentration of SOE employees and ethnic minority provinces benefitting from munificent central government transfers – prioritize generosity over coverage, whereas “risk pooling” provinces emphasize coverage over generosity.
The book analyses the impact of central–local relations on welfare state variations. While the central government determines the broad policy contours, it delegates implementation to local governments. And, because local officials encounter different conditions and challenges, they sometimes contravene central government directives. For example, cities in “dual type” provinces, China's more affluent, migrant-rich coastal region, either merged both “elite” and “non-elite” health insurance schemes or allowed migrants to join the more privileged health insurance programmes for urban, formal employees, thus violating the central government's framework of a stratified welfare state. Some of these policies were even criticized by the central government. “Risk-pooling” provinces, located in northeastern and southern provinces, have engaged in duplicate enrolment, adding to their insurance programmes rural-to-urban migrants who are often already enrolled in their cities of actual residence and work. They do so in order to demand more subsidies from the central government, while concealing duplicate enrolment. To further mitigate risk, they merge types of insurance programmes, contravening the central government's stratification policy.
Like all excellent books, Social Protection under Authoritarianism raises as many questions as it answers. It focuses on provinces, but lower levels of governments, cities and counties, such as Kunshan, Dongguan and Shenmu (which are mentioned in this book), have enacted their own, unique local health insurance policies. This could imply that China's welfare system is potentially even more fragmented and diverse than the one discussed in this book. Would an analysis of cities and counties have yielded more theoretical insights on China welfare system and revealed more information on other types of welfare states? Over the last two decades, China has expanded its welfare state, including health insurance programmes, to ensure regime survival. Has growth in the welfare state enhanced regime legitimacy, thus strengthening authoritarian resilience? And how have the “masses” viewed the persistence of stratification even after the establishment of a nearly universal welfare state?
These questions aside, this is a highly recommended book. Its theory and argumentation are persuasive, and it does an exceptionally good job in integrating both quantitative and qualitative methods. Insights drawn from fieldwork make this study rich and nuanced. This book will greatly benefit researchers interested in comparative welfare politics and comparative authoritarianism, as well as China specialists working on the politics of central–local relations.
