Chinese Engage Citizens on Healthcare Reform
- Specific Topics
- Health Care Reform
- UA Clinton School of Public Service Students
- Scope of Influence
- Start Date
- End Date
- Time Limited or Repeated?
- A single, defined period of time
- Make, influence, or challenge decisions of government and public bodies
- Deliver goods & services
- Co-production in form of partnership and/or contract with government and/or public bodies
- Spectrum of Public Participation
- Total Number of Participants
- Open to All or Limited to Some?
- Open to All
- General Types of Methods
- Informal participation
- General Types of Tools/Techniques
- Propose and/or develop policies, ideas, and recommendations
- Specific Methods, Tools & Techniques
- Online Deliberation
- Information and Communications Technologies (ICT)
- Online Consultations
- Face-to-Face, Online, or Both
- Types of Interaction Among Participants
- No Interaction Among Participants
- Informal Social Activities
- Communication of Insights & Outcomes
- Traditional Media
- Public Hearings/Meetings
- Type of Organizer/Manager
- Regional Government
- Type of Funder
- National Government
- Evidence of Impact
- Types of Change
- Changes in public policy
- Implementers of Change
- Appointed Public Servants
- Lay Public
- Stakeholder Organizations
- Formal Evaluation
Public opinion was engaged on a healthcare reform draft that was written by the Chinese Government, a process that occurred over a month in 2008.
Problems and Purpose
The problem was regarding healthcare in China. In 2008, the Communist Party of China (CCP) came together in order to release a policy of healthcare reform that would hopefully give 90% of citizens’ healthcare coverage by April 2011 (Kornreich, 2012). Under authoritarian governments, such as in China, it is often assumed that there is no deliberation or low levels of deliberation occur (He, 2014). Therefore, citizens are normally not able to participate in policy making processes. Rather, the elites of China make decisions that they believe are best for the government. However, in this particular case, the government used online platforms in order to engage as many citizens as possible. The purpose was to ensure that all of the citizens felt as though their voices were being heard. The government wanted to include a reform that was representative to how their citizens felt about healthcare, so the Chinese government used these online platforms to take their thoughts into consideration.
Background History and Context
Ever since the 1980s and 1990s, the Chinese government has had problems with regard to healthcare because the central government decided to cut spending on health and asked the local governments to handle its responsibilities (Kornreich 2012). This caused major problems within Chinese communities regarding health issues. Hospitals saw overcrowding and access to resources and quality care followed as well (Kornreich 2012). In 2005, a report was given by the Development and Research Center of the
State Council (DRC) and the World Health Organization (WHO) (Kornreich, 2012). This report exposed some serious vulnerabilities about the Chinese Healthcare System using local governments. Therefore, the Chinese government decided in October 2006 that they would work create a healthcare reform that would hopefully provide coverage to 90% of their citizens by April 2009 (Kornreich, 2012).
Organizing, Supporting, and Funding Entities
The process was organized by the Chinese Government. This government used an online platform to post and receive comments on the draft.
Participant Recruitment and Selection
The Chinese government discusses policy through what they call consultation sessions. The consultations are to provide information to the elite regarding policy issues that are occurring in China (Kornreich, 2012). Often times, these consultations can become deliberations when two elites have different thoughts regarding policy (Kornreich, 2012) The consultations are televised; therefore, the public stays informed although they are not allowed to provide any input. These consultations provided forums for limited deliberation that occurred, since this topic was being talked about in the consultation session. The media provided outlets for deliberation over Healthcare reform. Also, deliberations occurred behind closed doors and on online forums among stakeholders in the issue (Kornreich, 2012). The primary participant recruitment came through online use. The Chinese government wanted all citizens to be able to participate so the process could seem legitimate. Therefore, they put the draft of the healthcare reform online. There was a time limit of one month that was put on the document, and any Chinese citizen could make comments on different sections of the document. The Chinese government received a total of 35,260 online comments (Kornreich 2012). Since the draft was posted online, the Chinese government used broad publicity to try to get as many citizens involved in the process as possible.
Methods and Tools Used
The National Development and Reform Commission (NDRC) is the website that was used by the Chinese government to engage its citizens (Kornreich, n.d.). All citizens were encouraged to review the document and post their thoughts out to the side of the document, thereby using the method online deliberation. These comments were made anonymously.
One month later, the Chinese government took all comments made on the document and revised any issues that the public had. The government then proposed their final document in April of 2009.
What Went On: Process, Interaction, and Participation
The Chinese government is an authoritarian government. According to He, the Chinese tradition calls for ordinary citizens to not dispute over politics; rather, the citizens are only allowed to partake in public deliberation when there needs to be a reinstatement of authority and order (He, 2014). However, the public is not shunned from all discussions regarding policy in China. In fact, as He state “...all public discussions are supposed to promote the great gong (public). No official matters should be discussed in private. (He, p. 64, 2014). This is why the Chinese government televises all of their consultation sessions regarding policy. They want the public to be informed of what is going on. Even though, there government does not have any public deliberation.
Limited deliberation occurs within this government among citizens. Most of these deliberations have to occur behind closed doors. However, the media would set up deliberations to occur regarding healthcare issues. The only other way that deliberation was allowed to occur was in online platforms. These online forums were spaces were spaces that stakeholders and citizens could give their honest opinions regarding these issues.
The Chinese government wanted the process regarding their healthcare reform to seem legitimate. Therefore, they engaged citizens in a way that would get as many people involved as possible. Therefore, the government put a draft of the healthcare reform on their government website and encouraged all citizens to read through the document and make comments on what they believed was wrong with the document. Each person would submit their own document anonymously with their comments out to the side.
The public interaction was pretty effective. The government received over 35,260 comments on the reform. Therefore, many citizens were involved in the process. However, the face to face interaction between the government officials and their citizens was non-existent since they used online platforms.
Influence, Outcomes, and Effects
There is a small amount evidence that this process influenced the policy since the first draft was different from the final draft. However, due to the restricted ways that the citizens were able to voice their opinions, the impact on this process was quite limited (Kornreich 2012).
The Final draft of the health care reform addressed two specific key issues that citizens raised. First the Chinese citizens were upset with how expensive the healthcare was. Therefore, the document addressed the issue of affordable healthcare (Kornreich, 2012). Secondly, the citizens were upset that the “cumbersome procedures for receiving insurance compensation in their new places of residence” (Kornreich, p. 200, 2012).
All of the comments made by citizens were done so anonymously and were not published. Therefore, there is no way to know if the Chinese government took all of the concerns into account.
Analysis and Lessons Learned
This process was limited in the amount of policy impact that occurred. However, there were plenty of citizens that were able to participate in a manner that allowed their voice to be heard without fear of any outside source condemning them. This caused an effective influence over the outcome.
Kornreich, Y. (n.d.). Authoritarian Responsiveness: Online Consultation with ‘Issue Publics’ in China. Retrieved September 20, 2018, from http://www.wpsanet.org/papers/docs/WPSA%20Online%20Consultation%20YK.pdf
He, B. (2014). Deliberative Culture and Politics: The Persistence of Authoritarian Deliberation in China. Political Theory, 42(1), 58-81.
Kornreich, Y., Vertinsky, I., & Potter, P. (2012). Consultation and Deliberation in China: The Making of China's Health-Care Reform. The China Journal, (68), 176-203. doi:10.1086/666583
The original submission of this case entry was written by Andrew Counce, a Master of Public Service candidate at the University of Arkansas Clinton School of Public Service. The views expressed in the current version are those of the authors, editors, or cited sources, and are not necessarily those of the University of Arkansas Clinton School of Public Service.