Health insurance reform in Shanghai and Hong Kong: using the lens of historical institutionalism

Luk, Ching Yuen (2013). Health insurance reform in Shanghai and Hong Kong: using the lens of historical institutionalism. University of Birmingham. Ph.D.

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Abstract

Since the mid-1980s, both Shanghai and Hong Kong have implemented health insurance reform to contain healthcare costs. But the reform result in these two places represents polar extremes. While Shanghai witnessed a revolution in healthcare financing in 2000, Hong Kong remains status quo on healthcare financing. Using the theory of historical institutionalism, this study examines how the complex interplay of forces affects health insurance reform implementation in these two places. It finds that Shanghai succeeded in implementing health insurance reform because of contextual influences, ideological shift, policy feedback, the authoritative political institutions, the dominance of key bureaucratic stakeholders in health insurance reform process, the endorsement of new ideas, and the decentralization power given to local governments. On the other hand, it finds that Hong Kong failed to implement any health insurance reforms in 1993 because of a more democratic political system, policy feedback, the persistence of old ideas, and a robust economy. Besides, it finds that the government failed to implement healthcare financing reforms in 1999 and 2000 because of a disjointed political system, difficult economic circumstances, the new idea lacking public acceptance, policy feedback, and the institutionalization of old ideas.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

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