Welfare Reform and Public Social Service Provision: The Case of the Chinese Health Care System

Service providers are indispensable components of a social welfare system. Their performance is influenced by government policies and how service providers are active agents. Therefore, attaining the goals of social welfare services needs to consider the institutional arrangements for service providers.;Taking public health service in China as an example, this research answers why the public healthcare provision system in China turns out to be a reverse triangle structure, which is an anti-welfare model suggested by the World Health Organization. With a new institutionalism perspective, policy documents are used to study the effect of government intervention on public hospitals, and the interaction of government and public hospitals.;Findings suggest that: (1) Public hospitals are turned into state-owned enterprises as they are encouraged to grow into larger size by management autonomy and financial regulatory reform, and the abandonment of the government on the control over management and hospital assets; (2) government abandons its financial responsibility towards public hospital workers and the latter need to use market mechanism to earn their income by cross-reimbursement of price and that devalues professionalism of these workers; (3) government abandons the subsidy to public hospitals through the reform of public hospital financial system; (4) the large higher-tiered public hospitals obtain their preferential rights through political advantageous position; (5) the reform of public hospitals is not at all one dimensional: public hospitals respond by active actions, aggregate breaking of rules and regulations, individual break-through, and no response. In summary, marketization, de-professionalization, diswelfare and market diversification contribute to the reverse triangle model of China's public healthcare system.;Reform of China's public healthcare system is an extension of China's reform of its social welfare provision system. The above findings provide evidences on the economic rules, social relationships, and government actions in social welfare services as illustrated in the provision of health care by public hospitals in China. It is important reference for decision-makers in the new round of public service reform in the coming future.;Key words: social policy, public hospital, marketization, de-professionalization, discriminated market.