Has recentralisation improved equality? Primary care infrastructure development in China

Abstract

Since the early 2000s, the Chinese Government has undertaken a series of recentralisation efforts. In social policy areas, such efforts are targeted at greater equalisation and inclusiveness. These developments raise a critical question: has recentralisation improved equality? This study explores this question through the lens of primary care infrastructure development, an essential aspect of healthcare reforms that has received limited attention in the academic literature. Based on an analysis of health yearbooks (2004–2016), other government documents and fieldwork interviews, we find that, despite recentralisation efforts, the financing for primary care infrastructure development has remained highly decentralised. Provincial governments act as important intermediaries, reflected by their discretionary power in managing central targets and fundraising behaviour to leverage available resources for outcomes that align with local priorities. Despite an overall capacity increase in primary care infrastructure, significant inequality has remained, which contradicts the central governmentʼs intent to improve equality through recentralisation.