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This article focuses on the healthcare system reforms in the countries of Central and Eastern Europe (CEE) over the past decade. The first section provides an overview of healthcare financing, social insurance frameworks, and the public/private mix in service delivery. The second section discusses four reform challenges in CEE that are perhaps also relevant for China:

  1. subsidizing the supply side or demand side (that is, a national health service Beveridge model vs. Bismarckian social insurance);
  2. establishing a single payer or insurance competition;
  3. confronting the legacy of soft budget constraints; and
  4. provider payment reforms.

A brief conclusion uses the lens of current health policy controversies in Hungary to highlight some of the trade-offs implicit in the complex political economy of health system reforms.

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Bijiao (Comparative Studies)
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Karen Eggleston
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We report the results of a review of the Chinese- and English-language literatures on service delivery in China, asking how well China's health-care providers perform and what determines their performance. Although data and methodological limitations suggest caution in drawing conclusions, a critical reading of the available evidence suggests that current health service delivery in China leaves room for improvement, in terms of quality, responsiveness to patients, efficiency, cost escalation, and equity. The literature suggests that these problems will not be solved by simply shifting ownership to the private sector or by simply encouraging providers - public and private - to compete with one another for individual patients. By contrast, substantial improvements could be (and in some places have already been) made by changing the way providers are paid - shifting away from fee-for-service and the distorted price schedule. Other elements of active purchasing by insurers could further improve outcomes. Rigorous evaluations, based on richer micro-level data, could considerably strengthen the evidence base for service delivery policy in China.

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Health Economics
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Karen Eggleston
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Observers often note the glaring contrast between China's stunning economic progress and stalled political reforms. Although sustained growth in GNP has not brought democratization at the national level, this does not mean that the Chinese political system has remained unchanged. At the grassroots level, a number of important reforms have been implemented in the last two decades.

This volume, written by scholars who have undertaken substantial fieldwork in China, explores a range of grassroots efforts--initiated by the state and society alike--intended to restrain arbitrary and corrupt official behavior and enhance the accountability of local authorities. Topics include village and township elections, fiscal reforms, legal aid, media supervision, informal associations, and popular protests. While the authors offer varying assessments of the larger significance of these developments, their case studies point to a more dynamic Chinese political system than is often acknowledged. When placed in historical context--as in the Introduction--we see that reforms in local governance are hardly a new feature of Chinese political statecraft and that the future of these experiments is anything but certain.

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Harvard University Press in "Grassroots Political Reform in Contemporary China"
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Jean C. Oi
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0-674-02485-0
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China's Harmonious Society colloquium series is co-sponsored by the Stanford China Program and the Center for East Asian Studies

Since 2006, the official doctrine of China's Communist Party calls for the creation of a "harmonious society" (HeXieSheHui). This policy, identified with the Hu Jintao leadership, acknowledges the new problems that have emerged as China continues its amazing economic growth. The economy is booming but so are tensions from rising inequality, environmental damage, health problems, diverse ethnicities, and attempts to break the "iron rice bowl." In this series of colloquia, leading authorities will discuss the causes of these tensions, their seriousness, and China's ability to solve these challenges.

Depending on where one stands, China's state-owned enterprises have reformed too slowly or too fast. Some lament the incompleteness of China's efforts to break the "iron rice bowl," to free firms from inefficient industrial practices, to rid firms of non-production expenses. Yet, as incomplete and slow as the reforms seem to some, New Left critics charge that China's reforms have gone too far, that SOEs have been subject to asset stripping, that firms have been "given away," and that the privileged few, particularly factory managers, have become rich capitalists overnight, through corruption and collusion with local officials. The losers in this view are the workers, who have been left unemployed, subject to layoffs, without health care, and sometimes without even their promised pensions-the very problems that prompted Hu Jintao's call for fixes to create a new "harmonious society." These two views of SOE reform, while seeming to convey different realities, reflect the political cross currents that have shaped China's corporate restructuring. Based on recent research in China, Jean Oi will discuss how those charged with reforming SOEs have tried to walk the tightrope between too slow and too fast reform, and the consequences.

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Department of Political Science
Stanford University
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Senior Fellow at the Freeman Spogli Institute for International Studies
William Haas Professor in Chinese Politics
jean_oi_headshot.jpg PhD

Jean C. Oi is the William Haas Professor of Chinese Politics in the department of political science and a Senior Fellow of the Freeman Spogli Institute for International Studies at Stanford University. She is the founding director of the Stanford China Program at the Walter H. Shorenstein Asia-Pacific Research Center. Professor Oi is also the founding Lee Shau Kee Director of the Stanford Center at Peking University.

A PhD in political science from the University of Michigan, Oi first taught at Lehigh University and later in the Department of Government at Harvard University before joining the Stanford faculty in 1997.

Her work focuses on comparative politics, with special expertise on political economy and the process of reform in transitional systems. Oi has written extensively on China's rural politics and political economy. Her State and Peasant in Contemporary China (University of California Press, 1989) examined the core of rural politics in the Mao period—the struggle over the distribution of the grain harvest—and the clientelistic politics that ensued. Her Rural China Takes Off (University of California Press, 1999 and Choice Outstanding Academic Title, 1999) examines the property rights necessary for growth and coined the term “local state corporatism" to describe local-state-led growth that has been the cornerstone of China’s development model. 

She has edited a number of conference volumes on key issues in China’s reforms. The first was Growing Pains: Tensions and Opportunity in China's Transformation (Brookings Institution Press, 2010), co-edited with Scott Rozelle and Xueguang Zhou, which examined the earlier phases of reform. Most recently, she co-edited with Thomas Fingar, Fateful Decisions: Choices That Will Shape China’s Future (Stanford University Press, 2020). The volume examines the difficult choices and tradeoffs that China leaders face after forty years of reform, when the economy has slowed and the population is aging, and with increasing demand for and costs of education, healthcare, elder care, and other social benefits.

Oi also works on the politics of corporate restructuring, with a focus on the incentives and institutional constraints of state actors. She has published three edited volumes related to this topic: one on China, Going Private in China: The Politics of Corporate Restructuring and System Reform (Shorenstein APARC, 2011); one on Korea, co-edited with Byung-Kook Kim and Eun Mee Kim, Adapt, Fragment, Transform: Corporate Restructuring and System Reform in Korea (Shorenstein APARC, 2012); and a third on Japan, Syncretism: The Politics of Economic Restructuring and System Reform in Japan, co-edited with Kenji E. Kushida and Kay Shimizu (Brookings Institution, 2013). Other more recent articles include “Creating Corporate Groups to Strengthen China’s State-Owned Enterprises,” with Zhang Xiaowen, in Kjeld Erik Brodsgard, ed., Globalization and Public Sector Reform in China (Routledge, 2014) and "Unpacking the Patterns of Corporate Restructuring during China's SOE Reform," co-authored with Xiaojun Li, Economic and Political Studies, Vol. 6, No. 2, 2018.

Oi continues her research on rural finance and local governance in China. She has done collaborative work with scholars in China, including conducting fieldwork on the organization of rural communities, the provision of public goods, and the fiscal pressures of rapid urbanization. This research is brought together in a co-edited volume, Challenges in the Process of China’s Urbanization (Brookings Institution Shorenstein APARC Series, 2017), with Karen Eggleston and Wang Yiming. Included in this volume is her “Institutional Challenges in Providing Affordable Housing in the People’s Republic of China,” with Niny Khor. 

As a member of the research team who began studying in the late 1980s one county in China, Oi with Steven Goldstein provides a window on China’s dramatic change over the decades in Zouping Revisited: Adaptive Governance in a Chinese County (Stanford University Press, 2018). This volume assesses the later phases of reform and asks how this rural county has been able to manage governance with seemingly unchanged political institutions when the economy and society have transformed beyond recognition. The findings reveal a process of adaptive governance and institutional agility in the way that institutions actually operate, even as their outward appearances remain seemingly unchanged.

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Director of the China Program
Lee Shau Kee Director of the Stanford Center at Peking University
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
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Jean C. Oi William Haas Professor in Chinese Politics, Professor of Political Science, Senior Fellow at FSI, and Director, Stanford China Program Speaker Stanford University
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China's Harmonious Society colloquium series

co-sponsored by the Stanford China Program and the Center for East Asian Studies

Since 2006, the official doctrine of China's Communist Party calls for the creation of a "harmonious society" (HeXieSheHui). This policy, identified with the Hu Jintao leadership, acknowledges the new problems that have emerged as China continues its amazing economic growth. The economy is booming but so are tensions from rising inequality, environmental damage, health problems, diverse ethnicities, and attempts to break the "iron rice bowl." In this series of colloquia, leading authorities will discuss the causes of these tensions, their seriousness, and China's ability to solve these challenges.


Talk description will be posted soon.

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Thomas S Mullaney Assistant Professor of History Speaker Stanford University
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This is a slightly revised version of remarks from the December 20th panel discussion of "South Korea's Presidential Elections: Growing Pains of a Young Democracy," held by the Woodrow Wilson International Center for Scholars in conjunction with the U.S.-Korea Institute at SAIS, Johns Hopkins University.
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The background of the Yushin System(1972) has attracted the attention of many Korean and international political scientists. Although most of them consider security crisis in 1968 combined with the Nixon Doctrine as a turnning point of the Park government and President Park's own idea on ruling system, Park's remarks on the second economy in early January of 1968, two weeks before the Pueblo Incident, deserve the attention.

This presentation will focus on questions such as what triggered the transition and why Park designed such a new idea at this particular time in early 1968. Considering the timing, there was a possibility that original idea of Park for the Yushin System started before the 1968 crisis. This approach would be also relevant to the historiography in Korean history, which has been a very complex decussation of internal and external factors

Tae Gyun Park is Assistant Professor at Graduate School of International Studies, Seoul National University in Korea and is currently a Coordinate Researcher at Harvard-Yenching Institute. He is an editorial board member of Critical Review of History (Yoksa Pipong), Pacific Affairs(UBC), The Review of Korean Studies (Academy of Korean Studies), and Seoul Journal of Korean Studies (Gyujang-gak, SNU).

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Tae Gyun Park Assistant Professor Speaker Graduate School of International Studies, Seoul National University
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Some people said North Korea would not survive the end of the USSR and dissolution of the Soviet bloc. Some people said Kim Jong Il's likely tenure could be measured in months. Some people said that North Korea was on the verge of collapse in 1997; some people, in fact, proclaimed that the economy had already collapsed.

What sorts of myths and misperceptions do we entertain and perpetuate that make it difficult for us to deal with North Korea coherently?

Robert Carlin is a 2007 Pantech Fellow at Shorenstein Asia-Pacific Research Center and has been a visiting fellow at the Center for International Security and Cooperation at Stanford University since 2005. After receiving an A.M degree from Harvard University's East Asian Regional Studies program, he joined the Central Intelligence Agency in 1971. From 1974 to 1988, he was a senior North Korea media analyst in the Foreign Broadcast Information Service (FBIS), where he received the director of the CIA's Exceptional Analyst Award. From 1989 to 2002, he was the chief of the Northeast Asia Division in the State Department's Bureau of Intelligence and Research. Concurrently, from 1993 to 2002, Mr. Carlin served as senior policy advisor to the U.S. special envoy for talks with North Korea, taking part in every significant set of U.S.-DPRK negotiations of which there were many--during those years. He was on the delegation accompanying Secretary of State Madeline Albright to Pyongyang in October 2000. From 2003 to 2005, Mr. Carlin was senior political advisor to the executive director of the Korean Peninsula Energy Development Organization (KEDO), leading numerous KEDO negotiating teams to the DPRK. Altogether, he has made 25 trips to North Korea.

Much of Mr. Carlin's analysis on North Korea from his years at FBIS has been declassified and is available either in the "Trends in Communist Propaganda" or "Trends in Communist Media". Over the years, he has written chapters for several books on the Korean issue including, most recently, "Talk to Me, Later," appearing in North Korea: 2005 and Beyond. In 2006, he co-authored an IISS Adelphi paper "North Korean Reform: Politics, Economics and Security." His essay on negotiating with North Korea will appear in Korea 2007 - Politics, Economy, Society. Over his career, Mr. Carlin has lectured at the Harry S. Truman Presidential Library, the State Department's Foreign Service Institute, foreign ministries and intelligence organizations abroad, and numerous universities.

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Robert Carlin Pantech Fellow Speaker Shorenstein APARC
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On December 19, the conservative former CEO of Hyundai won a larger-than-expected percentage of votes to become Korea's president-elect. Shorenstein APARC's director, Gi-Wook Shin, chats with Warren Olney, host of NPR's To the Point, about the results of the election and what future changes we should expect to see in the North Korea/South Korea relationship and between Korea and the United States. Link to audio file of the entire day's show below. Professor Shin's conversation begins about 40 minutes into the full program.
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