Aims The prevalence of Type 2 diabetes mellitus (DM) has grown rapidly, but little is known about the drivers of inpatient spending in low- and middle-income countries. This study aims to compare the clinical presentation and expenditure on hospital admission for inpatients with a primary diagnosis of Type 2 DM in India, China, Thailand and Malaysia.

Methods We analysed data on adult, Type 2 DM patients admitted between 2005 and 2008 to five tertiary hospitals in the four countries, reporting expenditures relative to income per capita in 2007.

Results Hospital admission spending for diabetic inpatients with no complications ranged from 11 to 75% of per-capita income. Spending for patients with complications ranged from 6% to over 300% more than spending for patients without complications treated at the same hospital. Glycated haemoglobin was significantly higher for the uninsured patients, compared with insured patients, in India (8.6 vs. 8.1%), Hangzhou, China (9.0 vs. 8.1%), and Shandong, China (10.9 vs. 9.9%). When the hospital admission expenditures of the insured and uninsured patients were statistically different in India and China, the uninsured always spent less than the insured patients.

Conclusions With the rising prevalence of DM, households and health systems in these countries will face greater economic burdens. The returns to investment in preventing diabetic complications appear substantial. Countries with large out-of-pocket financing burdens such as India and China are associated with the widest gaps in resource use between insured and uninsured patients. This probably reflects both overuse by the insured and underuse by the uninsured.

Fractured Rebellion is the first full-length account of the evolution of China's Red Guard Movement in Beijing, the nation's capital, from its beginnings in 1966 to its forcible suppression in 1968. Andrew Walder combines historical narrative with sociological analysis as he explores the radical student movement's crippling factionalism, devastating social impact, and ultimate failure.

Most accounts of the movement have portrayed a struggle among Red Guards as a social conflict that pitted privileged "conservative" students against socially marginalized "radicals" who sought to change an oppressive social and political system. Walder employs newly available documentary evidence and the recent memoirs of former Red Guard leaders and members to demonstrate that on both sides of the bitter conflict were students from comparable socioeconomic backgrounds, who shared similar-largely defensive-motivations. The intensity of the conflict and the depth of the divisions were an expression of authoritarian political structures that continued to exert an irresistible pull on student motives and actions, even in the midst of their rebellion.

Walder's nuanced account challenges the main themes of an entire generation of scholarship about the social conflicts of China's Cultural Revolution, shedding light on the most tragic and poorly understood period of recent Chinese history.

Praise for Fractured Rebellion

An impressive and important work of scholarship which will join a small set of major books on the Cultural Revolution.
- Jeffrey N. Wasserstrom, University of California, Irvine

An analysis that will alter the view of one of the seminal events in the history of the People's Republic of China.
- Frederick C. Teiwes, the University of Sydney

A truly extraordinary scholarly achievement. Never has the immensely important puzzle of the Red Guard Movement ever been rendered in such rich, clarifying empirical detail as Walder gives us here.
- Doug McAdam, Stanford University

Better than anything else I have read, Andrew Walder's Fractured Rebellion explains how and why the Beijing students in the first two years of the Cultural Revolution became so sharply, bitterly, and fatally divided. An absorbing work of research and synthesis.
-Jonathan Spence, author of The Search for a Modern China