State, Collectivism and Worker Privilege: A Study of Urban Health Insurance Reform

Since 1998, the central government has focused its attention on social security. Among other things, it has created a ministry for social security, pressed for the extension of health and unemployment insurance to larger numbers of the urban working population, and increased spending. Does this mean that the party-state is rebuilding the eroded urban social security system and re-asserting its role in ensuring collective provision? Do recent initiatives repair or damage the interests of urban workers? This article examines these questions through a study of urban health insurance reform. It argues the state has taken over from work units the responsibility for health insurance, that collectivism has been partially preserved through redistributory “risk-pooling” systems, and that the party-state is moving away from its traditional state enterprise-centred working-class base and widening participation to include workers in the private and rural industrial sectors. However, continued prioritization of economic growth means that the party-state's role is limited, while collectivist provision is restricted to the non-agricultural working population. In practice, government officials and workers in successful state enterprises are still the most likely to be insured.