Challenging the Economic Reform Paradigm: Policy and Politics in the Early 1980s' Collapse of the Rural Co-operative Medical System

Over the last two decades an economic reform paradigm has dominated social security and health research: economic reform policies have defined its parameters, established its premises, generated its questions and even furnished its answers. This paradigm has been particularly influential in accounts of the early 1980s' collapse of China's rural co-operative medical system (CMS), which is depicted almost exclusively as the outcome of the post-Mao economic policies that decollectivized agriculture. This article draws primarily on government documents and newspaper reports from the late 1970s and early 1980s to argue that CMS collapse is better explained by a change in health policy. It shows that this policy change was in turn shaped both by post-Mao elite politics and by CMS institutions dating back to the late 1960s. The article concludes by discussing how an explanation of CMS collapse that is centred on health policy and politics reveals the limitations of the economic reform paradigm and contributes to a fuller understanding of the post-Mao period.