AbstractAuthoritarian local leaders face two driving forces in social policy making: top-down pressures from the regime and bottom-up motivations derived from local conditions. Existing studies recognize the importance of both forces but remain unclear as to how they interact and which of them is more influential in driving local policy adoption. Focusing on two health insurance integration policies in China, we find that when the policy is political (i.e., entailing substantial class conflicts and bureaucratic friction), top-down pressure for compliance is a dominant driver for local adoption of social policy reform. When the policy is less political, bottom-up motivations based on local economic geography together with top-down pressure drive local adoption. We find support for this argument from an analysis of an original city-level dataset on social health insurance in China from 2004 to 2016. This study has implications for distributive politics, decentralization and government responsiveness in authoritarian countries.
SubjectsLocal implementation, Social policy, Health insurance, China, Decentralization
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