Public-Private-Partnerships (PPPs) in the Chinese healthcare field: A perspective on the state and market relations

Abstract

This thesis presents an empirical study of the Chinese healthcare sector, investigating the introduction of privatisation and Public-Private-Partnerships (PPPs) in the healthcare system and the experiences of associated social agents and healthcare professionals in the midst of these changes. Bourdieu’s conceptual framework of the state, field, capital, and habitus is employed to examine the Chinese healthcare system and the social practices therein, which the Orthodox economics perspective and Marxist analysis largely overlook. The empirical research adopts a qualitative case study approach, with primary data sourced from thirty-three key informant interviews. The empirical analysis reveals that the Chinese state operates as a bureaucratic field with embedded and conflicting interests and values, where the Health Ministry seeks to increase the health budget and advocates for an increased role for the state, while the Finance Ministry tends to rely on the market to finance and deliver health services. Under the guidance of neoliberalism and through administrative measures, the Chinese state has transformed the power dynamics within the healthcare field, and the boundaries between the public and private sectors have become indistinct. These reconfigurations made possible – and likely – the historical emergence of hospital PPPs. Within the local healthcare field, where the PPP hospital investigated in this study is located, the experiences of public and private hospital presidents and managers with hospital PPPs are analysed in terms of struggles between the well-established public hospitals and the newcomer – the PPP hospital – for state recognition. Within the PPP hospital, the experiences of healthcare professionals are analysed as contestations between the traditional practices of medical professionals and the newly emerged managerial professionals over control of professional practices and the conditions of work.