Social Protection under Authoritarianism

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Why would an authoritarian regime expand social welfare without democratization? China, the largest authoritarian state, has dramatically increased its social health insurance coverage from 20% of the population in 2000 to 95% in 2012. This expansion has notably included previously uninsured groups like peasants and the urban poor, though their coverage is less comprehensive than that of the elite. With the wellbeing of 1.4 billion people and regime stability at stake, social health insurance has become a critical political issue. Xian Huang analyzes this transformation in the first decade of the 2000s, focusing on the expansion and distribution of health insurance. Utilizing government documents, interviews, surveys, and statistics, she uncovers a strategy of "stratified expansion," which maintains a privileged program for elites while offering modest provisions for the masses. This approach aims to balance elite interests with those of the general population, enhancing regime stability. China's multilevel governance involves both centralized and decentralized structures in distributing social health insurance, with local leaders adapting policies to varied local conditions, resulting in significant regional and socioeconomic disparities. This examination of China's health insurance system provides insights into the dynamics of social benefits in authoritarian regimes and decentralized governance.