The political economy of Chinese health reform.

Political economy studies of health policy offer more than simple economic or political studies. Politics can have a greater influence on health policy decisions and their implementation than either economic or health considerations. Politics constrain how much of an optimal economic or health programme can be adopted and implemented. At the same time, the economic interests of the stakeholders drive their political positions on any potential policy change. We need more political economy studies to understand how to craft and execute politically viable ‘best’ health policies. This editorial uses the decision choices facing China’s health reform to illustrate the importance of political economic analysis and argues for more integrated political economy studies, particularly ones examining the roles of the health bureaucracy and the medical profession. Political economy is a diverse field of study, embracing different theories and methods (Moe, 1997; Downs, 1965; Lindblom, 1959; Gamble, 1995). The role of experts in political economy has been studied extensively. In health policy, the role of the medical profession holds a special interest. The medical profession plays at least three exceptional political roles in health policy and implementation. First, health policy formulation and implementation require medical knowledge and expertise in delivering health care, both in the province of medical professionals. Second, physicians are the front-line troops whose daily medical practices determine how well a policy would perform. Hence, any major policy decision has to consider the grass-roots-doctors’ views. Finally, the medical profession has an extraordinarily strong voice in health policy-making through easy access to every decision-maker because most households have one or more personal physicians. When the medical profession holds a common view on a health policy, it has a direct channel to policy-makers which can be used to further the profession’s interests. Many countries, including the United Kingdom, Germany, Chile, Colombia, and transition economies, have undertaken reform of their health systems. Several large countries such as Mexico, China, and India are in the midst of such reforms. We could advance our knowledge about policy choices, priority-setting,