Decoding Agenda Setting in Health Policy: Chinese Critical Illness Insurance

• In Event: The Dynamics of Agenda Setting in Policymaking

Abstract

As a significant analytical tool for policy generation in western states, the Multiple Streams Framework (MSF) has found application across various fields. In contrast to democratic states, China’s socio-political system exhibits fragmented authoritarianism, significantly influencing the agenda-setting mechanism. This research employs the multiple streams approach to unravel the procedural intricacies of Chinese health policymaking, with a specific focus on the Critical Illness Insurance (CII) scheme as a case study. While existing literature has extensively discussed the features and effects of CII, there is a paucity of knowledge regarding its genesis. Therefore, this study specifically aims to unpack the formation process of the CII scheme, addressing core research questions: What is the precise agenda-setting process within the Chinese health policy realm, and what determinants shape the policymaking of the CII scheme?

Theoretically, the MSF can provide a comprehensive analytical framework encompassing five core elements: problem stream, policy stream, politics stream, policy entrepreneurs and policy window. In our study, a range of documents and materials related to CII have been obtained, including government annual reports, policy briefs, academic articles, online news, and commentaries, serving as qualitative data sources.

Through analysis, the results finds that the case of generating CII shows that policy-making can be influenced by multifaceted factors, including social political settings, key stakeholders and so forth. Particularly, the health policy making in China present some particular characteristics. Firstly, the role of experts, scholars and the media have been strengthened within the authoritarian context. In the process of framing CII, media coverage greatly shaping the public discourse, which created a favorable setting for issue identification. While experts and scholars provide professional advice for seeking feasible policy solutions. This indicates that policy-making environment in China is becoming open. Besides, the independence of problem, policy, politic streams under the Chinese context seems to be weakened, and it shows an integrated trend. For instance, with help of media coverage, focusing events could directly or indirectly affect policy communities as well political leaders. Additionally, unlike independent policy entrepreneurs in western states, policy entrepreneurs in China have multiple identities. For promoting agenda, these entrepreneurs may like to connect each stream at different situations. This implies three streams in the Chinese context have more natural links.

In summary, the policy-making process is complex and contextual, with agenda-setting mechanisms varying based on specific socio-political settings. This study uncovers unique pathways that push the opportunity window for establishing CII, presenting a comprehensive agenda-setting landscape in the Chinese scenario. It implies different interactions among multiple streams within distinct socio-political settings.

Authors

• Lili Shang, University of New South Wales

• Chengcheng Yue, Rutgers University-Camden