School of Social and Political Sciences - Theses
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ItemHealth and business in China’s state-led economy: the social construction of pharmaceuticals in China’s economic and healthcare reforms( 2018)In this thesis, I position Chinese health and medicine within the ongoing conceptualisation and practices of Chinese capitalism and socialism. Health care and medicine are important components of social welfare and, simultaneously, promising businesses in both the domestic and global markets. China's transformation from the socialist revolution to the capitalist reformation has been comprehensive and penetrating. Conversely, it has been inevitably fragmented and incomplete in the contradictory coexistence between market-oriented reform and the remaining socialist-oriented system. China's curious mixture of socialism and capitalism, or in China's own term, socialism with Chinese characteristics, has brought about institutional, ideological and practical contradictions, which have thus often been involved in informal/illegal variations in social and institutional relations. This complication has also permeated into the healthcare system, including pharmaceutical medicine. In this thesis, I firstly describe the historical transformation of China's healthcare system from China's Communist Revolution to the economic reform period beginning in the 1980s and on to the present. These historical transformations have impacted the pharmaceutical practices, the focus of my thesis, particularly as they are played out in hospitals and people's experiences therein. Following from these changes, I focus upon the following three aspects of China's pharmaceutical industry. Firstly, I examine the rise of economic nationalism in the Chinese pharmaceutical industry. China has maintained its strict approval control particularly on foreign generics' registration for sale in China to protect domestic pharmaceutical companies against foreign ones. Secondly, I point out the recent strategic change of China's pharmaceutical industry. The Chinese Government has stimulated industrial restructuring, which has given birth to giant Chinese pharmaceutical companies. As Chinese giants have acquired meaningful hold over both the domestic and global markets, they have built concrete consolidations involving Western multinational pharmaceutical companies that retain advanced products, rather than investing in the development of advanced products on their own. The third point is the widespread corruption, which has often been associated with the Chinese practice of guanxi. I argue, however, that its primary reason should be found firstly in the unfledged regulations and the government's loose law enforcement. Later chapters deal mostly with public hospitals and various experiences of doctors and patients in hospitals. The differentiated hospital market is closely related to hospitals' financial management. Compared to tertiary hospitals, smaller hospitals are relatively free from profit-oriented management and rely more on the government subsidy. I found that, in return, they are used to display government propaganda. Various political propaganda phrases mixed with public health education are displayed on the electric billboards, walls and ceilings of the hospitals. Since the Communist Revolution, Chinese public hospitals have played a role not only as therapeutic places but also as politically disciplinary places. Hospitals' profit-oriented management has led to doctors' increased prescriptions, resulting in an increase in patients' out-of-pocket payment. In this situation, China plans to make public health more affordable and accessible through the new healthcare reform. However, there are various complications in the way of the reform which I discuss in my thesis.