Socialist Retrenchment

Abstract

Both China and Vietnam went through retrenchment in their rural healthcare systems during the 1980s and 1990s. However, there is a difference between the two in the depth of retrenchment. While China allowed the Cooperative Medical System (CMS) to collapse, Vietnam nationalized the Commune Health Stations (CHS) and established national health programs. Why did the retrenchment paths of these two countries diverge? This article finds that political, economic, and social factors can explain variation across China and Vietnam. Whereas in the 1980s and early 1990s, politics was the dominant factor determining variation, the combination of political and economic factors shaped different outcomes during the mid- and late 1990s. In contrast, social factors were a contributing condition with a limited impact. In both countries, political factors such as succession struggles and institutions played a dominant role in determining the direction of change for rural healthcare policies, whereas economic factors either facilitated or delayed their execution.