Riding the tiger of performance legitimacy? Chinese villagers' satisfaction with state healthcare provision

Abstract

Authoritarian regimes often rely on performance legitimacy, but cannot always fulfill policy promises, thereby undermining the regime. In 21st-century China, a reliance on performance legitimacy may seem unwise, as policy outcomes have been mixed. However, the Chinese government has managed to navigate gaping inequality and ineffective social policy. Why have policy failures not produced greater discontent? Using my original survey data to examine rural healthcare, I argue that the Chinese government is pursuing an objectively minimal but subjectively sufficient course of action in healthcare provision. Regression analysis of my survey data, coupled with responses from open-ended questions and semi-structured interviews, demonstrates that the deficiencies in current policy have not threatened regime legitimacy because villagers have low expectations for state provision of healthcare. The data also suggest that, as China continues to urbanize, villagers' expectations are likely to rise, presenting new policy challenges for the state.