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Institutions, perceptions and social policy-making of Chinese local governments: a case study of medical insurance policy reforms in Dongguan

In the past three decades, reforms of China’s medical insurance policy have attracted considerable attention. Regarding the existing literature on China’s social policy research, much work has been done on identifying the characteristics of China’s medical insurance policy, defining the development paths of social policy, offering policy suggestions, etc., but inadequate efforts have been made in providing credible theoretical explanations of the development process of China’s medical insurance reforms. This article uses the medical insurance policy-making process in Dongguan to illustrate how policy perceptions in a defined institutional context affect the medical insurance policy-making process at the local government level. The research project reveals that when local governments engage in specific social policy-making, they are not only affected by financial resources and the institutional environment, but also by specific policy perceptions. The interactions between policy perceptions and the institutional environment offer a new perspective and framework to better understand policy-making and policy change in China.