From Mao to McDonaldization? Assessing the rationalisation of health care in China

Ross Millar*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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China's 2009 health care reform agenda has been referred to as one of the most ambitious health policy programmes in modern history. Significant investment has combined with new structures, incentives, and regulations that have aimed to improve access, as well as gain greater control over a health care market much criticised for putting profit before patients. A range of health services research has been undertaken to analyse these efforts. Sociological perspectives have also been documented yet up to now a review and synthesis combining these various contributions has not been undertaken. By drawing on the lens of McDonaldization, the paper presents a narrative review that analyses the extent to which China's 2009 reform agenda has increased efficiency, calculability, predictability, and control over service provision. The review identifies elements of McDonaldization within China's 2009 reform agenda, however, notable gaps remain. In response to the limits of McDonaldization as a lens for understanding China's health care reform, the paper calls for alternative perspectives that are better able to understand the sociocultural dynamics shaping service provision, as well as an interdisciplinary research agenda that is able to generate new insights and understanding regarding health care in China.
Original languageEnglish
Pages (from-to)1643-1659
Number of pages17
JournalSociology of Health and Illness
Issue number7
Publication statusPublished - 12 Aug 2021

Bibliographical note

Funding Information:
The author would like to thank both reviewers for their helpful comments and suggestions in shaping the development of the paper. The author would also like to thank my collaborators in China who have supported and enabled the development of these ideas.

Publisher Copyright:
© 2021 The Author. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL (SHIL)


  • bureaucracy
  • consumption
  • health policy
  • health service organisations
  • policy analysis
  • Weber


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