Markets for All, Healthcare for Whom? Healthcare Development and Reform Towards Marketisation in State-Socialist Asia

State-socialist countries have generally sought to supply state-financed health care universally to their populations, and in some cases, beyond. Yet, complex reform processes in state-socialist countries over the last four decades have significantly changed both institutions and expectations in these countries. Characteristic of this, the health sectors in both China and Vietnam have undergone significant changes that have involved the marketisation of public hospitals and health services, the decentralisation of health systems and the introduction and expansion of private healthcare – shifting the burden of risk to the individual – through processes of “socialisation”. This paper investigates the transformation of health care in China and Vietnam, arguing that – much like their broader developmental trajectories – health sector reform processes in both China and Vietnam since the 1980s are not simply unilinear processes of marketisation, decentralisation and commodification, but rather deeply political processes that also combine trial-and-error and path dependency. In a theoretical sense, the paper points to the manner in which the conflict between different social forces – including different classes, state and non-state interests, and a variety of national, sub-national, transnational and multilateral actors – within the context of a transforming world market underpinned by neoliberal ideology and institutions results in complex hybrid forms of healthcare provision in both countries, with the borders between state and private ever evolving and often nebulous.