History of Science, Medicine and Technology Colloquium
Rewarding Supporters and Alienating Workers: Towards a Critical History of Health Insurance, Medicine, and Ideology in China and Taiwan
This presentation examines the history of health insurance in the People’s Republic of China and the Republic of China in Taiwan and argues that both states privileged key political supporters while often failing the workers they claimed to serve from the 1950s to 1980s. Health insurance programs for party cadres in China and civil servants in Taiwan offered more generous benefits, fewer restrictions, dedicated medical services, and little concern for cost containment. In contrast, labor insurance schemes on both sides of the Taiwan Strait were promoted as free, benevolent, and accessible, yet in practice were often costly for workers, constrained by benefit limitations, vulnerable to fraud and abuse, and dependent on employers’ willingness to participate. Physicians and medical providers likewise expressed frustration with these systems. In addition, I argue that bottom-up democratization in Taiwan during the 1970s and 1980s helped transform health insurance into a more accessible and equitable system, whereas top-down health insurance reforms associated with China’s Reform and Opening era contributed to growing inequalities in access to care. Health insurance thus offers a revealing lens through which to rethink the relationship between ideology, medical care, and state power in modern Chinese East Asia.
Wayne Soon is an Associate Professor in the Program of the History of Medicine in the Department of Surgery and the Program of History of Science, Medicine, and Technology at the University of Minnesota Twin Cities. He is the author of Global Medicine in China: A Diasporic History (Stanford: 2020). He is currently completing two book-length projects: one on Taiwan’s response to COVID-19 and its transition to living with the virus, and another on the history of health insurance, medicine, and society in postwar China and Taiwan.