China's Trapped Transition_ The Limits of Developmental Autocracy - Minxin Pei [102]
The central government contributes only a small portion to China’s educational expenditures; for example, it provided 13 percent of the 334.9 billion yuan spent on education in 1999. Spending on compulsory education, in particular, is borne almost exclusively by subnational governments: township governments are responsible for 78 percent, county governments pay 9 percent; and provincial governments contribute 11 percent. The central government pays only 2 percent. This structure of financing compulsory education makes China an outlier in education spending. For example, in Mexico in 1994, 79 percent of education spending came from the central government; in South Korea, 96 percent came from Seoul. Among OECD countries, the average contribution from the central government is 50 percent.17 In addition, education spending by the central government was biased toward higher education: 94 percent of all the education spending by the central government in 1999 was for higher education; its combined contribution to secondary and primary education was 0.5 percent of its total education budget. In other words, local governments are responsible for all secondary and primary education spending.18
As a whole, the state’s contribution to education spending had been declining in the 1990s. From 1991 to 1997, the share of the state’s contribution to total education spending fell from 62.8 percent to 53.6 percent. The shortfall was made up through increased tuition and fees, thus reducing access to education, especially in poorer areas.19 One scholarly estimate suggests that government funding contributed to only 31 percent of the expenditures in middle-school education, 24 percent in primary-school education, and 40 percent in kindergarten education.20
Public Health
China’s public health delivery system has deteriorated considerably in recent years and compares poorly with that of its neighbors.21 In the World Health Organization’s (WHO) World Health Report 2000, China’s overall health system performance in 1997 ranked 144, placing China among the bottom quartile of WHO member states, behind India (112), Indonesia (92), and Bangladesh (88), countries often thought to have less effective governments. On the score of “fairness in financial contribution,” a proxy measure of equality in access to healthcare, China was ranked 188, ahead of only Brazil (189), Myanmar (190), and Sierra Leone (191). In terms of “overall goal attainment,” according to WHO, China was placed 132, again behind Indonesia (106), India (121), and Bangladesh (131).22 The decline in the state’s ability to provide health services has hit especially hard China’s rural population and people living in less developed areas.23 According to a study by the Development Research Center of the State Council, only 14 percent of the net increase in the government’s healthcare spending in the 1990s was channeled to the countryside; about 90 percent of this new spending was used on personnel and administration.24
In the 1970s, 90 percent of the rural areas were covered by a system of basic cooperative healthcare. By the end of the 1980s, this system survived in only 5 percent of the villages. Despite a halfhearted effort by the government to rebuild the cooperative health system in the 1990s, nearly all the 700,000 rural village and township clinics were privatized after local governments sold these facilities to private entrepreneurs and physicians in the 1980s.25 The collapse of the rural cooperative health system was further exacerbated by the antirural bias in the government’s health spending. Only 15 percent of the government’s health budget goes to rural areas, even though rural residents account for 70 percent of the Chinese population. On a per