This paper discusses central-local relations for healthcare policy in China from a principal-agent perspective, based on schistosomiasis control. In order to control the disease, the central government produced the Outline of the Mid-Long-Term National Plan for Schistosomiasis Prevention and Control (2004-2015) in 2004. By discussing the implementation of the National Outline at the provincial level, the author uses principal-agent theory to examine conflict and coordination between the central and provincial governments. The documents were collected from the Internet. Although the central and provincial governments all want to eliminate schistosomiasis, allocating funding among them creates conflict and forms an obstacle to achieving the goal. This paper extensively discusses the topics related to central-provincial relation and schistosomiasis control program. Further case study on a single province may be needed to intensify the discussion from a micro perspective. The conflict between central and provincial relations needs to be resolved in order to implement the national policy.
Keywords: Central-provincial relations, Healthcare, Schistosomiasis, Principal-agent, China
Following the reform of tax-sharing system in the 1990s, central-provincial relations in China became a key issue in the field of China studies. Facing the decline of centralized power and the rise of provincial power, both central and provincial governments began seeking new ways to accommodate the changing relationship. In 1950s, anti-schistosomiasis policy was a national matter, accompanied by the political "Patriotic Heath Movement." Provincial governments followed the policy dictated by the central government. However, when provincial governments became more autonomous in local affairs starting in the early 1990s, their role in implementing the national anti-schistosomiasis policy also changed. Antischistosomiasis policy thus serves as a lens through which we can examine current centralprovincial relations in China.
Taking the schistosomiasis control program as an example, this paper explores central-provincial relations using a principal-agent perspective to discuss a central government document. This paper will discuss the contents of the Outline of the Mid-Long Term National Plan for Schistosomiasis Prevention and Control (2004-2015), and explore the difficulties in implementing the schistosomiasis control program. It will also probe the centralprovincial relations in China from a principalagent perspective, based on the previous discussion.
Schistosomiasis is contracted from water snails, the intermediate hosts of the parasite Schistosoma japonicum, often in tropical and subtropical areas. In 2007, it was estimated that more than 560,000 people in China were infected with schistosomiasis, and 6.5 million more were at risk (1). The annual cost of treating patients with schistosomiasis had risen to 4 billion RMB. Since the 1990s, schistosomiasis has been high on the agenda of both the central and local governments, and controlling it is one of the most crucial issues in China.
In the early 1950s, Chairman Mao mounted the "Farewell to the Plague Spirit" campaign, aimed at containing schistosomiasis. Widespread mass mobilization, together with effective agricultural and water conservation projects, successfully eliminated water snails (2-3). However, during the 1960s and 1970s, political upheaval and social instability in China brought all these preventive measures to a halt, and schistosomiasis has become epidemic since then-a resurgence some refer to as "The Return of the Plague Spirit."
Construction of the Three Gorges Dam, along with frequent floods in the Yangtze River basin precipitated by environmental degradation, have provided ideal conditions for the spread of snails, the intermediate host of the disease, in the southern provinces (4). Thanks to the World Bank Loan Project implemented in 1992-2000, the control and treatment of schistosomiasis have been considerably improved (5). …