by Alex Jingwei He, Ling Zhu, and Jiwei Qian
Beyond conveying information about policy instruments, established government programs shape beliefs and expectations about policy benefits and burdens, as well as how individuals will be affected by existing policies. Social groups can then react to the information embedded in the design of policies, which, in turn, may strengthen or weaken them. The case study reported in this article explores how policy designs condition citizens’ behavioral and attitudinal responses to welfare retrenchment reforms in China. This article expands on recent policy feedback and comparative public policy literature by exploring how various policy designs, combined with individual proximity to reform, produce mixed responses. The article is guided by three hypotheses:
- Policy design that preserves individuals’ material self-interest will reduce opposition to welfare retrenchment reform.
- Policy design that improves the well-being of all in society will reduce opposition to welfare retrenchment reform.
- Individuals proximate to welfare retrenchment reform will exhibit stronger opposition than those with less policy proximity.
In 2020, the Chinese government engaged in a public consultation program regarding a proposed reform of the social health insurance system, which sought to reduce resources in individuals’ medical savings accounts. The authors conducted a survey experiment to gauge citizens’ responses to the proposed reforms and their hypothetical behavioral responses should the reforms go into effect. The survey participants were working and retired adults with social health insurance coverage and permanent residential status in Guangdong Province. Respondents were identified through a mature pre-existing sample and contacted via an online survey. The experiment measured socioeconomic characteristics and opposition to the healthcare reform before and after randomly receiving one of two policy design scenarios:
- Treatment Group 1 – Benefit-All Design: Reform will increase benefit generosity for both outpatient and inpatient care for social health insurance enrollees.
- Treatment Group 2 – Benefit-Family Design: Reform will allow individuals to use medical savings accounts to cover the healthcare expenses of their immediate family members.
The authors used a 1-4 Likert scale to measure opposition to the retrenchment reform. They measured demographic characteristics using a set of ordinal variables. They developed logistic regression models comparing group means with their corresponding 95% confidence intervals.
Figure 1 compares the mean opposition scores between groups before and after receiving the treatment message. Before treatment, the baseline preferences of the two groups were statistically similar. While both treatment messages reduced opposition, Treatment Group 2 (Benefit-Family Design) became more supportive of the reform compared to Treatment Group 1 (Benefit-All Design). At the same time, participants with higher educational attainment, poor health status, and large families were statistically more inclined to oppose the reform across both groups. These findings suggest that citizens prioritized preserving their material self-interest over supporting societal well-being. The authors therefore argue that sharing information on how a policy design allocates or reallocates resources garners meaningful attitudinal shifts. Therefore, this analysis supports hypotheses 1 and 2.
Figure 1. Comparing mean opposition scores before and after treatment. Vertical bars in the figure are the 95% confidence intervals.
Figure 2 compared whether the reduction of opposition to the reform varied by individuals’ proximity, specifically the frequency of medical savings account utilization. Based on the results, participants in Treatment Group 2 (Benefit-Family Design) who used their accounts at least once in the last 12 months showed significantly higher support for the reform compared to those in Treatment Group 1 (Benefit-All Design). Furthermore, individuals in Treatment Group 2 (Benefit-Family Design) who used their accounts more frequently (8-10 times) reported significantly higher opposition. These findings suggest that opposition to the reform increases as the frequency of utilization increases, which supports hypothesis 3.
Figure 2. Comparing mean opposition scores before and after treatment. Vertical bars in the figure are the 95% confidence intervals.
This article explores the significance of bridging policy design and feedback theories to better understand public response to the allocation and redistribution of material resources. While existing literature focuses on mass public opinion and participation behavior after policy adoption, this case study challenges scholars to examine citizens’ prospective assessments before policy changes as well. The authors suggest that future research should assess short-term feedback effects and long-term changes in those initial responses throughout the policy process. Unlike previous research, the findings reveal different sources of heterogeneous feedback effects other than partisanship, which vary by specific policy designs and individual experiences.
Read the original article in Policy Studies Journal:
He, Alex Jingwei, Ling Zhu and Jiwei Qian. 2025. “Policy Design and Policy Feedback in Welfare Retrenchment: A Survey Experiment in China.” Policy Studies Journal 53(2): 307–327. https://doi.org/10.1111/psj.12569.
About the Authors
Alex Jingwei is Associate Professor in the Division of Public Policy at the Hong Kong University of Science and Technology and Acting Director of the Institute for Public Policy at The Hong Kong University of Science and Technology (HKUST), where he also serves as the Co-Director of the Master of Public Policy (MPP) Program. He specializes in policy process theories, health policy and governance, and social welfare reforms. He received his PhD degree in Public Policy from the Lee Kuan Yew School of Public Policy, National University of Singapore.
Ling Zhu is Professor of Political Science at the University of Houston. Her research interests include public management, health disparities, social equity in health care access, as well as the management of local health care networks. She received her Ph.D in Political Science at Texas A&M University and joined the faculty at University of Houston.
Jiwei Qian is Senior Research Fellow at the East Asian Institute, National University of Singapore. He currently serves as the secretary of the East Asian Social Policy Research Network (EASP). His research interests lie in health economics, political economy, and development economics. He obtained his B.Sc. in computer science from Fudan University, China and Ph.D. degree in Economics from the National University of Singapore.
Policy Studies Journal Blog 