The ‘medical city’ and China’s entrepreneurial state: Spatial production under rising consumerism in healthcare

Photo: Construction of the Parkway Shanghai Hospital in Minhang. Credit: Xuanyi Nie

The concept of the “medical city” is not new but has not yet been widely discussed in urban studies. The conceptualisation between cities and healthcare usually resides in hospitals and equivalent medical institutions, which are often imagined as places where healthcare services are delivered, and diseases are cured. However, healthcare has both political and economic significance embedded in the specificities of healthcare systems and economic structures of different states. This understanding is rooted in the dual functions of the healthcare industry – it is a knowledge- and service-intensive industry consuming goods, labour force, scientific research, and of course, space. Meanwhile, the healthcare system that includes insurance and payment policies determines how these elements are consumed. Taking China as an example – the state is reforming its healthcare system to accommodate internal demographic and socioeconomic transitions while seeking growth opportunities by promoting the healthcare industry. This state-healthcare interplay translates itself into the medical city, where certain forms of urban space are produced, and certain types of economic activities take place. Therefore, studies on medical cities could offer new perspectives to understanding the roles of the state in the production of governance of urban spaces. More importantly, it could establish a bridge between the literature on healthcare and urban studies, particularly under the emergent pressures brought by the COVID-19 pandemic.

Taking these conceptual premises, this research seeks to contribute to the existing literature by empirically examining the case study of New Hongqiao International Medical Center, located in the Minhang district in Shanghai. Particularly focusing on the state-market and production-consumption dyads under the theories of state entrepreneurialism in which the state acts through the market to maximise its political and economic interests, this paper argues that the medical city is instrumentalised by the state to achieve its political purpose of reforming the healthcare system and economic interest in capturing economic opportunities brought by the consumption of healthcare. The state has orchestrated the institutional and market legitimacy for the rise of consumerism in China’s healthcare and allows the medical city to capitalise on the provision and consumption of high-end healthcare services. Using open company data, the empirical analysis investigates the public-private partnerships with which the state legitimises private sector participation and diffuses its power into market operation. Specifically, the analysis profiles the privately-built publicly-operated models of the private specialty hospitals and the stakeholding structure among the medical institutions in the New Hongqiao International Medical Center. The study also draws on expert interviews to substantiate the analyses. It is found that the public-private partnerships helped the state to diffuse its power into the private medical institutions through operating and holding stakes in the private medical institutions via quasi-governmental agencies, which reflect characteristics of state entrepreneurialism.

In a nutshell, this study links healthcare with urban studies and situates the medical city in the theories of state entrepreneurialism to understand an emergent urban phenomenon in China. It adds to the conceptualisation of producing urban spaces that have been traditionally anchored to issues in gentrification, housing, and redevelopment. This research calls for attention to new study areas that provide a new perspective on understanding China’s urbanism.

Read the accompanying article on Urban Studies OnlineFirst here.