Providing universal healthcare to over 1.3 billion Chinese people is a highly complex and Herculean task. In her book Financing Health Care in China, Sabrina Ching Yuen Luk reviews the PRC's efforts in achieving this goal over the last century. She finds that power relations as well as competing values and interests have strongly shaped the healthcare reform process. Although the Party-state has established a multi-layered healthcare system, many areas need further improvement to provide sustainable and universal healthcare in China.

Luk's book has two main merits: it offers a very detailed historical overview of Chinese healthcare system reforms and substantiates this analysis with a wealth of information and statistical data. Luk's overview ranges from transitions in population ageing over time (chapter two) and pre-reform era policies (chapter three) to more recent policy experiments and schemes (chapter five). It moreover identifies problems within the Chinese healthcare insurance system and proposes areas of future reform (chapters six and seven) to assess the strengths and weaknesses of the Party-state's healthcare system. Each chapter is filled with a great plurality of information, including statistical data (official statistics and statistics calculated by the author herself) or semi-structured qualitative interviews conducted with healthcare experts, professionals and common citizens. The book thus provides a brief (the main text is 106 pages in total) but informative overview of Chinese healthcare system reforms, particularly for readers in search of summaries of relevant data.

Yet, while highly informative, the book somewhat lacks rigorous critical analysis. First, the title is misleading: Luk's book is about healthcare system reform. Financing is a part of these reforms, yet not the central focus of the book. This is evident in Luk's central argument, which states that Chinese healthcare reform “is a political process revealing an intricate interplay of power relations and diverse interests” in which “competing values and interests” play a role (p. 9). While valid, this argument remains rather vague and could describe reforms in any given policy field. It is unclear, for instance, how different actors interact or negotiate healthcare reform, at which point in time, and with what political or socio-economic consequences.

This lack of analytical rigour is furthermore reflected in the book's theoretical approach. The choice of Historical Institutionalism (HI) theory to examine Chinese healthcare reforms is excellent, but Luk only briefly introduces it in four sentences (pp. 5–6). Moreover, despite highlighting important processes, the analytical factors in her “refined” HI approach are not as novel as suggested: like “actors,” “environmental triggers” (which to me are undistinguishable from “external shocks”) are common features of traditional HI theory. Similarly, “ideational processes” have been discussed in relation to HI theory for some time now. Finally, Luk largely justifies her criticism and introduces her “refined” HI approach by citing her previous book Health Insurance Reforms in Asia (Routledge, 2014) at great length. Given the lack of explanation and discussion of the HI literature, in my eyes, her criticisms and her refined approach are not entirely convincing. Even if the theoretical framework had been presented in greater detail, it is not rigorously applied in the book. The application of the theory takes place on only five pages in chapter four (pp. 51–55) where five analytical factors (top-down decision-making and bureaucratic interests; the discretionary power of local governments; positive and negative feedback effects; environmental triggers and ideational forces) are briefly applied to the case. The rest of the book remains largely descriptive.

Finally, Luk's research methods demonstrate a few shortcomings. For instance, although the book allegedly uses an “interpretive” approach (p. 8), the study mostly summarizes data and is not interpretive (for instance, it fails to analyse actor understandings and interpretations). Moreover, although the 15 semi-structured interviews conducted in Shanghai and Kunming are very valuable and informative, it is questionable whether they can “compensate for the lack and limitations of documentary evidence” (p. 8). Although only two interviews were held in Shanghai, and 13 in Kunming (mostly with nurses), the study does not reflect on how these interviews may portray particular experiences within a very diverse Chinese healthcare system.

Overall, the book brings together a bulk of materials and statistical data on the Chinese healthcare system and offers a valuable depiction of the reform process over time. Yet, at times it reads more like a report or policy recommendation document. Official policy objectives are presented without much reflection concerning the Party-state's political motives, or whether and how these objectives are in fact implemented locally. The study furthermore does not situate Chinese healthcare reforms within the “bigger picture” such as China's overall social policy reforms, socio-economic and political developments in China or potential international policy learning processes. Nevertheless, the book is useful as a reference book for students or researchers venturing into a new research area.