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In the last two decades, developing countries have increasingly engaged in improving the governance of their health systems and promoting policy design to strengthen their health governance capacity. Although many well-designed national policy strategies have been promulgated, obstacles to policy implementation and compliance among localities may undermine these efforts, particularly in decentralized health systems. Studies on health governance have rarely adopted a central-local analysis to investigate in detail local governments’ distinct experiences, orientations, and dynamics in implementing the same national policy initiative. This study examines the policy orientations of prefectural governments in strengthening governance in health financing in China, which has transitioned from emphasizing the approach of fiscal resource input to that of marketization promotion and cost-containment regulation enforcement at the national level since 2009. Employing text-mining methodologies, we analyzed health policy documents issued by multi-level governments after 2009. The analysis revealed three salient findings. First, compared to higher-level authorities, prefectural governments generally opted to use fiscal resource input over marketization promotion and cost-containment regulation enforcement between 2009 and 2020. Second, policy choices of prefectural governments varied considerably in terms of enforcing cost-containment regulations during the same period. Third, the extent of the prefectural government’s orientation toward marketization promotion or cost-containment regulation enforcement was not only determined by the top-down orders of higher-level authorities but was also incentivized by the government’s fiscal dependency and the policy orientations of peer governments. These findings contribute to the health governance literature by providing an overview of local discretion in policy choices, and the political and fiscal dynamics of local policy orientations in promoting health governance in a decentralized health system.

PurposeThis study analyzes the causal effect of education on consumers' cognition and attitudes toward genetically modified (GM) foods.Design/methodology/approachThe authors propose an analytical framework to clarify the role of education levels and education content in the formation of attitudes toward GM foods and utilize education reforms in China as natural experiments to test the theoretical predictions empirically. For education levels, the authors use Compulsory Education Law's implementation to construct the instrument variable. For education content, the authors utilize the revision of the biology textbook in the Eighth Curriculum Reform to implement staggered difference-in-difference estimation. The authors use two national household surveys, the China Genuine Progress indicator Survey (CGPiS) and the China Household Finance Survey (CHFS) of 2017, combined with provincial-level data of education reforms.FindingsThe education level, instrumented by the Compulsory Education Law's implementation, has an insignificant effect on consumers' cognition and attitudes toward GM foods, whereas the acquisition of formal education on genetic science, introduced by the Eighth Curriculum Reform, has a statistically significant and positive influence.Originality/valueThis is the first study to investigate the causal effects of education level and content on consumers' cognition and attitude toward GM foods using national representative data. It is also the first to evaluate the long-term effects of the biology textbook reform in China. The findings help open the black box of how education shapes people's preferences and attitudes and highlight the significance of formal biology education in formulating consumers' willingness to accept GM foods.

Gender differences in sub-major choices within the science, technology, engineering, and mathematics (STEM) fields have scarcely been discussed. This study uses administrative records from a top medical school in China to examine gender differences in medical students’ specialty choices. Results showed that, although the gender gap in choosing a clinical track shrinks over time, female students in the clinical track are far less likely to choose highly paid surgical specialties, and this gap persists over time. However, female students outperformed male students in all of the courses. Thus, academic performance cannot explain the underrepresentation of female students in surgery. We further collected questions such as “Why don’t female students choose surgical specialties” and answers to them in “Chinese Quora”, Zhihu.com. A preliminary text analysis showed that ultra-physical load, discrimination in recruitment, women-unfriendly work climates, and difficulties in taking care of family are barriers that prevent women from choosing surgery.