During the Mao period (1949–1976), China established the Cooperative Medical System (CMS), which provided nearly universal access to basic health services and preventive care. However, during the period of economic reforms, Mao's successors let the CMS collapse because of its association with the late Mao and the Cultural Revolution (1978–2003). The era of Hu Jintao as China's leader (2002–2012) saw yet another ideological and policy oscillation with the establishment of New Rural Cooperative Medical Scheme (NRCMS), a medical insurance program that is supported from all levels of government. Although the NRCMS now covers more than 95 percent of China's rural residents, there is significant geographic variation in how China's diverse provincial governments administer the program. Ratigan's excellent book examines the reasons for this local variation. Although health policies constitute the core component of the empirical analysis, the book also engages in discussion of local variation across welfare policies such as education and poverty alleviation.

Ratigan engages with the works of Evelyne Huber and John D. Stephens (“State Economic and Social Policy in Global Capitalism,” in A Handbook of Political Sociology: States, Civil Societies, and Globalization, eds. Thomas Janoski, Robert Alford, Alexander M.