The Civic Value and Economic Promise of Medical Cities in the United States and China

Abstract

The capacity of health care has transcended the provision of medical care in the past decades. Consumption associated with public and private spending on health care, as well as innovation produced by advancement in biotechnology, have together constantly reshaped the socio-economic order and urban landscape of cities. In the United States, health care is an urban asset that transforms the urban economy from the industrial past to the knowledge economy around life sciences. This economic transformation has produced medical cities that aggregate medical, university, and research institutions in cities. As an international counterpart, medical cities in China originated from a vastly different socio-political background. The changing demography and central leadership’s policy directives promoting various aspects of health have created opportunities for the government and real estate developers to build various forms of medical cities to mobilize resources from the market, universities, and medical institutions. As the semantic definitions of “medical city” have departed in the distinct institutional contexts in the United States and China, their practical experiences should also be contradistinguished.

This dissertation aims at offering insights into medical cities in the United States and China, and contextualizes them in the different institutional, political, and economic environments. The research concerns the differences between medical cities in the two countries and explores the underlying factors that have shaped these differences. It proposes the “Knowledge-Material Circuit” to examine the significance of American medical cities, and the “Institutionalized Spatial Practice” to unfold the complexities of medical cities in China. Supported by comparative studies of four case studies in Boston, Houston, Beijing, and Shanghai, medical cities are situated in their wider narratives of the transforming economy, the shifting realm of urban governance, the varying degree of civic engagement, and the changing perception of the civic-health relationship. Drawing upon the findings, recommendations are made to address the future path of medical cities.

The research finds that medical city in the U.S. is a reaction to the public and private, for-profit and non-profit interests of the health care system, a result of the state, market, and civic leadership, a culmination of place-based policies by the entrepreneurial states, and a representation of the spatial concentration of knowledge production and innovation. Medical city in China is a result of the changing state-market interests, a contestation between central and local governments, a trophy to inter-local competitions, an instrumentalized mega project to mobilize state resources, a negotiation between the public and private hospitals, and an experiment for the health care system under reforms. The significance of medical city extends beyond its physical planning and urban form – its interpretation has to be embedded in the dialogues among various participants from the state and the market, from the public and the private.