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Manoeuvring within a Fragmented Bureaucracy: Policy Entrepreneurship in China's Local Healthcare Reform

Published online by Cambridge University Press:  08 November 2018

Alex Jingwei He
Alex Jingwei He*
Affiliation:
Department of Asian and Policy Studies, The Education University of Hong Kong. E-mail: jwhe@eduhk.hk.
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Abstract

Policy entrepreneurs play a pivotal role in policy changes in both electoral democracies and authoritarian systems. By investigating the case of healthcare reform in Sanming City, this article illustrates how the fragmented bureaucracy in China enables and constrains local policy entrepreneurs, and how entrepreneurial manoeuvring succeeds in realigning the old institutional structures while attacking the vested interests. Both structural conditions and individual attributes are of critical importance to the success of policy entrepreneurship. Four factors and their dynamic interactions are central to local policy entrepreneurship: behavioural traits, political capital, network position and institutional framework. This study furthers theoretical discussion on policy entrepreneurship by elucidating the fluidity of interactional patterns between agent and structure in authoritarian China. The malleability of rigid institutions can be considerably increased by the active manoeuvring of entrepreneurial agents.

摘要

政策企业家在政策变革中发挥重要作用，不但在选举民主国家中如此，在威权政体下亦然。本文透过分析三明医改——中国大陆医药卫生体制改革的 “明星”，揭示了中国条块分割的碎片化官僚体制如何影响地方的政策企业家推动改革。文章尤其关注政策企业家如何创造性地重组既有的体制框架，并冲破既得利益。研究发现，结构性约束和政策企业家的个人特质都对改革的成败起到关键作用，而且具有企业家精神的政策创新是一个动态的过程。四个因素及其动态互动是地方政策企业家改革的关键: 个人行为特质、政治资本、网络地位、制度框架。本研究进一步阐明了在中国的体制之下，公共政策改革中结构因素和关键行为者的互动模式，并深化了关于政策企业家的理论探讨。尽管既有体制韧性强劲，但富有企业家精神的政策活动家仍有相当的空间通过各种策略来调整制度安排，推动改革。

Keywords

policy changefragmented bureaucracypolicy entrepreneurSanminghealthcare policyChina政策变革条块分割政策企业家三明医改中国
Type
Research Article
Information
The China Quarterly , Volume 236 , December 2018 , pp. 1088 - 1110
Copyright
Copyright © SOAS University of London 2018 

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