Manoeuvring within a fragmented bureaucracy: Policy entrepreneurship in China's local healthcare reform

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.

政策企業家在政策變革中發揮重要作用，不但在選舉民主國家中如此，在威權政體下亦然。本文透過分析三明醫改——中國大陸醫藥衛生體制改革的 “明星”，揭示了中國條塊分割的碎片化官僚體制如何影響地方的政策企業家推動改革。文章尤其關注政策企業家如何創造性地重組既有的體制框架，並衝破既得利益。研究發現，結構性約束和政策企業家的個人特質都對改革的成敗起到關鍵作用，而且具有企業家精神的政策創新是一個動態的過程。四個因素及其動態互動是地方政策企業家改革的關鍵: 個人行為特質、政治資本、網路地位、制度框架。本研究進一步闡明了在中國的體制之下，公共政策改革中結構因素和關鍵行為者的互動模式，並深化了關於政策企業家的理論探討。儘管既有體制韌性強勁，但富有企業家精神的政策活動家仍有相當的空間通過各種策略來調整制度安排，推動改革。 Copyright © 2018 SOAS University of London.