Looking for ‘New Ideas That Work’: county innovation in China’s health system reforms—the case of the New Cooperative Medical Scheme
Husain, L (2016) Looking for ‘New Ideas That Work’: county innovation in China’s health system reforms—the case of the New Cooperative Medical Scheme, Journal of Contemporary China, Volume 25, Issue 99, pages 438-452, DOI: 10.1080/10670564.2015.1104911
Sub-national governments in China have substantial responsibility for policy development as well as for direct implementation of circumscribed policy options set out by higher levels of government, and much policy discourse emphasizes the importance of sub-national flexibility and creativity in policy implementation. Discourses of government innovation aim to encourage local initiative in policy formulation and solving of systemically-important policy problems, and policy experimentation/innovation are increasingly credited as important elements of the Chinese government toolbox in managing reform. Recent studies have tended to treat experimentation/innovation as systemic phenomena, and there are few analyses of how local governments respond to central ‘experimental’ policy frameworks and develop locally- or systemically-useful policy solutions. Given concerns around the capacity of local governments, this is highly relevant in understanding how locally-generated policy relates to systemic reform. The article presents a case study of a low tech and ‘second best’ reimbursement mechanism developed sub-nationally under the New Cooperative Medical Scheme, China’s rural health insurance framework, and its spread and incorporation into national policy. It argues for the importance of local government development of ‘appropriate’ policy mechanisms (jizhi) as underpinning central reforms and system adaptation.