Maneuvering within Fragmented Bureaucracy and Vested Interests: Policy Entrepreneurship in China's Local Health Care Reform

Policy entrepreneurs have been thought to play a pivotal role in policy changes, in not only electoral democracies, but also authoritarian states, including China. By investigating the case of local health reform in Sanming... [ view full abstract ]

Policy entrepreneurs have been thought to play a pivotal role in policy changes, in not only electoral democracies, but also authoritarian states, including China. By investigating the case of local health reform in Sanming City, a national star of health reforms, this article illustrates how the Chinese fragmented bureaucracy enables and constrains local policy entrepreneurs and how they maneuver within the established institutional structure while attacking the vested interests opposing reforms. While the entrepreneur and his team present a range of strategies often adopted by their Western counterparts, it is the bureaucratic fragmentation itself that offers fertile soil in which entrepreneurs can maneuver. This study furthers theoretical discussion on policy entrepreneurship by elucidating the fluidity of interactional patterns between agent and structure. It shows that a successful entrepreneur may not just passively take the institutional structure for granted, but may also actively push the envelope to reshape it to serve reform efforts. The malleability of rigid institutions can be considerably increased by the active maneuver of entrepreneurial agents.