The COVID-19 pandemic has brought enormous challenges for public health crisis management in China. Crisis responses vary greatly among provinces. Many studies focus on the role of the central government in crisis management. However, how regional governments respond to such pandemic crises is underexplored. The existing literature lacks extensive comparative studies explaining why different regions respond differently to the crisis, and how different regional institutional environments affect crisis management. By proposing an analytical framework based on governance capacity and legitimacy theory, this article seeks to address these questions. This study mainly focuses on provincial governments because they play a crucial role in coordinating various organizations and different levels of government in response to the crisis. By comparing the different COVID-19 responses of Hubei and Zhejiang provinces, this study finds that different regional institutional environments based on the triangular linkage of government, business and society influence regional crisis management by shaping different governance capacities (coordination, analytical, regulation and delivery capacity) and legitimacy (input, throughput and output legitimacy). Regional governments with strong governance capacity can promote crisis management through cross-organizational collaboration, scientific analysis and timely decision-making, and effective policy implementation. Promoting citizen participation and information disclosure in the policy process and enhancing citizens’ support can improve governance legitimacy, thereby facilitating crisis management. Governance capacity and legitimacy also affect each other. These findings contribute to the literature on public health crisis management. They also shed light on how regional governments in China and other countries with regional variation can effectively tackle public health crises under different institutional environments.

How to explain the distortion of public–private partnerships (PPPs) is underexplored. Drawing on the principal–agent theory, this article proposes an institutional incentive-driven framework. Based on a case study of PPPs in China, this article finds that central–local government relationships play a crucial role in shaping PPP performance. Goal incongruence and information asymmetry lead to two types of distortion. First, PPPs become a political task for local governments to higher-level governments’ needs. Second, PPPs serve as financing tools to create political achievements. These opportunistic behaviors violate the goals of the central government’s PPP policy and increase government debt risks.