Seeking policy solutions in a complex system: experimentalist governance in China’s healthcare reform

Abstract

The proliferation of “wicked” policy problems in complex systems requires an experimental approach of problem-solving. Experimentalist governance offers a conducive framework through which to seek policy solutions amidst high levels of complexity in a multilevel governance structure. This study conceptualizes four distinctive experimental modalities based on varying levels of technical complexity and interest complexity, both of which represent salient constraints for policy reforms in a complex system, the health sector in particular. Trail-blazing pilots , crowdsourcing pilots , managed pilots , and road-testing pilots are all associated with distinct mechanisms of experimentation in a multilevel governance structure. Through four illustrative cases from China’s massive experimental program of public hospital reform, this study demonstrates how experimentalist governance seeks policy solutions in the health sector. Should governance arrangements, policy capacity, pragmatism, and informational devices become aligned in a conducive way, experimentalist governance can play an instrumental role in seeking solutions for difficult problems in a complex policy system. A governance structure capable of policy learning and adaptive management is the key.

Unpack the black box of pilot sampling in policy experimentation: A qualitative comparative analysis of China's public hospital reform

“…Last, yet also importantly, this study echoes other recent ones (Ettelt et al., 2015; He, 2022; He et al, 2022; Nair & Howlett, 2016) that found the use of pilots to be a versatile governance tool capable of serving multiple purposes. The five distinctive pathways elucidated through our study manifested the rich dynamics of policy experimentation.…”

“…As is illustrated in Figure 1, the program covered virtually every provincial administrative unit of mainland China, and the pilot cities represented the various levels of administrative status. A wide range of experimental activities has been observed since then (Barber et al., 2014; He et al., 2022).…”

“…In large countries with a multilevel governance structure, national policymakers increasingly resort to experimental programs across subnational regions, in their search for scalable solutions to complex policy problems (Ettelt et al., 2022; Husain, 2017; Jowell, 2003; Nair & Howlett, 2016). The recent literature has paid due attention to this thriving form of experimentalist governance, in which national and subnational governments interact in a dynamic fashion throughout the experimental process (He et al., 2022; Sabel & Zeitlin, 2010; Zhu & Zhao, 2021). Scholars have also gained an understanding, albeit preliminary, of the motives and behavioral patterns of subnational units when joining national‐level experimental programs (Ettelt et al., 2022; Wang et al., 2022; Wang & Yang, 2021).…”

Information-Driven Integrated Healthcare: An Analysis of the Cooperation Strategy of County Medical Community Based on Multi-Subject Simulation

“…Various integrative healthcare exploration practices are being conducted worldwide, including strategies such as integrated care pathways, improved governance models, integrated interventions, collaborative care, and integrated health services [4]. The reform of integrated healthcare occurs not only within health institutions but also in close connection with other public sectors, making it necessary to pay attention to cross-departmental partnerships in the promotion of integrated healthcare reform and, from the perspective of complex public affairs, governance can be called "wicked problem" [5][6][7]. In the context of building a comprehensive healthcare delivery reform, China has attempted to build a medical service alliance called the county medical community (CMC).…”

Frontiers of policy process research in China

“…Zhu and Zhao (2021) constructed a framework that includes four types of policy experimentation: hierarchical experimentation, comparative trial, selective recognition, and adaptive reconciliation, to understand experimentalist governance from China's central–local interaction. He et al (2022) extracted four modes of experimentation: trail‐blazing pilots, crowdsourcing pilots, managed pilots, and road‐testing pilots, to discuss China's public hospital reform.…”