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Table 2 Indicative typology of China’s experimental health policy processes

From: Policy experimentation and innovation as a response to complexity in China’s management of health reforms

Indicative type Salient features
Type I: Managed piloting/policy trialling - Direct experimentation, allowing trialling of targeted interventions in which pilots are relatively closely managed with the intention of trialling specific approaches to defined policy problem; local governments have a relatively low degree of discretion
- Technical support to implementing units is often provided by research institutes, academics, and/or international agencies; local governments retain discretion in concrete management approaches adopted and in timing, etc., in an attempt to find approaches with contextual fit
- Pilots may be in advance of the national (or provincial) policy agenda, and have an agenda setting function, or may fall within existing policy frameworks and form part of ongoing reforms and may provide lessons of supra-local or systemic significance
- Screening and learning: scale up of practices deemed useful may or may not take place; may be directed by higher levels of government (frequently through one size doesn’t fit all scale up) or may be relatively organic
Type II: Experimental policy frameworks; local government purposive reforms - Framework policy is set by central or provincial government, giving local governments or other implementing units limited discretion between relatively defined implementation choices; leads to multiple practices
- Implementing counties often have little expert support or technical assistance, though better-resourced jurisdictions may have support from national or sub-national research institutions, or occasionally external TA through international programmes; space for pragmatic problem solving and emergence of ‘appropriate’ approaches with contextual fit
- Local government reforms fall within the ‘implementation’ phase of the policy cycle; may provide lessons of supra-local or systemic significance
- Screening and learning: as above
Type III: Open policy frameworks; local government adaptive innovation and learning by doing - ‘Open’ policy frameworks are used by central government, allowing space for broad local discretion in implementation and learning by doing and emergence of multiple practices11
- Often little expert support – as above; space for pragmatic problem solving and emergence of ‘appropriate’ approaches with contextual fit
- Local government innovation falls within the ‘implementation’ phase of the policy cycle; may provide lessons of supra-local or systemic significance
- Screening and learning: as above
Type IV: Decentralised implementation; range of policy practices - Decentralised policy making in the absence of national standardisation can produce a range of policy practices
- Often little expert support – as above; space for pragmatic problem solving and emergence of ‘appropriate’ approaches with contextual fit
- May fall in multiple phases of policy cycle; may provide lessons of supra-local or systemic significance
- Screening and learning: as above
  1. 11Open’ policy frameworks deliberately allow implementers discretion in the co-construction of reforms [76]. Much Chinese policy is of this type, though by no means all local implementers are proactive innovators or engaged in learning by doing, and much foot dragging [77] and mis-communication also [78] exist, while financial resources and prior policy design may be inadequate [42].