Lesson-drawing under authoritarianism: generosity and cost control in China's hospital payment reforms

Local policy experimentation was a driving force behind China's economic progress, but its results in the field of social policy are more ambiguous. This article takes a lesson-drawing perspective on the transfer of international hospital payment reforms to Chinese cities, focusing on the Urban Employees' Basic Medical Insurance. We distinguish two waves of reform. The first wave was driven by local government initiatives dominated by simplified versions of international models which lacked strong prospective payment components (inspirations) and protected local bureaucratic and hospital interests. The second wave was driven by central government intervention dominated by syntheses and adaptations with strong prospective payment components and was more oriented toward patients' interests. Data were collected via expert interviews, administrative documents, academic studies, and newspaper articles. We find that elements of social policy are transferred depending on central–local interaction, with pressure from the center needed to overcome local bureaucratic self-interest.