Upscaling policy pilots: Four tales in Chinese health governance

Governments have widely applied policy pilots to test new policy initiatives before their full rollout. However, little is known about their upscaling styles. In this contribution, in relation to two attributes of the issues that policy pilots attempt to resolve – ambiguity and salience – we construct an analytic framework consisting of four policy-pilot upscaling styles: command replication, refinement by doing, waiting by doing, and putting on hold. Four representative cases in Chinese health governance, namely, the Sanming healthcare reform, the New Rural Cooperative Medical Scheme, medical staff’s salary reform in public hospitals, and income–expenditure two-line management in primary healthcare institutions, have been investigated to exemplify them. Our study contributes to the existing governance and policy literature by adding new building blocks to the upscaling of policy pilots.