The Role of Bureaucracy in Health Policymaking and Implementation in China


The role of bureaucracy in the health policy process is under-studied. Most literature focuses on technical issues surrounding policy design and evaluation, without considering how decisions and implementation are influenced by the motivations of bureaucrats and the incentives they face. In the small body of literature that examines how politics affects the health policy process, very little focuses on the role of bureaucracy.


The primary objective is to examine how bureaucratic incentives, behavior, and action affect health policymaking and implementation. We do this through retrospective case studies of recent policy reforms as well as analyses of a pilot reform that we are designing. We chose China as the focus of this work given both the historical health reform context and major ongoing reform efforts in recent decades.

Research Activities

We use an interdisciplinary approach that combines political analysis and economics to develop case studies. Retrospective cases analyze the formulation or implementation of a policy that has already been designed and implemented, drawing on policy records, publications, newspaper, social media, interviews, and, in some cases, the experience of the authors/researchers’ direct involvement in the process. Second, we are conducting a pilot experiment on how specific health policy reforms are implemented, and will study how bureaucrats at different levels of the government and different departments make decisions affecting policy decision-making and implementation of this pilot.

Expected Impact

This project will contribute to closing a critically important knowledge gap about the motivations and behavior of bureaucrats with findings of substantial practical as well as theoretical significance. The use of both a pilot experiment and retrospective case studies will allow us to examine bureaucratic behavior in active policy formulation and implementation as well as in the context of past health reform. The findings from this project should also provide a solid base for conducting comparative analysis with other large countries to understand how bureaucracies influence the design and implementation of health policies.

Partners and Funding

This work involves faculty from the Harvard T.H. Chan School of Public Health, Department of Global Health and Population, and Harvard University Faculty of Arts and Sciences, Department of Government. The work is funded from a grant from the Harvard Global Institute, which supports inter-disciplinary projects at Harvard University around matters of global significance