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Policy hybrids and bricolage: the life course of individual accounts in China’s health policy domain

Published online by Cambridge University Press:  23 September 2025

Yuxin Li*
Affiliation:
Center for Chinese Public Administration Research and School of Government, Sun Yat-sen University, Guangzhou, China

Abstract

China innovated a policy hybrid of ‘social pooling plus individual accounts’ for health protection in the 1990s and exnovated the individual accounts in the 2010s. On the basis of expert interviews and document analysis, this paper explores the life course of individual accounts from the perspective of Lévi-Strauss’s ‘bricoleur’. The individual accounts were grafted onto the social health insurance to signify the ideational shift from ‘egalitarianism’ to ‘fairness with considerable efficiency’. Meanwhile, piloting reform strategies provided a practical foundation for implementation of the policy. As China’s modern social security expanded and the capability for scientific policy-making grew, the government embarked on revising or removing the individual accounts. The analysis casts insights into the increasingly popular policy hybrid practices resulting from globalisation, responds to the debate on East Asian welfare regimes, provides a dynamic view on policy decoupling from world culture and furthers our understanding of policy innovation management.

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© The Author(s), 2025. Published by Cambridge University Press

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References

Bandelow, N. C. (2003). Lerntheoretische Ansätze in der Policy-Forschung. In Maier, M. (Ed.), Politik als Lernprozess (pp. 98121). Springer.10.1007/978-3-663-11061-3_4CrossRefGoogle Scholar
Cao, P. (2014). China’s new rural cooperative medical history. Fujian People’s Publishing House.Google Scholar
Carstensen, M. (2015). Bricolage as an analytical lens in new institutionalist theory. In Spanakos, A. (Ed.), Conceptualising comparative politics (pp. 4667). Routledge.Google Scholar
Ciborra, C. (2002). The labyrinths of information. Oxford University Press.Google Scholar
Cleaver, F. (2012). Development through Bricolage. Routledge.Google Scholar
Cong, S. (2006). On the construction of a medical security system with major illness protection as the core. Journal of Shanghai University of Finance and Economics, 8(1), 5259.Google Scholar
Deacon, B., & Stubbs, P. (2013). Global social policy studies: Conceptual and analytical reflections. Global Social Policy, 13(1), 523.10.1177/1468018112469798CrossRefGoogle Scholar
Deng, Z. (2015). From labor insurance to social insurance: Transformation of China’s social security system and its logic. China Social Science Press.Google Scholar
Duckett, J. (2019). International influences on policymaking in China: Network authoritarianism from Jiang Zemin to Hu Jintao. The China Quarterly, 237, 1537.10.1017/S0305741018001212CrossRefGoogle Scholar
Duymedjian, R., & Rüling, C. (2010). Towards a foundation of bricolage in organization and management theory. Organization Studies, 31(2), 133151.10.1177/0170840609347051CrossRefGoogle Scholar
Esping-Andersen, G. (1990). The three worlds of welfare capitalism. Princeton University Press.Google Scholar
Esping-Andersen, G. (1997). Hybrid or unique? The Japanese welfare state between Europe and America. Journal of European Social Policy, 7(3), 179189.10.1177/095892879700700301CrossRefGoogle Scholar
Field, M. (1973). The concept of the ‘health system’ at the macrosociological level. Social Science & Medicine (1967), 7(10), 763785.10.1016/0037-7856(73)90118-2CrossRefGoogle ScholarPubMed
Fu, Q. (2005). Analysis of the pros and cons of establishing personal accounts for basic medical insurance. Health Economics Research, 10, 3637.Google Scholar
Gilardi, F. (2012). Transnational diffusion: Norms, ideas, and policies. In Carlsnaes, W., Risse, T., & Simmons, B. (Eds.), Handbook of international relations (pp. 453477 ). Sage.Google Scholar
Gilardi, F., Shipan, C., & Wüest, B. (2021). Policy diffusion: The issue-definition stage. American Journal of Political Science, 65(1), 2135.10.1111/ajps.12521CrossRefGoogle Scholar
Gilardi, F., & Wasserfallen, F. (2019). The politics of policy diffusion. European Journal of Political Research, 58, 12451256.10.1111/1475-6765.12326CrossRefGoogle Scholar
Goodman, R., & Peng, I. (1996). The East Asian welfare states: Peripatetic learning, adaptive change, and nation-building. In Esping-Andersen, G. (Ed.), Welfare states in transition: National adaptations in global economies (pp. 192224). Sage.Google Scholar
Gray, V. (1973). Innovation in the states: A diffusion study. American Political Science Review, 67(4), 11741185.10.2307/1956539CrossRefGoogle Scholar
Hall, P. A. (1993). Policy paradigms, social learning, and the state: The case of economic policymaking in Britain. Comparative Politics, 25(3), 275296.10.2307/422246CrossRefGoogle Scholar
Hartley, J., & Knell, L. (2022). Innovation, exnovation and intelligent failure. Public Money & Management, 42(1), 4048.10.1080/09540962.2021.1965307CrossRefGoogle Scholar
He, A. J., Zhu, L., & Qian, J. (2025). Policy design and policy feedback in welfare retrenchment: A survey experiment in China. Policy Studies Journal, 53(2), 307327.10.1111/psj.12569CrossRefGoogle Scholar
Heinze, T. (2011). Mechanism-based thinking on policy diffusion: A review of current approaches in political science. KFG Working Paper Series, Freie Universität Berlin.Google Scholar
Hu, A. (2012). The global spread of neoliberalism and China’s pension reform since 1978. Journal of World History, 23(3), 609638.10.1353/jwh.2012.0071CrossRefGoogle Scholar
Hu, A. (2016). Social insurance ideas in the People’s Republic of China: A historical and transnational analysis. Transnational Social Review, 6(3), 297312.10.1080/21931674.2016.1222764CrossRefGoogle Scholar
Hu, X. (2019). History of social security development in China. China Labor and Social Security Press.Google Scholar
Hua, Y. (2020). The return of rationality to China’s social security reform: A perspective from the rise and fall of the mandatory individual account in social health insurance. Academic Research Journal, 4, 10.Google Scholar
Jones, C. (1993). The Pacific challenge: Confucian welfare states. In Jones, C. (Ed.), New perspectives on the welfare state in Europe (pp. 198217 ). Routledge.Google Scholar
Kaasch, A. (2013). Contesting contestation: Global social policy prescriptions on pensions and health systems. Global Social Policy, 13(1), 4565.10.1177/1468018112469797CrossRefGoogle Scholar
Kimberly, J. (1981). Managerial innovation. In Nystrom, P. & Starbuck, W. (Eds.), Handbook of organizational design (pp. 84104 ). Oxford University Press.Google Scholar
Kuhlmann, J. (2021). Mechanisms of policy transfer and policy diffusion. In Porto de Oliveira, O. (Ed.), Handbook of policy transfer, diffusion and circulation (pp. 4357). Edward Elgar Publishing.Google Scholar
Lanzara, G. F. (1999). Between transient constructs and persistent structures: Designing systems in action. Journal of Strategic Information Systems, 8, 331349.10.1016/S0963-8687(00)00031-7CrossRefGoogle Scholar
Leisering, L., Liu, T., & ten Brink, T. (2017). Synthesizing disparate ideas: How a Chinese model of social assistance was forged. Global Social Policy, 17(3), 307327.10.1177/1468018117704381CrossRefGoogle Scholar
Leisering, L. & Tao, L. (2010). Globale Wissensdiffusion in der Sozialpolitik: Die Einführung einer Arbeitsunfallversicherung in der Volksrepublik China. Zeitschrift für Sozialreform, 56(2), 173206.10.1515/zsr-2010-0204CrossRefGoogle Scholar
Lévi-Strauss, C. (1966). The savage mind. Weidenfeld & Nicolson.Google Scholar
Liu, Z. (1995). Social security system reform. Reform Press.Google Scholar
Liu, G., Dong, C., Meng, Q., & Yan, L. (2006). The functions and impacts of individual medical insurance accounts (review). China’s Health Economy, 25(2), 6164.Google Scholar
Mallinson, D. (2021). Policy innovation adoption across the diffusion life course. Policy Studies Journal, 49(2), 335358.10.1111/psj.12406CrossRefGoogle Scholar
Meyer, J. (1980). The world polity and the authority of the nation-state. Studies of the Modern World-system, 109137.Google Scholar
Meyer, J. (2010). World society, institutional theories, and the actor. Annual Review of Sociology, 36(1), 120.10.1146/annurev.soc.012809.102506CrossRefGoogle Scholar
Midgley, J. (1986). Industrialization and welfare: The case of the four little tigers. Social Policy & Administration, 20(3), 225238.10.1111/j.1467-9515.1986.tb00253.xCrossRefGoogle Scholar
Peng, R. (2010). Interview with Peng Ruicong. Hunan Education Press.Google Scholar
Pouliot, V., & Thérien, J. (2023). Global policymaking. Cambridge University Press.10.1017/9781009344999CrossRefGoogle Scholar
Reinhardt, T. (2008). Claude Lévi-Strauss zur Einführung. Junius.Google Scholar
Rogers, E. (1962). Diffusion of innovations. The Free Press.Google Scholar
Rose, R. (1991). What is lesson-drawing? Journal of Public Policy, 11(1), 330.10.1017/S0143814X00004918CrossRefGoogle Scholar
Shen, S. (2019). After the abolition of individual accounts for residents’ health insurance. China Health, 8, 7778.Google Scholar
Shen, S., & Hou, X. (2011). The equity and efficiency analysis of the medical savings account: Based on Guangdong medical insurance data. Chinese Journal of Population Science, 10(5), 7584.Google Scholar
Simmons, B., Dobbin, F., & Garrett, G. (2006). Introduction: The international diffusion of liberalism. International Organization, 60(4), 781810.10.1017/S0020818306060267CrossRefGoogle Scholar
Swiss Re Corporate History (2017). A history of insurance in China. Swiss Reinsurance Company. https://www.swissre.com/dam/jcr:eb1aba5f-05ca-4bd4-bfe6-d42a6ed6b8c5/150Y_Markt_Broschuere_China_Inhalt.pdf.Google Scholar
Verger, N., Duymedjian, R., & Roberts, J. (2024, February 12). Innovation is dead, long live exnovation? A systematic and bibliometric review for a theoretical conceptualisation of exnovation. https://osf.io/preprints/osf/c2mgk_v1 10.31219/osf.io/c2mgkCrossRefGoogle Scholar
Walker, J. (1969). The Diffusion of innovations among the American states, American Political Science Review. 63(3), 880899.10.2307/1954434CrossRefGoogle Scholar
Wang, C. (2013). The origin, effectiveness and development of the individual account system of basic health insurance for urban workers. Academic Journal of Zhongzhou, 8, 8086.Google Scholar
Wang, C. and Li, Z. (2015). Looking at the way out for urban workers’ basic medical insurance individual accounts from the top-level design perspective. Dong Yue Tribune, 2, 2126 Google Scholar
Wang, Z. (2005). The effectiveness, problems, and solutions of individual accounts for basic medical insurance. China Health Economy, 03, 4043.Google Scholar
Weick, K. (1993). The collapse of sensemaking in organizations: The Mann Gulch Disaster. Administrative Science Quarterly, 38(4), 628652.10.2307/2393339CrossRefGoogle Scholar
Weyland, K. (2005). The diffusion of innovations: How cognitive heuristics shaped Bolivia’s pension reform. Comparative Politics, 38(1), 21.10.2307/20072911CrossRefGoogle Scholar
White, G., & Goodman, R. (1998). Welfare orientalism and the search for an East Asian welfare model. In Goodman, R. (Ed.), The East Asian welfare model (pp. 324). Routledge.Google Scholar
Wu, R. (2003). International comparison of health security systems. Chemical Industry Press.Google Scholar
Wu, R. (2019). Bearing in mind the original intention of health reform and improving the institutional system - Commemorating the 20th anniversary of the implementation of Document No. 44 of the State Council [1998]. China’s Health Insurance, 01, 58.Google Scholar
Zhao, Z., Jiang, Y., & Liu, Y. (1993). Social insurance and employee benefits workbook. China Labor Press.Google Scholar
Zheng, G., & Yang, J. (1998). Challenges facing China’s health reform - One of the topic discussions on China’s health reform across the century. China Social Insurance, 06, 59.Google Scholar
Zheng, G. (2002). Changes and evaluation of China’s social security system. China People University Press.Google Scholar
Zhou, H., & Zhang, J. (2015), Towards a society with social protection for all. China Social Science Press.Google Scholar
Zhu, C. (2011). Perception of the United States in the process of reform and opening up. America Research, 25(2), 5.Google Scholar
Zhu, J., & Zhang, S. (1995). Encyclopedia of social insurance work in China. China Tongji Press.Google Scholar
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