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

机译：政策试验和创新以应对中国医疗改革管理的复杂性

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There are increasing criticisms of dominant models for scaling up health systems in developing countries and a recognition that approaches are needed that better take into account the complexity of health interventions. Since Reform and Opening in the late 1970s, Chinese government has managed complex, rapid and intersecting reforms across many policy areas. As with reforms in other policy areas, reform of the health system has been through a process of trial and error. There is increasing understanding of the importance of policy experimentation and innovation in many of China’s reforms; this article argues that these processes have been important in rebuilding China’s health system. While China’s current system still has many problems, progress is being made in developing a functioning system able to ensure broad population access. The article analyses Chinese thinking on policy experimentation and innovation and their use in management of complex reforms. It argues that China’s management of reform allows space for policy tailoring and innovation by sub-national governments under a broad agreement over the ends of reform, and that shared understandings of policy innovation, alongside informational infrastructures for the systemic propagation and codification of useful practices, provide a framework for managing change in complex environments and under conditions of uncertainty in which ‘what works’ is not knowable in advance. The article situates China’s use of experimentation and innovation in management of health system reform in relation to recent literature which applies complex systems thinking to global health, and concludes that there are lessons to be learnt from China’s approaches to managing complexity in development of health systems for the benefit of the poor.
机译：越来越多的人批评发展中国家扩大卫生系统的主导模式，并认识到需要采取一些方法来更好地考虑到卫生干预措施的复杂性。自1970年代后期的改革开放以来，中国政府在许多政策领域管理着复杂，迅速而相交的改革。与其他政策领域的改革一样，卫生系统的改革是经过反复试验的过程。人们对政策试验和创新在中国许多改革中的重要性日益了解；本文认为，这些过程对于重建中国的卫生系统非常重要。尽管中国目前的制度仍然存在许多问题，但在开发能够确保广泛的人口进入的有效制度方面正在取得进展。本文分析了中国关于政策试验和创新的思想及其在复杂改革管理中的运用。它认为，中国的改革管理为地方政府在改革结束时达成广泛协议提供了政策调整和创新的空间，并分享了对政策创新的共识，以及用于系统传播和编纂有用做法的信息基础设施，提供了一个框架，用于管理复杂环境中的变化和不确定性条件，在这些不确定性条件下事先无法知道“什么有效”。本文将中国在卫生系统改革管理中的实验和创新运用与最近的文献相结合，这些文献将复杂的系统思想应用于全球卫生，并得出结论，从中国管理卫生系统发展复杂性的方法中可以吸取教训。穷人的利益。

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