This chapter shows how pragmatist provinces shape social policy provision through the devolution of responsibility to local government. Pragmatist provinces have followed Deng Xiaoping’s “do what works” approach to the policy process. Despite the risks within an authoritarian system, officials in pragmatist provinces are more likely to experiment and innovate. These provinces devolve more responsibility to their localities, which offers opportunities for local officials to learn new skills and develop capacity in new areas. However, as they are generally wealthier, pragmatist provinces receive fewer fiscal transfers from the center for social policy. Therefore, they sometimes drag their feet in implementing unfunded mandates that do not coincide with their provincial priorities. While focusing on health policy in pragmatist provinces, this chapter also discusses the impact of pragmatism on education, poverty alleviation, and housing.