The conclusion recapitulates the book’s argument that Chinese provinces take different approaches to governing, which have impacted social policy implementation. This chapter discusses how recentralization under Xi Jinping may interact with local approaches to governing. The chapter also examines how policy style may have exacerbated local actors’ initial response to the novel coronavirus in 2019. The chapter concludes by discussing how the policy-style framework could be applied to subnational analysis beyond China and the broader implications of the argument.

Since 1949, the Chinese party-state’s approach to health policy has fluctuated with the vicissitudes of politics, oscillating between neglect and an instrumental use of healthcare to promote state legitimacy. This chapter examines health policy in China from 1949 until the 2000s, with a focus on rural areas. During the Maoist period, two factors hindered the erstwhile Ministry of Health in improving health services: budget constraints and political oscillations that prioritized ideology over expertise. In 1978, Deng Xiaoping initiated market reforms and subordinated healthcare and social policy to economic growth. In the early 2000s, due to pressure from society, shifts in governance style, and encouragement from at home and abroad, the Chinese government initiated a dialogue on healthcare reform that culminated in the 2009 plan to overhaul the health system. But because local government was still primarily responsible for funding health policy and faced budget constraints, legacies of health policy in the second half of the twentieth century continued to impact healthcare in the 2000s.

Local government in China is largely responsible for funding social policy and has significant control over the specifics of program design and implementation. Therefore, the same policy can look quite different across provinces and even across counties within the same province. What accounts for local variation in social policy provision? This chapter provides a framework of provincial policy styles and demonstrates how these distinct ways of governing help explain variation in social policy implementation. First, the chapter presents an index of policy styles to classify Chinese provinces based on their dominant policy style: pragmatist, paternalist, or mixed. Then, the chapter examines how provinces diverge in their social policy priorities using provincial social policy spending to measure social policy priorities. The analysis finds that pragmatist provinces are more likely to prioritize education and healthcare, while paternalist provinces are more likely to prioritize poverty alleviation and housing.

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.

This chapter focuses on the guiding case system, which is distinctive and cannot be simply explained by current case law theories. More specifically, it first explores the distinctiveness of the guiding case system in the specific context of China, as opposed to other types of case law in liberal democracies, then goes on to explain why the Supreme People’s Court (SPC) has been able to expand its judicial lawmaking authority in the sense of being able to interpret the law through guiding cases. Furthermore, it illustrates that the Main Points of Adjudication (caipan yaodian), as a part of a guiding case, has essentially become a form of statutory interpretation that enables the SPC to independently perform a legislative function to a certain extent without routine surveillance by the Standing Committee of the National People’s Congress (NPCSC). This stands in contrast to the previous practice, where the SPC performed the legislative function merely through having it delegated by the NPCSC. It is further suggested that, under China’s authoritarian regime, the effectiveness of the SPC’s lawmaking function through the guiding case system depends largely on the extent to which the courts could be independent in the context of China.