When top-down meets bottom-up: Local adoption of social policy reform in China

Authoritarian local leaders face two driving forces in social policymaking: top-down pressure from the regime and bottom-up motivations derived from local conditions. Existing studies recognize the importance of both forces, but remain unclear as to how they interact and which of them is more influential in driving local policy adoption. Focusing on two health insurance integration policies in China, we find that when the policy entails substantial class or distributive conflicts and bureaucratic friction, top-down pressure for compliance is a dominant driver for local policy adoption; when the policy does not entail such conflicts or bureaucratic infighting, bottom-up motivations based on local economic geography together with top-down pressure drive local adoption. We find support for this argument from an analysis of an original city-level data set in China from 2004 to 2016. This study has implications for social policy reform, decentralization, and government responsiveness in authoritarian countries with multilevel governance.