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Chinese governments have already applied pilot innovations widely with the aim of resolving various wicked problems efficiently, effectively and legitimately. Through an in-depth study on a pilot healthcare innovation in Sanming city, we identify a three-stage mechanism underlying its upscaling: its success in one setting, its horizontal upscaling in other settings, and its political upscaling nationwide. Moreover, we identify five conditions combined that are important in explaining its political upscaling: the support of central government, the knowledge transfer mechanism, the pilot’s salience, the involvement of a boundary spanner, and consistent institutional frameworks. Furthermore, we propose a state-led pilot innovation upscaling model; this implies that Chinese central government plays a deterministic role in achieving the upscaling of pilot innovations. Our study helps to elucidate mechanisms underlying the upscaling of pilot innovations in the Chinese governance context.

State-led pilot innovation upscaling? A tale of the Sanming healthcare reform in China