Previous research has credited China's top leaders, Hu Jintao and Wen Jiabao, with the social policies of their decade in power, arguing that they promoted these policies either for factional reasons or to achieve rational, problem-solving goals. But such arguments ignore the dominant “fragmented authoritarian” model of policymaking in China that centres on bargaining among bureaucratic agencies. This article asks whether top leadership factions, rational problem solving, or “fragmented authoritarianism” can explain the adoption of one of the Hu and Wen administration's flagship policies, New Rural Cooperative Medical Schemes. Based on a careful tracing of this policy's evolution, it finds little evidence for these explanations, and instead uncovers the role played by international events and organizations, and ideas they introduced or sustained within policy networks. The article highlights some of the effects that China's international engagement has had on policymaking and the need to go beyond explanations of the policy process that focus solely on domestic actors. It proposes a new model of policymaking, “network authoritarianism,” that centres on policy networks spanning the domestic–international, state–non-state, and central–local divides, and which takes account of the influence of ideas circulating within these networks.