Health system integration has been actively promoted in recent years as a promising approach to defragmentize the current delivery framework of health services and contain costs. Yet, integration often faces significant barriers from the bureaucratic sphere. Successful integration is hardly due to good technical design alone; rather, it is often explained by how the policy dimension of the reform is managed. This study embraces a policy sciences perspective to explain the micro policy dynamics of health system integration reforms in a fragmented health system. Engaging the policy entrepreneurship literature, it investigates the county medical conglomeration innovations that have flourished in China in the past few years. Two pioneer counties were selected for in-depth case studies. Qualitative methods were extensively used in data analysis. Analytical attention was specifically focused on how a small team of local policy entrepreneurs championed the reforms amidst multiple constraints. The analysis revealed the varying momentum of policy entrepreneurs and the distinctive reform pathways across the two cases. A certain degree of similarity was also observed in their use of entrepreneurial strategies to promote integration reforms. Importantly, close vertical integration combined with a bundled global budget was adopted in both cases, and this model was subsequently diffused to other localities.
