The competency of the Chinese health bureaucracy has long been questioned in light of past healthcare reform failures. This article, however, by analysing the case of the Fujian Provincial Health Bureau and a policy intervention led by it aimed at curbing rampant cost inflation, demonstrates that with a conducive political environment and firm policy determination, it is possible to achieve effective cost containment without touching fundamental economic levers. The health bureaucracy is not inherently incapable. It still possesses essential authority and policy instruments to exercise strong stewardship. The reassertion of its legitimacy, reinforcement of government stewardship, restoration of the collapsed accountability mechanisms and realignment of government tools epitomise the experiences of Fujian's healthcare reforms.