Addressing vulnerability in an emerging economy: China's New Cooperative Medical Scheme (NCMS)

Abstract

China's New Cooperative Medical Scheme (NCMS) is the successor of the national scheme that existed through the 1970s. Developed in response to the decline in health care services following the 1978 economic reforms, NCMS was launched in the mid2000s. Coverage is now nearly universal, through voluntary enrolment. The implementation framework allows local governments to make adjustments for regional peculiarities. NCMS is seen as a response to poverty as well as health care disparities, with a focus on covering expenditure incurred due to shocks. Evaluations of the pilot phase highlighted lack of funding and low levels of reimbursement, inadequate management and poor access, which limit effectiveness particularly for the poorest. This article reviews recent studies to assess the extent to which these challenges are being overcome.

Advancing the application of systems thinking in health: managing rural China health system development in complex and dynamic contexts

“…With limited and variable capacity in county health administrations charged with implementing the NCMS, a lack of local-level data on burden of disease and health service utilization, and reliance on a huge number of implementing units, China adopted a experimentation process to allow local governments to adapt the scheme to local conditions and produce lessons that could contribute to scheme design and promote bottom-up learning in development of a central government policy [53, 54]. …”

Beyond the Debates of Which is Best: Investigating the Complementarity of Chinese and Western Aid, and Possible Lessons from China’s Development

“…Following the reforms in 1978, the Chinese government moved away from the commune system toward the HRS, reducing the financial mechanisms that supported the Cooperative Medical Scheme (Chen et al 2012;You and Kobayashi 2009). While the CMS covered more than 90 % of all rural residents before and during the 1970s, by 2003, this figure had dropped to 9.5 (Zhang et al 2010a).…”

“…The NCMS is still plagued by a number of issues such as low real reimbursement rates, inadequate management, moral hazard, and lack of financial resources (Chen et al 2012). However, the impact on poverty reduction and access to health care has been generally positive (Chen et al 2012).…”

Epidemiological Transition and Health System Reforms in China

“…NCMS packages also provide progressively lower reimbursement rates as patients enter higher level hospitals, incentivizing patients to seek care at primary health centers and township hospitals. 38 Prior to the Chinese healthcare reforms, many urban residents not working in the formal sector had no access to government health insurance. This population included children, the retired, the unemployed, and workers in the informal sector.…”