Good and Bad News from China's New Cooperative Medical Scheme

Abstract

The overall goal of this article is to understand the progress in implementing the New Cooperative Medical Scheme, while seeking to assess the strengths and weaknesses of the programme and, in particular, to understand its effects on the incidence of catastrophic medical payment. The study is based on two rounds of nationally representative household survey data collected in 2005 and 2008. The study found that the programme has a very high level of participation, and has increased farmers' use of medical services. However, despite efforts by both central and local governments and high household participation, the programme is only partially achieving its policy objectives. In particular, it has been able to extend to almost all of the rural population, but has failed to cover expenses for catastrophic illness, due to insufficient funds.

The Caring State? On Rural Welfare Governance in Post-reform Vietnam and China

“…In China, barefoot doctors were abandoned in 1981, and the public health system was in near collapse; enrolment into primary and secondary schools dropped by 14 million students and more than 40 thousand schools were closed nationwide (Gao 1999;Zhang, Yi et al 2010). In Vietnam, a similar situation was observed following the reform (Bryant 1998;Truong 2007;London 2011).…”

“…In the 1980-90s, half-hearted experiments with rural health insurance took place in response to rural discontent with the deterioration of health services (Ensor 1995;Ensor and San 1996;Zhang, Yi, and Rozelle 2010). Not until the mid-2000s did both governments start to increase health insurance coverage in rural areas (Ekman et al 2008;Zhang, Yi, and Rozelle 2010).…”

“…Not until the mid-2000s did both governments start to increase health insurance coverage in rural areas (Ekman et al 2008;Zhang, Yi, and Rozelle 2010). The move was part of a program to build a 'new socialist countryside', which aims to improve rural infrastructure, social services, and rural human quality (Ekman et al 2008;Klotzbücher, Peter Lässig, and Weigelin-Schwiedrzik 2010).…”

“…Nevertheless, there was visible improvement in primary health care and education through public measures such as immunization and a basic schooling system -mortality, public health problems and illiteracy all declined in rural areas (Bryant 1998;Gao 1999;Zhang, Yi, and Rozelle 2010;London 2011). Basic healthcare was provided through state funding of commune health centers in Vietnam while in rural China, there was a system of barefoot doctors, local people trained in basic medical skills providing treatment for farmers.…”

“…3 The Chinese New Cooperative Medical Care is co-financed by governments at central and local levels and out-of-pocket payment; public funds are only released on condition that the participants have bought their insurance. For each participant's annual payment of 25-30 yuan, the county supplements 10 yuan, and the central government provides 20 yuan; the public share amounts to more than 60 percent of the total costs (Klotzbücher, Peter Lässig, and Weigelin-Schwiedrzik 2010;Zhang, Yi, and Rozelle 2010). Reimbursement ranges between 30 and 50 percent of the treatment costs, covering only the expenses of hospitalization and people are required to pay in advance of applying for reimbursement.…”