Abstract
Objectives: To describe the development of NCMS in the past decade including three sections and to bring up relevant policy implications. Methods: Based on secondary data and literature review, the evolution and achievement of NCMS in the past decade and the expected future challenges were analyzed. Results: Impressive advances have been seen in establishing the largest medical insurance system, New Cooperative Medical Scheme (NCMS), covered more than 800 million farmers in rural China during the past decade. Remarkable achievements during the development of NCMS include universal health coverage among rural residents, rapid increasing premium, balanced pooling fund, improved service, cost and coverage of farmers, and a strengthened primary health care system. In the meantime, the NCMS also confronted certain challenges: Institutionalization and legalization lagged behind the development of NCMS; payment reform failed to control the rapid growth of medical expenditure and financial protection for enrollees was insufficient; solidarity and equity between NCMS and other medical insurance systems is still an issue that needs to be solved; sustainable financing mechanism was not established successfully and moreover, it was also not compatible with the aging population and epidemiological transition of rural China; double coverage for rural residents turned up as portability was not achieved.
Highlights
Impressive advances have been seen in establishing the largest medical insurance system, New Cooperative Medical Scheme (NCMS), covered more than 800 million farmers in rural China during the past decade
The NCMS confronted certain challenges: Institutionalization and legalization lagged behind the development of NCMS; payment reform failed to control the rapid growth of medical expenditure and financial protection for enrollees was insufficient; solidarity and equity between NCMS and other medical insurance systems is still an issue that needs to be solved; sustainable financing mechanism was not established successfully and it was not compatible with the aging population and epidemiological transition of rural China; double coverage for rural residents turned up as portability was not achieved
This paper aims to describe the development of NCMS in the past decade including three sections: the evolution of NCMS, the achievement of NCMS in rural China, and the challenges on NCMS development
Summary
Establishment of health financial protection for rural residents in China has experienced ups and downs since the foundation of People’s Republic of China (P.R.C.) in 1949 [1]. The CMS was primarily financed by the welfare fund of the communes (collective farming) [2] [3] It organized health stations, paid village doctors to deliver primary care, and provided prescription drugs. In 1993, risk-pooling mechanisms (the government, state enterprise insurance systems and rural community financing schemes) covered only 21% of the population [13] and only 9.81% of rural residents were covered by CMS [14]. How to build a health financing system for rural residents and make them equitable and affordable access to primary health care became one of the priorities for policymakers in China [21]. Relevant policy implications are proposed to shed some light on the developing countries with the same goal to achieve universal health coverage
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