Abstract
In 2002, the Chinese leadership announced a change in national welfare policy: Voluntary medical schemes at county level, called the "New Rural Co-operative Medical System" should cover all counties by 2010. This article addresses the main characteristics of this system, analyses the introduction of local schemes based on our own field studies in one Kazak county of the Xinjiang Uyghur Autonomous Region since 2006, and argues that the fast progressing of the local scheme and the flexibility shown by local administrators in considering structural and procedural adjustments are not the result of central directives but of local initiatives. Recentralization from the township governments to functional departments in the provincial and the central state administration is only one aspect of current rural governance. Complementary forms of locally embedded responsiveness to the needs of health care recipients are crucial in restructuring the administration and discharge of health care. These new modes of governance are different from the hierarchical control and institutionalized representation of interests of the local population.
Highlights
In 2002, the Chinese leadership announced a change in national welfare policy: Voluntary medical schemes at county level, called the “New Rural Co-operative Medical System” should cover all counties by 2010
After years of waiting for local initiatives to find a solution for rural health care, the central government has come to realize that it needs to compromise with rural society in a way which recognizes that state intervention is not identical with state dominance and allows for local initiatives
The approach of responsive implementation when introducing NRCMS at the local level could be interpreted as another mode of governance in rural areas
Summary
Rural areas have seen excessive and extreme forms of governance, including interference by political campaigns or a total retreat of state action after privatization. Our field studies in Xinyuan show that sceptical households are not forced to join by systemic coercion In this form of governance the different levels of state administration play a vital role even if they do not directly interfere in the way NRCMS is run at the local level. Hospitals and physicians may find that possible financial losses as a result of NRCMS limits on medical services and drugs will only partly be compensated by an increased overall demand Pastoralists only confirmed their sustained interest provided the access procedures to health facilities and reimbursement were eased, and the reimbursement ratios for both in- and out-patient services further improved. Additional funding is needed to establish higher reimbursement levels and bring about the desired outcome, that is, the improvement of the economic and social status of the rural poor and the abolishment of the medical poverty trap
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