New Cooperative Medical Scheme

New Cooperative Medical Scheme
Name	New Cooperative Medical Scheme
Established	2003
Country	People's Republic of China
Type	rural health insurance program
Administered by	Ministry of Health (People's Republic of China)
Coverage	rural residents of the People's Republic of China

New Cooperative Medical Scheme is a government-initiated rural health insurance program launched in the early 21st century to expand access to medical services for rural residents in the People's Republic of China. It was implemented alongside national policy reforms and regional pilot projects to address disparities between urban and rural areas. The program linked county, township, and village levels of administration with provincial and central oversight, interacting with public hospitals, county hospitals, township health centers, and village clinics.

Background and Origins

The scheme traces roots to post-1949 health campaigns such as the Barefoot doctor movement and the later collapse of the Cooperative Medical System during the Reform and Opening-up of China. Policy debates during the 1990s involved actors like the Ministry of Health (People's Republic of China), the National People's Congress, the Chinese Communist Party leadership, and provincial governments including Guangdong, Sichuan, and Yunnan. Pilot programs drew on experiences from international models such as the German health insurance system, the Rwanda Health Sector, and the Medicaid expansion in the United States. Key events informing design included the 2003 Severe Acute Respiratory Syndrome outbreak and policymaking in sessions of the State Council (China) and the National Health Commission (China). Early advocates included scholars from Peking University, Fudan University, and Tsinghua University, as well as officials from the World Health Organization and World Bank missions.

Structure and Administration

Administration combined county-level agencies, township health centers, and village clinics, interfacing with institutions like county hospitals and provincial health bureaus. Central oversight involved the Ministry of Health (People's Republic of China), later reorganized into the National Health Commission (China), and coordination with the Ministry of Finance (People's Republic of China) and the National Development and Reform Commission. Local implementation relied on county governments, People's Liberation Army medical detachments in some regions, and health cadres trained at institutions such as the China Center for Disease Control and Prevention and Chinese Academy of Medical Sciences. Enrollment records interfaced with household registration systems administered by the Ministry of Public Security (China) and with statistical data from the National Bureau of Statistics of China.

Coverage, Benefits, and Enrollment

Benefits typically covered inpatient care in county hospitals, some outpatient services at township health centers, and basic public health interventions including maternal care and immunization linked to campaigns by the National Center for Women and Children's Health (China). Enrollment efforts coordinated with local cadres, township clinics, and village doctors, and sometimes involved partnerships with NGOs operating in Guangxi, Hunan, and Henan provinces. Populations targeted included peasants, migrant workers, and veteran families connected to institutions such as the People's Liberation Army veterans' bureaus. Comparative studies referenced systems like Japan's health insurance system, South Korea's National Health Insurance Service, and Thailand's Universal Coverage Scheme.

Financing and Sustainability

Funding combined central subsidies, provincial contributions, county budgets, and individual premiums, overseen by the Ministry of Finance (People's Republic of China), with oversight by local finance bureaus and provincial treasuries. Actuarial challenges involved demographic shifts highlighted by data from the National Bureau of Statistics of China and fiscal planning by the World Bank and Asian Development Bank. Cost containment measures intersected with reforms in public hospitals such as price controls and drug procurement reforms influenced by procurement models from the European Medicines Agency region and reforms discussed at the World Health Assembly. Sustainability debates referenced pension fund pressures similar to those faced by the Social Security Administration (United States) and health spending analyses by Organisation for Economic Co-operation and Development researchers.

Impact and Outcomes

Evaluations from research centers at Peking University Health Science Center, Harvard T.H. Chan School of Public Health, and the London School of Hygiene & Tropical Medicine reported increased utilization of inpatient services, reduced catastrophic out-of-pocket expenditures for some poor households, and mixed impacts on outpatient care. Health indicators examined included maternal mortality recorded by the National Center for Women and Children's Health (China), infant mortality tracked by the World Health Organization, and chronic disease management reviewed by the Chinese Center for Disease Control and Prevention. Regional case studies in Guangxi Zhuang Autonomous Region, Sichuan Province, and Inner Mongolia showed heterogeneity in outcomes related to local implementation and county fiscal capacity.

Criticisms and Challenges

Critiques came from academics at Renmin University of China and Zhejiang University and reports by international agencies like the World Bank and WHO, citing limited coverage of outpatient services, fee-for-service incentives in public hospitals such as county hospitals, inequities between affluent provinces like Zhejiang and poorer provinces like Gansu, and administrative fragmentation across county and township lines. Challenges included fraud and moral hazard investigated in provincial audits by offices of the Supreme People's Procuratorate and local discipline inspection commissions, and sustainability concerns amplified by aging trends reported by the National Bureau of Statistics of China.

Reforms and Legacy

Subsequent reforms integrated elements of the scheme into broader social insurance architectures, influencing the consolidation into urban and rural resident schemes and coordination with the Basic Medical Insurance for Urban Employees and municipal pilot programs in cities like Beijing and Shanghai. Legacy debates involve health system researchers at Peking University, policy advisors from the World Health Organization, and economists from the Asian Development Bank. The scheme's trajectory informed later universal health coverage efforts discussed at venues such as the World Health Assembly and in comparative policy studies from the Brookings Institution and RAND Corporation.

Category:Health care in the People's Republic of China