Evolution, Achievements, and Challenges for New Cooperative Medical Schemes in Rural China

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.