CHINA RURAL SCHEMES

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Achieve a universal cover by 2010 via developing a new rural cooperative medical insurance

In order to secure a basic access to health care, by 2010, for all rural inhabitants accounting for more than 700 million, roughly about 60% of the overall population, the Chinese Government has been implementing a national plan on developing a new rural cooperative medical insurance (NRCMI) since 2003, which is supported with increasingly allocated financial and human resources.

By the end of 2005, the NRCMI has been set up by 678 counties, out of a total of 2,862, covering 179 millions rural residents, 75.8% on an average of the targeted population in these counties. The number of the insured further rose to 396 million at the end of September 2006, accounting for more than 50% of the total rural population.

Its predecessor, the rural cooperative medical insurance (RCMI), can be traced back as early as half the century ago. It used to cover as much as 90% of the total rural population, making magnificent contributions to the improvement of the health of the rural population resulting in the rise of the life expectancy at birth from 40 to 65 years over the period of 1950-1975. As the RCMI was essentially collective financed, it experienced a landslip in the 1980s and 1990s following the dissolution of the rural collectives as part of the rural economic system reform. The coverage rate consequently dropped to as low as 5%.

The Government is determined to revive the RCMI with improved and strengthened characteristics, such as (a), a strong commitment of the Government, both at the central and local levels; (b), more ambitious national strategy together with concrete policies and measures; (c), an increasing amount of state subsidies accounting for 54% of its total revenue at the end of September 2005; (3), an enhanced risk-pooling and management that is put at the county level; (4), an advanced benefit package with a focus on catastrophic-illness and inpatient-treatment. In spite of these sound beginnings, the NRCMI is still at its early age of development. So, naturally there is a continuous need for improving its design and operation.

An important fact, that has every implication for its design and operation, is that the NRCMI will have been, once the national objective has been achieved by 2010 as planned, consisted of around 2800 schemes, equal to the number of the counties the country has, that are designed and run independently by their own county managements. With a view of encouraging local initiatives and better suiting it to local context, the guidelines for the designing and management issued by the Central Government deliberately leave a considerable room for the local governments to take actions. In consequence, every scheme is, in a sense, unique, although some lines may be drawn somewhere.

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