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The reform of the rural cooperative medical system in the People's Republic of China: interim experience in 14 pilot counties


  • Carrin, Guy
  • Ron, Aviva
  • Hui, Yang
  • Hong, Wang
  • Tuohong, Zhang
  • Licheng, Zhang
  • Shuo, Zhang
  • Yide, Ye
  • Jiaying, Chen
  • Qicheng, Jiang
  • Zhaoyang, Zhang
  • Jun, Yu
  • Xuesheng, Li


During the 1960's and 1970's the Chinese government encouraged the 'rural cooperative medical systems' (RCMS), in order to ensure access to basic health care among the rural population. There was a break in the development of the RCMS in the early 1980's, as a consequence of market economic reforms. These reforms involved a shift from a communal to a household production system. As a result the collective way of financing rural health care was more or less abandoned. However, the government of the People's Republic of China was aware of the need to provide social protection against health care expenses. In March 1994 the government initiated a project to reestablish the RCMS. This project was implemented on a pilot basis in 14 counties of seven provinces. The reestablishment of the RCMS would be guided by the basic principles of health insurance. In October 1995, a first mid-term evaluation of the RCMS Project was held. One of the major research questions concerned the extent to which the RCMS had reduced the risk of paying health care bills that would otherwise be a burden on families. This article addresses this question and assesses the results obtained after two years of RCMS experimental work. A general finding is that the population structure by occupation and income varies, and that the RCMS has adapted itself to this variety. It is also confirmed that the burden of health care costs on families was reduced, more so in some counties than in others, but this reduction has been modest. The research results indicate that there is ample room for improvement. The outlook is hopeful, however. At the national level, there is now systematic thinking about RCMS. The current RCMS work is also having a considerable influence on other counties that are keen to reestablish the RCMS.

Suggested Citation

  • Carrin, Guy & Ron, Aviva & Hui, Yang & Hong, Wang & Tuohong, Zhang & Licheng, Zhang & Shuo, Zhang & Yide, Ye & Jiaying, Chen & Qicheng, Jiang & Zhaoyang, Zhang & Jun, Yu & Xuesheng, Li, 1999. "The reform of the rural cooperative medical system in the People's Republic of China: interim experience in 14 pilot counties," Social Science & Medicine, Elsevier, vol. 48(7), pages 961-972, April.
  • Handle: RePEc:eee:socmed:v:48:y:1999:i:7:p:961-972

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    1. Cesur, Resul & Güneş, Pınar Mine & Tekin, Erdal & Ulker, Aydogan, 2017. "The value of socialized medicine: The impact of universal primary healthcare provision on mortality rates in Turkey," Journal of Public Economics, Elsevier, vol. 150(C), pages 75-93.
    2. Cuong Viet Nguyen, 2012. "The Impact Of Voluntary Health Insurance On Health Care Utilization And Out‐Of‐Pocket Payments: New Evidence For Vietnam," Health Economics, John Wiley & Sons, Ltd., vol. 21(8), pages 946-966, August.
    3. Xilong Pan & Hassan H. Dib & Minmin Zhu & Ying Zhang & Yang Fan, 2009. "Absence of appropriate hospitalization cost control for patients with medical insurance: a comparative analysis study," Health Economics, John Wiley & Sons, Ltd., vol. 18(10), pages 1146-1162, October.
    4. Liu, Hong & Gao, Song & Rizzo, John A., 2011. "The expansion of public health insurance and the demand for private health insurance in rural China," China Economic Review, Elsevier, vol. 22(1), pages 28-41, March.
    5. You, Xuedan & Kobayashi, Yasuki, 2009. "The new cooperative medical scheme in China," Health Policy, Elsevier, vol. 91(1), pages 1-9, June.
    6. Huazhang Li & Kun Liu & Jianjun Gu & Yimin Zhang & Yun Qiao & Xiaoming Sun, 2017. "The development and impact of primary health care in China from 1949 to 2015: A focused review," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(3), pages 339-350, July.
    7. Adam Wagstaff & Winnie Yip & Magnus Lindelow & William C. Hsiao, 2009. "China's health system and its reform: a review of recent studies," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 7-23, July.
    8. Wagstaff, Adam & Yu, Shengchao, 2007. "Do health sector reforms have their intended impacts?: The World Bank's Health VIII project in Gansu province, China," Journal of Health Economics, Elsevier, vol. 26(3), pages 505-535, May.
    9. Atella, Vincenzo & Brugiavini, Agar & Pace, Noemi, 2015. "The health care system reform in China: Effects on out-of-pocket expenses and saving," China Economic Review, Elsevier, vol. 34(C), pages 182-195.
    10. Wang, Hong & Zhang, Licheng & Yip, Winnie & Hsiao, William, 2006. "Adverse selection in a voluntary Rural Mutual Health Care health insurance scheme in China," Social Science & Medicine, Elsevier, vol. 63(5), pages 1236-1245, September.
    11. Adomah-Afari, Augustine & Chandler, Jim A., 2018. "The role of government and community in the scaling up and sustainability of mutual health organisations: An exploratory study in Ghana," Social Science & Medicine, Elsevier, vol. 207(C), pages 25-37.
    12. Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Abebaw, Degnet & Alemu, Getnet & Bedi, Arjun S., 2019. "The impact of Ethiopia's pilot community based health insurance scheme on healthcare utilization and cost of care," Social Science & Medicine, Elsevier, vol. 220(C), pages 112-119.
    13. Xiaohui Hou & Jing Zhang, 2017. "The effects of public health insurance expansion on private health insurance in urban China," International Journal of Health Economics and Management, Springer, vol. 17(3), pages 359-375, September.
    14. Sahoo, Amit Kumar & Madheswaran, S., 2014. "Out of pocket (OOP) financial risk protection: The role of health insurence," Working Papers 330, Institute for Social and Economic Change, Bangalore.
    15. Xiaoyun Sun & Sukhan Jackson & Gordon Carmichael & Adrian C. Sleigh, 2009. "Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province," Health Economics, John Wiley & Sons, Ltd., vol. 18(1), pages 103-119, January.
    16. Liu, Hong & Fang, Hai & Zhao, Zhong, 2013. "Urban–rural disparities of child health and nutritional status in China from 1989 to 2006," Economics & Human Biology, Elsevier, vol. 11(3), pages 294-309.
    17. Walaiporn Patcharanarumol & Anne Mills & Viroj Tangcharoensathien, 2009. "Dealing with the cost of illness: The experience of four villages in Lao PDR," Journal of International Development, John Wiley & Sons, Ltd., vol. 21(2), pages 212-230.
    18. Wagstaff, Adam & Lindelow, Magnus & Jun, Gao & Ling, Xu & Juncheng, Qian, 2009. "Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 28(1), pages 1-19, January.
    19. Cesur, Resul & Güne?, P?nar Mine & Tekin, Erdal & Ulker, Aydogan, 2015. "The Value of Socialized Medicine: The Impact of Universal Primary Healthcare Provision on Birth and Mortality Rates in Turkey," IZA Discussion Papers 9329, Institute of Labor Economics (IZA).
    20. Matthew Jowett, 2004. "Theoretical insights into the development of health insurance in low-income countries," Working Papers 188chedp, Centre for Health Economics, University of York.
    21. Devadasan, Narayanan & Ranson, Kent & Van Damme, Wim & Acharya, Akash & Criel, Bart, 2006. "The landscape of community health insurance in India: An overview based on 10 case studies," Health Policy, Elsevier, vol. 78(2-3), pages 224-234, October.
    22. Yu, Hao, 2015. "Universal health insurance coverage for 1.3 billion people: What accounts for China's success?," Health Policy, Elsevier, vol. 119(9), pages 1145-1152.
    23. Wang, H. Holly & Rosenman, Robert, 2007. "Perceived need and actual demand for health insurance among rural Chinese residents," China Economic Review, Elsevier, vol. 18(4), pages 373-388.


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