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

During the 1960's and 1970's the Chinese government encouraged the 'rural c ooperative medical systems' (RCMS), in order to ensure access to basic heal th 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 s ystem. As a result the collective way of financing rural health care was mo re or less abandoned. However, the government of the People's Republic of C hina 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 s even provinces. The reestablishment of the RCMS would be guided by the basi c 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 r esults obtained after two years of RCMS experimental work. A general findin g is that the population structure by occupation and income varies, and tha t the RCMS has adapted itself to this variety. It is also confirmed that th e burden of health care costs on families was reduced, more so in some coun ties than in others, but this reduction has been modest. The research resul ts indicate that there is ample room for improvement. The outlook is hopefu l, however. At the national level, there is now systematic thinking about R CMS. The current RCMS work is also having a considerable influence on other counties that are keen to reestablish the RCMS. (C) 1999 Elsevier Science Ltd. All rights reserved.