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Understanding Variation in the Design of China's New Co-operative Medical System

Published online by Cambridge University Press:  22 June 2009

Philip H. Brown ,
Alan de Brauw  and
Yang Du
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Abstract

Although the New Co-operative Medical System (NCMS) was expected to operate in all rural Chinese counties by the end of 2008, county governments were given significant leeway in the design of the local programmes. As a result, fundamental characteristics of NCMS programmes vary dramatically between counties. Such heterogeneity in programme design may influence satisfaction with the NCMS in each county, and thus each programme's prospects for success. This article uses survey data collected by the authors to consider five distinct measures of success. We find that households respond favourably to making emigrants eligible for coverage and to lowering the spending threshold for reimbursement eligibility. However, households are less likely to have received reimbursement in counties that require referrals or limit treatment to approved hospitals. Finally, out-of-pocket expenditures associated with catastrophic health care may still be too high to facilitate treatment of the rural poor.

Type
Research Article
Information
The China Quarterly , Volume 198 , June 2009 , pp. 304 - 329
Copyright
Copyright © The China Quarterly 2009

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19 Prior to 2006, the matches provided by the central and local governments were generally 10 yuan per participant.

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29 For evidence on variation in reimbursement rates from a nationally representative survey, see Wagstaff et al., “Extending health insurance.” While financial considerations drive most of these decisions, the experience and training of county-level administrators varies widely, suggesting that some programmes are likely to be better designed and more sustainable than others. For example, 19% of the top health care administrators in counties covered by our survey had at least 25 years of experience in health care management, whereas 15% had three or fewer years of experience. Similarly, almost a quarter of these administrators had not attended university. Indeed, in one county visited during survey pre-testing, responsibility for determining the reimbursement schedule was subcontracted to a junior high school maths teacher.

30 Outpatient medical treatment is more often eligible for reimbursement in western and central provinces, typically at the cost of offering lower reimbursement rates for inpatient care. For evidence supporting these statements, see Wagstaff et al., “Extending health insurance,” and Wang, Gu and Dupre, “Factors associated with enrollment, satisfaction, and sustainability.”

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35 All figures in this paragraph are from Nie, “Institutional construction and development of the NCMS.”

36 The household level data collection was undertaken by provincial offices of the National Bureau of Statistics in close collaboration with the Institute for Population and Labour Economics (IPLE) at the Chinese Academy of Social Science and Nanjing Agricultural University. The county-level survey was completed directly by researchers at IPLE.

37 Statistics presented in this paragraph are from the China National Bureau of Statistics, China National Statistics Yearbook.

38 These figures are consistent with those in Yan et al., “Insuring rural China's health?”

39 Statistics in this paragraph are derived from the county-level survey.

40 Economic development projects have recently displaced rural residents in all three of these counties in Jiangsu, suggesting perhaps that some urban participants may be provided an opportunity to enrol even though they are no longer officially rural residents.

41 Low eligibility for labour migrants is consistent with the findings of Yan et al., “Insuring rural China's health?”

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44 A programme administrator in one county confided that reimbursement procedures were intentionally designed to be cumbersome so the limited budget could be stretched further.

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