A presentation by Zhenzhong ZHANG and Yunping WANG of the China National Health Development Research Center. This was given at a Future Health Systems Consortium organised event at the Global Symposium on Health System Research.

1. 1
Zhenzhong ZHANG, Yunping WANG
China National Health Development Research Center
Implementing Rapid Medical Security reform in
China: Importance of a Learning Approach

2. Outlines
 What are NCMS and MFA?
 Scaling up of rural Medical Security system
 Strategies for management of scaling up
2

3. What are NCMS and MFA?
Rural New Cooperative
Medical Scheme (NCMS)
Medical Financial Assistance
Scheme (MFA)
Objectives To relieve the finacial burden of
disease, improve the health
status
To relieve disease-induced poverty
and improve access to health
service
Target
population
Overall rural population the Five Guarantee Households,
poor households
Financing individual contributions,
subsidies from the collectives
and government
government , donation from social
sectors
Benefit
package
catastrophic health expense
(inpatient expenditure) +
outpatient expenditure
catastrophic health expenses
(inpatient/outpatient expenditure)
Responsible
ministry
Ministry of Health Ministry of Civil Affairs
3

4. What are NCMS and MFA?
4
New Cooperative
Medical Scheme
Demand side:
rural residents
Supplier: health
facilities
Government
Fiscal inputFiscal input
Medical Financial
Scheme
Fiscal input for NCMS premiumFiscal input for NCMS premium
Services PurchaseServices Purchase
Premium
contribution
Premium
contribution
Reimburse-
ment for HE
Reimburse-
ment for HE
Fiscal inputFiscal input
Fiscal inputFiscal input
paymentpayment

5. 2003- 2009年全国新 合参合人数 化农 变
0. 8 0. 8
1. 8
4. 1
7. 3
8. 1 8. 3
0
1
2
3
4
5
6
7
8
9
2003年 2004年 2005年 2006年 2007年 2008年 2009年
Populaton (100 mil.)
Scaling up of NCMS
数据来源：根据卫生部农村卫生管理司、卫生部新型农村合作医疗研究中心 2004-2009 年统计数据整
理
Start PilotingStart Piloting
Extend pilotingExtend piloting
Universal
coverage
Universal
coverage
Population covered by NCMS from 2005-2009
94%
Launched in
Jul. 2003

6. 10
10
10
10
20
20
20
40
40
30
60
60
0
50
100
150
2003-
2005
2006-
2007
2008-
2009
2010-
2003- 2009年新农合人均筹资标准
农民缴纳 地方财政 中央财政
yuan
Scaling up of NCMS
Finance of NCMS per capita (2003-2009)
Individual Local gov. Central gov.

7. Real reimbursement rate of inpatients in 2008
Scaling up of NCMS
average
east
middle
west

8. Reflections on management of scaling up
8
（ 1 ） From government side ： changes in values/paradigms
 Recognition and highlight the health issues
 From means of convoying economy reform to one of the ultimate
goals of socio-economic development
 Government dominate, considering affordablity of socio-economic
development, seek consistent development in scale and speed

9. 1998
Basic Medical
Insurance for urban
employees has been
establihed
2002
NCMS and MA
proposed
2007
Urban residents medical
insurance system has been
established
GDP
Reflections on management of scaling up

10. 10
（ 2 ） Strategies employed in institutional change: learning by doing
 Health insurance reform: not realize in one leap over one night
 Programme foundations:
• simulation experiments in 10 counties by China Network for
Training and Research on Health Economics and Financing
from 1997-2002;
• experiment tracking studies of Health programme sinceⅧ
1998.
 “Pilot comes first” and then spread incrementally to avoid
massive cost of the reform.
Reflections on management of scaling up

11. 11
（ 3 ） Bridging the gap between research and policy
 All-around engagement of experts in the knowledge translation
process
• Experts panel for central + provincial government
• Contracted responsibilities for experts:
− policy design,
− consultation in mplementation,
− M&E and etc.
• Enhance policy makers’ capacities: problem identification,
prioritizing, taking actions with acquired resources
Reflections on management of scaling up

12. 12
（ 4 ） Management structure
 Decentralized + Relatively centralized
 Cross-ministries cooperation
Reflections on management of scaling up

13. 13
（ 5 ） Care for the engagement and voices of rural residents:
 No longer the passive policy accepters under typical
top-down model
 Pay attentions to their need and interest
 Promote better understandings of policies:
• Leaflets, bulletin, public media
• Nearby stories with positive incentives
Reflections on management of scaling up

14. [Country Name] 14
Thank you ！