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Zhenzhong ZHANG, Yunping WANG China National Health Development Research Center
Implementing Rapid Medical Security reform in
China: Importance of a Learning Approach
Outlines
What are NCMS and MFA?
Scaling up of rural Medical Security system
Strategies for management of scaling up
2
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 Affairs3
What are NCMS and MFA?
4
New Cooperative Medical Scheme
Demand side: rural residents
Supplier: health facilities
Government
Fiscal input
Medical Financial Scheme
Fiscal input for NCMS premiumServices Purchase
Premium contribution
Reimburse-ment for HEFiscal input
Fiscal input
payment
2003-2009年全国新农合参合人数变化
0. 8 0. 81. 8
4. 1
7. 38. 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 Piloting
Extend pilotingUniversal coverage
Population covered by NCMS from 2005-2009
94%
Launched in Jul. 2003
101010102020
2040
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.
Real reimbursement rate of inpatients in 2008
Scaling up of NCMS
average east middle
west
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
1998Basic Medical
Insurance for urban employees has been
establihed
2002NCMS and MA
proposed
2007Urban residents medical
insurance system has been established
GDP
Reflections on management of scaling up
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 since Ⅷ1998.
“Pilot comes first” and then spread incrementally to avoid massive cost of the reform.
Reflections on management of scaling up
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（ 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
（ 4）Management structure
Decentralized + Relatively centralized
Cross-ministries cooperation
国务
院
财政部
农业部
民政部
卫生部
教育部
人事部
中医药局
食品药品监管局
扶贫办
残联
部际联席会议办公室
省(市)自治区卫生行政部门
卫生部新型农村合作医疗研究中心
省级合作医疗管理机构
地市级合作医疗管理机构
县级合作医疗管理机构
人口计生委
发展改革委
地市级卫生行政部门
县级卫生行政部门
Reflections on management of scaling up
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
[Country Name] 14
Thank you ！
