Development of Health Insurance Scheme for the Rural Population in China

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1 Development of Health Insurance Scheme for the Rural Population in China Meng Qingyue China Center for Health Development Studies Peking University DPO Conference, NayPyiTaw, Feb 15, 2012

2 China has experienced a rapid economic development over the past three decades. However, its health system was not developed as well as economic performance in 1980s and 1990s. Disparities of health status between regions, urban and rural areas, and population groups are huge. Many poor were not able to afford basic health care. Out-of-pocket payment was the major source of finance for health, resulting in high incidence of medical catastrophe. Public complains had increased about health systems.

3 Urban Rural Mortality per 1,000 live birth by urban/rural area (MoH, 2009) Catastrophic Expenditure Due to Out-of-Pocket Payments in China (2003) (MoH 2004)

4 Growth rate of selected indicators in two time periods (%) Indicators Per capita GDP Per capita expenditure Life expectancy Infant mortality Human Development Index Source: China CDC, Healthy China 2020 Report, 2009

5 Market-oriented policies in health financing are the leading causes for lack of social health insurance schemes and unaffordable health care User fees were introduced to public health providers including clinical and preventive care from mid 1980s. The rural health insurance scheme started in mid 1950s was collapsed from mid 1980s. The vulnerable population including the poor and rural migrants were not protected by any forms of social security systems.

6 Health systems reform aiming to improve equity in health care was initially proposed in 2002/2003 with the government new development strategy and outbreak of SARS People-centered development policy. Five coordination in development including coordination between economic and social development. Stabilizing the society and identifying new development areas. To start the new rural cooperative medical scheme (NCMS), a health insurance scheme.

7 NCMS is a scheme to protect the rural people from financial risks of diseases and to improve their health access Government-fund- and -run scheme. 80% of the fund from government subsidies and 20% from individual farmers. Fund is pooled in each of the rural counties covering half million population on average. Both inpatient and outpatient care are included in the service package in most of the NCMS schemes. Premiums and copayment from the poor are subsidized by the government (Medical Assistance Fund).

8 The political decision on development of the NCMS In 2002 the Central Committee of Communist Party of China and the State Council sponsored a national conference on rural health development in which a document Decision on further strengthening rural health development. The Decision proposed the establishment of new CMS with financial support from the central government to reduce the number of people living in poverty that is caused by serious illnesses and the payment of expensive medical care. The New CMS was launched in July 2003 in over 300 pilot counties.

9 Both government subsidies and population coverage has been rapidly increased Population coverage (%) (MoH 2011) Fund contributions (MoH 2011)

10 The impact of NCMS is positive: 90% of rural people are satisfied with the scheme, one of the mostly recognized government achievements in rural area, improved health access, and reduced financial burden of medical care (MoH 2008, 2011)

11 Summary of the Key messages 1. To advance health and protect people from financial risks are not only for health itself, but also for a nation s overall development. 2. To establish a health protection mechanism, either CBHI (community-based health insurance)-based or tax-based or mixed, for all people is a key for a universal health coverage. 3. Strong political and financial supports from the government will determine the success of any initiatives.

12 Thanks for your attentions!

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