Table 1 Transition and adaption of NCMS
Time period | Events | Notes |
|---|---|---|
1950s to 1978 | The origin and development of the Cooperative Medical Scheme (CMS) | CMS: System History |
Dec. 1978 | China’s market oriented economic reform promoted a system of household responsibility | Transition Point I |
1978 to 1979 | The Ministry of Health (MoH) issued five national policies to strengthen rural health care facilities and organizations in staff compensation, training, management, investment, and subsidies to health facilities | Adaption Process I |
1980s | The CMS collapsed rapidly due to lack of support from the collective economy in rural China and other reasons | |
The MoH issued many documents on rural healthcare workforce and their compensations, such as retirement and pension calculation, subsidies, private clinic permissions, support to barefoot doctors, service fee charges for immunization work done by the grassroots clinics and doctors, and service fee charges by sanitation and anti-epidemic stations | ||
1990s | The MoH Started to rebuild CMS, but the efforts failed for lack of consensus between different government branches and the limited investment to the rural health system | |
Oct. 2002 | A “Decision on Further Strengthening the Public Health Work in Rural Areas” was issued jointly by the Central Committee of the Communist Party of China (CPC) and the State Council in October 19, 2002. The New Cooperative Medical Scheme (NCMS) was defined as a rural cooperative medical insurance system based on a co-financing system which included volunteer contributions from individuals and financial support from central and local government | Transition Point II |
2003 to 2005 | NCMS pilots were carried out in approximately 300 counties in order to improve the design of reimbursement plans, the management of funding and services , etc. | Adaption Process II |
2006 | A large-scale interim evaluation of the scheme was carried out, which helped inform subsequent policy and promote convergence in policy design | |
2006 to 2008 | The expansion of NCMS in China. The coverage rate of NCMS increased from less than 10% in 2002 to more than 90% in 2008. At the same time, the number of registered doctors, assistant doctors, available beds, and inpatients treated has increased significantly in Township Health Centers and County Hospitals | |
2009 | The Central Committee of the CPC and the State Council jointly endorsed and issued the Guidelines on Deepening the Reform of Healthcare System after about three years of intense debate and repeated revision | Transition Point III |
2009 to present | Policies on Essential Drugs, County Hospital Reforms, Payment Reforms; Integration of NCMS with Urban Health Insurance Systems at local level | Adaption Process II |