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of the author and do not necessarily reflect the views or policies of the
Asian Development Bank (ADB), or its Board of Governors, or the
governments they represent. ADB does not guarantee the accuracy of
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consistent with ADB official terms.

Scaling up Population Coverage in China:

The NCMS Story
Meng Qingyue
China Center for Health Development Studies
Peking University
National Health Insurance for Universal Health Coverage
27-30 September 2016, ADB, Manila

Background
Indicators
Total population (million)
Proportion of rural (%)
(number of rural population)
GDP per capita (US$)
GDP per capita at PPP (current
international $)
Annual GDP growth (%)
Public expenditure (% of GDP)

2000
1262.6

2012
1350.7

64
48
(801 million) (648 million)
949.2

6092.8

2864.1

10 944.5

7.6

7.7

15.8

13.7

Background

The NCMS
The NCMS was launched in 2003 in 300 pilot counties
(total 2000 rural counties).
Government-funded 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 scheme.
The government supports the poors premium
contributions and payment of copayment.

Population coverage of the rural health insurance

system (the phase of old CMS)

Revised from the Report of NCMS Development in China(2002-2012), MOH

Population coverage of the rural health insurance system

(the phase of New CMS)

Meng and Xu, WHO Bull, 2014

Source: Ye L, et al. GHSP,2015

Determinants of the population coverage

Incentives for
govt
Govt
commitment

Fund
collection

Population
coverage
Benefit
package

Scheme
management
Claim policy

Government commitment
Governments play a leading role in establishment
of the NCMS and provide financial and
organizational support as much as possible
Government actively took the responsibility as an
organizer, funder, manager and promoter
Top-level scheme design
Strong financial and performance incentives for
government at all levels to fulfill the responsibility
Advocating and communication in varied ways (radio,
television, brochures, blackboard newspaper, etc)
Way to collect premium (e.g.,door-to-door collection of fund)

Fund collection
Majority of the fund from the government subsidies
Government at all levels take the main financing responsibility (78%,
2014), CNY 30 (govt CNY 20, per capita premium CNY 10 ) in 2003 to
CNY 500 (govt CNY380, per capita premium CNY 120 ) in 2016
Subsidy collection: premium collection-county government subsidysubsides from provincial and central governments
Family-based premium collection

Source: National NCMS policy,2003-2014.

11

Benefit package
2003-2006, mainly covered hospitalization services,
with no or little outpatient services
2007-present, increase reimbursement for both
outpatient and inpatient services
2010-2012, increased financial protection for 20
catastrophic diseases (copayment rate less than 30%
for those diseases)
2013-present, build up urban and rural residents
catastrophic disease insurance (further reducing
OOP for patients with higher fees)
12

Claim policy
Simplified claim procedure
One-stop OOP payment when discharged from the
hospitals
Portable insurance for rural migrants in some provinces

For hospitalization
Lower deductibles in primary health care centres, higher in
high-level hospitals
Decreased deductible and co-payment
Increased ceiling of reimbursement (8 times of rural residents
annual net income per capita)

For outpatient service

Decreased deductible, co-payment and increased ceiling
13

Scheme management

Incentive for governments

Incentives for government at all levels to fulfill the
responsibilities
Financial incentive
Higher levels of governments allocate subsidies according to the
amount of funds raised by lower levels of governments
(matching fund)

Performance incentive
The implementation of NCMS financing, operation and management
was included as government performance evaluation indicators,
which could be assessed by higher levels of governments as well as
the public. The performance evaluation is critical for promotion

Determinants of the population coverage

Incentives for
govt
Govt
commitment

Fund
collection

Population
coverage
Benefit
package

Scheme
management
Claim policy

Impacts of NCMS on health care utilization

and financial burden
The share of OOP of inpatient services per
admission to annual net income per capita (%)

Source: China New Rural Cooperative Scheme development report, 2

2012

Conclusions
Rapid population coverage expansion of NCMS is a
result of political mobilization, government financial
support, family-based premium collection, incentive
for local governments, and expanded benefit package.
To sustain the universal population coverage needs
continued efforts from the government and scheme
administration.
How to improve service and cost coverage is the key
with the high population coverage
To unify the schemes of NCMS with urban residents
insurance scheme is a good opportunity

Thanks for your attentions