The China Quarterly

Research Article

Understanding Variation in the Design of China's New Co-operative Medical System

Philip H. Brown, Alan de Brauw and Yang Du


Although the New Co-operative Medical System (NCMS) was expected to operate in all rural Chinese counties by the end of 2008, county governments were given significant leeway in the design of the local programmes. As a result, fundamental characteristics of NCMS programmes vary dramatically between counties. Such heterogeneity in programme design may influence satisfaction with the NCMS in each county, and thus each programme's prospects for success. This article uses survey data collected by the authors to consider five distinct measures of success. We find that households respond favourably to making emigrants eligible for coverage and to lowering the spending threshold for reimbursement eligibility. However, households are less likely to have received reimbursement in counties that require referrals or limit treatment to approved hospitals. Finally, out-of-pocket expenditures associated with catastrophic health care may still be too high to facilitate treatment of the rural poor.

Philip H. Brown is assistant professor of economics at Colby College. He holds a PhD from the University of Michigan and an MIIM from the School for International Training. His current research emphasizes the use of primary source data collected in rural China to understand how China's rapidly changing economic environment affects the behaviour of rural households.

Alan de Brauw is a research fellow in the poverty, health, and nutrition division at the International Food Policy Research Institute. His research primarily focuses on rural labour, the effects of migration on source communities, and programme evaluation.

Yang Du is a professor at the Institute of Population and Labor Economics, Chinese Academy of Social Sciences. His research primarily focuses on the Chinese labour market, migration and poverty issues in China.