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Premium Collection and the Problem of Voluntary Enrolment in China's New Rural Cooperative Medical System

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Müller, Armin

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Abstract In late 2002, the Chinese government launched an initiative to extend the coverage of health insurance in rural China with the New Rural Cooperative Medical System (NRCMS). It covered all of rural China by 2008 and is being continuously adapted and developed. This study explores two conflicting goals in the policy design: universal coverage and voluntary enrolment. Local governments often faced the problem that only insufficient numbers of villagers were enrolling voluntarily. They developed different strategies to cope with it: Complementary outpatient reimbursement via medical savings accounts (MSAs) effectively transferred villagers’ premiums back to them, thus making the NRCMS more attractive. Adapting the premium-collection process to the local context or utilising collusive practices allowed them to pay premiums on behalf of the villagers from the insurance funds. These strategies undermine the effectiveness of the NRCMS as a risk-pooling mechanism, facilitate latent coverage gaps and turn it into a tax-funded service. (author's abstract)
Keywords China; rural area; village; social change; health care services; health policy; public health care delivery system; health insurance; policy implementation; cost recovery; costs; acceptance; insurance contribution; Far East
Classification Rural Sociology; Health Policy
Document language English
Publication Year 2016
Page/Pages p. 11-41
Journal Journal of Current Chinese Affairs, 45 (2016) 1
Issue topic Policy Implementation in the New Socialist Countryside
ISSN 1868-4874
Status Published Version; peer reviewed
Licence Creative Commons - Attribution-NoDerivs