Chinese health care in rural areas

In the linked study (doi:10.1136/bmj.c5617), Babiarz and colleagues assess the impact of China’s New Rural Cooperative Medical Scheme (NCMS) on village clinic operations and patterns of clinic use. The scheme aims to provide health insurance to 800 million rural citizens and to correct distortions in rural Chinese health care.1

One defining feature of contemporary China is the pervasive divide according to urban or rural residence. This divide has permeated all aspects of Chinese society, and health care is no exception. However, in the collective era (mid-1950s to early 1980s, when rural agricultural production was organised by production teams and collective farming), glaring health disparities were kept in check by the presence of almost universal health insurance coverage. In the countryside, a cooperative medical scheme was established in the 1960s. It was a collective, community based insurance programme organised, planned, and financed by the government. Its guiding principle emphasised basic primary health care for all, preventive medicine, and health promotion. The system worked. In the heyday of the scheme’s operation (mid-1970s), it effectively reached 90% of all rural Chinese people,2 with decades of accumulated benefits substantially improving the overall health profile of China’s population.

The market based economic reforms since 1978 set in motion a roller coaster of changes in every part of Chinese society. Like the economy, the healthcare sector …