ABSTRACT
By 1999, the pro-market actors clearly emerged as the winners from the conflict concerning rural China’s health insurance system, with the MoH abandoning the CMS program after two failed policy initiatives. Only three years later, the Central Committee and the State Council enacted a new policy that ultimately realized the long-held demand of the pro-government forces-that is, extending a state-subsidized CMS program in the rural areas. The document came out only weeks before the Sixteenth Party Congress and the transition to the Hu andWen administration, which emphasized social policy and a concern for the rural areas in its political self-description. Jiang Zemin had presided over two failed CMS initiatives, and Zhu Rongji had arguably played a crucial role in those failures. By the end of their term, however, a political compromise for the pro-government solution of the MoH had been formed, and preparations for the implementation of the new CMS program-the NRCMS-were already proceeding in several provinces. The first part of this chapter will analyze the conditions under which this change of orientation occurred, and the details of the resulting policy compromise. After the 2002 decision, the evaluation of the NRCMS program began with
a pilot stage that lasted from 2003 to 2005. In the national arena, the pilot stage was characterized by the lingering tensions between the pro-government and pro-market forces. While the MoF and the MoA had been integrated into the new policy regime, the insurance industry had been left out at first. Furthermore, after the SARS crisis the MoH leadership was divided between a pro-market minister and a pro-government party secretary. During the pilot stage, the issue of voluntary enrollment became a problem again and delayed the implementation. By 2005, however, both sides reached a new compromise: the insurance industry was integrated into the NRCMS policy regime, the pro-market minister of health resigned, and the extension of the program was scheduled. Between 2006 and 2008, the NRCMS program was evaluated and exten-
ded. It covered all jurisdictions in rural China by early 2008, two years ahead of the original schedule. The evaluation focused on the early cohorts of pilot counties with above-average implementation conditions. Among other things, it recommended the toleration of minor violations of the rule of voluntary enrollment. It criticized the use of MSAs for outpatient reimbursement as
ineffective and pointed to rising health costs as a problematic development threatening to neutralize the effects of the new insurance system.
