prosperity of modern China's urban elite has
always come at the expense of rural peasants,
who shared little of the gains associated with
rising productivity in manufacturing and ser
vices. As a result, the difference between rural
and urban living standards has always been
course, the collapse of the medical coopera
tives only added to the sense that rural areas
had been left behind.
Before the economic reforms, urban workers
weren't paid much, but they got a lot of ser
were subject to market pressures and had to
compete with private companies, all bets
just how hollow the health care system had be
come. And in 2005, Beijing officially acknowl
edged that the system was beyond repair.
Health care was once again declared a funda
mental responsibility of the state, and the cen
tral government embarked on the grand proj
ect of restoring universal access now for a
population of 1.3 billion.
started in 2002, with local governments again
put in charge. But this time around, local ad
ministrators knew that health care was a cen
tral government priority. In 2003, only 9.5
percent rural residents were covered by
NRCMS. Five years later, the figure had
reached 91 percent.
gradually from there, with households, local
governments and Beijing sharing the cost.
Primary Medical Insurance, the equivalent of
the NRCMS for urban residents, was re
launched in pilot programs in 2007.
While the principle of governmentsponsored
universal health care is now back in place, the
out. For example, it is unclear how insurees
will make premium payments or receive reim
bursement for outlays: China lacks the infra
structure a wellfunctioning tax system, an
electronic payment system with wide cover
age, or even a reliable postal system to make
pecially those in remote areas, has yet to be
tested. In the 1970s, when China was a wretch
edly poor nation, even minimal services went
a long way toward improving the quality of
life. Today, China faces the subtler problems
of deciding the breadth of services and level
of subsidies that should be offered to those
who can't afford to pay.
cess to health care a far more conservative
principle than say, equality of health out
comes or equality of expenditures. Even so,
hollow the health care
system had become.