China's New Cooperative Medical Scheme (NCMS) is the successor of the national scheme that existed through the 1970s. Developed in response to the decline in health care services following the 1978 economic reforms, NCMS was launched in the mid2000s. Coverage is now nearly universal, through voluntary enrolment. The implementation framework allows local governments to make adjustments for regional peculiarities. NCMS is seen as a response to poverty as well as health care disparities, with a focus on covering expenditure incurred due to shocks. Evaluations of the pilot phase highlighted lack of funding and low levels of reimbursement, inadequate management and poor access, which limit effectiveness particularly for the poorest. This article reviews recent studies to assess the extent to which these challenges are being overcome.

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