TIME-HONORED EXERCISE: Local residents practice taichi, a traditional Chinese art of shadow boxing, at a public square in Shanghai on the morning of October 3, 2012 (PAN HUAQING)

As early as 10 years ago, basic medical insurance was virtually nonexistent for China's vast rural population. Back then, farmers had to pay every cent of their medical bills out of their own pockets.

According to a nationwide survey on medical services conducted by the Ministry of Health (MOH) in 2003, 45.8 percent of Chinese farmers refused to seek treatment and 30.3 percent refused hospitalization when necessary simply due to financial difficulty. The Chinese Government announced a plan to install the New Rural Cooperative Medical Scheme in October 2002.

The word "new" in this title of the reform indicates five characteristics that distinguish it from previous schemes: mainly financed by government subsidies; family-based voluntary participation; county-based fund pooling and management; mainly supporting treatment of critical illnesses; and supplemented by a medical aid system.

So far, 80 percent of the funds for the New Rural Cooperative Medical Scheme come from government investment. Last year, the annual premium paid by farmers was 60 yuan ($9.64) per person, which was subsidized by the government at 240 yuan ($38.54) per person. For the last three years, pilot programs on the coverage of critical illnesses, such as congenital heart diseases, childhood leukemia, end-stage renal diseases, severe mental illnesses, breast cancer and cervical cancer, have been carried out in many places and are still expanding. More than 70 percent of hospitalization expenses for the treatment of these diseases are refundable, compared with 48 percent in 2008.

More than 805 million people participated in the scheme in 2012, covering more than 98 percent of the total rural population and making it the largest basic medical insurance program in the world in terms of the number of participants.

"The Chinese Government has pooled a huge amount of money to ensure that more people, especially those in the countryside, have access to medical services. This is a remarkable achievement," World Health Organization Director General Margaret Chan told China Radio International in May 2012.

China's urbanization rate reached 51.27 percent in 2011, when China's urban population surpassed its rural population for the first time. The accelerating urbanization process entails innovative research and new policies so that social changes won't affect health care provisions and the whole population can benefit from coordinated disease prevention and control efforts.

"The New Rural Cooperative Medical Scheme has become the original model for China's medical programs for people without stable employment, which has accumulated precious experience in promoting social reforms," said Jiang Zhongyi, a senior research fellow at the Research Center for Rural Economy under the Ministry of Agriculture. He said that this scheme inspired designers of other social security systems, such as urban resident medical scheme and rural pension plans, and laid a solid foundation for the building of an all-inclusive basic medical insurance system in China.

The Chinese Government in April 2009 unveiled an 850-billion-yuan ($136 billion) three-year program for health care reform. With the funds, the government promised universal access to basic health insurance, the introduction of an essential medicines system, improved community-level health care facilities, equitable access to basic public health services and pilot reforms of public hospitals.

According to a white paper on medical and health services in China issued by the Information Office of the State Council last December, the Chinese population's general health conditions have been ranked the best among developing countries. The report said that from 2002 to 2011 the country's maternal mortality rate went down from 51.3 to 26.1 per 100,000, the infant mortality rate dropped from 29.2 to 12.1 per 1,000, and the mortality rate of children under the age of 5 dropped from 34.9 to 15.6 per 1,000.

A pioneering reform

"At the beginning, I was driven more by determination and courage than confidence in pushing forward the health care reform," said Vice Premier Li Keqiang at a conference last April. At the beginning of his speech, he recalled his anxiety when presiding over the conference to kickstart the reform three years ago.

Li was entrusted with the daunting task of designing and promoting a health care reform program with the largest number of beneficiaries ever in 2008. On October 14 of the same year, a draft reform plan was publicized to solicit public opinions, which drew around 36,000 suggestions and comments from across the country within just one month.

"Health care reform is no easy task for any country, especially one with 1.3 billion people," said Minister of Health Chen Zhu.

Between 2009 and 2012, the Central Government issued 14 documents on health care reform and more than 50 supplementary documents were issued by various government departments, which have formed a policy framework. China's achievement of universal coverage of basic medical insurance has been spoken highly of by the international community.

"China's health reform process, solutions and lessons will provide evidence to inform debate and, ultimately, enhance global health care outcomes," wrote an editorial on China's health system published by renowned medical journal Lancet in March 2012.