Health insurance coverage rates in 9 provinces in China doubled from 1997 to 2006, with a dramatic rural upswing.

We examined the distribution of health insurance in China during 1997-2006, a period when government interventions were implemented to improve access to health care. We analyzed data from a survey that follows households in nine provinces that are home to more than 40 percent of China's population. The analysis shows that the percentage of individuals with insurance increased from 24 percent in 1997 to 28 percent in 2004 and then rose dramatically, to 49 percent in 2006. Rural and urban levels of insurance coverage became more similar, reflecting a dramatic upswing in coverage in rural areas that is likely to have benefited millions of rural Chinese. At the same time, the analysis suggests that health insurance reimbursement rates to consumers for inpatient care might have declined in rural villages. Because reimbursement and other insurance characteristics affect health care use, future efforts to reduce rural-urban disparities should address the quality of health insurance and the level of reimbursement in addition to coverage rates.