Guangxi's rural health insurance scheme: evidence from an ethnic minority region in China.

CONTEXT: China's New Rural Cooperative Medical Scheme (NCMS) is designed to improve health-service access for rural residents and prevent impoverishment due to medical expenses. Ethnic minority regions in China have specific socioeconomic conditions and policy environments worthy of exploration to assist in the development of rural health insurance schemes. ISSUE: At the end of 2008 the NCMS's coverage had expanded to cover most of China's rural population and enrollments were high in Guangxi Zhuang Autonomous Region. Government subsidies form the majority of NCMS funds with individual contributions only a small proportion of the scheme. While NCMS reimbursements are mainly provided for inpatient expenses, the NCMS has increased the use of healthcare services although the degree of financial protection for patients is limited. LESSONS LEARNED: In Guangxi the NCMS is managed and underwritten by strong government political and financial support. This, combined with a rational reimbursement program, are crucial for the scheme's success. Publicity is essential to improve awareness of the scheme in ethnic minority regions. Shortages of appropriately skilled healthcare workers, and control of escalating medical costs are major issues that will require policy reform.