ELSEVIER Health Policy 32 (1995) 181-191

Reform of the Chinese health care financing

system

Gu Xing-Yuan a, Tang Sheng-Lanb

Depatient of Health Policy and Management, School of Public Health,
Shanghai Medical University Shanghai, China
bDeparment of Health Statistics and Social Medicine, School of Public Health,
Shanghai Medical Universiry Shanghai, China

Revision received 20 January 1995; accepted 24 January 1995

Abstract

The radical changes which have been taken place in the Chinese economy since the late
1970s have influenced the health sector and the health care financing system. A rapid
increase in medical care costs in the last decade has placed a heavy financial burden on the
government and enterprises and a vast majority of the rural population. The public service
medical scheme for government employees and labor insurance for enterprise workers are
facing a great challenge of cost containment through a series of reforms in the mechanisms
of fund collection and management. In the meanwhile, the collapse of the cooperative
medical care scheme in most rural areas has raised the issue of gaining access to basic
health care for the rural population and in particular the poor. This paper provides a
description, with some explanation, of how and why the health care financing system had
been changed and experienced such a sharp increase in expenditure. In conclusion, how to
develop and improve a financing system appropriate to the level of socio-economic develop-
ment in China is addressed.

Key words: Health care financing system; Socio-economic reform; China

*Corresponding author.

0168%8510/95/$09.50 0 1995 Elsevier Science Ireland Ltd. AII rights reserved.

SSDZ 0168-8510(95)00735-B
182 X.-Y Gu, S.L. Tang /Health Policy 32 (1995) 181-191

1. Introduction

The health care financing system mainly refers to the economic mechanism for
the collection, distribution and use of health resources. Health care is one of the
basic needs, and as such, the Constitution of the Peoples Republic of China
indicates that every person has a right to have access to health care. However,
provision of health services for everyone depends on their availability as well as on
the effective organization of health services. Organizational aspects of health
service provision include adjusting the relation between provision and demand, and
balancing the interests of consumers, providers, government, employers, and insti-
tutions in China.
Since 1978, socio-economic reforms in China have been implemented; in rural
areas the unit of responsibility changed from the agricultural collective to the
household. To facilitate the transition from a centrally-planned to a socialist
market economy, elements of competition have been introduced to Chinese
enterprises and institutions. The government administrative and financial systems
are also changing. The centralized administration is evolving into a system in which
local governments play a more important role. The system of financial responsibil-
ity, that was established in the 198Os, states that parts of government revenue
generated at the provincial, municipal and county levels should be managed by
those levels, with a fixed amount of revenue transferred to the central-level
government based on established contracts. These reforms promote socio-eco-
nomic development, and as such, have a significant impact on health care and
health care financing,
Three types of health care financing schemes exist in China. These are the labor
insurance medical care scheme, the public service medical care scheme, and the
cooperative medical care scheme. In addition, those not covered by the above
schemes have to pay out of pocket for medical care they seek on a basis of a
fee-for-service. The first two schemes were part of the social security system
established by the government, and the last relied on agricultural collectives. These
three schemes should be improved to meet the goals of the socio-economic
reforms.
The purpose of this article is to review and analyze the Chinese health care
financing systems and the recent socio-economic reforms in terms of their impact
on health care. More recent and specific health care financing reforms will also be
discussed. Having considered historical factors and the great differences in socio-
economic development between rural and urban areas in China, the financing of
health care in the two areas, in turn, is addressed.

2. Chinese health care financing systems

2.1. Population coverage pre-1980

Before 1980 the three main types of health care financing systems in China
covered the vast majority of the population. By the end of the 197Os, the labor
insurance scheme covered all employees in state-owned enterprises and most
workers in collective-owned enterprises; the public service medical care scheme
 X.-Y Gu, S.L. Tang /Health Policy 32 (1995) 181-191 183

was responsible for the payment of medical care expenditure of government

employees; the cooperative medical scheme in rural areas covered about 90% of
the population [l]. Each system served a separate population, and was financed and
managed in a different way. The current levels of population coverage and
characteristics of each system are summarized in Table 1.

2.2. Labor insurance medical care

In 1951, the State Council issued a regulation entitled The Regulation on Labor
Insurance of the Peoples Republic of China. This stipulated that all enterprises
with more than one hundred employees should institute labor insurance. This
meant that health expenses of workers and staff should be paid by their enter-
prises, with employees dependents entitled to a 50% reimbursement of their
medical care costs as well. Later, labor insurance was implemented in collective-
owned enterprises in China in addition to state-owned enterprises [2,3].
In general, expenses incurred by enterprises due to the labor insurance medical
care scheme are managed and paid for by the individual enterprise. Five and a half
percent of the enterprises total wages was budgeted toward health care costs. This
was defined as being a part of production costs. Several years ago the government
issued new regulations saying that each enterprise can allocate an amount of
money equivalent to 11% of employees wages, as a public welfare fund, to cover
expenditures of medical care, and other welfare for employees. These expendi-
tures, however, have increased to 15% since 1980, owing to a rapid increase of

Table 1
Chinese health financing systems, 1990

Feature Scheme Labor Insurance Public Service Cooperative

Medical Care Medical Care Medical Care

Eligible population Employees of Government and Peasants and their

enterprises, institutional families
dependents employees

Coverage of Chinese
population (%) 17.8 2.4 7.0

Medical care providers Appointed hospitals, Appointed hospitals, Township health

enterprise clinics institutional centres, rural doctors
clinics

Cost per capita (1990 RMB) 190 201 15

Financed by Enterprise welfare Government budget Collective welfare fund

fund and individual contribution

Managed by Enterprises Local health Management comittee

authorities and
institutions
184 X-Y Gu, XL. Tang /Health Policy 32 (1995) 181-191

medical care costs in particular [4]. This implied that most enterprises had to use
their profits to pay the excess. At the national level, total expenditure due to the
labor insurance medical care scheme was 5.3 billion yuan in 1980 and 22.2 billion
yuan (13.3 billion yuan in 1980 prices) in 1990. This indicates an annual growth rate
of 9.6% for total medical expenditure and 9.2% for medical expenditure per capita
during the 1980s.
The population coverage of labor insurance has increased gradually with
economic development during the 1980s. The total number of employees covered
was 117.79 million in 1980, and 203.16 million in 19901. This percentage is the
equivalent of 17.9% of the total Chinese population, of which state employees
accounted for 47%, collective employees 20% and dependents of employees
accounted for 33%.

2.3. Public service medical care

According to the Regulation of Public Service Medical Scheme issued by the
Government in 1952, all government staff, including those who have retired, as well
as students in colleges and universities are entitled to free medical care. In
addition, it should be mentioned that in the mid-1980s some provincial and
municipal governments decided that their employees can usually have 50% of their
dependents medical care expenses reimbursed from the employees welfare funds,
but not the funds earmarked for the medical scheme. Expenses are covered by
government funds, and the management of the scheme can be done in three
different ways detailed below.
Expenditure due to the public service medical scheme is paid out of the
government budget, specifically, from funds appropriated to the health sector from
the Ministry of Finance. Until 1980, the budgeted expenditure per person was 24
yuan. In 1984 it rose to 36 yuan per person. Since 1984, the determination of the
health care budget per person has been left to local government based on local
budgets and the previous use rates of medical care services. The total expenditure
of the public service medical care scheme was 670 million yuan in 1980. The figure
rose to 5420 million in 1990 (3236 million in 1980 prices), of which 4420 million
came from the government budgets, 600 million was contributed by individual
institutes and 400 million was owed in hospitals. The average annual growth rate
was 11% during the 1980s.
Management of the public service medical scheme can be done by the local
(county or municipal) health authority, by state- owned institutions, or by the
appointed hospital. The public service medical care scheme covered 15.98 million
people in 1980, and 26.84 million in 1990. This accounts for 2.4% of the total
Chinese population [5].

The exchange rates of yuan to U.S. dollars in the years 1980 and 1990 were as follows: 1980, period
average .4984; 1990, period average $4.7832 (Source: International Financial Statistics Year Book, 1994,
International Monetary Fund).
 X.-Y Gu. S.L. Tang /Health Policy 32 (1995) 181-l 91 185

2.4. Evaluation of labor insurance and public service medical schemes

During the past 40 years, the labor insurance and public service medical schemes
have played an important role in the health care of the covered population, and in
the promotion of Chinese socio-economic development. These systems, however,
cannot match the pace of the socio-economic changes which have taken place since
the 1980s. The critical issues are the rapid increase in health care expenditure and
the limited resources of the medical care system.
Several studies have shown that medical care utilization was higher, average
length of stay was longer, and medical costs per visit or admission were higher in
the population covered by the labor insurance and the public service medical
scheme, as compared with those who pay for medical care out of pocket [6].
Generally speaking, people covered by the labor insurance and the public service
medical care schemes are more likely to overuse the services than the rural
population without any insurance schemes.
The growth rate for health care expenditure exceeds the growth rate of both
gross national product and government revenue. During the 1980s the average
annual per capita rate of growth for health expenditure was 9.2% for labor
insurance and 11.1% for the public service medical scheme. The annual rate of
growth for the GNP per capita was 7.6% and government revenue rose 4.6%
annually during the same period (Table 2). The increasing health expenditure has
become a heavy economic burden for both enterprises and government.
While part of the increase in health expenditure could be due to the increasing
number of people covered by the labor and public service schemes, the aging of the
population and change in disease patterns, other reasons for the increased health
care expenditure may be the result of the medical care financing system itself.
Medical care services are free for employees covered by the labor insurance and
the public service medical care schemes. In the meantime, the medical care

Table 2
Medical expenditure and coverage of insurance schemes, 1980-1990

1980 1990 Annual growth

(o/o)

Labour insurance coverage (million) 117.79 203.16

Expenditure/capita (RMB) 47 190 (113) 15.0 (9.2)
Public service coverage (million) 15.98 26.84
Expenditure/capita (RMB) 42 201(120) 16.9 (11.1)
Cooperative medical care coverage (% of peasants) 69 7
Expenditure/capita (RMBI 1.5 21.3 (12.7) 30.4 (23.8)
GNP/capita (RMB) 453 1,567 (935) 13.3 (7.6)
Income/capita (RMB) 374 1,267 (756) 13.0 (7.3)
Government income/capita (RMB) 110 290 (173) 10.2 (4.60)
Total health expenditure per capita (RMB) 13.4 58.1 (34.7) 15.6 (10.0)

Source: The State Statistical Bureau and The Ministry of Public Health. Note: Figures in brackets are
1980 prices.
186 X.-Y. Gu, S.L. Tang /Health Policy 32 (1995) 181-191

expenses paid by the government and the enterprises are the main sources of
income for service providers. As a result, neither medical care providers, nor
consumers have any incentive to control medical care expenditure under these
insurance schemes. This is the real reason why utilization was higher, average
length of stay longer, and medical costs per visit and admission higher than those
of patients who pay out of pocket for medical care.
Another disadvantage of the labor insurance and public service medical care
scheme is, to some extent, their limited ability to spread risk. Since the manage-
ment of these schemes is largely at the enterprise or government institution level,
each enterprise or institution has a limited ability to bear great financial risks, such
as hospital payment for a cancer patient, for example. Under the market economic
system, the fiscal status of enterprises and institutions varies a great deal. Some are
financially unable to provide complete medical care for their employees. For
instance, they cannot pay an expensive medical bill for an employee with cancer,
heart disease, or renal failure. Therefore, people working at certain enterprises and
institutions are not guaranteed access to the medical care they may require.
However, there is overuse of medical care by the employees of enterprises and
institutions that can pay all their medical bills.

2.5. The cooperative medical scheme

Before the foundation of the Peoples Republic of China, all Chinese peasants
paid out of pocket for the medical services they received. Traditional and Western
medical doctors in rural areas were private practitioners. The cooperative medical
scheme appeared as a result of agricultural collectivization that began in the mid
1950s. The agricultural collectives evolved into the Peoples Commune System in
the late 1950s. They provided a part of the public welfare fund to establish a health
station (cooperative medical care clinic) at the production brigade (now village)
level. One or two health workers (so-called barefoot doctors, now called rural
doctors) who were responsible for provision of primary health care for peasants at
low cost were paid by the collectives based on the workpoints they earned. This
system also received financial contribution from peasants through a prepayment
mechanism and the peasants could obtain a reimbursement for a fixed percentage
of medical care expenses. In the early 1960s the government recognized that the
cooperative medical scheme could promote the health status of the rural Chinese
population through provision of basic health services, and that it should be
extended to the whole country. By the mid 1970s the cooperative medical scheme
had been implemented in about 90% of Chinese villages, and became the primary
means of financing rural health services.
The socio-economic base of the cooperative medical scheme was initially the
agricultural collective. When this was transformed into the household responsibility
system at the end of 1970s most of the cooperative medical schemes collapsed.
The collapse of the cooperative medical care scheme has been attributed to a
combination of financial, political and managerial problems [7]. The radical reform
of the rural socio-economic system at the end of 1970s and early 1980s resulted in
the shrinking of financial support from agricultural collectives. Meanwhile, the
political support to the schemes at various levels, especially at township and village
 X-Y Gu. S.L. Tang /Health Policy 32 (1995) IN-191 187

levels, had been weakened. In addition, there were problems in management of the
scheme. For instance, no clear guidelines were produced for the design and
management of the scheme. Many schemes were introduced without advice from
experts in health planning and financial management.
The percentage of villages covered by the scheme fell to 69% in 1980, and then
fell further to around 5% in 1985. However, some of the cooperative medical
schemes have still survived in the counties, townships and villages mostly located in
the relatively developed regions. Some counties and townships have developed
innovative schemes covering curative or/and preventive services for local people.
Government policy is to encourage the rebuilding and improvement of the cooper-
ative medical scheme, which is an important element for the implementation of the
global health strategy of Health For All by the year 2000. Under the circumstances,
there has been a tendency toward strengthening the cooperative medical care
schemes or developing rural health insurance schemes. For example, the health
sector in Jinshang county of the Shanghai municipality has worked with the county
insurance company since the late 1980s to develop a rural health insurance scheme
through a co-payment mechanism 181. Jintan county in Jiangsu province has
strengthened the cooperative medical care scheme which is financed jointly by the
rural enterprises, the village welfare funds and peasants [9].
A series of comparative studies indicate that the cooperative medical scheme can
provide basic health care for the majority of the peasants at reasonable cost (Table
3). It plays a key role in the implementation of rural primary health care in China,
In comparison with those who pay for medical care out of pocket, peasants covered
by cooperative medical schemes use more medical care with the same costs [lo].
The difficulties of the cooperative medical care scheme are that the funds
collected from village welfare funds and local governments have been reduced, or
in some cases disappeared. Because of changes in the structure and function of
local governance, funding and risk spreading are limited to the village level. The
cooperative medical scheme must be adapted to current socio-economic situations
and local circumstances.

2.6. Fee for service health care financing

Before the 1980s health care was an important component of social welfare in

Table 3
Comparison of rural health financing systems

Self-payment Cooperative Labor Insurance, public

service

Annual out-patient visit per peasant 3.1 3.7 3.6

Unmet out-patient care (%o) 20.1 10.7 16.6
Annual admission rate (o/o) 2.7 3.7 5.4
Unmet in-patient care (%) 20.5 10.3 3.1
Annual medical costs per peasant 14.5 15.8 37.2

Source: Gu X.Y. et al., Comparative Study On Health Financing System in Rural China, in Study of
Health Financing System in Rural China, 1991, pp. 54-66.
188 X.-Y Gu, S.L. Tang/Health Policy32 (1995) 181-191

China, which was the responsibility of the government and the collectives. Most
hospitals and health facilities were state-owned or collective-owed. There were no
private practices or private hospitals in China before 1980. The main sources of
financing for health services were the government, enterprises, and agricultural
collectives. Medical fees paid by individuals accounted for a small part of national
health expenditure. Health resources were allocated directly by the Ministry of
Public Health according to the distribution of the population, and the health care
network was established based on the administrative structure. Prices of medical
services were set below their costs. Health care development expenditure and part
of the recurrent expenditure were financed by the government. In general, re-
sources for health were limited, and demand for health care was also not high. The
health care supply and demand were balanced at a lower level.
The situation has changed dramatically. Presently, 14% of urban residents and
93% of rural residents have to pay for medical care out of their pockets. While the
socio-economic reforms of the 1980s promoted economic development and led to
an increase in peoples income, medical care expenditure paid directly by patients
grew more rapidly. As indicated in Table 2 the annual rate of growth of GNP per
capita during the 1980s was 7.6%. The national per capita income also rose during
the same period at an annual rate of 7.3%. The per capita income for peasants
grew at a rate of 6.4% annually between 1980 and 1990. The growth rate for total
health expenditure was much higher, being 10.0% in 1980s (in 1980 prices).
Medical care costs paid for by peasants were 1.5 yuan per person in 1980, and 21.3
yuan (12.7 yuan in 1980 prices) in 1990, with the annual growth rate being 23.8%.
Medical care costs became a heavy burden for those not covered by the schemes,
especially peasants. The ability to pay is a strong determinant of utilization of
medical care. Financial constraints were the main reason for peasants unmet
medical care needs. A national household health survey in 1988 showed that 20%
of rural patients did not seek outpatient services. Among those in poor counties,
half of the patients not treated were not treated due to the magnitude of costs
involved. Meanwhile, 25% of the rural population that was referred to hospital by

Table 4
Economic and medical care statistics for rural China (1988)

Rich county Medium county Poor county

Income/peasant (RMB) 999 524 319

Hospital beds/1000 2.1 1.8 1.4
Annual out-patient visit per peasant 2.8 3.2 3.8
Annual admission rate (%I 4.4 2.4 2.5
Annual Bed-day/peasant 0.55 0.25 0.19
Unmet in-patient need (%I 10 17 25
Medical care costs/peasant (RMB) 18.3 11.8 15.1
Percent of medical cost in peasants income 1.83 2.26 4.73

Source: Gu X.Y. et al., Medical Care in Rural China, in Study of Health Financing System In Rural
China, 1991, pp. 7-25.
 X.-Y Gu, S.L. Tang /Health Policy 32 (I 995) 181-l 91 189

doctors were not admitted, largely because of financial difticulty (Table 4). As
Zhang reported [ll], of 60 poverty-stricken families in Yuhan county of Zhejiang
province, 47% of them stated that payment for expensive medical care for family
member(s) was the most important contributing factor in forcing them into poverty.
Hence, it is necessary to change the existing situation by expanding the coverage of
the cooperative medical scheme or developing innovative health financing schemes
in order to provide PHC for millions of Chinese peasants at a reasonable cost.

3. Reforms of Chinas health sector and health care financing systems

As a result of population growth, population aging, the change in disease

patterns, and the rise of peoples standard of living, health care demands and
utilization have increased. The current system cannot meet the needs of the
population due to the limited government resources available. Therefore, it is
urgent for China to reform its health sector and health care financing system in
order to ensure that people, particularly in rural area, can get access to basic
health services they need.
Because the government did not provide sufficient funding to cover recurrent
expenditure for health care, hospitals and other health facilities have had to
generate revenue by adjusting medical prices, prescribing more drugs (especially
those made by joint ventures that are more expensive) and using more high
technology examinations. Hence, of the hospitals income, the revenue raised
increased in proportion to the governments appropriations. This resulted in a
weakening of government direct control over hospitals.
Due to the increased medical care demands and the governments policy of
medical care modernization many new hospitals have been built, sophisticated
medical technologies and equipment have become more common, and more
imported and new drugs have been used in recent years. These have all been
factors that contributed to the rising medical care costs. In 1985, the medical care
costs for curative services account for 77% of total health expenditure while the
costs of disease prevention, maternal and child care and family planning shared
only 7%. Construction costs were 9% of total health expenditure. It is clear that
preventive health care has suffered due to the transfer of resources into high
technology areas. The rural areas in particular have been affected by the reduced
investment in preventive health care, as health workers in grassroots facilities shift
into medical care facilities where they can earn more money.
As shown in Tables 2 and 4, the disparities in economic development, health
resources and health service uses have widened between different regions (pro-
vinces and counties), and different population groups (peasants, workers, and
officers). There is overuse of medical care and wastage of health resources by
some, and at the same time, for peasants, there is no access to basic health care.
To face these challenges and cope with the problems, reforms of the Chinese
health sector are underway. As stated in The Compendium of Health Develop-
ment and Reform in China developed by the Ministry of Public Health, the
general objective is to build an appropriate health care system based on the
socio-economic development level and living standards of the people, giving access
190 X.-Y Gu. XL. Tang /Health Policy 32 (1995) 181- I91

to basic health care to everyone. The emphases have been placed on improvement
of rural health, strengthening of preventive and promotive services and develop-
ment of traditional Chinese medicine. The following measures have been taken in
order for China to achieve the goals outlined:

. To develop different ways of collecting funds from government at various levels.

collectives and individuals to increase health input. For instance. the govern
ment could establish special funds supporting rural health services and iu
particular disease prevention in poor areas.
. To modify regional health development plans through which limrtcd health
resources may be reallocated for controlling the pace of hospital developmenr
in urban areas and improving health facilities in rural areas.
. To adopt a number of effective means that can improve the medical price
system, perfect hospital economic and management mechanisms, advocate
appropriate medical technology, and develop an essential drug list for con
trolling a rapid increase of medical care costs.
. To reform and improve health care systems in rural and urban areas. and
gradually expand population coverage of health insurance schemes through
which more people can get access to basic health care.

Early in 1985, the Central Committee of the Communist Party of China suggested
that it was necessary to study and establish a new social security system that would
be compatible with the recent socio-economic reforms. Certain reforms of the
health care financing system have been conducted in the past decade.
In rural China, the rebuilding and improvement of the cooperative medical
scheme has been encouraged by the government for years. The scheme should bc
based on the level of local economic development and accepted by the vast
majority of the local population. The sources of finance for the scheme include
government subsidies, and collective and household contributions. To ensure that
the funds collected for the cooperative medical care scheme can be used in an
efficient way, the management of the scheme must be strengthened through use ot
some insurance mechanisms and monitoring of medical practice and consumer
behavior. The governments at various levels should play a leading role in develop-
ing the cooperative medical care scheme.
In urban areas, the main objective of reforming the public service medical
scheme and the labor insurance is to contain medical care costs, given that people
covered can get access to medical care when needed. To achieve the goal. several
issues have to be properly addressed in reforming the public service medical
scheme and the labor insurance. First, it is necessary for the government to
develop mechanisms of not only controlling the use of services, but also limiting
hospitals from over-providing services. Second, as shown in many studies. drug
expenditure accounts for a substantial percentage of medical cart costs. The
service providers, especially in urban areas of China, are more likely to use drugs
imported or made by joint ventures, which generate more revenue for them.
Therefore, it is very important to limit use of expensive drugs and tonics for cost
 X.-Y Gu, XL. Tang /He&h Policy 32 (1995) 181-191 191

containment. Third, the government should formulate a regulation aimed at

control of high technology purchases by hospitals. Finally, management of the
public service medical and labor insurance schemes is a critical issue influencing
effective and efficient use of already limited health resources.
Previous reforms of the public service medical scheme and the labor insurance
scheme have placed more emphasis on controlling consumers behavior by es-
tablishing co-payment mechanisms. However, it is also very important to develop
mechanisms of monitoring service providers through a case reviewing system.
In short, although we have carried out reforms and made progress in health
sector and health care financing reforms, we still face serious challenges. How to
establish an appropriate health care system based on the socialist market economy
still needs further study.

Acknowledgements

The authors would like to express their appreciation to Professor William Hsiao
of Harvard School of Public Health and some participants at the conference on
Health Sector Reform in Developing Countries: Issues for the 1990s who provided
insightful comments on an earlier draft of the paper. They would also like to thank
MS Anupa Bir for her editorial work.

References

Zhou, S.Q. and Zhang, B., Development of Health Care Financing System in Rural China, Study
of Health Care Financing System in Rural China, Shanghai Scientific & Technical Press, 1991, pp.
40-46.
121 Liu, C.Q. and Sun, K.D., Social Insurance and Employees Welfare, Labor Press, China, 1987.
131 Zhou, P., Reform of Employees Health Care Financing System, Huawen Press, China, 1993.
141 Institute of Sociology of Shanghai Academy of Social Sciences, Contemporary Social Security,
China, 1989.
151 Song, L.Z., Overview of Work-Related Insurance and its Reform in Mainland China. A Paper
Presented at the Mainland China-Taiwan Conference on Health Economics, Beijing, China,
October 1994.
b1 Gu, X.Y. et al., Financing health care in rural China: preliminary report of a nation-wide survey,
Social Science and Medicine, 3M4) (1993) 385-391.
[71 Feng, X.S. et al., Practice and perspective of rural health care financing schemes in China, Health
Economics Research, 5 (1994) 9-14.
181 Bao, J.T. et al., Rural Health Insurance Scheme in Tiing Township of Jinshan County, Study of
Health Care Financing System in Rural China, Shanghai Scientific & Technical Press, 1991, pp.
99-107.
191 Jiang, W.Z., Welfare and Welfare-Risk Types of the Cooperative Medical Care Schemes in
Jintan County, Study of Health Care Financing System in Rural China, Shanghai Scientific &
Technical Press, 1991, pp. 91-98.
1101 Gu, X.Y. et al., Utilization of health services in rural China, Health Econonomics Research, 5
(1994) 15-23.
t111 Zhang, C.M., The Cooperative Medical Care System in Yuhan County, Study of Health Care
Financing System in Rural China, Shanghai Scientific & Technical Press, 1991, pp. 83-90.