Table 4 Assessing health system governance underpinning CMS and NCMS

Policy guidance and vision

Long term health plans/development goals/strategies;

Role of this health policy in overall country development;

Policy initiated from populations’ problems;

Technical plans or strategies for this policy;

Goals and priorities clearly defined in the policy strategies;

Policy strategies and designs define the roles of different actors;

There was clear health sector development strategy, but no formal long-term health sector development plan;

Establishment of the importance position for CMS in national rule on collective economy development;

Initiated from local practices and needs of rural residents;

Several official documents were issued by central government to direct local governments to design and implement CMS;

Economic and production development was the final aims and this policy was regarded as the important contributor to health and economic development;

The policy design guidance documents included the roles of different actors but the contents were not detailed;

A clear vision for health system development was illustrated. But no formal long-term health sector development plan;

The development of a health insurance system in rural China was added to the five-year national development plan;

Initiated by government but based on social problems;

Official documents provided technical plans and guidance for this policy design and implementation;

Improving health status and reducing financial burden are the explicitly defined as the goals of this policy;

The policy design guidance documents defined the roles of different actors in detail;

System design

Specific health policy is related to overall health or national development plan;

Health system structure responds to what needs to happen in this policy;

Duplication and fragmentation are avoided and reduced?

Related to national health development strategy;

Applying existing health system resources and fit into existing structure;

Making use of existing agricultural production cooperatives to manage their CMS funds;

Related to national vision for health system development;

Forming an organizational structure to support the NCMS fund management and policy operation;

New administration department was built inside the health administration department;

Regulation and management capacity

Appropriate system or measures to ensure the policy to be operationalized (e.g. regulation, contract, legal or incentives);

System or measures to ensure the different levels of government accountable to the policy aims;

System or measures to ensure the management capacity of different levels of governments;

Issuing regulations and rules to implement by top-down way;

Top-down way: Supervision by and reporting to higher authority;

Training and learning management experience from typical areas;

Issuing regulations and rules to implement by top-down way;

Top-down way and incentives for local government;

Training for local government officers and NCMS managers;

Accountable and transparent

System or measures to ensure different levels of governments to adopt policies based on the needs of local residents?

The performance of health authorities or health providers is transparent to the public;

The finance situation of health authorities or health providers or health insurance fund is transparent to the public;

It was encouraged that the local authorities adopted the CMS design based on local situation;

No documents provided relevant information on this specific criteria;

In some areas, there were relevant requirement on transparency, but some information implicitly reflected the transparency was not implemented well;

The central government only imposed a basic requirement on policy content, and local governments have rights to design each specific NCMS contents;

No documents provided relevant information on this specific criteria;

The transparency on the NCMS fund income, expenditures, and reimbursement situation was compulsory;

Intelligence and oversight

Evidence basis is available for policy design and contents;

Monitoring and evaluation systems are in place and contribute to policy;

No evidences support at the beginning, but the expansion of policy was based on evidences from typical areas, for which decision makers conducted field investigation;

No documents show there was any monitoring on policy implementation;

Academic researches provided evidences for policy planning and design;

Pilot and evaluation were required before the scale up of policy to over the country, regular monitoring from superior government and regular reporting NCMS operation situation, and large amount of researches and evaluations on NCMS happened together with the development of NCMS;

Collaboration and coalition building

Different government departments work together on design and implementation of policy;

Different social actors outside government contribute to the design and implementation of policy;

No documents show how different government departments were collaborated in CMS;

No documents show how actors outside government were mobilized and collaborated in CMS;

Different government departments were involved of process of NCMS initiation and design;

Academic research institutions took important roles in the process of NCMS design and implementation;