Community-based health insurance in China: bending to the wind of change

China's Cooperative Medical System, a community-based health insurance scheme, declined markedly after the economic restructuring of rural communities and the development of a private market in the health sector during the late 1970s. However, a study of the modified system in Taichang County, where it remains popular, has revealed that insurance premiums (calculated as a percentage of household income), copayments, the inclusion of non-agricultural workers, and strong political support not only favoured the system but also increased its efficiency and effectiveness.