Objective  To examine the fund operation of the New Rural Cooperative Medical Scheme (NRCMS) in central region of China and evaluate the policy effect of the NRCMS and to provide references for the improvement of medical insurance policy in China.

  Methods  We selected 61 counties in six provinces of Central China for the study during May 2017 and extracted relevant data of the counties from NRCMS Management System. SPSS statistical software was used to analyze the data.

  Results  For the counties surveyed, the participation rate and the number of participants of NRCMS increased in the pre-policy period till 2009 and remained stable thereafter. The inpatient medical services of the NRCMS were mainly supported by medical institutions at township level and the flow of NRCMS fund was mainly to medical institutions at county level and those above the county level, with a fund outflow of more than 40% of the NRCMS fund to medical institutions outside the surveyed counties during the period between 2011 and 2014. The average annual growth rate for average expense of per hospitalization was 9.15%; the average expense of per hospitalization and its annual growth rate were the highest for inpatients medical service supported by medical institutions outside the counties surveyed. The actual reimbursement ratio of hospitalization showed an upward trend of fluctuation in general, with an actual reimbursement ratio of about 55% after 2012. The annual balance of the NRCMS fund fluctuated greatly among years, with negative fund balance rates in some of the counties in the latter period of NCMS and the fund accumulated balance rate of the NRCMS fund was high.

  Conclusion  The participation rate of NRCMS is high and the operation of NRCMS alleviates the burden of medication among peasants in central regions of China. However, there are still some problems such as imperfect funding mechanism, lack of mechanism for medical expenses control, fund flow regulation and the fund operational safety for NRCMS fund operation in the regions.