As a unique feature of China’s health care reform, the
central government required local governments not only
to share the premium subsidies, but also to take political
responsibilities for expanding coverage. The State Council’s
Health Reform Office signed “responsibility forms” –
effective political contracts – with provincial governments,
which further delegated tasks through contracts with
municipal or county governments. The contract required
that performance evaluation criteria for provincial and
local officials include specific targets, such as 90% coverage
by NRCMS or URBMI. Not achieving these targets would
lead to poor scores for the performance evaluation of local
officials, and have negative impacts on their future promotion.
With the delegated political responsibilities, local
officials took considerable time and efforts to intensify outreach
and enrollment activities.