Advancing the application of systems thinking in health : managing rural China health system development in complex and dynamic contexts

This paper explores the evolution of the Cooperative Medical System (CMS) and New Cooperative Medical Schemes (NCMS) as a case study of the complex process of health system development. The study identifies three major transition points associated with changes in development strategy, and demonstrates how the adaptation of large numbers of actors to these contextual changes have had a major impact on the performance of the health system. The case of NCMS provides insight into health system development in low- and middle-income countries. In China, the existence of a strong Ministry of Health has contributed to the system resilience