At the end of the 1970s, China had a rural cooperative medical system (RCMS) in place in about 95 per cent of villages. This system relied upon collective financing. The economic reforms of the 1980s jeopardised the collective financing of rural health care, and hampered the access of the rural population to basic health care. In march 1994 the Chinese government initiated a project aimed at strengthening RCMS. This article gives an overview of the RCMS policy since 1950, it highlights the key features of the implementation of RCMS project in 14 countries, and it proposes adjustments for the future.