The New Cooperative Medical Scheme (NCMS) is a heavily subsidized voluntary health insurance program established in 2003 to reduce the risk of catastrophic health spending for rural residents in China. In this review, we present the current collection of knowledge available regarding the performance of NCMS on the aspects of revenue collection, risk pooling, reimbursement rules and provider payment. The available evidence suggests that NCMS has substantially improved health care access and utilization among the participants; however, it appears to have no statistically significant effect on average household out-of-pocket health spending and catastrophic expenditure risk. As NCMS is rolled out to other counties, it must be careful to generalize the findings reported in the published papers and reports, because the early pilot counties were not randomly selected and there are a lot of local adaptations. In addition, we expect that NCMS could be an important opportunity to establish some trust-based institutions in the best interest of the participants to monitor provider quality and control cost inflation. Rigorous evaluations, based on richer and latest micro-level data, could considerably strengthen the evidence base for the performance and impact of NCMS.