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China's New Cooperative Medical Scheme (NCMS), established in 2003, is a universal health care insurance program for rural residents aimed to improve access to basic health care services and reduce financial risks of catastrophic illnesses in the rural population. It is a cornerstone of China's most recent health care reform efforts. The purpose of this paper is to share insights and learnings from two evaluations of NCMS payment reform. The evaluations were conducted by local researchers and evaluators who were deeply involved in the design and implementation of NCMS in their own region and have gone through a process of reflection of their own work to bring learnings to the broader health systems and evaluation communities in China. [ABSTRACT FROM AUTHOR]