Since the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, health care in China has become a leading national concern. Often highlighted by the popular phrase, kan-bing-nan, kan-bing-gui (seeking care is difficult and expensive), healthcare costs can be devastating. Prior to 2007, there were two formal insurance programs: the Urban Employee Basic Medical Insurance (UEBMI) for the urban employed population, and the New Rural Cooperative Medical Insurance (NRCMI) for rural residents. A third major group-urban resident without formal employment-was essentially left out of the state health security system. In July 2007, the State Council initiated a pilot experiment in 79 cities-the Urban Resident Basic Medical Insurance (URBMI). The plan targeted urban residents without formal employment, especially the elderly and children (State Council 2007). The present health policy note provides an updated review of healthcare settings and policy reforms, focusing primarily on urban health financing. It discusses urban insurance in the context of universal coverage and how to harmonize insurance schemes across urban and rural areas. This discussion is placed in the context of global experience and emerging principles of best practices.