China aims to maintain the nation's basic medical insurance coverage rate of about 95 percent over the next five years, as achieved from 2021 to 2025, while simultaneously enhancing the quality and structure of its healthcare security system.
The rate is expected to remain stable at about 95 percent over the next five-year period, according to the 15th Five-Year Plan (2026-30) for healthcare security that was published recently.
Key priorities include expanding coverage for flexible workers, advancing long-term care insurance programs and strengthening supervision over insurance funds, according to the plan released by the National Healthcare Security Administration.
The plan stresses broadening insurance coverage for an evolving workforce. This includes enabling residence permit holders to enroll in basic medical insurance, while also encouraging flexible workers and those engaged in emerging job sectors to sign up for the employee insurance program.
It also proposes widening medical insurance enrollment and improving coverage for childbirth-related costs, including prenatal checkups and labor pain relief. The aim is to essentially achieve "no out-of-pocket expenses" for baby deliveries.
As China's population ages — with 23 percent of its people aged 60 or above as of the end of 2025 — the plan outlines a series of measures to develop long-term care insurance, a social insurance program initiated in 2016.
The insurance provides services or financial support for basic nursing and medical care for people with sustained disabilities. As of early July, the insurance covered about 320 million people, with about 1.37 million having received benefits from January to May.
In line with the newly released plan, the insurance will be further expanded, and efforts will be made to improve related technical standards, training programs and management and supervision protocols, as well as to encourage innovation in the sector.
To safeguard the security of insurance funds, the plan emphasizes establishing a more robust, whole-process oversight system. This includes stepping up routine and random checks, building big data supervision models and deploying artificial intelligence and other novel technologies in oversight efforts.
An official with the administration said heightened oversight will feature a full-chain governance framework spanning the entire process from budget execution to utilization.
It will oversee various aspects including pricing for drug and medical consumables, platform listing rules, resource allocation across institutions as well as the credit records of healthcare and pharmaceutical personnel.
The plan also highlights a series of measures to foster pharmaceutical innovation and make medical services more convenient for the public.
For instance, it calls for exploring the provision of medical insurance data services to support pharmaceutical innovation and R&D, adding more innovative drugs to the national drug reimbursement list, and improving the commercial insurance catalog that specifically targets high-value, high-cost medical products.
The plan also aims to improve reimbursement policies at the grassroots level in order to enhance access to primary care, upgrade online tools that allow users to compare medicine prices and locate pharmacies as well as streamline direct settlement policies for cross-regional medical treatment.
