National Healthcare Security Administration: We will never allow the medical insurance fund to become easy prey…

On the morning of May 18, the State Council Information Office held a series of thematic press conferences under the “Authoritative Departments on the Start of the New Year” initiative, briefing on efforts to implement major policy decisions and promote high-quality development of the medical insurance system, and fielding questions from reporters.
 
　　According to reports, since its establishment, the National Healthcare Security Administration has placed great emphasis on ensuring universal health insurance coverage. By refining policies, streamlining services, integrating systems, and reinforcing accountability, it has continuously expanded coverage and improved quality. In recent years, China’s participation rate has remained stable at over 95 percent. By the end of 2022, the number of people covered by basic medical insurance nationwide reached 1.34592 billion. The annual total revenue of the basic medical insurance fund (including maternity insurance) increased from RMB 2.14 trillion to RMB 3.09 trillion, while annual total expenditures rose from RMB 1.78 trillion to RMB 2.46 trillion. The fund has operated steadily, with a modest surplus.
 
　　Promoting centralized bulk procurement, the national program has achieved average price reductions of over 50% for 333 pharmaceutical products and more than 80% for eight high-value medical consumables, including cardiac stents and artificial joints. Combined with regional alliance procurement, these measures have collectively reduced out-of-pocket expenses by approximately RMB 500 billion. In addition, reforms to the system for covering chronic diseases among residents have expanded coverage to include outpatient medications for hypertension and diabetes under the basic medical insurance scheme, benefiting 140 million people with chronic conditions.
 
　　The industry has been encouraged to pursue research and innovation, and a mechanism for drug reimbursement access and negotiation‑based renewal—centered on new medicines—has been established. The time required for newly approved drugs to be included in the national reimbursement drug list has been shortened from an average of nearly five years in the past to less than two years; some new drugs have even been added to the list within just six months of launch. Expenditures on new drugs covered by basic medical insurance rose from RMB 5.949 billion in 2019 to RMB 48.189 billion in 2022, an increase of 7.1 times.
 
　　Expanding sales channels for negotiated drugs, the “dual-channel” management mechanism now allows certain drugs that were previously available mainly in large hospitals to be sold at 155,000 nationally designated medical insurance pharmacies and reimbursed under the national health insurance scheme. To purify the pharmaceutical industry ecosystem, centralized volume‑based procurement is being institutionalized and carried out on a regular basis, continuously reducing inflated prices of medicines and medical consumables and effectively curbing the practice of “pay‑for‑sales.”
 
　　I don’t dare to lie, can’t lie, and don’t want to lie.
 
　　The medical insurance fund is the “life-saving money” of the people. The National Healthcare Security Administration has thoroughly implemented the spirit of the General Secretary’s important instructions and directives, consistently prioritizing the strengthening of oversight over the medical insurance fund and the safeguarding of its security. It vigorously cracks down on all forms of improper and illegal use of the fund, ensuring that it will never become easy prey for those seeking to exploit it.
 
　　After five years of concerted efforts, a high-pressure regulatory environment for medical insurance funds has been established through an integrated approach that combines point‑level, line‑level, and area‑level measures.
 
　　First, ad hoc inspections employ a “point‑targeted” verification approach to achieve breakthroughs at specific focal points. By adopting a mechanism of “no prior notice, top‑down oversight, and cross‑inspection,” these inspections effectively address the challenges posed by “familiar networks and peer‑level supervision,” cracking down hard on detected violations and striking decisively at any sign of misconduct, thereby fully leveraging the deterrent power of such unannounced checks. At the same time, designated medical institutions are encouraged to draw broader lessons from individual cases and conduct self‑inspections and corrective actions to prevent the recurrence of similar violations. For institutions that proactively undertake self‑examination and rectification, appropriate consideration is given in terms of inspection frequency and penalty discretion, thus embodying a law‑enforcement philosophy that balances strictness with leniency. Since 2019, the National Healthcare Security Administration has dispatched a total of 184 ad hoc inspection teams, examining 384 designated medical institutions and uncovering suspected misuse of public funds amounting to RMB 4.35 billion.
 
　　Second, the targeted rectification campaign has advanced online by conducting “penetrative” inspections. The medical insurance authorities, in collaboration with public security, health, and other relevant departments, have focused on key areas such as orthopedics, hemodialysis, and cardiology, as well as on priority drugs and medical consumables, fraudulent medical treatment, and the resale of insured‑drug products—targeting these high‑risk activities with precision to eliminate the “lesions” that siphon off the public’s life‑saving funds. In 2022 alone, 2,682 cases were solved, 7,261 suspects were apprehended, and RMB 1.07 billion in misappropriated medical insurance funds was recovered.
 
　　Third, routine oversight leverages data to create a comprehensive, networked monitoring system. By fully harnessing smart surveillance, big data, and other cutting-edge information technologies, we are accelerating the development of an all‑encompassing, multi‑tiered, and three‑dimensional regulatory framework. In 2022, smart monitoring enabled us to deny payments and recover RMB 3.85 billion, accounting for approximately 26% of the total funds recovered. Moreover, a single big‑data model targeting fraudulent hospitalizations pinpointed leads that led to the apprehension of nearly 500 individuals and the investigation of cases involving nearly RMB 100 million.
 
　　Going forward, the National Healthcare Security Administration will continue to intensify ad-hoc inspections, launch in-depth special campaigns to combat fraud and abuse of insurance funds, rigorously investigate and prosecute a number of high‑profile cases, crack down on major criminal gangs, and publicly expose egregious examples, thereby reinforcing the high‑pressure deterrent against fraudulent practices. It will strengthen big‑data‑driven oversight, build a society‑wide supervisory framework, and establish an all‑encompassing system that makes fraud impossible. At the same time, it will refine policies such as global budgeting for medical insurance funds and the retention of surplus from centrally procured drugs, guiding designated medical institutions and healthcare professionals to voluntarily standardize their service practices and fostering a long‑term mechanism that discourages fraudulent behavior.
 
　　New drugs reach patients more quickly.
 
　　80% of new drugs can be included in national medical insurance within two years of launch.
 
　　The management of the national medical insurance drug list has long been a subject of widespread public attention. Since its establishment, the National Healthcare Security Administration has remained committed to the principle of “ensuring basic coverage,” continuously refining the drug list and significantly enhancing the level of medication access for the general public. This progress is reflected in the following key areas:
 
　　First, the national medical insurance catalog has adopted an annual update cycle, enabling new drugs to reach patients more quickly. Over 80% of newly approved drugs are now included in the catalog within two years of their market launch. For example, among the 108 drugs added through the 2022 catalog revision via negotiation and price‑bidding, 105 were launched within the past five years, with a significant number being incorporated into the insurance list in the year they received approval.
 
　　Second, the number of drugs included in the national reimbursement drug list has increased significantly, and the scope of coverage continues to expand. Over the past five years, the list has added a total of 618 new medications, covering clinical treatment areas such as COVID‑19, oncology, cardiovascular and cerebrovascular diseases, rare diseases, and pediatric medicines. A large number of drugs with novel mechanisms and new therapeutic targets have also been incorporated. Among the top 20 highest‑cost items at medical institutions, there are now very few ancillary drugs with uncertain efficacy or prone to misuse; these have been replaced by therapeutic agents for major and chronic diseases. The current version of the National Reimbursement Drug List includes 2,967 items, spanning all clinical treatment domains, thereby better meeting the clinical medication needs of the vast majority of insured patients.
 
　　Third, we have vigorously ensured the implementation and availability of drugs on the national reimbursement drug list, significantly improving access to essential medicines. In collaboration with the National Health Commission, we have introduced a series of policies, including the “dual-channel” mechanism for negotiated‑price drugs, to support the effective rollout of the list. As of the end of December 2022, 209,000 designated hospitals and pharmacies nationwide had stocked the negotiated‑price drugs listed in the catalog.
 
　　Fourth, we have implemented the national innovation-driven development strategy and supported pharmaceutical technology innovation. Over the past five years, of the 70 major new‑drug R&D projects that underwent price negotiations, 66 were successfully negotiated, yielding a success rate of 94% and enabling rapid clinical application. As a result, companies have received appropriate returns on their early‑stage R&D investments, significantly boosting their enthusiasm for innovation.
 
　　Overall, over the past five years, adjustments to the national medical insurance drug list have better served the vast majority of insured individuals. Patients now have access to more effective innovative medicines at more affordable prices, while also driving China’s pharmaceutical industry toward a development path that prioritizes innovation and robust R&D. Moving forward, the National Healthcare Security Administration will continue to strike a balance between doing its utmost and acting within its means, further refining and optimizing the management of the drug list to include more high‑quality medications that meet the criteria, thereby continuously enhancing medication coverage for insured populations.
 
　　The fourth round of centralized procurement for high-value medical consumables will be launched.
 
　　Primarily targeting ophthalmic intraocular lenses, among others.
 
　　For a long time, drug and high-value medical consumable prices in China have been excessively inflated. In particular, certain “old imported drugs,” even after their patents have expired, continue to be sold domestically at relatively high prices, while the prices of high-value medical consumables remain far above international levels. In response to this situation, the National Healthcare Security Administration, in accordance with the decisions and arrangements of the CPC Central Committee and the State Council, has worked closely with relevant departments to vigorously advance centralized procurement of drugs and high-value medical consumables, thereby reducing production and marketing costs for winning bidders and achieving price reductions for selected products.
 
　　Over the past five years of reform, the results of centralized procurement have become increasingly evident. First and foremost, the financial burden of medication on the public has been significantly reduced. Through centralized purchasing, we have begun to reverse the longstanding trend of rising drug prices in China. According to relevant estimates, compared with 2018, China’s pharmaceutical procurement price index declined by 19% in 2022.
 
　　The quality of winning‑bid products is a key concern throughout the centralized procurement process, and price reductions have effectively improved access to a range of high‑quality pharmaceuticals and medical consumables. For example, among drugs procured through centralized purchasing, the share of high‑quality medications—both originator products and generic drugs that have passed consistency evaluations—has risen from 50% prior to the program to over 90%. Similarly, following the centralized procurement of coronary stents, the proportion of chromium‑cobalt alloy stents, which offer superior material performance, has increased from 60% to more than 90%, while stainless‑steel stents—once dominant in the market but generally less performant—have gradually been phased out.
 
　　The pharmaceutical industry is evolving in a healthier, more sustainable direction. Centralized procurement has shifted drug companies from a past focus on “competing through distribution channels and sales” to a current emphasis on “competing on quality and price,” steadily strengthening their intrinsic drive to pursue growth through quality. Driven by this procurement reform, since 2018, the cumulative number of generic drugs that have passed the evaluation of quality and therapeutic equivalence in China has surged from fewer than 200 at the time to over 3,000 today, indicating that high‑quality medications are gradually becoming the mainstream choice in clinical practice.
 
　　Going forward, we will continue to expand the scope and enhance the quality of centralized bulk procurement of pharmaceuticals, ensuring coordinated, integrated implementation at both the national and local levels. At the national level, the eighth round of drug procurement has already been launched this year, and the fourth round of high-value medical consumables procurement is also planned, focusing on intraocular lenses for ophthalmology and sports‑medicine‑related orthopedic consumables. Additional rounds of drug procurement will be initiated as appropriate.
 
　　At the local level, we will prioritize inter-provincial alliance procurement for chemical drugs, traditional Chinese medicines, interferons, neurosurgical consumables, in vitro diagnostic reagents, and other products not covered by national centralized procurement. At the same time, we will work with relevant departments to further strengthen quality oversight and supply assurance for centrally procured items, encourage medical institutions to give priority to purchasing and using winning‑bid products, and ensure that the public truly benefits from the reforms.