The National Healthcare Security Administration provides an overview of efforts to promote high-quality development of the national medical insurance system.

Basic medical insurance is vital to people’s access to healthcare and to the development of the health sector. What is the current status of basic medical insurance coverage in China? How can more innovative and high‑quality drugs be included in the insurance scheme? And how can we safeguard the public’s life‑saving funds?
 
　　In response to public concerns on pressing issues, a relevant official from the National Healthcare Security Administration addressed them at the State Council Information Office’s “Authoritative Departments Discuss the Start of the New Year” series of thematic press conferences held on the 18th.
 
　　The national health insurance coverage rate has remained stable at around 95%, establishing the world’s largest basic medical security network.
 
　　“Over the past five years, we have continuously strengthened the world’s largest basic medical insurance network,” said Hu Jinglin, Director of the National Healthcare Security Administration, at a press conference. From 2018 to 2022, the national health insurance coverage rate remained stable at around 95 percent, while the reimbursement rates for inpatient expenses within the scope of employee medical insurance and urban–rural resident medical insurance reached approximately 80 percent and 70 percent, respectively.
 
　　Universal health insurance coverage is a fundamental, overarching task in the development of the medical insurance system. According to Shi Zihai, Deputy Director of the National Healthcare Security Administration, the Administration will continue to expand and improve coverage from four key areas:
 
　　By conducting data comparisons, we will enhance the precision of expanding insurance coverage and refine the nationwide enrollment database; by fostering inter‑departmental coordination, we will strengthen the targeted outreach to increase enrollment rates among college students, newborns, migrant workers, and rural migrant laborers; and by optimizing service delivery, we will improve the convenience of enrolling in insurance, bolstering collaboration with tax authorities to provide “one‑stop” services for insured individuals.
 
　　To ensure that low-income rural residents have access to basic medical care and to firmly prevent large-scale poverty recurrence due to illness, the National Healthcare Security Administration will continue to intensify its efforts in multiple areas, including establishing a diversified medical assistance system, improving a unified and standardized medical assistance framework, and refining comprehensive support mechanisms for patients facing exorbitant medical expenses.
 
　　Include more innovative and high-quality drugs in the national medical insurance scheme to continuously enhance medication coverage for insured individuals.
 
　　In recent years, the National Healthcare Security Administration has implemented a range of measures—including medical insurance negotiations, centralized bulk procurement, and reforms to the system for covering chronic diseases among residents—to continuously ease the financial burden of seeking medical care.
 
　　Li Tao, Deputy Director of the National Healthcare Security Administration, stated that over the past five years, the National Reimbursement Drug List has added a total of 618 medications, covering clinical treatment areas such as COVID-19, oncology, cardiovascular and cerebrovascular diseases, rare diseases, and pediatric medicines.
 
　　To enhance access to medicines, the National Healthcare Security Administration, in collaboration with the National Health Commission, has introduced policies such as the “dual-channel” system for negotiated drugs, supporting the effective implementation of the national reimbursement drug list. As of the end of December 2022, a total of 209,000 designated hospitals and pharmacies nationwide had stocked the drugs included in the negotiation list.
 
　　According to reports, the national centralized procurement 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 patients’ financial burdens by approximately RMB 500 billion.
 
　　Going forward, the National Healthcare Security Administration will continue to expand the scope and enhance the quality of centralized bulk procurement of pharmaceuticals.
 
　　At the national level, the eighth round of centralized drug procurement was launched in 2023, and the fourth round of centralized procurement for high-value medical consumables is set to follow, focusing primarily on intraocular lenses and orthopedic and sports medicine consumables. Additional rounds of centralized drug procurement will be initiated as appropriate.
 
　　At the local level, interprovincial alliance procurement will be prioritized for chemical drugs, traditional Chinese medicines, interferons, neurosurgical consumables, in vitro diagnostic reagents, and other products not covered by national centralized procurement.
 
　　Safeguard the people’s “life-saving funds” and ensure the implementation of more measures that benefit the public.
 
　　Hu Jinglin stated that over the past five years, through measures such as unannounced inspections, targeted rectification campaigns, and routine oversight, a robust regulatory framework for medical insurance funds has been established. Moving forward, the National Healthcare Security Administration will continue to intensify unannounced inspections, carry out in-depth special campaigns to combat fraud and benefit‑seeking misconduct, strengthen big‑data‑driven supervision, build a comprehensive public‑monitoring system, and refine policies related to global budgeting and the retention of savings from centralized drug procurement.
 
　　To address the inconvenience of reimbursement for out-of‑province medical care, the National Healthcare Security Administration has vigorously promoted direct interprovincial settlement. Currently, the number of designated medical institutions nationwide that offer interprovincial network access for inpatient expenses, routine outpatient services, and outpatient treatment for chronic and specific diseases stands at 68,800, 382,100, and 24,600, respectively.
 
　　Hu Jinglin stated that the National Healthcare Security Administration will continue to expand coverage, facilitate the inclusion of more designated medical institutions in the interprovincial networked settlement system for out-of-town medical care, and further streamline the registration process. It will also encourage more regions to implement self-service registration, thereby making it more convenient for the public to seek medical treatment elsewhere.
 
　　As the population continues to age, the number of older adults with disabilities is steadily rising, and long-term care coverage has increasingly become a focal issue in society. By the end of 2022, the number of participants in the long-term care insurance scheme had reached 169 million, with a cumulative total of 1.95 million individuals receiving benefits.
 
　　Hu Jinglin stated that the National Healthcare Security Administration will continue to deepen and strengthen existing pilot programs, refining the multi‑party cost‑sharing financing mechanisms and the equitable, appropriately scaled benefit‑guarantee systems that have already been established in earlier phases. At the same time, it will encourage local authorities to improve and implement the disability‑level assessment standards that have been clearly defined at the national level.
 
　　Supporting the coordinated development of the “Three Medicines” and actively fostering the growth of commercial health insurance.
 
　　Li Tao stated that since its establishment, the National Healthcare Security Administration has emphasized the fundamental role of medical insurance in the coordinated reform of the “three‑medicine” system—medical care, medical insurance, and pharmaceuticals—fostering positive synergy and collaborative reforms among the healthcare security system, the medical service delivery system, and the pharmaceutical supply‑guarantee system. This has helped alleviate the financial burden of medical care for the public, promoted high‑quality development of medical institutions, and supported and encouraged innovation in the pharmaceutical and biotechnology sectors.
 
　　Going forward, the National Healthcare Security Administration will institutionalize and normalize centralized bulk procurement, refine the mechanism for setting pharmaceutical service prices, and deepen supply-side reforms in the healthcare sector. It will also support the further advancement of public hospital reform oriented toward public welfare, coordinate efforts to expand high-quality medical resources and ensure their balanced regional distribution, and promote mutual reinforcement between healthcare insurance reform and pharmaceutical innovation.
 
　　Huang Huabo, Deputy Director of the National Healthcare Security Administration, stated that, on the basis of clearly defining the boundaries between basic medical insurance and commercial health insurance, the healthcare security authorities have implemented measures such as promoting information sharing, supporting coordinated administrative services, and enhancing the efficiency of fund utilization, thereby fostering the development of commercial health insurance.
 
　　“Going forward, we will work with relevant departments to actively explore appropriate pathways and effective models for the coordinated development of basic medical insurance and commercial health insurance—ensuring they complement and reinforce one another—to better meet the public’s multi-tiered healthcare needs,” said Huang Huabo.