China is preparing a new phase of health insurance changes that would extend coverage for childbirth-related services, fertility treatment, and long-term care, while modifying how the system supports pharmaceutical and health technology innovation.
According to China Daily, the priorities were set out in a report by National Healthcare Security Administration (NHSA) director Zhang Ke at the administration’s annual work conference. The document reviewed implementation of the 14th Five-Year Plan (2021-25) and identified healthcare security priorities for 2026. In response to declining birth rates and an aging population, the NHSA plans to “reasonably expand” maternity insurance coverage for prenatal checkups within the financial limits of the insurance fund. Authorities are studying a basic maternity service package that would formally incorporate prenatal examinations and change families’ out-of-pocket exposure for routine pregnancy care.
The administration has set a target for next year of nationwide full reimbursement of all policy-covered medical expenses related to childbirth. Under the proposed framework, insured pregnant women would have almost no out-of-pocket spending for services and drugs listed in the reimbursement catalogue, while charges for premium wards, non-listed medicines, and other excluded items would remain self-funded. According to the NHSA, seven provincial-level regions – including Jilin, Jiangsu, and Shandong – have implemented policies under which insured mothers face minimal out-of-pocket payments for childbirth at the point of care.
The NHSA reported that 255 million women are now enrolled in the national maternity insurance program. Fertility treatment has been added to basic health insurance plans in all regions, and nearly 95% of fund pooling regions now pay fertility subsidies directly into individuals’ personal accounts rather than through employers, changing how benefits are distributed in relation to employment status.
For 2026, regulators intend to increase participation in maternity insurance among flexible workers, migrant workers, and people in new forms of employment, and are assessing ways to extend protection to non-employed residents in both urban and rural areas. All provincial-level regions will also be required to cover eligible labour pain relief procedures, while reimbursement rules for assisted reproductive technology will be further adjusted.
On long-term care, the report called for continued development of China’s public long-term care insurance program, which covers about 300 million people. The measures are framed as support for the country’s 220 million residents aged 65 and above, who accounted for 15.6% of the population at the end of 2024. Authorities have asked commercial insurers to develop long-term care and health products that operate alongside the public scheme. These directions align with the agenda from the Central Economic Work Conference, which identified demographic issues as a policy priority and called for expanded rehabilitative care services, stronger support for vulnerable groups, and efforts to promote “positive views on marriage and childbearing” as part of the stated goal of stabilising the newborn population.
The NHSA report also described a more defined role for both public and commercial payers in relation to innovative drugs and emerging healthcare technologies. Over the past five years, 949 medicines have been added to the national reimbursement drug list, bringing the total to 3,253. In the latest update released this month, 114 new products were included, including a record 50 first-in-class novel drugs.
In a move relevant to health insurers, the NHSA has issued the country’s first commercial insurance innovative drug list, initially covering 19 medicines that the administration described as having “significant clinical value, high innovation levels, and substantial patient benefits.” Commercial health insurers are being urged to use the list and to consider covering a broader range of “reasonable medical expenses” that fall outside the basic social insurance catalogue. The report also calls on insurers to allocate more capital to innovative therapies to support research and development.
The NHSA plans to use medical insurance’s “strategic purchasing” function to shape industry competition, influence the direction of innovation, and modify multichannel payment mechanisms for new drugs and technologies. The agency highlighted artificial intelligence and other “smart technologies” as tools to digitise healthcare security operations and to build an evaluation system that uses real-world data to assess the value of reimbursed medicines. Local governments will be encouraged to test healthcare security application scenarios involving advanced technologies, including multimodal AI-assisted diagnosis and non-invasive brain-computer interface applications. For insurers, these pilots may indicate future expectations for data reporting, claims processes, and outcome-focused contracting.
China’s policy changes are taking shape as medical inflation remains elevated worldwide, with implications for underwriting, pricing, and product structures across Asia’s health and employee benefits markets. Global health insurance costs are projected to increase 10.3% in 2026, according to WTW’s 2026 Global Medical Trends report, following estimated growth of 10% in 2025 and 9.5% in 2024. The figures indicate continued pressure on insurers and employers.
Asia-Pacific is expected to record the largest regional increase, with medical trend forecast at 14% in 2026, above the global average and higher than in other regions. Latin America is projected to rise from 10.5% this year to 11.9% next year, while the Middle East and Africa are expected to reach 11.3%. North America and Europe are forecast at 9.2% and 8.2%, respectively. In the US, healthcare costs are projected to grow 9.6% in 2026, slightly below 2025’s 9.7% but still above the 7.6% trend in 2024.
WTW’s survey indicates that more than half of insurers expecting elevated medical trends anticipate that these conditions will last more than three years. Respondents cited high medical costs, increased pharmacy and outpatient spending, and structural changes in healthcare delivery as main drivers. New medical technologies, mentioned by 74% of insurers, were identified as a key source of claims inflation, followed by declining public health systems at 52% and pharmaceutical advancements at 49%.
