China is adjusting its medical insurance policies to direct a larger share of funding to primary healthcare facilities, building on a system that covers most of the population. Officials from the National Healthcare Security Administration (NHSA) outlined the measures at an April 10 news conference, saying the changes are intended to affect grassroots providers and the operation of the national health insurance fund.
China Daily reported that Xu Na – deputy director of the NHSA’s medical services management department – said a guideline issued in March by the NHSA, the National Development and Reform Commission, and the National Health Commission sets out a series of measures for primary care. Under the guideline, medical insurance authorities will gradually increase the proportion of fund expenditures allocated to primary-level medical institutions. The document also calls for adjustments to outpatient reimbursement rules at the grassroots level and for payment mechanisms that match the service profile of community and township providers. One provision states that the basic medical insurance reimbursement rate for outpatient services at primary medical institutions should be no lower than 50%. The change is expected to affect how patients use different tiers of the system and may result in more insured individuals receiving initial treatment at local facilities.
Primary care institutions will be required to maintain supplies of commonly used and chronic-disease medicines, supported by the national centralized drug procurement program, which aggregates public-sector purchasing. Authorities also plan to assist these facilities in installing facial recognition devices to accelerate payment processing and insurance settlement, bringing digital identification tools into routine administrative processes. Xu said the administration will select about 15 pilot regions to test implementation of the new policies and to identify practices that could be applied more widely.
The primary care policy changes are being introduced against the backdrop of a broad basic medical insurance system. As of the end of 2025, more than 1.33 billion people were enrolled in basic medical insurance, with the coverage rate at about 95%, according to NHSA data released March 16, reported by China Daily. In 2025, the basic medical insurance fund, including maternity insurance, reported revenue of nearly 3.59 trillion yuan and expenditure of around 3 trillion yuan.
During the year, 7.215 billion outpatient visits were reimbursed under the schemes, an increase of 25.51% from 2024. Inpatient services covered by the system totalled 278 million treatments, a decrease of 3.40% year on year. The NHSA said the medical insurance system continued to reduce childbirth-related expenses in 2025. Approximately 260 million people were covered by maternity insurance, 6.66 million more than in the previous year.
China has also expanded the range of services eligible for reimbursement, particularly in reproductive and maternal health. From the beginning of 2025, certain assisted reproductive procedures, including egg retrieval and artificial insemination, were added to the list of services covered by medical insurance. By the end of the year, medical insurance had paid for more than 3 million assisted reproductive treatments, reaching over 1.6 million people nationwide, according to NHSA figures.
In many markets, such services are funded primarily through private insurance or out-of-pocket spending, so the inclusion of these treatments in a public scheme may alter the mix of payers involved in fertility care. In parallel, 30 provincial-level regions added pain relief during labour to their medical insurance benefit packages. These adjustments may influence how private products are designed alongside statutory coverage in areas such as maternity and reproductive health.
In rural areas, the NHSA reported that more than 99% of low-income residents and people who have been lifted out of poverty are now covered by medical insurance. Officials have stated that the aim is to limit the financial impact of illness on lower-income households. The 2025 national medical insurance drug list was updated to include an additional 114 products, bringing the total to 3,253 reimbursable medicines. The combination of a broader formulary and centralized procurement is expected to affect pricing and utilization patterns. This may be relevant for domestic and multinational pharmaceutical companies supplying therapies to the Chinese market and to other Asian health systems that monitor China’s policy changes.
Alongside the expansion of benefits and the reallocation of resources toward primary care, regulators have continued to supervise the use of medical insurance funds. In 2025, enhanced oversight led to the recovery of 34.2 billion yuan and to the identification of 1,626 institutions involved in fraudulent activities, according to NHSA data. Authorities used drug-tracking codes to inspect 124,700 medical and pharmaceutical institutions and imposed penalties on 39,100 entities for regulatory breaches. These activities indicate an ongoing focus on fund governance, claims integrity, and provider compliance.
China’s recent policy moves combine several elements: reoriented financing toward primary care, an expanded set of covered reproductive and maternal services, sustained high coverage levels, and tighter scrutiny of fund use. How these components develop, and how they interact with private insurance and provider behaviour, will be of interest to public payers, commercial insurers, healthcare providers, and pharmaceutical manufacturers across the region.
