China Expands Medical Insurance Sharing Across Provinces
China has taken a major step toward nationalizing its healthcare financing system, issuing new procedural rules that allow workers to share their medical insurance funds with family members across provincial borders. The policy, released on June 5 by the National Healthcare Security Administration (NHSA) and the Ministry of Finance, marks the culmination of a multi-year expansion of the country’s medical insurance co-payment system.
A Landmark Expansion of Healthcare Access
The new “Procedural Rules for Cross-Province Sharing of Individual Accounts Under Basic Medical Insurance for Employees (Trial)” establish a framework for what the NHSA calls the “third expansion” of individual account co-payment — moving from intra-city to intra-province, then from direct relatives to close relatives, and now from within provinces to across the entire country.
According to Xinhua News, the policy allows participants in the Urban Employee Basic Medical Insurance (UEBMI) to share funds from their individual accounts with close relatives enrolled in either UEBMI or the Urban-Rural Resident Basic Medical Insurance (URRBMI), regardless of where those relatives live.
Who Can Benefit and How It Works
The eligible recipients are broad: spouses, parents, children, siblings, grandparents, grandchildren, and maternal or paternal grandparents — provided they are enrolled in a basic medical insurance scheme. This directly addresses the needs of China’s more than 300 million migrant workers, who often contribute to medical insurance in their host provinces while their families face healthcare costs in their home provinces.
The mechanism relies on a “Medical Insurance Wallet” hosted on the National Unified Medical Insurance Information Platform. As Wang Fang, Director of the Medical Insurance Center at NHSA, explained, “Compared with previous intra-province co-payment, the biggest breakthrough is relying on our national unified information platform to establish individual medical insurance wallets, accelerating the realization of cross-province individual account co-payment goals.”
Users can establish or dissolve co-payment relationships through the National Medical Insurance Service Platform app, provincial platforms, or in-person at local medical insurance offices. A commitment-based system is used for kinship verification — no separate documentation is required, simplifying the process significantly.
Permitted Uses and Financial Impact
Funds from the shared accounts can be used for:
- Out-of-pocket medical expenses at designated医疗机构 (medical institutions)
- Out-of-pocket costs for approved drugs, medical devices, and consumables at designated pharmacies
- Premium payments for Urban-Rural Resident Basic Medical Insurance
- Premium payments for Long-Term Care Insurance
The policy unlocks a substantial financial resource. China’s employee medical insurance individual accounts hold over 1 trillion yuan in accumulated surplus — funds that have often sat idle while families struggled with out-of-pocket costs. Intra-province co-payment alone has served over 7.8 billion person-times in five years, totaling more than 100 billion yuan, demonstrating the pent-up demand for such sharing mechanisms.
A Solution for China’s Mobile Population
Wu Ruidong, a commentator for Beijing Youth Daily, described the policy as “an important step in the digitalization and integration of medical insurance services, and a vivid manifestation of social security moving toward refinement and warmth.”
The policy is particularly significant for China’s vast migrant workforce. Many workers contribute to UEBMI in economically developed coastal provinces where they work, but their elderly parents and children — who often have greater healthcare needs — reside in less developed interior provinces. Previously, those accumulated funds could not be used across provincial lines, creating what analysts describe as a “resource mismatch.”
Implementation Timeline and Challenges
The NHSA has set a target for all coordinated regions — there are 337 across China — to achieve full coverage of cross-province co-payment by the end of 2026. The policy builds on a pilot program launched in December 2024 in Suzhou, Jiangsu Province, and a January 2026 notice that expanded co-payment from intra-province to nationwide.
As the official policy interpretation on gov.cn notes, the cross-province sharing system uses a monthly full settlement mechanism, with funds cleared nationally and settled at provincial levels, similar to the existing cross-province direct settlement framework for medical expenses.
However, challenges remain. Local governments must integrate with the national information platform, and some regions may experience technical delays. The commitment-based kinship verification system will require robust monitoring to prevent fraud. Ensuring that elderly and rural residents can access the digital tools required for the Medical Insurance Wallet will also be critical to the policy’s success.
What This Means for China’s Healthcare Future
The cross-province sharing policy represents more than a convenience improvement — it is a fundamental shift in how China’s healthcare financing system operates. By unlocking over 1 trillion yuan in accumulated individual account funds, the policy increases the overall efficiency of medical insurance fund utilization, directing resources to where they are most needed.
Experts suggest this could pave the way for broader medical insurance portability reforms, potentially leading to a truly national, unified medical insurance system. For now, the immediate impact is clear: millions of Chinese families will no longer have to choose between the funds in a worker’s medical account in one province and the healthcare needs of their family in another.
As the NHSA’s Wang Fang stated, the new policy “further optimizes the individual account system, breaks regional restrictions, strengthens the family co-payment function, and expands the scope of individual co-payment from within provinces to the whole country.”
With nationwide implementation targeted by the end of 2026, China’s medical insurance system is moving decisively from a patchwork of provincial systems toward a truly national safety net.