China Unveils Five-Year Plan to Reform Healthcare Insurance

China’s National Healthcare Security Administration has published a comprehensive five-year plan aimed at improving the quality and efficiency of the country’s healthcare insurance system, with a focus on reducing the medical burden on patients and expanding coverage by 2030. The “National Healthcare Security ‘15th Five-Year Plan’” was formally issued on July 27 and publicly released on August 19, according to Xinhua News.

The plan outlines a vision for a comprehensive multi-level healthcare security system covering all citizens, with goals centered on fairness, rule of law, safety, digital intelligence, coordination, and scientific development. As Xinhua reported, it represents “a medical security blueprint affecting more than 1.3 billion insured people.”

Key Targets for 2026-2030

The plan sets eight major indicators with specific target values for the 2026-2030 period. Among the most significant targets, basic medical insurance participation will be maintained at approximately 95 percent annually, while immediate settlement coverage of basic medical insurance fund expenditure will rise to 80 percent or more, up from roughly 70 percent in 2025.

According to the official government document, the plan also calls for long-term care insurance to be expanded from 92 coordination regions to cover all coordination regions by 2030, and for maternity allowances to be directly distributed to individuals in all coordination regions. By 2029, the plan aims to basically achieve provincial-level coordination of basic medical insurance.

From ‘Having Protection’ to ‘Better Protection’

The plan proposes 26 specific measures across eight areas, including five livelihood initiatives and three major projects. As People’s Daily reported via gov.cn, the initiatives include universal participation consolidation, drug purchase assistance, medical insurance assistance for grassroots healthcare, standardized cross-province direct settlement management, and a personal medical insurance cloud.

“From ‘having protection’ to ‘better protection’, every aspect of the plan falls on the urgent needs of insured people,” Xinhua reported. “In the next five years, this medical security network will be woven tighter, warmer, and stronger.”

A National Healthcare Security Administration official said the “15th Five-Year Plan” period represents “a critical five years for promoting the high-quality development of the medical insurance industry,” adding that the plan is “based on the current status of medical insurance reform and development, closely follows safe and sustainable development, focuses on refined management, and scientifically plans development indicators.”

Expanding the Medical Insurance Catalog

A notable change in the new plan is the expansion of the medical insurance catalog from drugs to include medical service items and medical consumables. This move is designed to provide broader coverage and reduce out-of-pocket costs for patients, according to the China Military Online report of the Xinhua article.

The plan also emphasizes digital and intelligent services, including face payment, QR code payment, mobile payment, and credit payment systems, with full implementation targeted within three years. Additionally, it aims to ensure that 98 percent or more of administrative villages with village clinics are included in designated management.

Strengthening Fund Supervision

Fund safety and sustainability form the foundation of the universal healthcare insurance system, and the plan includes detailed provisions for strengthening fund management and supervision. The administration official emphasized building a “wide-tolerance, strict-punishment, comprehensive, multi-dimensional, and three-dimensional” supervision system for medical insurance funds, vowing to “resolutely safeguard the people’s ‘medical money’ and ‘life-saving money.’”

The plan calls for completing on-site inspection coverage of all designated medical institutions nationwide during the plan period. National flight inspections will cover all provinces annually and all prefecture-level cities within five years, while provincial inspections will cover all counties within the same timeframe.

Building on the 14th Five-Year Plan Legacy

The new plan builds on the achievements of the previous “14th Five-Year Plan” period (2021-2025), during which China built the world’s largest basic medical insurance network covering 1.36 billion people, with participation rates stable at over 95 percent. As noted in the China News Service background report on the previous plan, national organized drug and high-value medical consumables centralized procurement reduced prices by an average of over 50 percent during that period.

The participation rate target has shifted from “above 95 percent” to “maintained stable,” reflecting a policy pivot from pursuing high participation rates to improving participation quality and structure. This change, as Guancha reported, aims to encourage local governments to focus on closing gaps in coverage for workers in new employment forms and flexible employment.

What’s Next

As the plan moves from publication to implementation, observers will be watching how quickly provincial-level coordination is achieved, how effectively the expanded medical insurance catalog reduces patient costs, and whether the strengthened supervision system successfully curbs fraud and misuse of insurance funds. The plan’s success will ultimately be measured by its impact on the more than 1.3 billion people it is designed to serve—and by whether China can deliver on its promise of moving from “having protection” to “better protection.”