China’s basic medical insurance program added more than four million enrolees in 2026 compared with the same period last year, with a participation rate holding at 95%, officials at the National Healthcare Security Administration (NHSA) said July 9. The enrolment figure is stable, but the more consequential developments in the same briefing – and in the regulatory activity surrounding it – concern what the NHSA now explicitly requires from private insurers, and where the boundaries of the public system have been formally drawn.
The clearest structural signal preceded the July briefing. On Dec. 7, 2025, the NHSA and the Ministry of Human Resources and Social Security jointly released China’s first-ever Commercial Health Insurance Innovative Drug List, known as the CHIIDL, alongside the updated National Reimbursement Drug List. Both took effect on Jan. 1, 2026. The CHIIDL covers 19 high-cost innovative drugs – including CAR-T therapies, bispecific antibodies for cancer, and treatments for Alzheimer’s disease and rare diseases – that carry significant clinical value but exceed the affordability thresholds of the basic medical insurance system. According to CMS Law’s January 2026 legal analysis of the framework, drugs listed in the CHIIDL are exempt from volume-based procurement monitoring, DRG/DIP bundled payment scope, and basic medical insurance self-payment rate metrics – structural carve-outs designed to make coverage by commercial insurers operationally straightforward.
The pricing architecture differs materially from the public system. While National Reimbursement Drug List negotiations have historically resulted in average price reductions of around 60%, CHIIDL products recorded negotiated discounts of 15% to 50%, with prices agreed through negotiations involving the NHSA, commercial insurers, and pharmaceutical companies. For commercial insurers, the framework creates a defined product design mandate: proactively including CHIIDL drugs increases product appeal and enrolment rates, while the discounted negotiated prices support claims cost management. Shenzhen has already announced that all listed therapies will be covered under its city supplementary commercial insurance scheme, according to the CMS Law analysis. This is the operational resolution of a question China’s health insurance reforms have raised for several years: where public coverage ends and private product design begins. The NHSA has now answered it with a government-curated formulary as its instrument.
The July 9 briefing confirmed that China’s long-term care insurance scheme now covers 320 million people, up from 190 million at the end of 2024, according to NHSA data. “The long-term care insurance scheme now covers 320 million people, while more than 50,000 certified long-term care workers have been trained,” NHSA official Liu Juan said at the news conference.
Authorities have asked commercial insurers to develop long-term care and health products that operate alongside the public scheme, as reported by Insurance Business Asia in December 2025. The Swiss Re Institute quantified the underlying gap in July 2025: China’s health protection gap stood at an estimated US$377 billion in 2024 – approximately double the 2014 level – with around 30% of potential healthcare risk remaining uncovered. Commercial health insurance premiums reached US$133.9 billion in 2023, up at a 20% compound annual growth rate from 2014, though premium growth has softened to 8.2% in 2024.
The ILO’s Global Care Policy Portal provides a regional reference: Japan introduced mandatory long-term care insurance in 2000 to address growing eldercare needs from rapid population aging and shrinking family support systems, and as of July 2025, over seven million people aged 65 and older – around one in five older persons – were certified as needing long-term care or support. China’s scheme, having added more than 130 million covered persons in the space of roughly 18 months, is scaling at a pace that has no regional precedent.
NHSA official Wang Xiaoning told the July 9 news conference that prices for 33 categories of medical consumables – including defibrillators, heart valves, and embolic protection devices – had been reduced this year through the volume-based procurement program. Vagus nerve stimulators were cited as a specific example, with prices from three manufacturers falling from as much as 268,000 yuan per unit to 152,000 yuan, a reduction of roughly 43%.
Since 2018, China has carried out 10 rounds of centralized medicine procurement, covering 435 medicines, according to the NHSA’s July 2025 14th Five-Year Plan achievement briefing. For health insurers with inpatient or surgical book exposure in China, that sustained compression directly affects claims costs, reserving assumptions, and the pricing of supplemental products. A new round of bulk procurement of medicines and medical consumables has been launched, officials said.
The July 9 briefing reported 4.81 million maternity insurance benefit payments in 2025, with an average allowance of nearly 30,000 yuan – up from 26,000 yuan in 2024, according to NHSA data reported by the Global Times in October 2025, and from 2024’s total maternity insurance fund expenditure of 143.2 billion yuan, which itself rose 33.92% year-on-year, according to the NHSA’s 2024 Healthcare Security Development Statistical Bulletin. Twenty-eight provincial-level regions have moved to eliminate out-of-pocket payments for inpatient childbirth, and 20 provincial-level regions have adopted policies to encourage flexible workers and migrant workers to enrol in maternity insurance alongside standard employee medical insurance.
For private insurers operating alongside China’s system, the July 9 briefing consolidates a regulatory posture that is now structurally explicit across three dimensions: the CHIIDL defines which high-cost drugs commercial products are expected to cover; VBP compresses input costs across medical consumables and medicines; and long-term care insurance expansion creates a public base that simultaneously defines the ceiling on state provision and the floor from which private supplemental products can be built. The architecture is no longer a policy aspiration – it is an operational framework with product, pricing, and claims implications that are measurable today.
