China’s public medical insurance program covered more than 1.3 billion people in the first quarter of 2026 (Q1 2026), with premium revenues climbing to 598.1 billion yuan – a 5.3% increase from the same period a year earlier – data from the State Taxation Administration showed, cited by China Daily.
The Q1 figures build on a 2025 annual report from the National Healthcare Security Administration, or NHSA, which put year-end enrolment at 1.33 billion and recorded a fund surplus of roughly 590 billion yuan. For commercial insurers operating in China, the gap between what the public system covers and what it does not remains a primary variable in product development and pricing decisions.
Employed contributors numbered 260 million in Q1 2026, a 1.8% rise year-on-year, according to the State Taxation Administration. When retirees and urban and rural residents enrolled under the residents’ scheme are included, total coverage exceeded 1.3 billion. Enrolment for the 2026 residents’ program has largely wrapped up, with payment income from that cohort reaching 350.4 billion yuan. The 2025 year-end count from the NHSA showed enrolment had grown by 4.06 million over the prior year, holding the national coverage rate at roughly 95%. In rural areas, more than 99% of low-income residents and individuals previously lifted out of poverty were enrolled.
Tang Jiqiang, a professor at the China Financial Research Institute of Southwestern University of Finance and Economics, pointed to labour market conditions as a stabilizing factor. “China’s stable and improving economy, along with overall stable employment, has provided fundamental support for the deeper implementation of the basic medical insurance system,” Tang said, as reported by China Daily. On the financing side, Tang noted that government subsidies have historically accounted for the majority of residents’ scheme revenue. “The continued injection of fiscal subsidies has effectively reduced the payment burden on residents, improved medical insurance benefits, and provided strong support for consolidating universal insurance coverage,” he said.
In 2025, outpatient visits processed under the public schemes reached 7.215 billion, a 25.51% jump from 2024. Inpatient admissions moved in the opposite direction, declining 3.4% to 278 million over the same period, NHSA data showed, as reported by China Daily. The divergence between outpatient growth and inpatient contraction may reflect policy changes that have extended coverage to primary and community care settings, funnelling patients away from hospital admissions. Commercial health insurers may need to reassess hospitalization-linked benefit structures in light of that trend. The three-tier arrangement – combining basic medical insurance, serious illness insurance, and medical assistance – reduced medical spending for more than 246 million low-income rural residents by approximately 193 billion yuan in 2025.
The NHSA broadened coverage in 2025 to include certain assisted reproductive procedures, among them egg retrieval and artificial insemination. Thirty provincial-level regions also brought labour pain relief within the scope of covered services. By year-end, more than 3 million assisted reproductive procedures had been reimbursed, reaching over 1.6 million individuals. The national reimbursement drug formulary was expanded by 114 entries in 2025, putting the total at 3,253 medicines. The NHSA noted that eight consecutive annual updates since its founding in 2018 have collectively added 949 drugs to the list. The 11th round of centralized national drug procurement covered 55 drugs. The formulary expansions narrow the gap that supplemental commercial policies have traditionally filled. Insurers monitoring product relevance will likely track whether future rounds of centralized procurement continue to absorb high-cost specialty medicines.
Patients settling hospitalization bills across provincial lines reached 15.82 million visits in 2025, with the fund disbursing 162 billion yuan – a 10% rise in visit volume and a 2% rise in fund payments compared with 2024. For outpatient cross-provincial settlements, visits reached 292 million, with fund payments of 45.5 billion yuan, up 30% and 26%, respectively. Wider portability across regions has practical consequences for group insurers and employee benefit providers whose policyholder populations are geographically mobile.
The NHSA recouped 34.2 billion yuan in 2025 from institutions and individuals found to have misused public insurance funds. Insurance verification channels accounted for 27.8 billion yuan of that total, with 1,626 medical institutions formally found guilty of fraud. Working alongside public security authorities, the administration handled 3,776 cases and saw 10,357 individuals taken into custody. Tip-offs from the public produced an additional 2.74 billion yuan in recoveries; informants received approximately 1.56 million yuan in rewards. Authorities inspected 124,700 medical and pharmaceutical outlets using drug-tracking codes, penalizing 39,100 for regulatory violations. The scale of fund leakage, even after recoveries, is a figure that reinsurers and risk modelers involved in the public-private interface may treat as a baseline for estimating systemic exposure.
The State Taxation Administration said online payment infrastructure for basic medical insurance premiums is now operational nationwide, with more than 95% of transactions handled through digital channels. Coming upgrades are to include automated payment reminders, a unified enrolment-and-payment pathway for workers in non-standard employment arrangements, and a digital portal for individuals to query their own contribution records. The last item is of particular note for insurers writing products for the gig economy and other flexible work segments, where patchy contribution histories have historically complicated both underwriting and claims adjudication.
