China will expand the scope of medical insurance coverage, strengthen support for medical innovation, streamline services and tighten fund supervision during the 15th Five-Year Plan period (2026-30).
According to a news report in China Daily.com, the National Healthcare Security Administration has pledged to deliver more accessible and equitable healthcare security for China's 1.33bn medical insurance policyholders.
Senior officials of NHSA addressing a media conference recently, detailed the NHSA’s priorities for the 2026-2030 period, building on solid progress made during the previous five years. The country now maintains the world's largest basic medical insurance network, with coverage stability at 95%.
The NHSA along with six other ministries, has issued a special action plan to remove residency restrictions on enrolment and allow monthly or flexible premium payments — making it easier for mobile workers to maintain coverage.
The coverage under maternity schemes has also been expanded in recent times and has touched 260m persons and in the first seven months of this year, benefit payouts totalled CNY78.4bn ($11.7bn), with maternity allowances now paid directly to individuals.
For long-term care insurance, the media was informed that 22 provincial regions have issued implementation plans, covering over 320m participants. By the end of 2028, the system is expected to cover the entire country, extending from urban employees to urban and rural residents, with unified disability assessment standards and wider mutual recognition across regions.
During the 15th Five-Year Plan period, the administration will continue annual catalogue updates to include more innovative drugs for cancer, rare diseases, chronic conditions and child health.
At the same time, it will work toward a unified national reimbursement list for medical services and consumables — currently determined by provincial regions — to reduce regional disparities.
The administration will also expedite pricing approvals for new technologies and implement special case review mechanisms to ensure hospitals are not penalized for using novel therapies in complex cases.
NHSA plans to use Big Data and AI for proactive risk detection, while special probes will target fraud in maternity benefits and long-term care — such as fabricated disability assessments or bogus service claims.