More Chinese people walked out of or did not join the voluntary health insurance scheme for urban and rural residents in 2024 according to the Chinese National Healthcare Security Administration (NHSA).
The latest data released by NHSA in July this year reveals that China’s basic medical insurance which is basically a scheme designed for farmers and the unemployed (both in the rural and urban areas), covered a total of 1.32bn people in 2024 – down 7.27m from 2023.
China’s health insurance system is already under strain from a rapidly ageing population and a shrinking workforce. One of the main reasons for the poor enrolment has been the rising premiums and stagnating incomes. The disinterest in the scheme has also been catalysed by piling pressure on the system amid economic challenges and declining public trust.
The basic health insurance scheme cost each of the residents CNY400 ($56) in 2024 and this was subsidised by the Chinese government to the tune of CNY670 bringing total annual funding to CNY1,070 per person in 2024. According to sources Individual contributions increased by 5% compared with 2023.
According to a new report China's experience in pursuing universal health coverage, published by International Labour Organization in April 2025, China’s basic health insurance coverage has expanded from urban employees to rural residents and then to urban residents, with both scope and benefit levels steadily increasing, however, the ILO report highlights that since 2011, China’s basic health insurance participation rate has held steady at 95% though efforts to bring the remaining 5% under the cover of basic health insurance have not been slow.
The NHSA report said as at the end of 2024, the basic medical insurance system had a membership of over 1.32bn. This translates to a coverage rate of 95% of the country’s total population, leaving 5% again uninsured.
The NHSA has over the years maintained that the overall participation rate in the basic medical insurance programme has remained above 95% but it does not specifies any year-on-year change.