Published by ChinaMNC · Huaian

China's New Five-Year Healthcare Insurance Plan: What Foreign Founders Should Know

China's National Healthcare Security Administration released its 15th Five-Year Plan for universal medical insurance on August 19. Here is what foreign founders operating in China should understand about the 2030 goals, cost-sharing, fund supervision, and service upgrades.

China Releases Five-Year Plan for Universal Medical Insurance

On August 19, China's National Healthcare Security Administration (NHSA) published the Universal Medical Insurance "15th Five-Year Plan." The document sets out how the country intends to build a multi-tiered medical security system covering the whole population over the next five years. For foreign founders running or registering a company in China, the plan is worth reading closely: it touches on how basic insurance is funded, how contributions are shared between individuals, employers and the government, and how medical funds will be supervised.

The plan states that China will keep public health at the center of its approach, pursue high-quality development of medical insurance, and rely on reform and innovation. It calls for a system that is universal, integrated between urban and rural areas, fair and unified, safe and standardized, and sustainable. The stated aim is to steadily raise people's sense of gain, happiness and security.

What the Plan Envisions by 2030

The plan describes six broad visions for 2030. Each is framed as a direction of travel rather than a fixed promise:

• Fair insurance: basic public medical insurance services should become more accessible and evenly distributed.
• Rule-based insurance: a legal framework for medical insurance should basically take shape, with stronger administration according to law and stricter, more standardized enforcement.
• Safe insurance: fund management will be strengthened, fund operations should remain safe and sustainable, and security capacity should be consolidated.
• Digital and intelligent insurance: big data and artificial intelligence should be widely applied in fine-grained management and precision services.
• Coordinated insurance: the coordination mechanism among medical services, medical insurance and pharmaceuticals should be improved, raising the efficiency of fund use.
• Scientific insurance: standardization should accelerate, scenario-testing systems should gradually improve, and a full-process scientific system for medical insurance should basically be established.

To support these visions, the plan sets overall requirements for reform during the 15th Five-Year Plan period and includes eight main development indicators with target values. According to an NHSA official, the indicators reflect China's economic and social situation, population trends and the direction of medical insurance reform. New indicators include the number of pooled regions covered by the long-term care insurance system, the number of months of accumulated balance available in the pooled funds for employees and urban-rural residents, the coverage rate of immediate settlement of basic medical insurance fund expenditures, and direct payment of maternity allowances to individuals.

Cost-Sharing and the Multi-Tiered System

The plan notes that during the 15th Five-Year Plan period, population aging will deepen, demand for medical treatment will continue to be released, and new medical technologies will develop rapidly. It calls for a comprehensive protection framework in which basic medical insurance works alongside commercial medical insurance, charitable donations and medical mutual aid, with complementary functions and shared development, to ease the burden of medical costs.

Basic medical insurance and its three-tier protection system remain the mainstay. The plan emphasizes improving the basic medical insurance system by:

• continuously raising the quality of participation in universal insurance;
• optimizing a sustainable financing mechanism that balances the funding responsibilities of individuals, employers and the government and promotes diversified funding;
• improving a fair and moderate benefits mechanism.

Reimbursement policy will lean toward primary-level medical institutions, with inpatient reimbursement levels across different tiers of medical institutions appropriately differentiated according to local conditions. The plan also calls for unified standards for outpatient chronic disease and special disease coverage within each province, deeper reform of operating mechanisms, and improved fundraising and protection management in pooled regions. By 2029, provincial-level pooling should be basically achieved, improving the funds' risk resistance and efficiency. Supplementary insurance such as critical illness insurance will play a greater role, and medical assistance will serve as a backstop.

Beyond the three-tier system, the plan pushes for stronger commercial medical insurance to meet needs not covered by basic insurance, and encourages charitable organizations and other social forces to participate in multi-channel medical assistance.

Service Upgrades: What Changes for Patients and Employers

The NHSA official said the next five years will bring measures to improve medical insurance services so that treatment and reimbursement are less burdensome. The plan outlines four directions:

• More complete infrastructure: a grassroots medical insurance service network covering townships, streets, villages and communities nationwide, with service points extended downward.
• More efficient processing: more high-frequency services available via mobile and online channels, and more services that can be handled across regions or nearby. Local lists and service guides will be standardized on the basis of the national list of 28 high-frequency items, with friendlier services for older people, children, people with disabilities and those in difficulty.
• Smarter services: wider use of facial recognition, QR-code, mobile and credit-based payments, with the goal of completing a convenient payment system within three years. Intelligent agents and a national smart customer service line will also be promoted.
• Easier reimbursement: expanding the types of insurance covered by direct settlement for out-of-town medical treatment, including maternity-related costs, and fully realizing cross-provincial mutual use of employee personal accounts to strengthen family mutual aid.

Fund Supervision: Tighter Oversight

Fund safety and sustainability underpin the system. The plan sets out a supervision framework described as combining leniency and strictness, addressing both symptoms and root causes, and using comprehensive measures across multiple levels. The NHSA will focus on three areas: cracking down on fraud to reinforce a deterrent; using technology to build denser oversight; and addressing root causes to build a long-term mechanism.

Specifically, the plan aims for on-site inspections to cover all designated medical institutions nationwide. National flight inspections will cover all provinces each year and all prefecture-level cities over five years; provincial flight inspections will cover all prefecture-level cities each year and all counties over five years. Big-data supervision models will be expanded, with a goal of forming a model matrix covering the entire chain, cycle and multiple scenarios of fund use within five years. The plan also aims for full coverage of pre-event reminders at designated institutions so that irregularities are eliminated early.

Practical Takeaways for Foreign Founders

For foreign founders, the plan is a signal of policy direction rather than a set of immediate compliance obligations. The key points to watch are the balanced funding responsibilities among individuals, employers and government; the move toward provincial-level pooling by 2029; the expansion of commercial insurance as a supplement; and tighter supervision of medical funds. Companies operating in China should follow how local implementing rules develop, particularly on employer contributions and on the rollout of digital payment and settlement services.

Foreign founders can contact ChinaMNC on WhatsApp / WeChat at +86 153 1898 8535 for help registering and operating a company in China.

This summary is based on information published by the relevant Chinese government website and is general information, not legal or tax advice.