China is rolling out a series of targeted updates to its national medical insurance framework, designed to shore up the development of under-resourced primary healthcare systems across the country, a senior official from the National Healthcare Security Administration (NHSA) announced during a Friday press briefing.
Xu Na, deputy director of the NHSA’s Department of Medical Service Management, explained that the new policy direction comes from a joint guideline published one month prior by three top national regulators: the NHSA, the National Development and Reform Commission, and the National Health Commission. The document outlines a full slate of coordinated support measures aimed at strengthening grassroots medical institutions and expanding access to high-quality, easily accessible care for the general public.
Among the key adjustments laid out in the guideline are provisions to gradually increase the share of national medical insurance fund spending directed to primary-level care facilities, revise outpatient reimbursement formulas to favor grassroots providers, roll out customized payment system reforms aligned with the unique needs of primary care, resolve persistent gaps in pharmaceutical access, and integrate smart digital tools to streamline patient experiences.
A concrete and significant requirement in the new framework mandates that the basic medical insurance reimbursement rate for outpatient services delivered at primary medical institutions must meet or exceed 50 percent, a threshold designed to incentivize patients to seek routine care at local grassroots facilities rather than overcrowded large urban hospitals.
To address widespread shortages of essential medications at the community and township level, authorities will leverage the national centralized drug procurement program to guarantee a stable supply of common medications and chronic disease treatments at primary care sites. Additionally, the policy supports grassroots institutions in rolling out biometric technology, including facial recognition devices, to cut down wait times for payment and insurance claim processing.
To refine the rollout and identify effective implementation strategies, the NHSA will select approximately 15 regional pilot sites to test the new policy package. Data and best practices gathered from these pilots will be used to develop replicable models that can be scaled out across all regions of China in the coming years.