From Basic to Excellent: The "Addition and Subtraction" in Medical Insurance Accounts

Xinhua News Agency, Beijing, March 14 — Title: From Basic to Excellent: The “Addition and Subtraction” in the Medical Insurance Ledger

Xinhua News Agency reporters Peng Yunjia and Xu Penghang

“The per capita financial subsidy standard for residents’ medical insurance has increased by 24 yuan” was included in this year’s government work report. From 450 yuan in 2017 to 724 yuan in 2026, the fiscal subsidy standard for residents’ medical insurance has steadily increased for ten consecutive years.

This is another warm “addition” on the medical insurance ledger.

Reviewing China’s recent medical insurance reform practices, a set of “additions and subtractions” becomes increasingly clear: adding fiscal investment, drug lists, and coverage scope; subtracting administrative procedures, inflated drug prices, and public burdens.

Making new and good medicines more accessible.

Starting January 1, 2026, the new version of the National Medical Insurance Drug List was officially implemented. From the treatment of triple-negative breast cancer with Luksan Satozumab to the new lipid-lowering drug Enkexilan Sodium… Among the 114 newly added medicines, 50 are innovative drugs, setting a new high in number. A batch of urgently needed “life-saving drugs” has been included in the insurance through negotiations, reducing patients’ medication costs.

Meanwhile, the first edition of the Commercial Insurance Innovative Drug List was implemented simultaneously, supporting the construction of a multi-layered healthcare security system. The list includes targeted tumor therapies such as CAR-T and TCE, as well as drugs for rare diseases like Gaucher’s disease and treatments for Alzheimer’s disease.

With a new batch of nationally pooled medicines being rolled out across the country, the national organized drug procurement now covers 490 medicines. Over the years, procurement rules have been continuously iterated and optimized. Through policy innovations as “additions,” this has helped enterprises increase efficiency and reduce burdens on the public.

Enhancing social security.

At the beginning of 2026, a piece of good news warmed many mothers: nationwide, maternity allowances are now directly paid to individuals. Streamlining intermediate steps, the maternity benefits reach families directly.

From including eligible assisted reproductive technology projects in medical insurance payments, to 11 provinces achieving full coverage of inpatient delivery costs within policy scope, and many regions including labor analgesia in insurance reimbursements, a series of tangible measures are continuously lowering families’ medical costs for childbirth, giving them more confidence.

Basic medical insurance is steadily upgrading toward “more balanced, higher quality, and more considerate” protection. Currently, the reimbursement rate for inpatient expenses within the scope of China’s residents’ medical insurance policy is about 70%, outpatient medication reimbursement within policy scope exceeds 50%, and the scope of cross-provincial direct settlement has expanded from inpatient to outpatient and to 10 outpatient chronic and special diseases such as hypertension and diabetes. Coverage continues to expand.

Making medical insurance services more convenient.

With the deepening digital and intelligent transformation, medical insurance services are upgrading from “capable” to “better, faster, and easier” to operate.

Cross-provincial pooling of employee medical insurance personal accounts has accelerated, turning more “dormant” funds into “family health funds”; the construction of medical imaging cloud services is speeding up to solve problems like inconvenience in carrying films and cumbersome management when patients seek cross-hospital treatment; efforts are being made to promote facial recognition payments, QR code payments, mobile payments, and credit payments, so that paying for medical visits no longer involves long queues… A series of measures reduce procedural complexity and increase warmth in people’s lives.

Adding “additions” to expand and improve people’s well-being; subtracting “subtractions” to reduce burdens and improve efficiency in medical treatment. These are in line with the series of measures proposed in this year’s government work report, such as “improving a multi-layered healthcare security system,” “optimizing centralized drug procurement and price regulation,” and “accelerating the development of commercial health insurance,” all aimed at better meeting the diverse medical and medication needs of the public.

From full coverage to enhanced protection, these warm-hearted initiatives are continuously weaving and strengthening the world’s largest healthcare security network, safeguarding the health and happiness of thousands of families. (End)