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

Xinhua News Agency Reporters Peng Yunjia and Xu Penghang

The “per capita financial subsidy standard for residents’ medical insurance 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 yet another warm “addition” on the medical insurance ledger.

Reviewing China’s recent medical insurance reform practices, a series of “additions and subtractions” are becoming clearer: increasing fiscal investment, expanding drug lists, and broadening coverage, while streamlining procedures, reducing inflated drug prices, and lowering the burden on the public.

Making new and good medicines more accessible.

On January 1, 2026, the new version of the National Medical Insurance Drug List was officially implemented. Among the 114 newly added medicines, including Lu Kang Sa Tu Zhu for treating triple-negative breast cancer and the new lipid-lowering drug Inxilan Sodium, 50 are innovative drugs, reaching a record 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 treatments such as CAR-T and TCE therapies, as well as drugs for rare diseases like Gaucher’s disease and treatments for Alzheimer’s disease.

With a new batch of nationally centralized procurement medicines being rolled out nationwide, the national drug procurement coverage now includes 490 medicines. Over the years, procurement rules have been continuously refined and optimized. Through policy innovations, these “additions” help enterprises improve efficiency and reduce burdens on the public.

Enhancing social security.

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

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

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 exceeds 50%, and the scope of cross-provincial direct settlement has expanded from inpatient to outpatient services and to 10 outpatient chronic and special diseases such as hypertension and diabetes. Coverage continues to grow.

Making medical insurance services more convenient.

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

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

By doing “additions,” we expand and improve people’s livelihood benefits; by doing “subtractions,” we reduce medical burdens and improve efficiency for the public. These are in line with the series of initiatives proposed in this year’s government work report, such as “improving a multi-layered healthcare security system,” “optimizing centralized drug procurement and pricing governance,” and “accelerating the development of commercial health insurance,” aiming to better meet the diverse medical and medication needs of the public.

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