According to a report released on the 16th via the National Healthcare Security Administration's official WeChat account, China's basic medical insurance system saw continued growth and optimization in 2025.
By the end of 2025, the number of people enrolled in basic medical insurance reached 1.33068 billion, an increase of 4.06 million compared to the previous year. The enrollment rate remained stable at 95%. The structure of enrollees improved, with 388.56 million covered by employee medical insurance and 942.12 million by resident medical insurance.
In 2025, the total revenue and expenditure of the basic medical insurance fund (including maternity insurance) were 3.587311 trillion yuan and 3.000938 trillion yuan, respectively. Revenue for employee basic medical insurance (including maternity insurance) reached 2.464671 trillion yuan, while expenditure was 1.935231 trillion yuan. For resident basic medical insurance, revenue stood at 1.122640 trillion yuan, with expenditure at 1.065707 trillion yuan.
Outpatient services were utilized 7.215 billion times, a year-on-year increase of 25.51%. Employee outpatient visits grew by 30.28% to 3.849 billion, while resident outpatient visits rose by 20.47% to 3.366 billion. In contrast, inpatient treatments decreased by 3.40% to 278 million. Employee inpatient treatments increased by 3.77% to 85 million, while resident inpatient treatments fell by 6.27% to 193 million. The average cost per inpatient admission was 8,509.28 yuan, with employee admissions averaging 11,152.69 yuan and resident admissions averaging 7,338.49 yuan.
By the end of 2025, maternity insurance enrollment reached 259.6574 million, an increase of 6.6623 million year-on-year. Maternity insurance fund expenditure totaled 135.965 billion yuan, benefiting 35.3449 million individuals. This included 3.9964 million female employees and 195,600 spouses of male employees receiving benefits. Services included 24.2665 million prenatal check-ups, 3.8713 million hospital deliveries, and 4.8064 million recipients of maternity allowances. Direct payment of maternity allowances to individuals was essentially achieved nationwide.
Starting January 1, 2025, all provinces included suitable assisted reproductive technologies, such as egg retrieval, embryo culture, sperm retrieval, and artificial insemination, within medical insurance coverage. Thirty provinces also incorporated labor analgesia. Throughout the year, assisted reproductive treatments covered by insurance were provided 3.2397 million times, benefiting 1.6018 million people.
Enrollment in long-term care insurance reached 308.5444 million in 2025, with 1.8813 million individuals receiving benefits.
Approximately 77.394 million people in 25 provinces formerly targeted by poverty alleviation efforts received premium subsidies, with 164.9 billion yuan spent on subsidized enrollment. The enrollment rate for low-income rural and formerly impoverished populations remained above 99%. The triple system of basic medical insurance, critical illness insurance, and medical assistance benefited rural low-income individuals 246.293 million times, reducing medical cost burdens by 193.39 billion yuan.
By the end of 2025, 655,800 medical institutions and retail pharmacies were connected for cross-province direct settlement, including 241,800 medical institutions and 414,000 retail pharmacies. Cross-province direct settlement for inpatient costs involved 15.823 million instances, with fund payments of 162.005 billion yuan, representing increases of 10.38% and 2.10%, respectively. Cross-province outpatient settlement reached 292 million instances, with fund payments of 45.501 billion yuan, up 30.17% and 26.21% year-on-year.
The 2025 National Drug Reimbursement List included 3,253 Western and Chinese patent medicines, along with 892 types of Chinese herbal decoction pieces. Since 2018, 949 drugs have been added through dynamic adjustments, including 114 new additions in 2025. Negotiated drugs within agreement periods were reimbursed over 240 million times.
The Diagnosis-Intervention Packet (DIP) 2.0 payment model was fully implemented, covering over 95% of short-term inpatient cases and more than 80% of inpatient pooled funds. All regions established five supporting mechanisms, and over 95% completed biannual data releases. All provinces initiated cross-region DIP payments within their jurisdictions.
Price reforms advanced with 39 batches of medical service price guidelines issued, promoting national standardization. Dynamic adjustment mechanisms were activated in 23 provinces. Six batches of drug and medical consumable price risk assessments were conducted, involving discussions with 487 drug and 104 consumable manufacturers.
The 11th national centralized drug procurement covered 55 drugs, while the 6th national high-value consumables procurement included 12 types. Three provinces led renewal procurement for 316 drugs from previous rounds. Total online procurement orders via provincial platforms reached 969.8 billion yuan, involving 4,390 enterprises and 82,014 medical institutions. Drugs within the reimbursement list accounted for 900.9 billion yuan, or 93% of total orders.
In 2025, 6,865 commercial bribery case leads were processed, with seven batches communicated to provinces. By year-end, 1,236 enterprises were rated as dishonest, including 62 as "severely dishonest," 91 as "seriously dishonest," and 1,083 as "dishonest."
A total of 34.2 billion yuan in insurance funds was recovered, including 27.8 billion through audits. Investigations confirmed 1,626 fraudulent institutions, with 1,678 referred to judicial authorities, 19,000 to disciplinary agencies, and 59,000 to health administrations. Joint operations with police resulted in 3,776 cases and the arrest of 10,357 suspects. Intelligent monitoring subsystems recovered 3 billion yuan. Whistleblower rewards totaled 15.58 million yuan, leading to the recovery of 2.74 billion yuan.
The national insurance platform collected 100.182 billion drug traceability codes from medical institutions and integrated 44.307 billion codes from production and distribution. Over 3,572 enterprises uploaded and downloaded traceability data. A public query function recorded over 5 million daily searches. Crackdowns on resold drugs investigated 240,000 suspicious leads, inspected 124,700 institutions, penalized 39,100 entities, and solved 695 cases with 2,576 arrests.
During the "14th Five-Year Plan" period, insurance fund expenditures totaled 13.66 trillion yuan, supporting healthcare access and pharmaceutical industry development. Reforms expanded family sharing of personal accounts, which utilized 68.77 billion yuan in 2025. Direct settlement with manufacturers averaged 30-day payment cycles for procured items. A medical imaging cloud system collected 313 million data indexes and enabled cross-province access.
Measures to support innovative drug development were issued, accelerating market-to-reimbursement timelines. Negotiated drugs since 2018 generated over 700 billion yuan in sales, with insurance covering 480 billion yuan. A commercial insurance innovative drug directory included 19 high-value drugs, nine of which were first-in-class. A national drug price registration system launched in December 2025, issuing price certificates for 15 companies, facilitating global expansion. Regional platforms in Guangxi, Xinjiang, and Tianjin promoted international medical trade.
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