China plans to expand cover for childbirth-related bills

China aims to broaden insurance coverage for childbirth-related medical expenses and strengthen support for pharmaceutical innovation in the coming year, according to the National Healthcare Security Administration.

The goals were outlined in a report delivered by Zhang Ke, director of the administration, at its annual work conference on Saturday. The report reviewed progress in healthcare security during the 14th Five-Year Plan period (2021-25) and detailed priority areas for 2026.

To adapt to demographic shifts marked by declining birth rates and a rapidly aging population, the report said maternity insurance coverage for prenatal checkups will be reasonably expanded within the financial capacity of the insurance fund.

Authorities will explore the creation of a basic service package that incorporates prenatal examinations, aiming to ease the financial burden on families.

By next year, the goal is to achieve nationwide full reimbursement for all policy-covered medical expenses related to childbirth, enabling insured expectant mothers to incur almost no out-of-pocket costs for covered services.

Additional expenses, such as those for premium hospital wards or medications not included in the reimbursement list, will remain uncovered.

So far, seven provincial-level regions, including Jilin, Jiangsu and Shandong provinces, have implemented policies that make childbirth nearly free of charge.

The administration said the number of women enrolled in the national maternity insurance program has risen to 255 million, and all regions have included fertility treatment in their basic health insurance plans.

Nearly 95 percent of fund pooling regions now distribute fertility subsidies directly to beneficiaries' personal accounts rather than through employers.

For the coming year, authorities will promote participation among flexible workers, migrant workers and individuals in new forms of employment in maternity insurance, while exploring the feasibility of extending coverage to nonemployed urban and rural residents.

All provincial-level regions will be required to cover eligible labor pain relief procedures under insurance and further implement and refine reimbursement policies for assisted reproductive technology services.

To assist the 220 million people aged 65 and older — who make up 15.6 percent of China's total population as of end of 2024 — the report called for the further development of the long-term care insurance program, which currently covers about 300 million people, and encouraged commercial insurers to develop related products.

Addressing demographic challenges was also among the priorities set by the annual two-day Central Economic Work Conference that concluded on Thursday. The conference emphasized expanding rehabilitative care services, advancing the long-term care insurance program, and strengthening care and support for vulnerable groups.

The meeting also stressed the importance of promoting positive views on marriage and childbearing and striving to stabilize the newborn population.

The healthcare security report also underscored stepped-up support for innovative drugs and emerging healthcare technologies.

Over the past five years, 949 medicines were added to the national reimbursement drug list, bringing the cumulative total to 3,253.

In the latest update released earlier this month, a record 50 first-in-class novel drugs were added, accounting for nearly half of the 114 newly included products.

At the same time, the administration issued the country's first commercial insurance innovative drug list, covering 19 medicines with significant clinical value, high innovation levels and substantial patient benefits.

The report called for active implementation of the commercial drug list and encouraged commercial health insurers to cover more reasonable medical expenses outside the basic insurance catalog. Commercial insurers will also be mobilized to increase investment in innovative drugs to support research and development.

To further foster innovation, the report highlighted the need to leverage medical insurance's strategic purchasing role, guide the industry toward healthy competition and differentiated innovation, and improve multichannel payment mechanisms for innovative drugs.

The rapid development of artificial intelligence and other smart technologies also presents opportunities to build a more digital healthcare security platform and establish an evaluation system using real-world data to comprehensively assess the value of insurance-covered medications.

Authorities will support local governments in launching competitions for healthcare security application scenarios involving advanced technologies such as multimodal AI-assisted diagnosis and noninvasive brain-computer interfaces.

Official data show the national basic medical insurance coverage rate has remained stable at about 95 percent over the past five years, with total expenditures exceeding 13 trillion yuan ($1.82 trillion). Flexible workers, migrant workers and individuals in new forms of employment have increasingly been supported to enroll.

During this period, China carried out eight rounds of centralized drug procurement covering treatments for diabetes, cancer, bacterial infections and other common chronic diseases, as well as four rounds of bulk purchasing for high-value medical consumables such as artificial joints, intraocular lenses and cochlear implants.

Local authorities recovered about 120 billion yuan in misused insurance funds and prevented an additional 9.5 billion yuan in losses by using big data and smart monitoring tools. The introduction of drug traceability codes has strengthened efforts to crack down on drug resale and fraudulent reimbursement.