China Moves Medical Insurance Funding Toward Primary-Level Healthcare
China has issued a new policy guideline to redirect medical insurance resources toward primary-level healthcare, aiming to improve access, affordability and continuity of care for residents. Jointly released by national health and economic authorities, the measures focus on funding allocation, reimbursement design and service delivery at grassroots facilities. According to the policy announcement, selected regions will pilot the reforms, with an emphasis on preventive care and easing pressure on large hospitals.
Redirecting funds to strengthen primary care
The guideline sets out 14 measures to support primary healthcare institutions, including changes to fund management and reimbursement policies. Newly added annual medical insurance funds will be appropriately tilted toward grassroots providers, a move intended to stabilise financing and encourage earlier intervention rather than hospital-based treatment.
“The move would ease concerns among primary-level institutions and encourage a shift from treatment-focused care to preventive healthcare.” — Zhang Liqiang, Director, Smart Data Department, Institute of Healthcare Security, Capital Medical University
Expanding access through designated grassroots facilities
Under the policy, the number of primary healthcare institutions designated under the medical insurance system will be expanded. At least one grassroots facility in each township or community will be designated to provide medical assistance services, enabling residents to access insured care closer to home.
Settlement procedures will also be streamlined to reduce cash-flow pressure on grassroots providers. In some regions, authorities will lower the proportion of deposit funds required from primary healthcare institutions, improving their operational sustainability.
Using reimbursement policy to guide patient pathways
The guideline promotes more favourable reimbursement for treatment at primary-level institutions. Differentiated reimbursement rates between hospitals of different levels will be expanded, with higher reimbursement ratios for inpatient care at grassroots facilities. Referral procedures will also be simplified to support continuity of care.
For example, patients transferred from higher-level hospitals to primary healthcare institutions for the same illness within a single treatment cycle will not be required to pay a new deductible. These measures are designed to guide patients to appropriate levels of care and ease congestion at major hospitals.
Improving convenience for chronic and vulnerable patients
Additional provisions allow eligible chronic disease patients to receive long-term prescriptions at primary healthcare facilities. The policy also supports a moderate expansion of the range and quantity of drugs available in rural clinics, addressing common access gaps outside urban centres.
“These measures both provide financial incentives for patients to seek care at the primary level and significantly improve convenience.” — Miao Yanqing, Researcher, Health Development Research Center, National Health Commission
Low-income residents, older people and patients with chronic conditions are expected to benefit most from the changes, reflecting a broader equity focus within China’s health system reforms.
Digital tools and pilot implementation
The guideline also encourages grassroots institutions to install payment facilities equipped with facial-recognition technology and to use intelligent assistants to provide round-the-clock online consultation. These steps align with wider national efforts to integrate digital tools into healthcare delivery, including work highlighted in China’s national AI healthcare strategy.
Authorities plan to select about 15 regions nationwide to pilot the policies and develop approaches that can be replicated elsewhere. The pilots will inform future scaling, alongside related international collaboration and research initiatives, such as those discussed in recent China-linked healthcare innovation partnerships.
