Millions Drop Out of Key Health Insurance Plan in China
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China’s public health-insurance program for its vast urban and rural population shed nearly 16 million members last year, marking a sixth straight year of decline and exposing deepening fissures in the nation’s social safety net, according to official data released Monday.
The sharp drop in enrollment, coupled with growing demographic and financial pressures on a separate insurance fund for salaried employees, raises critical questions about the long-term sustainability of China’s health care financing. For Beijing, the health of the system is a key indicator of the state’s fiscal capacity to manage a rapidly aging society.
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- China’s public health-insurance program lost nearly 16 million members in 2024, with the residents’ program enrollment dropping to 947 million.
- The fund’s annual surplus fell by 40.04 billion yuan, and deficits appeared in major cities, raising concerns over long-term sustainability as the population ages.
- Authorities implemented cost-control reforms, recovered 27.5 billion yuan in misused funds, and over 90% of hospital discharges are now reimbursed on a per-case basis.
- 2023：
- The national fund’s annual surplus was less by 40.04 billion yuan compared to this year's surplus.
- 2023：
- Deficit emerged in Suzhou in the residents’ program.
- 2024：
- China’s public health-insurance program for urban and rural populations lost nearly 16 million members, marking the sixth straight year of decline.
- 2024：
- Residents’ medical-insurance program enrollment fell by 15.8 million to 947 million.
- 2024：
- Deficits emerged in major municipalities and cities including Beijing and Tianjin in the residents’ program.
- 2024：
- The ratio of active workers paying into the urban employees’ fund for every retiree dropped to 2.63, down from 2.71 in 2023.
- 2024：
- The urban employees’ insurance program covered 379.5 million people, a 2.3% increase from 2023.
- 2024：
- China’s basic medical insurance funds collected 3.49 trillion yuan and paid out 2.98 trillion yuan.
- 2024：
- The national medical-security system recovered 27.5 billion yuan in misappropriated funds; authorities investigated 2,008 institutions for fraud and arrested 10,741 suspects in insurance-related cases.
- 2024：
- Over 90% of hospital discharges were paid for on a per-case basis under payment reform efforts.
- End of 2024：
- China’s overall health-insurance participation rate remained stable at 95%, covering 1.33 billion people.
- 2025-07-14：
- Official data regarding the decline in China’s public health-insurance program enrollment and system finances was released by the National Healthcare Security Administration.
- CX Weekly Magazine
Jul. 18, 2025, Issue 27
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