China is directing a greater share of newly added national medical insurance funds towards primary healthcare institutions as part of efforts to reduce patients' out-of-pocket costs and strengthen community-level healthcare.
A joint guideline issued by the National Healthcare Security Administration and two other government departments calls for newly added annual medical insurance funds to be allocated increasingly to primary healthcare institutions and community hospitals, reported China Daily.
The move aims to address an imbalance in China’s healthcare system, where major hospitals face heavy patient loads while community-level facilities have comparatively fewer resources, medications and incentives to provide basic care.
Under the guideline, reimbursement for outpatient services under the resident medical insurance programme will be no less than 50%, which authorities expect will encourage patients to seek treatment at primary healthcare facilities and reduce their out-of-pocket expenses.
Primary healthcare institutions will also be allowed to prescribe medicines for up to 12 weeks to eligible patients with chronic conditions, enabling stable patients to obtain up to three months of medication during a single visit.
China had 1.06m primary healthcare institutions and 5.25m grassroots healthcare workers by the end of 2025. Visits to primary healthcare institutions reached 5.56bn last year, accounting for 52.6% of total patient visits nationwide.
The guideline also provides for surplus medical insurance funds within county-level medical consortia to be directed primarily towards grassroots medical institutions and frontline healthcare workers.
Under the revised payment approach, county-level institutions will focus on more severe and complicated cases, while community clinics will primarily handle common and chronic diseases, rehabilitation and nursing services.
Authorities will also use China's centralised drug procurement programme to improve supplies of common and chronic medicines at primary care facilities. Primary healthcare institutions will additionally be supported in adopting facial recognition technology to facilitate medical insurance payments and settlements.
The National Healthcare Security Administration plans to select 15 pilot regions to test the new approach and identify practices that could subsequently be expanded nationwide.
The changes form part of China's broader effort to strengthen primary healthcare and encourage residents to obtain treatment closer to home, while easing pressure on larger hospitals and reducing healthcare costs for patients.