Summary of Key Points
The Medical Security Law has been officially passed after three rounds of deliberation and will come into effect on January 1, 2027. This marks the first high-level legislation in the field of medical insurance in our country, ending the previous fragmentation of medical insurance regulations and signaling a transition from policy-based regulation to legal protection. The law consists of 7 chapters and 56 articles, focusing on aspects such as improving the national medical insurance system, optimizing public services, and standardizing fund management. It addresses issues of concern to the public, including participation in insurance by flexible employees, settlement of medical expenses in different regions, long-term care insurance, and the security of the insurance funds.
1. Finally, a Fundamental Law for Medical Insurance: Ending the Era of Fragmentation
Previously, medical insurance regulations were scattered across various policies and administrative rules, lacking authority and prone to implementation flaws. This new law serves as the overarching framework for medical insurance, consolidating established practices. For example, the National Medical Insurance Administration had planned to establish "1 law + 3 regulations + 3 rules" since 2019. After several years of research and public consultation, the law was approved in the first round of deliberations in 2025 and the second round in 2026, providing a more stable and authoritative basis for medical insurance governance.
2. The Addition of "National" Enhances Protection for Flexible Employees and Vulnerable Groups
The term "national" has been added to the description of the "multi-level medical security system," reflecting a shift from a mere "system arrangement" to a legally mandated right for all citizens. This means that every citizen is entitled to medical insurance, and the state has the obligation to provide it:
- Flexible Employees: The Social Insurance Law previously only allowed flexible employees to opt into employee medical insurance, but now it encourages them to do so, with more favorable reimbursement rates. For instance, delivery riders and freelancers, who might have been limited to resident medical insurance with lower benefits, are now encouraged to participate in employee medical insurance, and the State Council has been authorized to develop specific measures to address their practical needs.
- Vulnerable Groups: Individuals in extreme poverty or receiving low-income subsidies can now participate in resident medical insurance with the government covering part of the personal contributions, ensuring they do not face financial barriers to receiving necessary medical care and preventing them from falling back into poverty due to illness.
3. More Considerate Medical Insurance Services: Facilitated Settlements in Different Regions and Legal Support for Long-Term Care
The law includes a dedicated chapter on medical security services, aiming to solve common issues for patients:
- Direct Settlement of Medical Expenses in Other Regions: Previously, patients had to pay out of pocket before seeking reimbursement for medical treatment in different regions. The law now requires the optimization of direct settlement services, allowing insurance to cover costs directly at designated hospitals outside the user's home region. The current rate of direct settlement for inpatient services across provinces exceeds 90%, and this will be expanded to more types of insurance and scenarios in the future.
- Long-Term Care Insurance: With the aging population, the care for elderly individuals with disabilities has become a significant issue. The inclusion of long-term care insurance in the law means that this initiative has been elevated from a local pilot to a national standard. In the future, the costs of caring for such individuals can be covered by insurance, reducing the financial burden on families, for example, by covering the costs of hiring caregivers or staying in nursing homes.
4. Proper Management of "Lifesaving Funds": Combating Fraud and Lowering Drug Prices through Centralized Procurement
Medical insurance funds are essential for people's healthcare needs. The law focuses on ensuring the effective and responsible use of these funds:
- Combating Fraud: It clarifies that fraud (such as forging medical records or prescribing unnecessary medications) will result in the return of funds and fines of 2 to 5 times the amount defrauded. Both hospitals, pharmacies, and individuals responsible for fraud will be held accountable, deterring such behavior.
- Centralized Procurement to Lower Drug Prices: The law establishes a system for the centralized procurement of drugs and medical supplies, allowing for better negotiation with pharmaceutical companies and resulting in lower prices. For example, the cost of heart stents has been reduced significantly through such efforts.
- Scientific Payment Methods: Different payment methods are used for different types of medical services to prevent excessive testing and treatment by hospitals, thereby avoiding waste of funds. Decisions are made with input from doctors, companies, and insured individuals to ensure that policies reflect practical realities.
The introduction of this law not only standardizes the medical insurance system but also addresses the real needs of the public. Whether it's flexible employees seeking to enroll in insurance, patients seeking reimbursement for medical treatment in different regions, or elderly individuals in need of care, there is now legal protection in place, providing greater peace of mind and convenience.