China recovers $4.95b in medical insurance funds in 2025
By Zou Shuo | chinadaily.com.cn | Updated: 2026-03-16 18:25
China's healthcare security administration recovered 34.2 billion yuan ($4.95 billion) in medical insurance funds in 2025, according to a statistical report released Monday by the National Healthcare Security Administration.
The recovery included 27.8 billion yuan identified and reclaimed through insurance verification channels, with 1,626 medical institutions found guilty of insurance fraud, the administration said. Collaborating with public security authorities, the department investigated 3,776 cases, leading to the arrest of 10,357 suspects.
Whistleblower tips led to the recovery of 2.74 billion yuan, with about 1.56 million yuan paid out in rewards, the administration said.
By the end of 2025, basic medical insurance covered over 1.33 billion people in China, an increase of 4.06 million from the previous year, maintaining a coverage rate of 95 percent. The basic medical insurance fund, including maternity insurance, recorded total revenue of 3.59 trillion yuan and total expenditure of 3 trillion yuan.
Outpatient services reached 7.22 billion visits in 2025, a 25.51 percent increase from the previous year, while inpatient services totaled 278 million visits, down 3.4 percent. The coverage rate for low-income rural residents and those lifted out of poverty remained above 99 percent. The three-tier system of basic medical insurance, serious illness insurance, and medical assistance benefited more than 246 million low-income rural residents, reducing their medical expenses by about 193 billion yuan.
Cross-provincial direct settlement of hospitalization expenses reached 15.82 million visits, with the fund paying 162 billion yuan, marking a 10 percent increase in visits and a 2 percent increase in fund payments year-on-year. Cross-provincial direct settlement of outpatient expenses reached 292 million visits, with the fund paying 45.5 billion yuan, up 30 percent in visits and 26 percent in fund payments.
Maternity insurance coverage reached almost 260 million people by the end of 2025, an increase of 6.66 million. The fund paid about 136 billion yuan in maternity benefits to more than 35 million recipients.
The national reimbursement drug list added 114 drugs in 2025. Since the establishment of the National Healthcare Security Administration in 2018, eight consecutive annual adjustments have added 949 drugs to the list. The 11th round of national centralized drug procurement covered 55 drugs.
