Seeing the Real Value Behind Fluctuations in Annual Medical Insurance Statistical Data

The National Healthcare Security Administration released the “2025 Medical Security Development Statistical Bulletin” on the 16th, showing that by the end of 2025, the number of people enrolled in basic medical insurance reached 1,330,681,400, an increase of 4.06 million year-on-year, with the participation rate remaining steady at 95%, and the operation of the medical insurance fund remaining stable.

By the end of 2025, 385.607 million employees and 942.1208 million residents were covered by medical insurance, with the insurance structure becoming more optimized. In 2025, the total income of the basic medical insurance fund (including maternity insurance) was 3.587311 trillion yuan, and the total expenditure was 3.000938 trillion yuan. In 2025, outpatient benefits were enjoyed by 7.215 billion people, a year-on-year increase of 25.51%. Hospitalization benefits were enjoyed by 278 million people, a decrease of 3.40% year-on-year.

Although some annual insurance data show little fluctuation, careful analysis reveals significant progress. For example, the nationwide basic medical insurance participation rate has remained steady at 95% for many years. While this figure is relatively fixed, the structure of participation continues to change. In 2021, 354 million employees and 1 billion residents were covered (resident insurance far exceeds employee insurance). By 2025, the numbers are 389 million employees and 942 million residents. It’s important to note that the保障水平 (coverage level) of employee insurance is significantly higher than that of resident insurance, and as the participation structure continues to optimize, the保障力度 (protection strength) will also increase.

Some data show substantial changes, reflecting significant improvements in related保障能力 (protection capacity). For example, in cross-province and out-of-town medical treatment, the number of inpatient cross-province settlements increased by over 11 million compared to 2021. In outpatient cross-province settlements, there were 9.496 million cases in 2021 (pilot program only), rising to 292 million in 2025. The data on cross-province out-of-town medical treatment shows exponential growth, indicating that after the implementation of a nationwide unified medical insurance information platform and other convenient measures, cross-province out-of-town medical treatment has transformed from bottlenecks into accessible pathways, providing great convenience especially for retirees relocated out of town, migrant workers, and accompanying elderly.

Some data have emerged from nothing, corresponding to new or strengthened医保福利 (medical insurance benefits). The most典型 (typical) example is that by the end of 2024, 31 provinces had included assisted reproductive technology into their medical insurance; from 2025 onwards, all provinces have done so. Last year, a total of 3.2397 million people received assisted reproductive treatment covered by insurance, benefiting 1.6018 million people. In just one year, assisted reproductive services have expanded from pilot programs to nationwide coverage, demonstrating the policy commitment of医保 (medical insurance) to reducing fertility costs. Additionally, measures such as including childbirth pain relief in insurance and direct distribution of maternity allowances to individuals mark a shift from purely medical treatment to building a fertility-friendly society.

Some data show sharp short-term increases, aimed at sustaining overall positive trends. For example, in fund supervision, 27.5 billion yuan was recovered in 2024, rising to 34.2 billion yuan in 2025. Moreover, supervision methods have shifted from large-scale on-site inspections to precise, full-chain tracking using big data and drug traceability codes. In 2025, the national medical insurance information platform collected over 100 billion traceability codes, using big data to combat drug return flows and smart supervision to recover 3 billion yuan in losses. With proper use of big data and intelligent tools, the recovery of医保 (medical insurance) funds is expected to reach a turning point of rapid growth, ensuring greater security for “life-saving funds.”

Compared with recent years’ annual medical insurance data, we can see not only the many benefits brought by data changes but also the progress in medical management and technology, as well as the steady pace of healthcare system reform. The underlying significance of the fluctuations in annual data is inspiring, but what is even more commendable is the vitality implied by these data changes, which will undoubtedly lead to continuous and steady improvements in医保福利 (medical insurance benefits) and medical convenience.

Text by Luo Zhihua