China Responds to '83 Million Drop in Resident Medical Insurance Enrollees': Multiple Factors at Play

In response to claims that 'the number of people enrolled in resident medical insurance has fallen for seven consecutive years, with a cumulative decrease of 83 million,' an official from China's National Healthcare Security Administration said this is caused by multiple factors, including efforts to eliminate duplicate enrollments, residents switching to employee medical insurance, and the continuous decline in the total population, and that it 'represents a reasonable and normal decline.' According to reports from Beijing Daily and China News Service, at a media briefing held on Thursday (November 5), Zhang Chenguang, deputy director of the Planning, Finance and Regulations Department of the National Healthcare Security Administration, said that in 2026 China's basic medical insurance enrollment is generally stable with growth, and as of the end of September, the number of people enrolled in basic medical insurance was 1.328 billion, including 391 million in employee medical insurance and 937 million in resident medical insurance.

Zhang Chenguang said that enrollment in the first three quarters of this year has already exceeded the full-year level of 2024, and enrollment figures for January to October are still being compiled and are expected to reach the full-year level of 2025. 'It can be judged that enrollment this year will definitely exceed last year's.' Regarding the recent public claim that 'from 2019 to 2025, the number of resident medical insurance enrollees fell for seven consecutive years, with a decrease of 83 million,' Zhang Chenguang said that, apart from the issue of uninsured persons that has drawn public attention, the decline in enrollment is caused by multiple factors.

Zhang Chenguang explained that when the National Healthcare Security Administration was first established, a unified medical insurance information platform had not yet been built, and at that time the integration of urban and rural resident medical insurance was still underway, with some duplicate enrollments existing in various localities.

Starting in 2019, the administration began focusing on eliminating duplicate enrollments.

From 2019 to 2024, about 25 million invalid duplicate enrollment records were cleaned up nationwide at the resident medical insurance level, which is an important reason for the decline in enrollment.

He also mentioned that another important reason is that each year a considerable number of resident medical insurance enrollees switch to employee medical insurance through employment.

From 2019 to 2025, the number of employee medical insurance enrollees increased from 329 million to 389 million, a net increase of 60 million, and a large part of that 60 million came from transfers out of resident medical insurance.

Zhang Chenguang also said that the decline in the resident population is an important reason.

China's total population continued to decline from 2022 to 2025, and the reduction in births directly affects the pool of future enrollees. 'The decline in the number of resident medical insurance enrollees is consistent with the trend of change in China's total population and adapted to the optimization of the enrollment structure; it is a reasonable and normal decline.' In addition, the Law of the People's Republic of China on Medical Security was passed in August this year and will take effect in January next year.

This law, for the first time in legal form, clarifies that citizens have the right and obligation to participate in basic medical insurance in accordance with the law.

Zhang Chenguang said that efforts to encourage medical insurance enrollment will be more standardized.

This year, the National Healthcare Security Administration directly addressed issues frequently raised by the public, such as increasing the burden on grassroots levels, and made clear that hard enrollment targets must not be imposed on villages (communities), that layer-upon-layer target escalation and frequent ranking-based notifications must not be used, and that enrollment or payment must not be forcibly tied to access to other benefits and services.

According to the introduction, other Chinese departments will also provide more convenient policies.

Zhang Chenguang mentioned that tax authorities will promote models such as one-time lump-sum payment of enrollment fees by university students, and will allow qualified regions to collect payments through banks and other withholding arrangements.