In 2025, 34.2 Billion Yuan of Medical Insurance Fund Recovered, Basic Medical Insurance Participants Increased by 4.06 Million Year-on-Year

Image Source: National Healthcare Security Administration

DentalGoodNews | On March 16, 2026, the National Healthcare Security Administration (NHSA) released the "2025 Statistical Bulletin on the Development of Medical Security" (hereinafter referred to as the "Bulletin"). The data shows that in 2025, the number of outpatient benefit claims nationwide reached 7.215 billion, a year-on-year increase of 25.51%. The total revenue of the Basic Medical Insurance Fund (including maternity insurance) was 3,587.311 billion yuan, with total expenditures of 3,000.938 billion yuan during the same period.

By the end of 2025, the number of people covered by basic medical insurance was 1,330.6814 million, an increase of 4.06 million year-on-year, with the coverage rate stabilizing at 95%. Among them, 388.5607 million were covered by employee medical insurance, and 942.1208 million were covered by resident medical insurance.

Regarding outpatient services, employees claimed outpatient benefits 3.849 billion times, a year-on-year increase of 30.28%; residents claimed outpatient benefits 3.366 billion times, a year-on-year increase of 20.47%. Throughout the year, there were 278 million inpatient benefit claims, a year-on-year decrease of 3.40%, with an average cost per inpatient admission of 8,509.28 yuan.

Starting from January 2025, all provinces across the country have included suitable assisted reproductive projects within the scope of medical insurance payment. Throughout the year, a cumulative total of 3.2397 million treatment sessions were provided, benefiting 1.6018 million people. The number of people covered by long-term care insurance reached 308.5444 million, with 1.8813 million people receiving benefits.

The version 2.0 grouping scheme for Payment by Disease Type / Case-based Payment has been implemented in all coordinated regions nationwide. Over 95% of short-term inpatient cases are now paid under this model, with inpatient pooled fund coverage exceeding 80%.

In terms of fund supervision, in 2025, the national medical insurance system recovered 34.2 billion yuan of Medical Insurance Fund, identified 1,626 institutions involved in fraud and abuse, jointly investigated 3,776 cases with public security authorities, and apprehended 10,357 criminal suspects. According to a previous report by DGN, the NHSA has listed dentistry as one of the seven key areas for the 2026 Medical Insurance Fund Unannounced Audit.

The "National Basic Medical Insurance, Work-Related Injury Insurance, and Maternity Insurance Drug List (2025)" (hereinafter referred to as the "Drug List") includes a total of 3,253 Western and Chinese patent medicines. In 2025, 114 new drugs were added. This marks the eighth consecutive year of dynamic adjustments since 2018, with a cumulative total of 949 new drugs added.

The 11th batch of national volume-based procurement (VBP) covered 55 drugs. The 6th batch of national VBP for high-value Medical Consumables covered 12 types of consumables across two major categories: Drug-Coated Balloon | DCB and urological intervention. The total annual value of online procurement orders nationwide was 969.8 billion yuan.

In 2025, there were 15.823 million instances of cross-provincial direct settlement for inpatient expenses, a year-on-year increase of 10.38%. Cross-provincial direct settlement for outpatient services reached 292 million instances, a year-on-year increase of 30.17%. By the end of the year, the number of designated cross-provincial networked medical institutions and pharmacies reached 655.8 thousand. The "Bulletin" notes that outpatient benefit claim data are preliminary statistics.

National Healthcare Security Administration "2025 Statistical Bulletin on the Development of Medical Security" | March 16, 2026 | Data as of the end of 2025

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NHSA: Dentistry Listed as a Key Area for 2026 Medical Insurance Fund Unannounced Audit | DGN | February 2, 2026