National Healthcare Security Administration Announces Nationwide Pilot for Real‑World Medical‑Insurance Value Evaluation

The National Healthcare Security Administration (NHSA) today issued a notice outlining a multi‑city pilot program designed to establish a real‑world comprehensive value evaluation framework for medical insurance. The initiative will roll out across 13 pilot regions—including Haidian District (Beijing), Dalian (Liaoning), Nanjing & Suzhou (Jiangsu), Hangzhou & Wenzhou (Zhejiang), Xiamen & Sanming (Fujian), Shenzhen (Guangdong), Hainan, Chongqing, Chengdu (Sichuan), Xi’an (Shaanxi), and Lanzhou (Gansu)—with the goal of scaling the system nationwide by the end of 2027.

Three‑Stage Implementation Roadmap

1. Initiation Stage (by 2025‑end) – Pilot regions will draft norms for real‑world value assessment, establish data‑governance protocols, attract multidisciplinary talent, and form dedicated evaluation teams.
2. Implementation Stage (2026) – Local databases will be built to meet national unified standards. Separate evaluations will be conducted for pharmaceuticals, medical consumables, and medical services, producing preliminary results for NHSA submission by the end of 2026.
3. Application Stage (2027) – Findings will be prioritized for use in medical‑insurance decision‑making, operational mechanisms will be refined, and national credible evaluation sites will be selected for ongoing, regular assessment tasks.

Why It Matters

• Data‑Driven Decision Making – By integrating real‑world evidence, the NHSA aims to create a value‑oriented system that aligns reimbursement with actual clinical benefit and cost‑efficiency.
• Cross‑Regional Benchmarking – The diverse geographic mix—from coastal tech hubs to inland provinces—provides a robust test bed for identifying best practices and scalable solutions.
• National Roll‑Out Blueprint – Successful pilots will serve as templates for a nationwide framework, potentially reshaping how China evaluates and funds healthcare services.

Expected Outcomes

• Standardized Metrics – Uniform indicators for pharmaceuticals, consumables, and services will enable transparent, comparable assessments.
• Policy Influence – Early adopters will leverage evaluation results to inform coverage decisions, price negotiations, and policy reforms.
• Continuous Improvement – The pilot framework will evolve through iterative feedback, ensuring that the system remains responsive to emerging medical technologies and market dynamics.-Fineline Info & Tech