China’s National Healthcare Security Administration (NHSA) released its 2025 Healthcare Security Development Statistical Bulletin, revealing that Basic Medical Insurance (BMI) participation reached 1.33 billion people (coverage rate >95%), with fund inflows totaling RMB 3,587.3 billion (USD 520 billion) against expenditures of RMB 3,000.9 billion (USD 440 billion). The 2025 NRDL update added 114 new drugs, bringing total covered medicines to 3,253, while DRG/DIP payment reform now covers >95% of inpatient cases and inter-provincial direct settlement surged 30.17% for outpatient visits, demonstrating sustained universal health coverage expansion and cost control efficiency.
BMI Coverage and Fund Performance
Metric
2025 Result
Change (YOY)
Strategic Note
BMI Participants
1.33 billion
+4.06 million
>95% coverage rate maintained
Maternity Insurance
259.7 million
+6.7 million
Expanded social safety net
Fund Inflows
RMB 3,587.3 bn (USD 520 bn)
—
Sustainable revenue base
Fund Expenditures
RMB 3,000.9 bn (USD 440 bn)
—
83.6% inflow-to-outflow ratio
Maternity Benefits
RMB 136 bn (USD 19.7 bn)
—
Direct patient support
Fund Balance
RMB 586.4 bn (USD 85 bn)
—
Reserve for future obligations
Healthcare Utilization Trends
Service Type
2025 Volume
Change (YOY)
Implication
Outpatient Visits
7.215 billion
+25.51%
Shift to ambulatory care; COVID recovery; chronic disease management
Inpatient Visits
278 million
–3.40%
DRG/DIP cost control reducing unnecessary admissions
Average Inpatient Cost
RMB 8,509.28 (USD 1,233)
—
Cost containment stable
Low-Income Rural Access
246.3 million beneficiaries
—
Triple protection system (BMI + major illness insurance + medical assistance)
Expense Reduction
RMB 193.39 bn (USD 28 bn)
—
Catastrophic health expenditure protection
NRDL and Drug Access
Element
2025 Data
Strategic Impact
Total Covered Medicines
3,253
Comprehensive formulary
Western Medicines
1,857
Innovation access
Chinese Patent Medicines
1,396
Traditional medicine integration
Prepared Slices
892
Herbal medicine standardization
New Drugs Added
114
Annual innovation refresh; market access for pharma
Negotiation Drug Visits
>240 million
High utilization of price-negotiated innovative drugs
Payment Reform and Cost Control
Reform Initiative
2025 Coverage
Efficiency Metric
DRG/DIP Implementation
>95% of planning areas
Case-based payment standardization
Short-Term Inpatient DRG/DIP
>95% of cases
Prospective payment controlling costs
Inpatient Pooling Fund DRG/DIP
>80% of expenditures
Fund sustainability protection
Five Supporting Mechanisms
100% of pooling regions
Exceptional review, advance payment, feedback, negotiation, data working groups
Forward‑Looking Statements This brief contains forward‑looking statements regarding BMI sustainability, NRDL expansion, and payment reform implementation based on NHSA 2025 statistical data. Actual results may differ due to demographic shifts, economic growth variations, and healthcare demand inflation.-Fineline Info & Tech
By Fineline Cube