National Healthcare Security Administration
The National Healthcare Security Administration (NHSA; 国家医疗保障局) is a national administrative agency of the People's Republic of China responsible for the administration of healthcare security, including medical insurance, maternity insurance and medical assistance. Established in May 2018, it operates directly under the State Council of the People's Republic of China.
The administration develops policies and standards for healthcare security, supervises healthcare security funds, establishes medical insurance coverage and payment standards, and coordinates policies concerning the prices and procurement of medicines and medical supplies.
History
The National Healthcare Security Administration was established in May 2018 as part of China's institutional reforms. It was created to consolidate responsibilities for medical insurance, maternity insurance, medical assistance, healthcare reimbursement and related pharmaceutical pricing and procurement policies.
Before its establishment, these responsibilities were distributed among several government departments. The creation of the NHSA was intended to improve coordination across China's healthcare security system and strengthen the administration of medical insurance funds.
The administration's establishment formed part of broader reforms aimed at improving healthcare coverage, managing medical expenditure and coordinating medical insurance policies across urban and rural populations.
Responsibilities
The NHSA's principal responsibilities include:
- formulating policies, plans and standards for medical insurance, maternity insurance and medical assistance;
- administering and supervising healthcare security funds;
- developing medical insurance coverage catalogues and reimbursement standards;
- establishing payment standards for medicines, medical consumables and healthcare services;
- formulating policies concerning pharmaceutical and medical consumables procurement;
- supervising medical institutions and healthcare providers participating in medical insurance programmes;
- developing healthcare security information systems;
- coordinating the settlement of medical expenses incurred outside an individual's place of insurance registration;
- supporting the development of long-term care insurance; and
- enforcing rules concerning healthcare security and the proper use of insurance funds.
Medical insurance system
The NHSA coordinates policies relating to China's basic medical insurance system, which includes arrangements for employed urban residents and a basic medical insurance programme for urban and rural residents.
The administration develops policies concerning insurance coverage, contribution arrangements, reimbursement and the coordination of healthcare benefits.
A simplified representation of the medical insurance process is:
The specific contribution rates, reimbursement conditions and benefit levels depend on the applicable national and local policies.
Healthcare security funds
The NHSA supervises the administration and use of healthcare security funds. These funds finance eligible medical expenses under China's medical insurance and related healthcare security arrangements.
The administration develops measures intended to improve fund management, monitor expenditure and prevent fraudulent claims or improper use of insurance resources.
A simplified representation is:
Fund supervision includes monitoring healthcare expenditure, reviewing reimbursement practices and enforcing compliance requirements for participating medical institutions and other entities.
National medical insurance catalogue
The NHSA is responsible for developing and maintaining the national medical insurance coverage catalogue and associated payment standards for medicines and other healthcare services.
The catalogue determines which medicines and medical treatments are eligible for reimbursement under specified medical insurance arrangements. Coverage and reimbursement conditions may vary according to the applicable policies.
The administration also conducts negotiations with pharmaceutical companies concerning the inclusion of certain medicines in the national medical insurance catalogue.
These negotiations can influence the prices at which medicines are made available for reimbursement under the public medical insurance system.
Pharmaceutical pricing and procurement
The NHSA plays a central role in China's pharmaceutical pricing and procurement policies.
Its responsibilities include developing policies for the procurement of medicines and medical consumables, supervising procurement arrangements and coordinating mechanisms intended to improve purchasing efficiency.
The administration also participates in the development of payment standards and pricing policies for medicines and healthcare services.
A simplified procurement process is:
These mechanisms form part of China's broader efforts to manage healthcare expenditure and improve access to covered medicines.
Medical assistance
The NHSA administers policies concerning medical assistance for eligible individuals and households that require additional support with healthcare expenses.
Medical assistance programmes are intended to reduce the financial burden of eligible medical treatment, particularly for people facing economic hardship.
These arrangements operate alongside basic medical insurance and other social protection programmes. Eligibility and assistance levels depend on the applicable national and local rules.
Cross-regional medical reimbursement
The NHSA coordinates policies supporting the settlement of eligible medical expenses incurred outside an individual's home region.
Cross-regional settlement mechanisms allow eligible insured individuals to obtain medical services in other locations without necessarily having to complete the entire reimbursement process through their home insurance authority.
These arrangements are particularly relevant to migrant workers, retirees living away from their place of insurance registration and patients seeking treatment in other regions.
Digital infrastructure and standardization
The NHSA promotes the standardization and digital administration of healthcare security information. Its work includes developing information coding standards for medicines, medical consumables and healthcare services.
Standardized information systems support insurance administration, claims processing, expenditure monitoring and the settlement of medical expenses across regional boundaries.
A simplified representation is:
Relationship with other institutions
The NHSA works with other Chinese government departments responsible for healthcare, pharmaceutical regulation, public finance and social security.
Its responsibilities are distinct from those of the National Health Commission, which is principally responsible for health policy, public health and the administration of healthcare services. The National Medical Products Administration is responsible for the regulation of medicines and medical devices.
The division of responsibilities supports coordination among healthcare provision, medical insurance financing and pharmaceutical regulation.
Significance
The National Healthcare Security Administration is an important institution in China's healthcare financing system. Its policies influence medical insurance coverage, reimbursement arrangements, pharmaceutical procurement and the allocation of healthcare security funds.
The administration's work is closely connected with efforts to expand healthcare protection, control medical expenditure and improve the coordination of healthcare financing across China's regions.