China unveils five-year plan to tighten oversight of healthcare insurance fund
The National Healthcare Security Administration has unveiled a five-year action plan to strengthen oversight of the national healthcare insurance fund, aiming to establish a comprehensive, multitiered supervision system by 2030.
According to the document released on Wednesday, the nation aims to achieve full coverage of on-site inspections at all healthcare institutions designated under the national medical insurance program during the 15th Five-Year Plan period (2026-30). Meanwhile, national-level flight inspections will cover all provincial-level regions each year and all prefecture-level cities over the five-year period.
The plan introduces, for the first time, the exploration of special flight inspections for long-term care insurance — a rapidly expanding social insurance program designed to support the growing elderly population with disabilities or cognitive impairments.
The plan also stresses integrating various forms of inspections, including annual and special flight inspections, scheduled and random checks, open inspections and unannounced visits.
For violations identified during inspections, healthcare security authorities will apply a combination of enforcement measures, including contract management, administrative penalties and payment eligibility management.
In addition, the plan highlights the role of technology in strengthening supervision. It proposes developing a matrix of big-data monitoring models targeting typical illicit practices and other key areas, as well as exploring the application of drug traceability coding systems and artificial intelligence.
Data released by the administration showed that a total of 34.2 billion yuan ($5 billion) in healthcare insurance funds was recovered in 2025. An additional 3 billion yuan in potential losses was prevented through the administration's intelligent monitoring system.
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