Why millions in China are still quitting the national health insurance scheme
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The downward trend in participation – in a scheme designed for farmers and the unemployed – continued in 2024, with 15.8 million fewer people enrolled compared with 2023, according to figures released by the National Healthcare Security Administration (NHSA) on Monday.
China's basic medical insurance, which also includes a separate programme for urban employees, covered 1.326 billion people in total – down 7.27 million from 2023, the NHSA said.
The falling participation rate poses a challenge for China's
health insurance system, which is already under strain from a rapidly ageing population and a shrinking workforce.
Enrolment among urban and rural residents has declined in recent years, driven by rising premiums and stagnating incomes.
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'The trend of less interest in participation continues because the economic conditions have not changed – it's a financial burden for a rural family if the breadwinner doesn't see their income increase,' said Professor Xiong Wansheng, an expert on rural development at the East China University of Science and Technology.
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