Why millions in China are still quitting the national health insurance scheme
Rising costs, stagnant incomes and growing distrust drive people to opt out of medical coverage, analysts say
More Chinese people dropped out of the voluntary health insurance scheme for urban and rural residents last year, the latest available data shows – piling pressure on the system amid economic challenges and declining public trust.
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.
Enrolment among urban and rural residents has declined in recent years, driven by rising premiums and stagnating incomes.
“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.