China Unveils First Unified National Insurance Catalogue for Medical Services

China's National Healthcare Security Administration has released a work plan to establish the country's first unified national medical service item catalogue for basic medical insurance. The initial batch covers 13 clinical categories, including cardiovascular care, respiratory care, dental implants, and assisted reproduction. Items must be clinically necessary, safe, and reasonably priced to qualify, while non-therapeutic procedures such as cosmetic surgery and routine health screenings remain excluded. Once finalised, the catalogue will first apply to cross-provincial healthcare settlements before gradually aligning with provincial reimbursement schemes.

China's basic medical insurance system has long operated under fragmented regional lists, leading to varying reimbursement standards across provinces and complicating cross-border care. Establishing a single national catalogue standardises reimbursement boundaries, curbs regional disparities, and improves fund efficiency as patient mobility rises nationwide.

China has launched its first initiative to establish a unified national catalogue of medical service items covered by basic medical insurance, marking a major step toward standardising reimbursement rules across the country, state media reported on September 16. The National Healthcare Security Administration (NHSA) released a comprehensive work plan detailing the formulation of the first batch of covered services, according to reports by Xinhua and the Daily Economic News. The measure is designed to delineate clear payment boundaries, enhance the fairness of public healthcare coverage, and improve the operational efficiency of health insurance funds. The inaugural batch encompasses 13 broad clinical and procedural categories: cardiovascular systems, respiratory systems, ophthalmology, gynaecology, obstetrics, radiotherapy, anaesthesia, nursing, clinical scale assessments, dental implants, assisted reproduction, radiological examinations, and rehabilitation services, as well as related procedures across other clinical disciplines. Regulators outlined strict access criteria grounded in a policy of "guaranteeing basic needs." Services eligible for inclusion must be clinically necessary, proven safe and effective, appropriately priced, and associated with manageable financial risks for the state fund. Non-therapeutic services—such as cosmetic surgery, lifestyle wellness procedures, and routine health checkups—along with treatments demonstrating uncertain efficacy or elevated safety risks, are explicitly excluded from coverage. According to the NHSA plan, the catalogue will be formulated through phased expert appraisals tied to the ongoing implementation of national medical service pricing guidelines. Once enacted, the unified catalogue will first be deployed to settle medical bills for patients seeking care outside their home provinces, known as cross-provincial direct settlement. Regulators will then progressively harmonise local provincial reimbursement catalogues with the national standard, accounting for regional fund sustainability and clinical requirements.