context: A call for comment on the Healthcare Insurance Law (draft)—the PRC's first high-level law in the medical insurance field—was released by the National People's Congress on 27 June. Industry discussion focuses on commercial health insurance being excluded from the draft, causing scholars and practitioners to express concerns about commercial health insurance development and future positioning.
PRC scholars argue that multi-level medical security systems cannot lack commercial medical insurance. Clear top-level design would provide better guidance for formulating laws and regulations governing commercial health insurance development.
The legislative process spans four years
- 2021: NHSA (National Healthcare Security Administration) released draft for comments
- 2023: listed as second-category project in NPC (National People's Congress) Standing Committee planning
- April 2024: State Council approved draft, entering NPC review
The draft mentions 'multi-level security' but excludes commercial health insurance. Article 29 discusses multi-level medical security connection settlements, establishing direct settlement mechanisms connecting basic medical insurance, supplementary medical insurance and medical assistance. This refers to systems within medical security itself, excluding commercial health insurance scope.
Article 15 encourages employers to establish enterprise supplementary medical insurance for employees, referring to supplementary insurance within the medical insurance system rather than commercial health insurance.
Industry insiders worry that without defining multi-level medical security systems, future system integration effects will be difficult to achieve. Unlike economic legislation, social legislation's prominent feature is legislation first. However, the PRC currently only has the 2010 Social Insurance Law regulating employee basic medical insurance, which cannot cover entire medical security systems.
The draft only mentions commercial health insurance in supplementary provisions, indicating legislators position this as basic social security law, notes Zhu Minglai 朱铭来 Nankai University Health Economics and Medical Security Research Centre director. This aligns with legislative logic strictly distinguishing statutory medical insurance from commercial insurance boundaries, he added.
Zhu explained that commercial health insurance is essentially insurance with financial nature exceeding security nature
- commercial health insurance's supervisory departments are financial regulatory agencies
- medical insurance bureaus mainly handle basic medical insurance management
- policy-led inclusive commercial products like Huimin Bao aren't purely commercial
- these products undertake social security functions between social and commercial insurance
Zhu suggested the draft could specify that the state establishes multi-level medical security systems with national medical security management departments responsible for coordination, whilst relevant departments fulfil management functions within their jurisdictions. This would provide higher-level legal basis for subsequent specialised legislation.
Multi-department coordination difficulties may explain why the draft excludes commercial health insurance. Scholars emphasise that multi-level medical security system leadership must be clearly defined because this involves multi-department legislation. The NHSA should undertake coordination responsibilities, with relevant departments participating according to their duties.
One scholar noted the draft should play top-level design roles, pointing out that current medical security mentions only triple security—basic medical insurance, supplementary medical insurance and medical assistance—whilst excluding commercial insurance and charitable mutual aid from legal regulatory scope.
The scholar argued the draft should expand based on current foundations, constructing comprehensive frameworks that clarify main responsibility for multi-level medical security systems. This reflects broader challenges in defining the PRC's evolving healthcare landscape where boundaries between public-private and social-commercial insurance continue blurring.