context: The first comprehensive policy document focused on public well-being since the 18th Party Congress was issued by the State Council. It outlines directions for social security, public service, medical and educational resources expansion. It sets targets including compulsory education coverage, building or expanding over 1,000 quality general high schools, new nursing home beds comprising at least 80 percent nursing-type facilities and promoting embedded childcare coverage for over 80 percent of communities in eligible major cities within a decade.
Central budget investment supporting public well-being is expected to increase over 30 percent compared to the end of the 13th 5-year plan, notes Xiao Weiming 肖渭明 National Development and Reform Commission deputy secretary-general.
2025 national education expenditure and social security employment spending budgets each approaches C¥4.5 tn, increasing 6.1 percent and 5.9 percent respectively, explains Ge Zhihao 葛志昊 Ministry of Finance Social Security Department.
However, other measures that have repeatedly appeared in policy documents lack substantive implementation, including
- completely eliminating hukou (household registration) restrictions for workplace insurance participation
- increasing pension benefits
- ensuring migrant workers receive equal public services
- raising minimum wage standards
- expanding quality medical resources
Employee social insurance already operates without hukou constraints, but the real difficulties are in resident pension and medical insurance due to high dependence on fiscal subsidies
- population inflow areas remain unwilling to bear additional subsidies while outflow areas resist losing healthy net contributors
- nine cities including Beijing, Shanghai, Guangzhou and Shenzhen prohibit non-local household registration populations from participating in local resident medical insurance
- provincial capitals like Shijiazhuang and Taiyuan require floating populations to hold residence permits for participation
To solve this problem, the PRC needs to change the current central-local government fiscal sharing mechanisms, argues Wang Chaoqun 王超群 Central China Normal University's School of Public Administration associate professor. Wang suggests central government transfer subsidies based on specific location standards.
Education in the PRC faces demographic structural changes as declining birth rates impact kindergartens through middle schools while high school resource imbalances remain severe, and employment pressures affect higher education program settings.
Guo Peng 郭鹏 Ministry of Education Development Planning Department director outlines three focus areas
- expand existing quality school and kindergarten capacity while incorporating weaker schools into quality school group management
- achieve standardised construction coverage for all compulsory education schools within five years
- build or expand over 1,000 quality general high schools, focusing on improving county-level conditions
As basic medical insurance payment space for innovative drugs narrows, commercial insurance carries hopes despite weak development. According to Taikang Insurance's reports, health insurance market original premium scale reached C¥922 bn by November 2024, less than half the previously planned C¥2 tn target for 2025.
Since industry associations lead commercial insurance directories, they lack mandatory force and substantial funding support, serving more as guidance for insurance companies by indicating which drugs can bear compensation responsibility, explains Wang Pingyang 王平洋 Zhejiang Medical Security Research Association vice president and Commercial Supplementary Medical Insurance Committee director.
The Category A directory includes 30 drugs and 19 indications, primarily tumour medications including immunotherapy drugs and CAR-T products. However, the originally scheduled Category C directory remains incomplete due to unresolved coordination between medical insurance and financial regulatory departments.