Recently, the National Healthcare Security Administration issued the “Reply to Proposal No. 5532 of the Fourth Session of the 13th National People’s Congress” (hereinafter referred to as the “Reply”). In response to the proposal submitted by deputies to the National People’s Congress on “Strengthening Medical Insurance Policy Support for the Development of Traditional Chinese Medicine,” the Administration clarified that currently 95% of TCM hospitals and 92% of integrated TCM–Western medicine hospitals have been included in the designated medical insurance network, thereby essentially meeting the medical service needs of insured individuals.

With regard to the management of medical insurance access for traditional Chinese medicines and TCM diagnostic and therapeutic services, the Reply states that, in formulating the National Basic Medical Insurance Drug List, the state adheres to the fundamental principle of giving equal emphasis to both traditional Chinese medicines and Western medicines. The National Medical Insurance Drug List issued in 2020 includes a total of 2,800 proprietary Chinese medicines and Western medicines, comprising 1,426 Western medicines and 1,374 proprietary Chinese medicines, with the new list achieving a roughly balanced representation of the two categories. For the section on crude herbal medicines, an access-based approach was adopted to determine the scope of the list, ultimately including 892 items. At present, the vast majority of provinces and municipalities, based on the actual needs of insured persons and the financial status of the medical insurance fund, have incorporated distinctive diagnostic and therapeutic services—such as acupuncture and therapeutic tuina—into the scope of medical insurance reimbursement.

The Reply states that, in adjusting prices for medical services, the principle of “giving equal emphasis to traditional Chinese medicine and Western medicine” has consistently been upheld, so as to ensure that the general public has access to high-quality, efficient, and affordable healthcare services. The National Healthcare Security Administration will provide guidance to local authorities to prioritize and scientifically adjust the prices of TCM medical service items that are widely accepted by patients, demonstrate distinctive strengths and advantages, reflect the value of professional labor, and have a long history of clinical application.

The “Reply” clarifies that the primary purpose of basic medical insurance is to mitigate the financial risks associated with illness faced by insured individuals; all treatment expenses, including those for both traditional Chinese and Western medicine, are eligible for reimbursement from the basic medical insurance fund in accordance with relevant regulations, without any distinction based on the type of treatment. In recent years, primary-level medical and health institutions have broadly implemented and strengthened TCM services, and insured individuals’ expenditures on such services at the primary level are entitled to higher reimbursement rates than those at secondary- and tertiary-level hospitals. Localities have actively undertaken pilot initiatives to leverage the role of medical insurance in promoting the inheritance, innovation, and development of TCM—for example, some regions have selected TCM-preferred disease categories for piloting reforms in payment and fee collection models, while others are exploring the principle of equal pricing for equivalent treatments under both TCM and Western medicine.

In addition, with regard to commercial insurance products specific to traditional Chinese medicine, efforts will be intensified to enhance inter-agency communication and coordination, thereby promoting the development of health insurance products that highlight the unique characteristics of TCM. This includes designing insurance offerings such as TCM-based wellness and preventive healthcare plans, TCM approaches to disease prevention, as well as a range of commercial health insurance products, including medical insurance, illness insurance, and long-term care insurance.