At least seven provincial governments, as well as dozens of cities from seven other provinces, have announced extensions for participants to join the program, which is intended for anyone who is not a formal employee and is run by local governments.
As one of the two pillars of China’s basic medical insurance system – the other is a mandatory plan for urban employees – the Urban and Rural Residents’ Plan typically requires participants to pay the annual premium before the start of the year.
The voluntary scheme, which has been in operation since 2003, has a lower fixed annual premium compared to the Urban Employees Scheme. In recent years, government subsidies accounted for more than 60 percent of total insurance premiums for residents of urban and rural areas.
More than 25 million people dropped out of the scheme in 2022 due to a combination of factors including rising premiums, low income and lack of awareness.
The number of subscribers has fallen by the millions each year since 2019, according to the National Health Care Security Administration.
Last week, the government in northwestern Gansu province ordered local officials to target students, migrant workers and newborns to help expand enrollment.
The Gansu Provincial Medical Security Bureau said that grassroots-level officials had been asked to check “person to person and family to family.”
For migrant workers who have left their hometowns, officials should contact the local government of their workplace to ensure their participation in the scheme, the office added.
In Yuncheng, central Shaanxi Province, the local government pledged to extend the payment period until the end of February for “registration filling” during the New Year and Lunar New Year holidays.
A high price to pay: Millions falling out of China’s state health insurance system
A high price to pay: Millions falling out of China’s state health insurance system
The aim is to ensure that “all those who should be covered are covered”, according to a directive issued at the end of last month.
Hua Ying, a researcher from the Institute of Population and Labor Economics under the Chinese Academy of Social Sciences, said the scheme faces a “crisis of continuously weakening sustainability” due to methodological flaws.
High insurance premiums for individuals have sparked complaints
Instead of a lower fixed amount set by the government, the bonus for subscribers should be linked to their income to ensure equality, she said in a research paper published in the September issue of the Chinese Academic Journal.
She pointed out that the financial burden resulting from premiums on the lowest-income group in rural areas is more than 20 times compared to the highest-income group in urban areas.
“Our research showed that higher individual insurance premiums sparked complaints among low-income people in many areas, which significantly affected their enthusiasm for enrolling and led to an increased risk of cancellation,” she wrote.
The minimum annual personal contribution required for the urban and rural residents’ program rose from just 10 yuan (1.4 US dollars) in 2003 to 380 yuan last year.
In one district of Baoji City, Shaanxi Province, the participation rate in the urban-rural population scheme has declined over the past three years, falling from 98.5 percent in 2021 to 96.3 percent in 2023.
An article published on the website of the province’s political advisory body in November attributed the decrease to increased premiums.
“The trend of low interest in the scheme and cancellations is set to continue,” she warned, urging that premium increases be halted and linked to individual income.