Beijing, China – 16 Sep 2026 – China’s National Healthcare Security Administration (NHSA) released the Work Plan for Formulating the First Batch of the National Basic Medical Insurance Medical Service Item Catalogue, establishing a unified national catalogue of reimbursable medical service items — starting with 13 clinical categories including cardiovascular, respiratory, ophthalmology, gynecology, radiotherapy, anesthesia, nursing, clinical scale assessment, dental implants, assisted reproduction, obstetrics, radiological examination, and rehabilitation — to be applied first to cross‑province direct settlement and then progressively aligned with provincial payment scopes.

Policy Snapshot

Inclusion & Exclusion Criteria

• Inclusion Baseline: Items must be listed in the current national medical service price project listing guidelines (trial), be clinically necessary, safe, effective and appropriately priced, and pose controllable impact on basic medical insurance fund expenditure without threatening fund security.
• Explicit Exclusions: Items subject to market‑regulated pricing; non‑disease‑treatment services such as cosmetic procedures, weight loss, health checkups, prevention and wellness; services with insufficient clinical application, uncertain efficacy, or major safety risks; and anything else outside the basic insurance coverage scope.
• Guiding Principle: The catalogue adheres to the “basic coverage” positioning of basic medical insurance — acting within capability, keeping total volume stable, and ensuring smooth transition, weighing fund affordability, clinical demand and social impact.

Work Program – Three Phases

• Preparation Phase: Establish a dedicated task force and expert database; finalize work rules covering integrity, confidentiality and conflict‑of‑interest recusal; collect provincial data on price‑listing implementation, service pricing and payment status; and run fund modeling on the first batch’s insurance expenditure and the overall national cost envelope for medical services.
• Review Phase: A survey across representative medical institutions at all levels in 31 provinces (regions, municipalities) plus the Xinjiang Production and Construction Corps; joint review by management and clinical experts scoring each item on inclusion merit, health benefit, clinical need, equity and cost‑effectiveness; expert discussion of restricted payment scopes; and a fund impact assessment with local insurance authorities before shortlisting items.
• Publication Phase: The first‑batch catalogue is finalized based on expert opinions and fund impact modeling, submitted for approval per procedure, then issued to guide local implementation.

Governance & Expert Oversight

• Expert Composition: Reviewers — insurance management, price management, health economics/HTA and clinical experts — are recommended by relevant departments or randomly drawn from the expert pool, with geographic balance, representation across institution types and tiers, and inclusion of primary‑care institution representatives.
• Clinical Reviewer Scope: Clinical experts evaluate items only within their specialty fields.
• Supervision Mechanisms: Disciplinary inspection and supervision bodies are invited to oversee preparation, review and publication; internal controls mandate role accountability, confidentiality, recusal and liability rules; experts sign non‑disclosure agreements, must commit to impartial service, are barred from unauthorized public activity in the catalogue‑expert capacity, and all proceedings are fully documented to preserve independence.

Market Impact & Outlook

• Reimbursement Architecture: A unified national service catalogue replaces the current patchwork of provincial coverage lists — a structural shift for hospitals’ revenue predictability and for cross‑province settlement efficiency serving China’s large migrant population.
• Provider Strategy: Medical institutions should map their service portfolios against the 13 first‑batch categories and the inclusion criteria, anticipating which items may face restricted payment scopes or exclusion as market‑priced services.
• Sector Winners & Watchpoints: Categories inside the catalogue — notably dental implants, assisted reproduction, rehabilitation and radiotherapy — gain clearer reimbursement visibility, while cosmetic, wellness and weight‑loss services are explicitly ring‑fenced outside basic insurance.
• Phased Expansion: Subsequent batches will follow the rollout of national price project listing guidelines, signaling a multi‑year build‑out toward full national standardization of insured medical services.

Forward‑Looking Statements
This brief contains forward‑looking statements regarding the formulation, approval and implementation of China’s national medical insurance medical service item catalogue. The work plan remains subject to consultation, expert review and fund impact assessment; the final catalogue composition, payment restrictions, effective dates and local implementation may differ materially from current expectations.-China Health Reform Pulse

Policy Source: https://ylbz.gansu.gov.cn/ylbzj/c105248/202609/174394881.shtml