As the National People's Congress convenes, the development of a multi-tiered healthcare and pension security system has once again become a focal point of public concern. National People's Congress deputy and Director of China Pacific Insurance's Strategic Research Center (ESG Office), Zhou Yanfang, submitted multiple proposals during this year's session. These proposals offer recommendations in areas including the coordinated development of commercial health insurance and innovative pharmaceuticals and medical devices, pension security for flexible employment populations, optimization of long-term care insurance mechanisms, and the implementation of voluntary guardianship systems.
Regarding the promotion of innovative pharmaceuticals and medical devices through commercial health insurance, Deputy Zhou Yanfang pointed out that China's healthcare insurance system has entered a phase of diversified composite payments dominated by DRG/DIP. While centralized procurement optimizes the use of healthcare insurance funds, it also objectively squeezes the profit margins and R&D motivation of pharmaceutical companies. Against this backdrop, there is growing demand from the industry for commercial health insurance to play a greater role in payment and to open new market-based channels.
Simultaneously, a significant gap remains between the public's demand for quality medical care and medicines and their existing payment capacity. Data shows that in 2024, the total payment scale for innovative pharmaceuticals and medical devices in China reached 162 billion yuan, of which patients paid 78.6 billion yuan out-of-pocket, accounting for 48%, while commercial health insurance payments constituted only 8%.
Zhou Yanfang stated that accelerating the development of commercial health insurance can both alleviate patients' out-of-pocket burdens, addressing public concerns about affordability of good medicines, and create stable market-based payment channels for pharmaceutical industry innovation, achieving a win-win for both public welfare and industrial development.
Although products like "Hui Min Bao," launched through cooperation between local governments and commercial insurers in recent years, have included some specialty drugs in their coverage, and the National Healthcare Security Administration released the first edition of the "Commercial Health Insurance Innovative Drug Directory" by the end of 2025, Zhou Yanfang believes that the current contribution of commercial health insurance to payments for innovative drugs remains limited, constituting only 8% of the total payment scale in 2024, which is insufficient to drive industrial development.
To address this, she proposed four recommendations: First, she suggested that government and industry regulators increase efforts to promote group medical insurance, encouraging pilot demonstrations of group insurance clauses for innovative drugs in suitable regions, with coverage focusing on medical devices and health management services outside the national reimbursement drug list, and encouraging the inclusion of more quality medicines. Second, using the pilot of group insurance demonstration clauses as an opportunity, establish a co-financing model involving both enterprises and individuals, aggregating various tax incentives and support policies for health insurance. Third, construct a dynamic adjustment mechanism for the commercial insurance innovative drug directory and improve a multi-dimensional value assessment system. Fourth, strengthen guarantees for drug accessibility, incorporate the availability of drugs listed in the commercial insurance directory into hospital performance assessments, and establish a one-stop instant settlement mechanism to effectively solve the "last mile" problem of medication access.
The extension of health security is inseparable from attention to long-term care for disabled populations. After ten years of pilot programs, China's long-term care insurance now covers over 80 cities nationwide, benefiting nearly 300 million people, with annual fund expenditures around ten billion yuan. It has formed a mainstream social-commercial cooperation model based on "risk sharing," effectively alleviating the dual pressures of economic and care burdens on families with disabled members.
However, in practice, commercial insurance institutions face prominent issues such as insufficient operational sustainability, inadequate implementation of the break-even and minimal profit principle, and imperfect systems and mechanisms.
For instance, commercial insurance companies currently underwriting long-term care insurance must bear additional costs, including approximately 0.8% for the insurance protection fund and 0.06% for regulatory fees. Zhou Yanfang emphasized, "These costs are a significant reason for operational losses among commercial insurance institutions and cannot be avoided through improvements in the company's operational capabilities."
Addressing these pain points, Zhou Yanfang recommended improving operational mechanisms and strengthening policy support by referring to the mature experience of critical illness insurance for urban and rural residents, to promote high-quality conduct of policy-based long-term care insurance business by commercial insurance companies.
She specifically proposed three suggestions: First, reduce or waive policy-related fees to effectively implement the break-even and minimal profit principle. Implement preferential policies such as tax reductions, exemptions from administrative fees, and waivers of insurance protection fund contributions for insurance institutions underwriting long-term care insurance, to lower the operational costs of policy-based business. Second, implement specialized management参照ing critical illness insurance, and健全 an independent operational mechanism. Learn from the specialized management model of critical illness insurance for urban and rural residents, implementing separate accounting, separate核算, separate assessment, and separate supervision for long-term care insurance, achieving a strict separation between policy-based business and commercial insurance business. Third, deepen government-society collaborative management to compensate for insufficient healthcare insurance administrative capacity. Continuously improve the management model involving government supervision, commercial operation, and social participation, fully leveraging the professional advantages of commercial insurance companies to undertake more administrative management services, achieving separation of management and operation for efficient functioning.
Beyond solving the nursing challenges for disabled elderly, structural changes in the labor market also pose new demands on the pension system.
Currently, the size of the flexible employment and new forms of employment population in China is vast. However, as of the end of 2024, the number of flexible workers participating in the basic employee pension insurance was 70.57 million, representing a participation rate of less than 40%.
Zhou Yanfang analyzed that the design of the traditional pension security system is difficult to adapt to the employment relationships of new forms of work. Coupled with many platform companies avoiding formal employer recognition of workers to reduce basic pension insurance contribution burdens and lower corporate labor costs, alongside relatively high individual participation costs, this leads to prominent issues of "non-participation" and "contribution breaks" within this group.
To address this challenge, Zhou Yanfang suggested exploring the development of more flexible and convenient annuity security measures结合 the second and third pillars within the current basic pension insurance framework.
She proposed exploring the establishment of special annuities for new employment groups, adopting a Defined Contribution (DC) model with fully accumulated individual accounts, allowing "contribution per order," achieving cost-sharing among the "government, enterprise, and individual"三方, and enabling account portability across regions and platforms. Regarding tax incentives, she recommended implementing parallel individual pension tax incentive models of EET and TEE, adding a TEE model where contributions and withdrawals are tax-exempt, allowing groups whose income does not reach the tax threshold to also enjoy the benefits of the system and avoid逆向 incentives. Simultaneously, she called for expanding the pilot scope of commercial pensions to fully utilize their core advantages of flexible contribution and withdrawal, adapting to the characteristic of large income fluctuations among flexible workers.
As material security becomes increasingly完善, the self-determination rights and personal dignity of the elderly cannot be overlooked. Data from the National Bureau of Statistics shows that by the end of 2024, China's population aged 60 and above had reached 310 million, accounting for 22% of the total population, officially entering a phase of deep aging society.
Alongside changes in family structures, specific elderly groups face practical difficulties in medical decision-making and property management. Although the voluntary guardianship system has been established at the national legal level, it still faces obstacles such as incomplete supporting systems, prominent information barriers across departments, and lack of supervision mechanisms.
To comprehensively promote the effective implementation of the voluntary guardianship system, Zhou Yanfang suggested systematically summarizing the experiences of pioneering regions like Shanghai and accelerating the issuance of implementation opinions and other supporting systems.
She emphasized the need to build a多元 collaborative enforcement mechanism, clearly defining the responsibilities of neighborhood (village) committees in排查 and temporary support through normative documents, and accelerating the cultivation of professional social guardianship institutions.
To破解 "information silos," she suggested that civil affairs departments take the lead, jointly with judicial administration, health authorities, financial regulators, courts, and other units, to establish a national or provincial unified registration, filing, and sharing platform for voluntary guardianship information. This would achieve unified collection and dynamic management of full-cycle information, including the establishment, modification, and revocation of guardianship agreements, civil capacity assessments, and the initiation and termination of guardianship.
Simultaneously, fully utilize digital intelligence technologies like big data and informatization to promote the intelligent and standardized operation of the entire voluntary guardianship process, from agreement signing and capacity assessment to guardianship execution and risk warning.健全 information query and usage norms, granting necessary information query and online verification permissions to medical institutions, public security, courts, financial institutions, etc., to achieve trusted cross-departmental and cross-domain sharing of guardianship information, solving prominent problems like "difficulty in proving" and "conflicts of rights confirmation" at the source.