How China created an efficient universal health coverage ecosystem

Urban Employee Basic Medical Insurance (UEBMI): Covers urban formal workers and retirees, funded through mandatory payroll contributions shared by employers and employees 

Urban-Rural Resident Basic Medical Insurance (URRBMI): Covers informal workers, rural populations, and non-employed residents, financed through a mix of individual premiums and significant government subsidies  

Strong public provisioning: Majority of care delivered through public hospitals within a tiered referral system  

Focus on inpatient coverage: Core benefits prioritize hospitalization, with outpatient care still relatively under-covered 

Cost control mechanisms: Policies such as zero-markup drug pricing and pilot DRG-based payments to reduce over-prescription and manage costs 

Supplementary private insurance (~13% coverage): Provides top-up benefits such as lower copayments, expanded provider choice, and critical illness coverage 

Leverage tiered public insurance with targeted subsidies: A differentiated approach- combining payroll-linked contributions for the formal sector and subsidized coverage for informal and rural populations- can enable rapid expansion of coverage.

Prioritize government financing for vulnerable populations: Sustained public investment is critical to ensure inclusion of low-income and informal workers, who form a large share of India’s population. 

Integrate fragmented schemes to improve equity: Consolidating multiple insurance schemes can reduce inefficiencies and ensure more uniform access and benefits across geographies.

Strengthen primary care as the first point of contact: China’s push to revive village clinics and primary health centers highlights the importance of frontline care integration- an area where India can further strengthen Ayushman Bharat Health & Wellness Centres.

Enable private insurance as a complementary layer: Supplementary private insurance can help bridge coverage gaps without undermining public systems, particularly for middle- and higher-income segments.