On 22 march, the national health service and the national health commission issued a joint publication on health supportPrimary careThe guidelines for the development of health services introduced 14 specific measures to strengthen health-care support at the primary level, combining the basis for the arrival of more than 90 per cent of the country's population at the nearest health-care point in 15 minutes, and turning the concept of “care at the door of the home” into a normal and cost-effective situation。
The core of this new policy, known as “most than 14 of the health insurance foundation,” is to leverage health insurance payments to leverage the upgrading of primary health care to make primary health-care institutions truly “gatekeepers” of the population’s health, while maintaining the health-care fund’s “doorkeepers” function. Whether it be community health centres, township health centres or village health units, more health support will be provided in the future, more cost-effective, better-medicine, easier to settle, and a radical change in the habit of “going to big hospitals with small diseases”。
The article makes it clear that the new deal is going to benefit everyone through 14 measures, and tells you how convenient primary care is, how much money will be saved in the future, how much less travel, and what real cases and practical techniques will be used。
First, let's get this straight: what has been changed to the 14-year-old health insurance
The 14 measures put in place by the three sectors are not piecemeal policies, but a combination of the seven pillars of “fund flows, targeted management, price policies, security of treatment, reform of payments, drug security, settlement efficiency,” each of which is closely related to people’s health. A brief summary is that health insurance goes more to the grass-roots level, reimbursement rates tend to the grass-roots level, procedures are simpler and medicines are more complete。
Health insurance funds favour the grass-roots level: there is a stable “fund pool” for primary care
The new deal clearly optimizes the management of the regional totals of the health insurance fund, whereby the annual new health insurance funds can be slanted to the grass-roots level as appropriate; and improves the close district medical community's total payments, with the balance being allocated to primary health-care institutions as a priority. This means that basic hospitals will no longer be “defunct” and that there will be sufficient funds to upgrade services and to reduce the number of necessary diagnostic and treatment projects due to funding shortfalls。
At the same time, primary health-care facilities have been expanded to cover at least one primary health-care facility at the commune (street) level, both in urban communities and in rural areas。
2. Upgrading of claims: primary care money
This is one of the most important aspects of the new deal:
- not less than 50 per cent of out-patients are paid for: general out-patients in primary health-care institutions are paid for by employees and residents, and within the framework of the policy are paid for at least 50 per cent。
- hospitalization claims tend to be paid at the grass-roots level: the proportion of claims paid at different levels of health care is properly divided and the percentage of claims paid at the primary level is higher; for patients referred to the primary level, the payment line can be calculated on a continuous basis at the higher level, and the transfer from the basic level to the higher level is no longer subject to double payment。
- prescriptions for slow patients: to allow long-term prescriptions of up to 12 weeks for slow patients with stable conditions at the grass-roots level, without the inclusion of an average cost assessment for outpatients, without having to run a monthly hospital to prescribe medication and save time。
Reform of the payment modality: “customs and good care” in primary hospitals
The new deal explores how to pay for outpatients at the grass-roots level, encourages the combination of head-to-head payments for outpatients and management of chronic diseases, and pays the contracted out-patient health insurance fund to a team of grass-roots or family doctors on a head-to-head basis, and directs grass-roots doctors to take the initiative to follow up and monitor slow diseases. At the same time, the quality of hospital care is being consolidated, with a dynamic adaptation of treatment to grass-roots care, so that primary hospitals are able to deal with both common and partial hospitalization needs。
Access to medicines: at the grass-roots level, there is no longer a “lack of medicines”
The lack of medicines in primary hospitals has been a problem, and the new deal has targeted:
- the development of a “level 3” drug connection mechanism, the harmonization of drug purchases and distributions between the primary and lead hospitals in the medical community, the implementation of prescription regulations and the availability of the same drugs at the basic level as at the major hospitals。
- to speed up the development of a “health-care cloud platform” to facilitate access to medicines at the grass-roots and mass levels and to ensure that medicines are available in time。
- to expand the coverage of the collection of medicines, to increase the availability of medicines for common and chronic diseases at the grass-roots level, and to ensure that slow medications such as hypertension and diabetes are available at the grass-roots level and that hospitals are no longer required。
5. Settlement and ease of service: no running for medical clearance
- implementation of the medical insurance fund advance policy to extend immediate settlement coverage to 20 working days after filing; starting in 2028, the liquidation of the previous year's health insurance fund was completed by the end of march each year, thus reducing the pressure on capital turnover at the grass-roots level。
- base operations are equipped with terminal equipment to support face-washing payments, advance 24-hour on-line intelligence counselling and run health insurance without running a sub-window。
6. Price policy optimization: better cost of primary care
It is clear that general medical treatment costs, in principle, amount to approximately $10, including registration fees, diagnostic fees, injection fees, cost of pharmaceutical services, and transparent charges. At the same time, the price gap between the first and second level of surgery, care and video screening at the primary and secondary levels of care has been reduced, so that people can see at the grass-roots level and enjoy low prices and quality of services。
Ii. The current situation is overwhelming: 90 per cent of the country's population has been given a “15-minute medical circle”
The foundation for grass-roots health care in our country was solid before the new deal, which was the foundation of health care. According to the national health council, more than 90 per cent of the country's population is now able to reach the nearest health-care point within 15 minutes, essentially “with a few steps out of the house”。
By the end of 2025, there were more than 1. 1 million health-care institutions in the country, of which over 95 per cent were at the grass-roots level, including 333,000 townships, 570,400 village health units and 102,000 community health service centres. These institutions cover all urban and rural areas, with rural areas having “sanitary homes, village and village health units”, urban areas having “community service centres, street services” and the elimination of “gaps” in medical services。
More crucial is the continuous upgrading of primary health-care capacity. By the end of 2024, the number of medical practitioners (associates) at the grass-roots level stood at 2. 07 million, an increase of 542,000 over 2020; 93 per cent of rural health centres and community health centres were able to provide paediatric consultations, and more than 90 per cent met the basic service capacity standards and met the demand for treatment for common and multiple diseases。
To give a real example: aunt lee of foshan, guangdong, who has five years of hypertensive disease, used to run a community hospital three kilometres away every month to prescribe drugs for an hour. Community hospitals are now upgraded to provide primary health care, not only for a 12-week long prescription, but also to monitor blood pressure at home. The reimbursement of health insurance costs only 10 doses per month, nearly $100 less than before, and no more frequent foot running。
Iii. After the new deal: three major changes in the general population's access to health care
In conjunction with the 14 measures and the current 15-minute medical cycle, there will be three most visible changes in the future, which will save money, care and time。
Change 1: lower cost of medical care and more cost-effective reimbursement
In the past, many people had felt that grass-roots hospitals were underpaid and underserved, preferring to spend more on major hospitals. With the implementation of the new deal, the reimbursement for primary clinics is not less than 50 per cent, the rate of hospitalization is higher, and the cost of treatment is significantly lower, combined with a reduction in the price of the drugs collected。
In shenzhen, for example, the employee health insurers watch the cold at the community health service centres at a cost of $50 for outpatient consultations and $25 for 50 per cent reimbursement; the resident health insurers watch high blood pressure at a cost of $80 per month and only $40 per month for 50 per cent reimbursement. The cost of going to the same hospital in the past, combined with transportation costs and queues, is at least three times higher than at the grass-roots level。
Change 2: access to health care is easier, no big hospital
The policy of 15 minutes of medical circles plus prescriptions, home service and so forth, has prevented people from running to hospitals for minor and slow diseases. Community health centres and township health centres can deal with common problems such as cold, fever, hypertension and diabetes, and large hospitals can focus on serious problems and achieve a pattern of treatment of “small diseases at the grass-roots level, major diseases at the hospital level and rehabilitation back”。
In the case of chronic disease management, mr. Wang of the beijing dynamite district, who has been diabetic for three years, had to visit sancha hospital every week. Family doctors are now contracted to follow up online consultations on a weekly basis, to visit community hospitals for prescriptions once a month and to review them quarterly, saving time and reducing financial burdens。
Change 3: improved availability of medicines and services
When the supply of drugs at the basic hospitals has been completed, there is no longer any need to line up at the large hospitals to obtain them. It covers the grass-roots level, with a full range of common and chronic diseases, while it also provides home-based services, home-based beds and palliative care to meet the needs of different populations。
In shanghai, for example, the elderly woman zhang, who lives alone, is in a difficult position to move, the community health service centres are not only able to drop in and change medicines, but also provide home-based bed services, the reimbursement of health insurance is 60 per cent lower than the cost of hospitalization in a major hospital, and family members are no longer required to accompany them frequently。
Iv. Common answers: these errors must be avoided
Many have doubts about the new deal, and some of the issues that are of greatest concern to all of us are sorted out here and made clear at once。
1. Do all primary health-care facilities have access to health-care support
Not all grass-roots institutions have access to them, but only primary health-care institutions that are part of the health-care focus are able to benefit from the policies of the health insurance fund, which tends to increase the reimbursement rate. Before you go to the hospital, you can use the app and the official public number to check the local health-care points in the vicinity to avoid running empty。
2. How does the prescription work? What are the conditions
The prescription applies to slow patients with stable conditions, such as hypertension, diabetes, coronary heart disease, etc. A prescription of up to 12 weeks is required after an assessment by a physician at the primary level and is not included in the sub-event. On the other hand, it is necessary to carry a personal identity card, a medical certificate, a previous medical record and to ensure that there is no acute outbreak。
3. How will home-based services be charged? Can you report it
Basic home-based services include door-to-door infusion, home-to-door substitution, health monitoring, slow-disease follow-up, etc. The costs are covered by general diagnostic fees or special-purpose services, which are reimbursed by health insurance within the scope of the policy, with a small out-of-pocket cost to the individual. Specific fees may be paid in consultation with local primary health institutions。
4. How to sign a family doctor? What service
A family doctor may be contracted with his/her identity card, medical certificate and travel to his/her community health service centre or town health centre. Free health check-ups, follow-up visits, online consultations, priority referrals and, in some areas, individualized health management programmes are available。
V. Practical guidelines: how can the general population benefit from primary health care dividends
Once the new deal is in place, it will be easy and easy for everyone to enjoy the benefits。
1. Targeted institutions: check the local hospitals in nearby health-care locations
Open an official app, micro-process, or call the number 12333 social security hotline to check the primary health-care facilities of the health-care centres of the communities and towns where they are located, giving priority to close and well-served institutions to facilitate daily visits。
Contracted family doctor: binding exclusive health “housekeepers”
With identity cards and medical certificates, family doctors are contracted at primary health-care institutions, and are provided with free health care services when tied up. Persons with chronic illnesses are also given priority access to follow-up services, prescription services and savings。
3. Rational choice of access: small diseases at the grass-roots level, major diseases referred to higher levels
Common diseases such as flu, fever and diarrhoea, and slow diseases such as hypertension and diabetes are referred directly to primary health-care facilities, with a high rate of reimbursement and a short waiting period; in case of serious problems, they are referred to the primary level and then referred by family doctors to a higher-level hospital, with continuous medical coverage without double payment。
4. Good prescription and online service: reduced number of running legs
People with slow health problems apply to doctors on their own initiative for a prescription to reduce the number of hospital trips per month; use online consultations and 24-hour smart services from primary health-care institutions to address minor health problems, and obtain guidance without going out, saving time and transportation costs。
To put it at the end: to upgrade primary health care for everyone
In essence, the 14-minute health-care system, combined with the 15-minute health-care system, is being sunk in the country's efforts to promote health-care resources, allowing quality health-care services to reach thousands of households. The primary health-care system is no longer a “no-no-no-no” supplement, but the core of the hierarchical system, which reduces the burden of access to large hospitals and provides access to quality, affordable and accessible health services at home。
For the general population, this is not only a cost-saving, time-saving benefit, but also an escalation of health security. In the future, there will be no need to travel for minor diseases, no need to worry about expensive and difficult medical care, and primary hospitals will become the first line of defence for everyone。
Of course, grass-roots health care is not developed overnight, and requires policy support, improved service capacity in health-care institutions and voluntary grass-roots visits. Only by working together can the hierarchical treatment be truly put on the ground and the 15-minute medical circle play a greater role。
What have been the changes in primary health-care services in your community or town? Do you choose to go to hospital? What else do you expect from the upgrading of primary care? You are welcome to share your experiences and views in the comment area and to share them。
This document is based on data from the national health insurance board, the national development and reform commission, the national health commission's guidance on health insurance support for the development of primary health care services,** and the national health and health commission's “15 minutes of health care circles”, which provide information only on individual points of view。
