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China to Enhance Medical Insurance Oversight

by Celia

BEIJING – China’s National Healthcare Security Administration (NHSA) unveiled plans on Thursday to implement stricter oversight of medical insurance funds by rolling out a nationwide drug traceability code system this year.

The move aims to address issues such as the resale and substitution of insured medications, misuse of medical insurance cards, and the circulation of counterfeit prescriptions, according to the NHSA’s statement.

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Described as a “unique electronic ID” for each drug, the traceability code will be used to create comprehensive data models to improve regulatory supervision. This data will help the NHSA identify violations and strengthen enforcement against fraudulent activities, the statement noted.

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In April 2024, the NHSA launched a national pilot program to collect and utilize these traceability codes. In November 2024, the administration raised concerns with 46 designated medical institutions regarding duplicate claims linked to these codes, marking the beginning of its efforts to regulate medical insurance funds through this new technology.

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The NHSA has also engaged in two rounds of discussions with over 100 pharmaceutical companies, guiding them on self-inspection practices, addressing potential violations, and clarifying regulatory expectations. Local health authorities have organized similar initiatives to reinforce these efforts.

The NHSA has urged all medical institutions to strictly comply with regulations, perform self-checks, and report violations to local authorities. The statement further emphasized guidelines such as avoiding “empty billing,” ensuring ethical procurement, and refraining from dealing in illegally sourced medications.

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