Xinhua Viewpoint丨How to make medical reimbursement more secure for flexible employees

Xinhua Viewpoint丨How to make medical reimbursement more secure for flexible employees

Xinhua News Agency, Beijing, September 8th. Title: How to make medical reimbursement more secure for flexible employees

Peng Yunjia, reporter of Xinhua News Agency’s “Xinhua Viewpoint”

On September 8, seven departments including the National Medical Insurance Administration jointly issued a notice to launch a special action to improve the quality of basic medical insurance for flexible employment personnel, migrant workers, and people with new employment forms. It will take about three years to continue to increase the number of key groups such as flexible employment personnel participating in basic medical insurance, especially the number of employees participating in employee medical insurance.

Where do you usually live and where do you participate in insurance? Flexibly accumulate employee medical insurance years... What benefits will these measures bring to food delivery boys, online ride-hailing drivers and other groups? "Xinhua Viewpoint" reporters conducted interviews and research.

Insurance participation measures are more targeted

Whenever a lumbar disc herniation occurs, Xiao Chen, a 27-year-old takeaway rider in Chengdu, will go to the pharmacy to buy a few plasters. "A trip to the hospital may be a waste of half a day's work."

On February 16, a delivery boy rode on the streets of Wenxian County, Jiaozuo City, Henan Province, delivering food to customers. Published by Xinhua News Agency (Photo by Xu Hongxing)

Workers in new forms of employment, such as takeout riders, couriers, and online ride-hailing drivers, travel for long periods of time, sit and stand for long periods of time, and eat irregularly. They are at a higher risk of suffering from chronic diseases such as lumbar disc herniation and gastroenteritis, which can easily lead to hidden health risks and may also increase subsequent medical expenses.

On the one hand, there are possible health risks, and on the other hand, there is the practical dilemma of being "reluctant to spend money for medical treatment." How to make these workers affordable and well-treated has become an important starting point for policy design.

The relevant person in charge of the National Medical Insurance Administration said that the special action provides more convenient security channels for qualified flexible employment personnel by lowering the threshold for employee medical insurance, flexible payment rules, and opening up conversion channels for two types of basic medical insurance.

——Lower the insurance threshold. Promote the removal of household registration restrictions in places of employment and permanent residence in megacities, so that more people can participate in insurance in their actual place of work; encourage local governments to include flexible employment personnel into the coverage of maternity insurance.

——The insurance form is flexible. Taking into account that flexible employment personnel who work outside the country may participate in insurance in stages every year, their employee medical insurance payment years are allowed to be accumulated on a monthly basis, and every 12 months is counted as one year; explore the conversion of resident medical insurance payment years into employee medical insurance payment years.

——Diversified payment methods. For flexible employment personnel to participate in employee medical insurance, monthly payment will be implemented, or quarterly, half-yearly or full-year prepayment will be explored.

Zhao Ying, an associate researcher at the Medical Security and Nursing Security Research Office of the Chinese Academy of Labor and Social Security Sciences, said that this allows practitioners to pay fees for a longer period when their income is sufficient according to their own income rhythm, so that the payment arrangement matches income fluctuations and helps maintain the continuity of the insurance relationship.

Encourage more people with flexible employment to join employee medical insurance

"I used to think that employee medical insurance was only available to employees of formal units, but now we riders also have the opportunity to participate." Shanghai rider Che Zhenyu has been running food delivery for eight years and started participating in employee medical insurance last year. "The last time I went to the community health service center to see a doctor, I basically spent no money and the pressure is much less."

The "Fifteenth Five-Year Plan for National Medical Security" clearly encourages and supports people with flexible employment and new employment forms to participate in employee basic medical insurance. Why should more flexible employment personnel participate in employee medical insurance?

Calculating personal bills not only makes it cheaper to see a doctor and buy medicines, but it can also share personal account funds with family members.

Ge Huimin, director of the Medical Management and Benefit Security Department of the Hefei Municipal Medical Insurance Bureau in Anhui Province, calculated the accounts for reporters. The total monthly medical insurance payment for local flexible employment workers is about 275 yuan. During the pilot period, platform companies and individuals will each bear half. The actual annual payment for an individual is more than 1,600 yuan, while the annual payment for local residents’ medical insurance is about 400 yuan.

"In total, it costs about 1,200 yuan more per year, but in exchange for a higher reimbursement ratio and more comprehensive protection projects." Ge Huimin said, taking the first quarter of 2026 as an example, the payment ratios of hospitalization expense funds within the scope of Hefei's employee medical insurance and resident medical insurance policies are 89.28% and 73.79% respectively, a difference of about 15 percentage points.

Generally speaking, for the same hospitalization expenses that meet the regulations, the employee medical insurance will reimburse more from the medical insurance fund, and the individual will pay less. In addition, flexible employment personnel who participate in employee medical insurance can participate in maternity insurance and enjoy maternity subsidies; after reaching the payment period, they do not need to pay anymore when they retire, and they can enjoy the same retirement medical insurance benefits as employees of the unit.

For regions that have set up personal accounts for flexible employment employees, their personal accounts can be used jointly by families across provinces, supporting spouses, children, parents and other close relatives to share account funds.

Calculate social bills and enhance the sustainability of medical insurance funds, which will help residents’ medical insurance be more tilted towards low-income and non-employed people.

"There is still a lot of room for optimizing the structure of my country's medical insurance participation." Zhao Ying said that encouraging more flexible employees to join employee medical insurance will accelerate the formation of a pattern in which the proportion of employee medical insurance will steadily increase and residents' medical insurance will accurately cover the bottom line, which can make the security level and employment form more consistent.

Medical insurance rights can be accumulated and connected, which can reduce the worries of flexible employment personnel moving across regions and platforms. It can also help optimize the allocation of labor in a wider range and improve the matching efficiency of the job market.

Multi-party sharing is the key

On May 15, at the "New" Post Station in Zhongjun Commercial District, Jingtai Road Street, Hailing District, Taizhou City, Jiangsu Province, medical staff served traditional Chinese medicine tea to delivery workers. Published by Xinhua News Agency (Photo by Gu Jihong)

At present, the scale of medical insurance coverage for employees with flexible employment continues to expand. In 2025, 69.8218 million people with flexible employment and other personnel will participate in employee medical insurance nationwide, a year-on-year increase of 5.54%.

Many places are also constantly exploring relevant payment models and services, and accumulating practical experience for the launch of special actions across the country.

For example, if the employment relationship of flexible employees in Jiangsu changes within the province, the payment period information system will automatically accumulate and continuously calculate, and the payment data will "follow the person"; workers with new employment forms in Hefei, Anhui can pay employee medical insurance premiums in a one-time or "zero deposit and lump sum" method.

The special action is clear, and platform companies are encouraged to adopt payment methods such as "individual payment + platform subsidy" and payment of social insurance based on the unit employee model for employees with new employment forms who receive stable orders to participate in employee medical insurance.

At present, many platforms are also conducting related explorations. For example, Taobao flash sales provide flexible employment pension insurance and medical insurance subsidies for riders who regularly perform orders; JD.com provides more comprehensive welfare protection for couriers, sorters, full-time riders, etc. who sign labor contracts and pay five social insurances and one fund.

"My current monthly medical insurance expenses are 359.81 yuan and pension insurance are 899.6 yuan. I upload the payment voucher in the personal center of the platform App and wait for the subsidies to arrive." Huang Yang, a rider in Wuhan, said that he receives a full subsidy from the platform every month, which is equivalent to more than 10% more income and an additional medical insurance.

Some platform leaders also said that some crowdsourcing riders freely accept orders on multiple platforms, resulting in less income on a single platform. "Some crowdsourcing riders may earn less than 1,000 yuan per month on a single platform, which cannot reach the payment base, so it is difficult to provide platform subsidies." How to enable some flexible employees with scattered incomes and ambiguous identities to "access" the security system is still a practical problem to be solved.

Industry insiders suggest that a multi-pronged approach is needed to solve the problem of insurance coverage for flexible employment workers. It is necessary to make good use of policy tools to make companies more predictable and make it more convenient for more people to participate in insurance. It is also necessary to promote the gradual loosening of platform employment and social insurance participation responsibilities from traditional labor relationship identification, establish a payment responsibility sharing mechanism that is compatible with the characteristics of platform employment, and strengthen the incentive and sustainability of platform subsidies. It is also necessary to make good use of big data to accurately push policies, carry out popular propaganda in rider stations and gig markets, and gradually change the concept of insurance participation.