China’s basic medical insurance fund exceeded 3 trillion yuan for the first time in 2025, with the ratio of in-service personnel to retired personnel (work-retirement ratio) dropping to 2.6. As the number of retirees continues to increase, enterprises are cutting jobs, reducing salaries, and decreasing job positions, leading to changes in the basis for healthcare payments. Respondents indicated that the Chinese Communist Party sidesteps the gap in protection inside and outside the system, pushing the costs of economic downturn and population aging onto ordinary workers, flexible employees, and young people.
According to a report by “First Finance” on July 23, the National Healthcare Security Administration of the CCP recently released the “2025 National Development Statistics Bulletin for Healthcare Security Industry,” indicating that the total revenue of China’s basic medical insurance fund in 2025 was 3.5921 trillion yuan, with total expenditure of 3.0055 trillion yuan, and a surplus of 525.772 billion yuan in the current fund. Over 80 billion yuan of healthcare funds flow to hospitals, pharmacies, and insured persons on average each day throughout the year.
Chinese social scientist Zhang Liangdong told reporters that behind the 3 trillion yuan expenditure lies not only aging and increasing healthcare demands but also the problem of the Chinese Communist healthcare system’s long-term reliance on medical insurance funds to operate. He said, “Officials only emphasize that there is still a surplus in the fund but rarely tell the public how many young people with stable jobs need to continue paying. Retirees generally no longer contribute based on current employment standards, and with the increase in the retired population, slow growth in the working population, and ongoing job cuts by enterprises, I don’t think the current ratio of 2.6 active employees supporting one retiree’s medical expenses can hold for long.”
The policy of the Chinese workers’ medical insurance stipulates that only in-service personnel contribute, while retirees do not. In 2025, the work-retirement ratio dropped to 2.6, meaning on average, for every 2.6 active insured persons, there is 1 retired insured person. Public data shows that the work-retirement ratio was 3 in 2012, decreased to 2.82 by 2020, reached 2.71 in 2023, and further dropped to 2.63 in 2024.
Zhang Liangdong predicted that the pressure on current employees will continue to increase in the future. He stated, “The work-retirement ratio may drop to around 2.3 by 2027, and it will keep decreasing thereafter. It’s not a matter of whether the new generation is increasing; people are becoming passive, not paying social security and medical insurance. How can you expect young people to listen to the recent call by CCTV to move to rural areas?”
The bulletin showed that in 2025, the revenue of the workers’ medical insurance fund grew by 4% and expenditure by 1.4%. However, Zhao Heng, founder of a medical consulting firm, mentioned that the revenue growth of the medical insurance fund has again outpaced expenditure growth, ending the period from 2023 to 2024 when expenditure growth exceeded revenue. Nevertheless, both workers’ medical insurance and residents’ medical insurance revenue have entered single-digit growth, with continued expenditure growth, possibly requiring the use of accumulated funds in the coming years.
After the release of related data, mainland netizens have shifted their focus to the disparities in retirement benefits, youth unemployment, and healthcare fund distribution. A netizen in Beijing asked, “I just want to know if I can still receive benefits 15 years from now.” Another netizen from Jiangsu questioned, “How will the post-80s generation of employees be protected after retirement?” And another netizen remarked, “It’s not that young people are unwilling to pay; it’s that some retirees receive too much, while ordinary people cannot find jobs, so how do we pay?” Another netizen added, “Retired individuals receive over 10,000 yuan per month, while those working get only 4,500 yuan.”
Mr. Chen, a self-employed individual operator in Guangdong, informed reporters that after leaving the company, he now needs to pay for medical insurance and pension insurance himself. He said, “Previously, the company paid a portion, and I paid a portion, feeling the pressure was not as heavy. Now, with business not doing well, I have to pay a lot more for medical expenses. The news keeps talking about improving security, it’s utter nonsense.”
Mr. Xu, a rights advocate in Hubei, believes that the healthcare funds used by retirees come from the social security fees they paid during their working years. He stated, “Retirement benefits for government employees and enterprise leaders are much better than those for ordinary people. Last year, healthcare spending exceeded 3 trillion yuan, most of which did not benefit the ordinary people. Although official figures claim to provide healthcare for the entire nation, in reality, ordinary citizens do not receive many benefits.”
In recent years, various regions in China have successively extended the minimum payment duration for workers’ medical insurance. By January 1, 2030, Guangdong has stipulated that the cumulative payment duration for employees across the province will be unified at 30 years for male workers and 25 years for female workers. Those who do not meet the specified duration can continue to pay as required or make a lump sum payment, only enjoying retired personnel medical insurance benefits after reaching the designated period.
The National Healthcare Security Administration of the CCP stated that the healthcare fund still had a surplus in 2025. However, despite no national deficit, difficulties in employment for the younger generation and disparities in treatment both inside and outside the system cannot be concealed. These healthcare data expose the Chinese Communist social security system’s reliance on continuous payments from working individuals while failing to provide stable employment and equal treatment for the younger generation. With the economy continuing to decline, healthcare costs will still be borne by ordinary workers, self-employed operators, and the younger generation, with an increasing trend.