Xiamen’s universal health insurance model adopted as national blueprint

China’s National Development and Reform Commission (NDRC) has officially endorsed and promoted a groundbreaking medical insurance enrollment model from the city of Xiamen, setting it up as a national template for advancing universal coverage.

The initiative, pioneered by the Xiamen Medical Insurance Bureau in Fujian Province, is being hailed as a transformative practice with strong replicability in other countries.

Proponents say it offers a potential roadmap for nations worldwide, especially those struggling to achieve universal health coverage.

For African countries like Kenya, where UHC remains a central policy goal, the lessons are immediate and practical.

The Xiamen model focuses on closing access gaps for four demographics: newborns, students, workers in new forms of employment, and vulnerable populations.

Through mechanism optimisation, digital empowerment, and interdepartmental coordination, the city has dismantled long-standing bottlenecks in enrollment and strengthened the universal healthcare safety net.

A defining feature is the shift from passive enrollment to proactive service delivery.

Instead of requiring citizens to seek out policies, the system is designed so that “policies actively reach people.”

Xiamen pioneered China’s first “instant approval” service for newborn medical insurance enrollment and reimbursement.

Parents can complete the process online in as little as one minute, enabling “insurance upon birth and instant settlement upon discharge.”

The system links hospital records with insurance and tax databases, so coverage activates at birth and bills are settled directly on discharge.

This eliminates advance payments and cuts unnecessary travel for families.

Coverage now extends to all maternity hospitals across the city. To date, more than 110,000 newborn families have benefited from the instant approval service.

China’s second batch of national regional medical centre pilot projects—the West China Xiamen Hospital of Sichuan University, located in Jimei New Town, Xiamen

For students, the Xiamen Medical Insurance Bureau worked with tax authorities, education departments, and universities to build a “student enrollment in one integrated process.”

The model uses data sharing, batch processing, and intelligent reminders to enable “one form, one-click submission, and one-stop online processing.”

The rollout has pushed enrollment among primary and secondary school students in Xiamen to nearly 100 per cent.

University student enrollment reached 92.8 per cent in 2026, with 156,000 students insured, which is a record high.

The system reduces lapses that typically occur when students change schools or lose parental coverage.

Xiamen also tackled the challenge of insuring gig economy workers, such as delivery riders and ride-hailing drivers, who face high mobility, fragmented enrollment, and identification difficulties.

By strengthening multi-departmental data coordination and governance, the city built a “One Person, One File + Grid Connectivity” universal medical insurance system.

The unified record system tracks eligibility and prompts enrollment without requiring workers to navigate multiple offices.

The system won first prize at the 2025 China National Smart Medical Insurance Competition.

For vulnerable groups, Xiamen adheres to a people-centred approach by improving dynamic enrollment, targeted subsidies, and one-stop settlement services.

The move has shifted the workflow from “people seeking policies” to “policies actively reaching people,” ensuring full coverage and benefit access.

Through targeted subsidies and flexible mechanisms, the system provided support to 31,500 vulnerable individuals as of May 2026.

Officials say this addresses the “last mile” of healthcare accessibility and allows the public to feel the warmth of inclusive medical insurance policies.

As African nations continue to grapple with the complexities of achieving Universal Health Coverage, the Xiamen model offers a practical reference point.

Kenya’s quest for UHC has been a cornerstone of the government’s development agenda, yet fragmented data systems, exclusion of informal sector workers, and cumbersome enrollment remain persistent hurdles.

Xiamen’s experience shows that political will paired with technological innovation can overcome these barriers.

The “instant approval” system for newborns and the “one-click” model for students could be adapted to enhance enrollment under Kenya’s Social Health Insurance Fund, moving from bureaucratic delays to digital inclusivity.

The “One Person, One File” approach is especially relevant for Kenya’s growing digital economy, which still lacks formal social protection for many platform workers.

More practically, the “policies actively reaching people” philosophy offers a crucial lesson that safety nets must be visible and accessible to be effective.

The Xiamen Medical Insurance Bureau continues to refine the strategy, strengthening the healthcare safety net so that every insured person can “receive medical treatment when needed and enjoy medical protection.”