Topic: Health coverage: who's required to have it, and who actually pays
What does China require?
Everyday topic
Mainland China runs a two-track medical insurance system: Article 23 of the Social Insurance Law makes Employee Basic Medical Insurance mandatory, jointly funded by employer and individual; Article 25's Urban Resident scheme relies mainly on individual premiums topped up by government subsidy. The National Healthcare Security Administration reports 95% coverage overall, though the employee scheme covers only 29.2% of the population. Contribution rates are set locally — Beijing charges the employer 9.8%, the individual 2%. The most telling comparison is the reimbursement gap: the employee scheme's fund pays 84.1% of in-catalog inpatient costs, the resident scheme only 66.0% — an 18-point gap within the same “universal coverage” figure. Foreign nationals with a valid work permit must be enrolled by their employer in all five social insurances, including medical, under Order No. 16 (effective 2011).
What is this topic?
Taiwan's National Health Insurance Act declares enrollment mandatory in its very first article, launched in March 1995, with premiums split employer 60%, insured person 30%, government 10%.
Japan closed the last gap in "universal coverage" only in 1961, after a 1958 law forced every municipality to run its own scheme; patient co-payments still scale by age, from 10% at 75-plus to 30% between 6 and 69.
Indonesia's 2004 SJSN Law states outright that "participation is compulsory," and a foreign worker becomes covered after six months on the job — almost the same threshold Taiwan uses.
Brazil's SUS is the direct product of Article 196 of its 1988 Constitution, "health is a right of all and a duty of the State," free to anyone within its borders.
China, by contrast, reports 95% nominal coverage, but its employee and resident schemes reimburse hospital stays at rates 18 points apart — 84.1% versus 66.0%.
India has no universal mandate at all: PM-JAY reaches only the poorest 40% of households, and out-of-pocket spending still runs 43.4% of the total.
The United States is the only one of the seven with no coverage guarantee whatsoever — its federal mandate has existed in name only since 2019, 8.0% of the population remained uninsured in 2024, and it spends more per person on healthcare than any other.
Sources and dates
Dates follow local time zones, calendars, and official notices. Check the source when a date is estimated or locally variable.