Nie Riming/Text Shanghai recently announced the upgrade of its maternity medical expense guarantee policy, which will be implemented from October 1st. At that time, the medical expenses for childbirth within the policy scope will be realized as "no out of pocket" for individuals.

The biggest highlight of this new policy is to raise the maternity medical benefits for women participating in Shanghai residents' medical insurance to a level similar to that of women participating in employee medical insurance and enjoying maternity insurance benefits.

For a long time, the guarantee of medical expenses for childbirth in China has been closely linked to employment status. There are about 300 million women of childbearing age in China, while only about 110 million women participate in employee maternity insurance. Considering that some older insured women actually have little need for childbirth, the proportion of women of childbearing age covered by employee maternity insurance is about 30%. Women who participate in employee maternity insurance can enjoy reimbursement of maternity medical expenses and maternity allowances, which are income guarantees during maternity leave.

Women who have not participated in employee maternity insurance mainly rely on resident medical insurance. They can be reimbursed according to the resident medical insurance hospitalization standard for hospital delivery, but usually still need to bear a certain proportion of the expenses; The benefits of prenatal check ups vary by region, and the level of protection varies greatly. This group usually cannot enjoy maternity allowances. In a few regions, non employee medical insurance spouses of male employees under employee medical insurance are allowed to enjoy maternity medical expenses, but the reimbursement standards are usually lower.

In recent years, the country has begun to focus on expanding the coverage of maternity medical insurance, but the specific treatment standards are mainly explored by various regions. Generally speaking, the reform path in various regions is to first increase the medical benefits for employees' childbirth, then extend the "no self payment" policy for hospital delivery to residents' medical insurance participants, and gradually include prenatal check ups in outpatient reimbursement or fixed subsidy scope.

Tianjin and Zhejiang, which have made significant reforms, will respectively implement the same set of prenatal examination and childbirth protection standards for employees' medical insurance and residents' medical insurance at the provincial level by 2023 and 2025. According to the currently publicly available provincial-level unified policy, Shanghai is another provincial-level region after Tianjin and Zhejiang that has raised the overall level of residents' medical insurance and maternity medical benefits to be close to the level of employees' maternity insurance. The guarantee standards in Shanghai are higher, and there is no simple quota cap for prenatal examination service packages and hospital delivery. Expenses within the policy scope can continue to be paid by the fund.

In the context of low fertility rates, the importance of ensuring medical expenses for childbirth is even more prominent. In 2025, 107000 permanent residents will be born in Shanghai, of which the total fertility rate of registered residence population is only 0.66, lower than 0.80 in South Korea in 2025. The total fertility rate in the country is only slightly higher than 1.0.

Of course, relying solely on reimbursing medical expenses for childbirth is difficult to change the choice of families who originally had no intention of having children. But for families who already have the intention to have children, reducing the immediate expenses of prenatal check ups and childbirth, reducing the uncertainty of related costs, can still help alleviate their fertility concerns.

As mentioned earlier, up to 70% of women are unable to enjoy full maternity insurance benefits. Therefore, the key to expanding the coverage of medical expenses for childbirth is to more fully include the relevant expenses of unemployed individuals, self-employed individuals, and women without stable labor relationships in the scope of protection. For women who used to rely mainly on resident medical insurance, improving the level of prenatal check ups can also help reduce the impact of cost constraints on necessary prenatal check ups, thereby improving the quality of childbirth.

The key to further advancing reform is still the source of funding.

The expenses within the policy scope in Shanghai are uniformly paid by the maternity insurance fund; The excess amount will still be covered by the maternity insurance fund for employees' medical insurance participants, and by the resident medical insurance fund for residents' medical insurance participants. Due to the relatively low proportion of expenses outside the policy scope, in terms of actual effectiveness, Shanghai mainly relies on the maternity insurance fund to bear the increased expenses for expanding the coverage. Zhejiang and Tianjin, on the other hand, rely more on the resident medical insurance fund to bear related expenses, and a large proportion of the resident medical insurance fund comes from financial subsidies, so it can be said that public finance bears a more direct responsibility for expenditure.

If the Tianjin, Zhejiang, and Shanghai models are promoted nationwide, what is the approximate size of the additional expenditure?

According to data from the National Healthcare Security Administration, in the first seven months of 2026, the maternity insurance fund spent 78.42 billion yuan, including 60.78 billion yuan on maternity allowances and approximately 17.6 billion yuan on maternity medical expenses. Based on this calculation, the annual expenditure on maternity medical expenses is approximately 30 billion yuan.

At present, maternity insurance only covers about 30% of women of childbearing age. If we further raise the medical benefits for women who have given birth but are not included in the employee maternity insurance to a level close to that of the employee maternity insurance, a simple calculation would result in an additional expenditure of over 60 billion yuan. Due to the current resident medical insurance already covering some of the maternity medical expenses, the actual net additional expenditure will be lower than this amount. At the national level, it is obviously difficult to expand the coverage solely through the maternity insurance fund, and corresponding arrangements need to be made by various levels of finance. From the principle of corresponding payment and benefit, the newly added maternity medical benefits for residents' medical insurance participants are jointly borne by the residents' medical insurance fund and the finance department, which is more reasonable than direct cross group subsidies from the employee maternity insurance fund.

It must also be noted that medical expenses for childbirth are only a relatively small part of the cost of family childbirth. The income loss of women during late pregnancy and postpartum cessation of work is often a greater burden faced by families. From the perspective of fund expenditures, in the first seven months of 2026, maternity allowances have accounted for nearly 80% of the maternity insurance fund expenditures.

Women who participate in employee medical insurance and enjoy maternity insurance benefits can receive maternity allowances to compensate for some income losses during maternity leave. However, women covered by resident medical insurance usually do not receive maternity allowances. For a large number of women who do not have stable labor relationships or maternity allowance guarantees, childbirth means they must make difficult choices between taking care of their children and maintaining their labor income.

Therefore, while other regions gradually raise the level of medical expense protection for childbirth to be close to the standards of Shanghai, Tianjin, Zhejiang and other places, these leading provinces and cities can also further explore expanding the maternity allowance to women who have given birth but have not participated in the employee maternity insurance, in order to reduce the burden of childbirth on families.

The benefits generated from childbirth and raising the next generation are not solely attributed to a single family, but are shared by the entire society. In that case, the cost of childbirth should not be borne solely by the family. The government and society should provide more compensation for the cost of childbirth borne by families.

(The author is a researcher at Shanghai Institute of Finance and Law)

(Author's Commentary)