Hailey Tran
Healthcare in China is primarily provided by state-owned hospitals, with over 95% of the population having at least basic health insurance coverage. However, the quality of care varies, and hospitals are often crowded with long waiting times. Chinese citizens with public health insurance may still need to pay fees for care and medication, and hospitals are not always conveniently designed for patients. The country's rapid healthcare reforms have brought new infrastructure and technology, but the system continues to face challenges, including violence and disputes over insurance and treatment costs. As a result, some Chinese citizens opt to visit multiple hospitals to ensure they receive accurate information about their health.
| Characteristics | Values |
|---|---|
| Healthcare services provided by | State-owned hospitals (90% of patients) and private hospitals |
| State-owned hospitals | Larger, better physicians and medical equipment, regulated prices and wages |
| Private hospitals | Available throughout the country, with a bigger choice in large cities and provincial capitals |
| Healthcare system | Traditional Chinese medicine (TCM) and modern medicine as two parallel systems |
| TCM | Challenged by a lack of professionals and rising awareness of modern/Western models |
| Public hospitals | Vary in quality by location, with the best treatment in public city-level hospitals |
| Public hospitals | May have VIP wards, can be dirty and poorly maintained |
| Public hospitals | May run unnecessary tests, prescribe unnecessary medication, or make patients stay overnight to increase bills |
| Public hospitals | May force foreigners to go to an international department which costs more money |
| Insurance | Government-supported public health insurance is available to most Chinese citizens, but cover is not mandatory |
| Insurance | Private health insurance is available, with the government encouraging its development |
| Insurance | Foreigners with permanent resident status may be able to access government-supported public health insurance |
| Insurance | International patients may pay more in private hospitals due to insurance |
| International students | May be directed to the most appropriate hospital or provider by opening a case file with CISI ahead of time |
| International students | Should prepare mentally and bring a friend who speaks Chinese |
| Urban residents | Pay almost all health costs out-of-pocket |
| Rural residents | Often cannot afford healthcare in urban hospitals |
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What You'll Learn
Healthcare insurance in China
Healthcare in China is primarily provided by state-owned hospitals, which account for approximately 90% of patients in the country. The Chinese healthcare system has undergone significant reforms since 2009, with the availability of medical insurance increasing in urban areas. By 2011, over 95% of the population had basic health insurance coverage. This was achieved through three public insurance programs: Urban Employee Basic Medical Insurance, the Newly Cooperative Medical Scheme, and the Urban Resident Basic Medical Insurance.
The basic medical insurance system in China consists of two parts: employee medical insurance and resident medical insurance. The former covers the urban employed population, while the latter covers the urban non-employed population and rural residents. The employed are required to enroll in an employment-based program funded through payroll taxes, while other residents can voluntarily enroll in the Urban-Rural Resident Basic Medical Insurance, financed by central and local governments. These basic plans cover primary, specialty, hospital, and mental healthcare, as well as prescription drugs and traditional Chinese medicine. However, public health insurance generally only covers about half of medical costs, and patients may still need to pay out of pocket, especially for serious illnesses.
To address this, the Chinese government is encouraging the development of the private health insurance market, allowing broader healthcare choices for foreigners and high-income citizens. Private hospitals are available throughout the country, with a greater concentration in large cities and provincial capitals. These hospitals tend to be more expensive but offer higher standards of treatment and English-speaking staff.
Expats in China should carefully consider their health insurance options, as not all hospitals recognize all insurers. While public hospitals are an option, they often have long waiting times and language barriers. Some public hospitals in major cities have established international wings or VIP wards, providing higher-quality treatment at a lower cost than private hospitals.
Overall, China has made significant strides towards achieving universal health insurance coverage, and the quality of healthcare provision varies across the country, with urban areas generally having better access to healthcare services than rural areas.
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Long wait times at hospitals
Historically, Chinese hospitals often did not schedule appointments, leading to clogged hospitals and long wait times. The introduction of various appointment-scheduling methods, such as web, landline, smartphone, and ATM-based systems, has been a crucial step in improving patient access to timely healthcare services. However, the problem of long wait times persists, exacerbated by the rapid increase in patient demand outpacing the growth of healthcare resources. Between 2005 and 2015, the number of public tertiary hospitals doubled, while the annual number of outpatient visits quadrupled, highlighting the imbalance between healthcare supply and demand.
The Chinese healthcare system is primarily served by state-owned hospitals, which cater to approximately 90% of patients. These hospitals are generally larger and better equipped than private hospitals, with the government regulating the prices of services and wages for personnel. However, the quality of healthcare in China varies across locations, with the best treatment typically found in public city-level hospitals, followed by smaller district-level clinics. This variation in quality and access to healthcare has led to a growing market for private health insurance in China, encouraged by the government to offer a broader range of healthcare choices for foreigners and higher-income Chinese citizens.
Despite these efforts, long wait times in Chinese hospitals continue to be a challenge, impacting patient satisfaction. The implementation of organisational and structural changes, improved flow control, and better capacity allocation are essential to minimising the negative effects of prolonged waiting times. Additionally, the development of a triage system in emergency rooms has been suggested to optimise the utilisation of limited medical resources and reduce waiting times for patients requiring urgent care.
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Private vs public hospitals
Healthcare services in China are primarily provided by state-owned hospitals, which serve approximately 90% of patients. State-owned hospitals are larger than private hospitals and have better physicians and medical equipment. The government regulates the price of services and wages for state-owned hospital personnel.
Private hospitals, on the other hand, have experienced rapid growth in China over the last decade. They now outnumber public hospitals by a factor of two. Private hospitals are available throughout the country, with a bigger choice in large cities and provincial capitals. However, outpatient visits and hospitalizations remain higher among public hospitals, while per-patient expenditure is higher in private hospitals.
Healthcare in China is free for Chinese citizens and permanent residents. Most Chinese citizens can choose to take up government-supported public health insurance, although cover is not mandatory. Even for citizens with public health insurance, there may be some fees for care and medication, but these costs are heavily subsidized. The Chinese government is encouraging the development of the private health insurance market to allow foreigners and higher-income Chinese citizens to have a broader range of healthcare choices.
The quality of healthcare in China varies by location, with the best treatment usually found in public city-level hospitals, followed by smaller district-level clinics. Many public hospitals in major cities have so-called "VIP wards". Healthcare for residents of rural areas unable to travel long distances to urban hospitals is provided by family doctors who travel to patients' homes, which is covered by the government.
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Chinese hospitals' sanitation
Sanitation in Chinese hospitals has been a focus of the Chinese government for several decades. Since the 1990s, the government has included the improvement of sanitation in rural areas in its national five-year plan. In 2019, China launched a national policy called the "Notice on Launching a Special Action for Improving Cleanliness of Toilets in Medical and Healthcare Institutions". This initiative emphasised the renovation of toilet facilities and the enforcement of hygiene standards across the healthcare system.
In 2021, standards for general hospital construction explicitly required sanitation facilities, including toilets, to meet patient needs, aiming to enhance the patient experience through an improved toilet environment. China has also been investing in improving rural sanitation since 2009, with a particular focus on low-income areas. From 2009 to 2011, the Chinese government invested 4.448 billion yuan in rural sanitation improvement through a three-year health reform program.
Despite these efforts, there are still disparities in the availability of sanitation facilities between private and public healthcare institutions. Private healthcare institutions, especially at the primary level, often offer affordable services rather than high-end healthcare. In contrast, public hospitals dominate the Chinese healthcare system and benefit from substantial financial support. This has led to inadequate attention to the sanitary facilities within examination rooms and the lack of hand hygiene management among healthcare workers in non-infection control-focused departments.
Healthcare services in China are primarily provided by state-owned hospitals, which serve approximately 90% of patients. State-owned hospitals are larger than private hospitals and have better physicians and medical equipment. The government regulates the price of services and wages for state-owned hospital personnel. Most Chinese citizens can choose to take up government-supported public health insurance, although cover is not mandatory. As a result, some people still need to pay out of pocket for all medical expenses.
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Healthcare for foreigners in China
Healthcare in China is free for Chinese citizens and permanent residents. However, foreigners living in China or visiting the country will need to pay for medical treatment. As such, it is strongly recommended that foreigners take out private health insurance to cover any medical expenses incurred during their time in China.
The Chinese government is encouraging the development of the private health insurance market to allow foreigners and higher-income Chinese citizens to have a broader range of healthcare choices. Private hospitals are available throughout the country, with a greater choice in large cities and provincial capitals. These hospitals are generally only found in major metropolitan areas and are more expensive than public healthcare services. However, they tend to be closer to the standard found in Europe or North America, and in some cases, the quality of treatment can be as good as or better than what one might expect in their home country.
Public health insurance in China is not mandatory, and even those with insurance may need to pay some fees for care and medication. The quality of public healthcare varies by location, with the best treatment usually found in public city-level hospitals, followed by smaller district-level clinics. State-owned hospitals provide services for approximately 90% of patients in China and are larger than private hospitals, with better physicians and medical equipment.
Expats should be aware that public medical institutions in China are not often used by other expats due to long waiting times, language barriers, and slow service. However, the quality of medical expertise generally compares quite favourably to Western medical standards, and some public hospitals in major cities have established international wings to bridge the gap between public and private healthcare.
It is important to note that ambulances in China do not carry sophisticated medical equipment, and ambulance personnel generally have little to no medical training. Therefore, it is recommended to go directly to the nearest major hospital in an emergency, as rural clinics are often reluctant to accept responsibility for treating foreigners. Additionally, some medicines may have extensive requirements and restrictions when being brought into the country, so it is essential to research this before travelling to China.
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Frequently asked questions
Healthcare in China is provided by state-owned hospitals and is free for citizens and permanent residents. However, there may be some fees for care and medication, which are subsidised by the government.
Chinese hospitals are divided into three divisions, offering three levels of care. First-level hospitals deliver primary care, while third-level hospitals deliver state-of-the-art care. Hospitals in China are known for long waiting times, with patients queuing for hours to see a doctor. Doctors are also known to see a high number of patients daily, which can result in rushed and impersonal consultations.
As of 2020, about 95% of the Chinese population has at least basic health insurance coverage. However, there are still some out-of-pocket costs, and healthcare privatisation has made it difficult for urban and rural residents to afford healthcare.
Many foreigners face language barriers in local hospitals, and international hospitals provide better sanitation, privacy, and shorter waiting times.
