healthcare-in-china

Healthcare in China

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Health Insurance and the Healthcare System of China Explained

Healthcare in China varies significantly in terms of cost, quality, and accessibility to foreign residents. Most expats opt for private health insurance, for which there are a variety of options. Read on to find out more about expat healthcare in China, including the legendary, spa-like maternity hospitals.

Understanding a different healthcare system can be one of the most challenging parts of living abroad, particularly when there are significant language barriers and cultural differences to navigate.

Though China has established a national healthcare system covering an impressive 90% of its vast population, coverage varies based on the regional interpretation of national laws. Expats can choose between the public system, VIP wards, and private medical insurance.

This overview of the Chinese healthcare system covers key topics that are crucial for expats, including insurance options, finding a doctor, and even giving birth in China which can be a luxurious experience for those with the right insurance.

For those first few weeks after relocating, keep in mind that local hospitals and their VIP wards often don’t accept international insurance; you’ll need to pay in cash (not by card) for any treatment, and then claim the expenses from your insurance provider.

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How Does the Healthcare System Work in China?

China does have free public healthcare which is under the country’s social insurance plan. The healthcare system provides basic coverage for the majority of the native population and, in most cases, expats as well. However, it will depend on the region you reside in. As some areas don’t require their foreign residents to support the local healthcare system by paying the appropriate taxes, those residents will not be covered by public healthcare.

Medical insurance can be broken down into three subcategories: basic cover for urban enterprise employees, basic cover for other urban residents, and rural cooperative medical insurance for the farming population.

In China, urban employee basic medical insurance is obligatory insurance and the healthcare costsare paid by the employer and employee. Although the contributions to it vary from one municipality to another, they are usually 6% of the salary cost for the employer and 2% of the salary for the employee. The self-employed can also benefit from this insurance but must make all contributions.

For non-enterprise residents, health insurance is paid for by themselves and the state. For the unemployed or those on social assistance, insurance is subsidized by the state.

Still, no matter where you live and how much you’re covered, the way healthcare in China works will require you to pay for the services upfront and out of your own pocket. Depending on the insurance scheme and treatment, you may be reimbursed for some of the costs or none at all.

As for what does the public healthcare covers, it is worth noting that there are some gaps in the public health system. For example, it doesn’t usually cover the cost of emergency transportation, nor grant you access to private facilities. Also, even if you have access to public health insurance, your non-working family members may not be covered.

You should weigh the pros and cons of the health systemand look into private insurance options to see what is more suitable for you and your family’s needs.

An Overview of Private Health Insurance

With Chinese government mainly focusing on public healthcare, the way how the private health insurance works is sort of a mystery. The lack of understanding of the consumer’s needs and cooperation between hospitals and insurers makes private healthcare services confusing and expensive. The average costs of health insurance in China are rarely affordable for people with average wages. In addition to that, the public is poorly informed about their options and even the people who can afford it, rarely ever opt for private healthcare.

The most common types of the healthcare plans are the life insurance policies, that pay out a lump-sum for any critical illness a person is diagnosed with. And while this kind of health insurance is limited in coverage, it is inexpensive. Reimbursement-type policies are often too expensive for private individuals and it’s something mostly companies can allow themselves to take out. Therefore, see if it is possible for your employer to include you and your family in the company’s group insurance plan.

At the moment, the landscape of the health insurance market is quite narrow. Local companies provide their services in Mandarin and it is highly unlikely for an expat to find a customer care service that would provide information in English. However, if you know the language or have someone that can help navigate the process of obtaining health insurance, you can choose one of the local companies. The benefit of getting one there is a more comprehensive package that should give you a wider variety of options when choosing your doctor or hospital.

Some of the Chinese private insurance companies include:

International healthcare providers usually cater to the needs of expats. They should be able to provide the necessary information in English, however, the choices in their policies can be limited and they aren’t always able to cover you for expenses in some hospitals. Therefore, make sure you fully understand what is covered by your plan

Some of the companies include:

However, if you take out international health insurance in China, please be aware that public hospitals might not accept or recognize it. Your global provider may cover the costs for any bills from public clinics, but you’ll have to pay in cash first. And in the case of, say, surgery after a major accident, the costs can be rather steep.

Best Private and Public Hospitals

If you are on the lookout for the best hospital in China, first you have to familiarize yourself with the county’s classification system. All hospitals in China, no matter public or private, are classified into ten levels in total, the system referred to as 三级十等(sānjí shíděng). Firstly, it is broken down into three categories:

  • Primary – small town hospitals with under 100 beds. Provides basic preventive care.
  • Secondary – hospitals located in medium-sized cities with over 100 but under 500 beds. Provides comprehensive care and medical education as well as conducting research.
  • Tertiary – general city hospitals with over 500 beds. Provides comprehensive care that includes specialist health services, serve as hubs for medical research and education.

Those three tiers are then broken down into three more categories according to the provided services and the quality of them as well as medical equipment, technology, and management. Those are:

  • A (甲[jiǎ]) – the best hospitals with top-notch services.
  • B (乙[yǐ]) – good hospitals with qualified staff.
  • C (丙[bǐng]) – average hospitals of the country.

The special 3AAA level makes up the tenth category of the system. This title indicates the most specialized hospitals in the country.

By knowing these basic levels of classification, you should be able to identify the quality of the services provided in any medical institution that you visit.

Some of the best hospitals in China include:

To find more hospitals check out the US Embassy’s list of hospitals in China with phone numbers and addresses. If English isn’t your first language, your own embassy or consulate may have a similar list of doctors who speak your mother tongue.

What to Expect from Private Hospitals in China?

Expats often prefer private clinics for a variety of reasons. The staff mostly consists of foreign nationals, as well as Chinese doctors who have trained abroad. Therefore, there’s no language barrier. Moreover, private facilities in popular destinations offer top-notch standards of medical care.

On the downside, the health insurance costs are rather high. Some patients claim that the same treatment can cost up to ten times as much as at a public hospital.

While these clinics are often very expensive, expats with international health insurance can expect to be reimbursed. The insurance company may even cooperate with selected hospitals in China, where they offer direct billing services. Hence it is important that you talk to the insurance provider about the options you have.

What to Expect from Chinese Public Hospitals?

Depending on the facility, as well as your experience with life in China, attending a public hospital in China can be a bit of an adventure. It probably helps a lot if you have plenty of cash, lots of patience, and a friend who is fluent in Mandarin.

If you aren’t in a medical emergency, be prepared to spend quite some time in the waiting room. First, you need to register (guàhào) at the admission desk, where you pay an admission fee. If you haven’t been to that particular clinic before, you’ll get a hospital card (binglikă). Keep your card carefully as you’ll need to show it again during your visit.

The staff at the admission desk will send you to the respective department. For example, if you have an allergic rash, they’ll tell you to go to the dermatological ward (pífūkē). There you may need to register again and pay another fee.

Then you receive a number and wait patiently. Just have a look around to see if the number system actually works. If everyone keeps jumping the queue at will, feel free to join them after a while, otherwise, you’ll still be waiting at the end of the day.

Sooner or later, you’ll get to see a doctor. Many public hospitals in China don’t have separate waiting areas and consultation rooms. If you have to undress, you may need to do so behind a curtain or screen. Otherwise, there won’t be much privacy.

The doctor will give you a diagnosis and tell you to get a prescription (chŭfāng) from the hospital pharmacy (yàofáng) or prescribe further tests. Once you go to the pharmacy, lab, or another department, you need to pay for each item or examination, and you’ll have to wait in line again.

The In-Between Option: VIP Wards

Another option is to try the so-called “VIP wards” of local public hospitals in China. They offer similar care to private clinics and employ some English-speaking staff members. Moreover, they are somewhat cheaper than the expat hospitals described above.

However, please be aware that most public hospitals in China – including their VIP wards – don’t accept insurance coverage from international companies. An insurance plan from a Chinese provider is a definite advantage here.

Still, your global insurance company may still reimburse you for treatment at the VIP clinic, though you’ll have to pay upfront first. Again, ask your insurance provider which hospitals in China they recommend and how they handle the billing process.

Cultural Differences

It’s important to have an interpreter (e.g. a friend or co-worker) with you, especially if your Mandarin language skills are limited. Not all hospitals in China accept debit or credit cards, so carrying cash is your best option. Also, don’t forget to ask for a receipt (fāpiào). Your insurance provider may reimburse you later.

If your doctor seems overly pushy or alarmist, you might want to reconsider their recommendations or get a second opinion. As soon as it becomes obvious that you can afford the required tests and treatments, some doctors could be tempted to order more examinations or prescribe more medication than necessary.

It’s also helpful to know if you prefer traditional Chinese medicine, such as acupuncture or qi gong, or Western-style medicine. Thus, you can consult the right doctor and get the sort of treatment you are most comfortable with.

Also, be prepared for a bit of culture shock. In addition to the language barrier that awaits you in most hospitals in China, doctors may also have different attitudes to the doctor-patient relationship. Generally speaking, medical staff can be hesitant to discuss the consultation process and procedures with their patients.

Last but not least, hygiene standards vary a lot among public hospitals in China. If you are worried about this, ask other expats which clinics they recommend.

How to Find a Doctor or Dentist

Before you figure out how to find a doctor or a dentist in China, know that there is plenty to choose from. The Chinese Medical Doctor Association(CMPA) claims to be the home of four million medical practitioners in China. Since the association tries to unite such a large number of doctors, sub-associations were established based on the area of the practitioners (26 regions) and their specialty (18 sub-associations including dermatologists, neurologists, general practitioners, and others).

How to Find a Family Doctor and Specialists

When looking for a doctor in your area, the Chinese online market offers a few options that might help you out. Ping An Good Doctorand Chunyu Yishengare online tools (also available as apps) that list the available doctors in your area. On them, you can usually check the doctor’s background, see what hospital they are working in, and what’s their schedule. It also lets you register for an appointment. However, as well as most of the other resources, the pages are only available in Chinese.

If you do not speak the language, ask your health insurance provider to give you a few suggestions. Some insurance companies list their affiliate doctors and their contact information on their websites as well.

Word-of-mouth might be another good option to find a good doctor. Ask for some recommendations from your colleagues and other expats and check out expat forums online. One of the useful websites, in this case, can be The Care Voice that lets you read reviews about the healthcare experiences of others and share your recommendations as well.

How to Find a Dentist in China

Just like with any other hospital experience in China, when it comes to dental care you have a few options to choose from. You can opt for a public, private, or expat-oriented hospitals, with prices increasing accordingly. With standard health insurance rarely covering dental procedures, make sure you budget enough funds for your dental appointments and possible treatments.

The most common way of finding a dentist in China seems to be contacting or attending the clinic of your preference and choosing from one of the specialists there. The above-mentioned platforms can also help you find a good local dentist.

If you are looking for a specific doctor and would like to research their background before meeting them, ask around for recommendations. Your family doctor might know a few reputable specialists while your colleagues might share some useful tips about their experiences as well.

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Giving Birth in China

Giving birth as a foreigner in China should not be too complicated. If you are using public healthcare insurance, most of the maternity expenses should be covered by the government. If you are using private insurance, make sure your plan includes maternity care.

The price of giving birth in China varies greatly. The fees will not only depend on the care you choose and the delivery type (natural or C-Section), but also the region you’re in, the hospital of your choosing, and even the ward you wish to stay in. The average costs of giving birth in public hospitals in China range from about 2,000 to 10,000 CNY. The private clinics will charge you way more than that; you can expect to pay around 50,000 CNY on average, but don’t be surprised if the bill exceeds 100,000 CNY.

If you want to know more about the rules regarding maternity leave, check out our guide on working in China.

How Prenatal Care Works in China

Some expat women may decide to give birth at a public Chinese hospital, especially those without private health insurance. Once you go to see your gynecologist to have your pregnancy confirmed, they will hand you a red booklet for prenatal care. Don’t lose it, as the doctor uses it to track important details like your blood pressure, weight, and the baby’s vital signs.

Your prenatal health check-ups will be scheduled at regular intervals: first every month, then bi-weekly, and weekly for about the last month. At week 20, you will get an ultrasound exam, and you’ll be able to see your child’s heartbeat for the first time.

However, always make sure to find out what exactly the doctor is checking at these exams. In many cases, you may have to request extra lab work to get your blood or urine tested, for which you will have to pay an additional fee.

What to Expect from Public Maternity Hospitals

The closer your date for giving birth in China is, the better you should prepare yourself for what awaits you at delivery. If you are giving birth in China, you might have to cope with some additional challenges.

The language barrier will be just one of the obstacles to overcome. Moreover, cultural attitudes with regard to pain management during delivery, birthing methods, the doctor-patient relationship, and the role of spouses may differ widely from your home country.

For example, Caesarean sections are ever more common among women giving birth in China. Natural births, on the other hand, aren’t very popular. You may also be expected to share the birthing room with several other patients, and your partner might not be allowed in the room.

Standards of medical care for neo-natal emergencies differ wildly from Chinese clinic to clinic. But in general, most children arrive more or less smoothly, no matter where you’re giving birth in China.

What is the Hospital Experience in China?

After giving birth to a healthy child, you’ll usually stay in the hospital for a week. Please be aware that you are expected to bring your own pajamas and baby clothes as well as your own bed linen, towels, and hospital gowns. Also, bring some hygiene products such as sanitary napkins, breast pads, diapers, and baby wipes.

Most public clinics don’t provide food for the patients, either. After giving birth, your family is expected to come in, visit you, and bring you regular meals.

In addition to all that, make sure that you have enough money to cover the services. You’ll mostly have to pay in cash. However, do insist on getting a tax receipt (fāpiào) for each and every hospital bill. Depending on your health insurance plan, the provider may reimburse you for the costs of giving birth in China.

What if You Choose a Private Maternity Clinic?

If you decide on giving birth in China and have enough funds to cover a fancier option, China’s private maternity hospitals are the way to go. Not only do these Chinese clinics have English-speaking medical staff, but at times, they may also feel like a hotel or wellness spa rather than a hospital. However, keep in mind that all these benefits of giving birth there come at a very hefty price.

Citizenship and Giving Birth in China

After giving birth, you have to take care of various administrative issues. If the baby is born at a public hospital, make sure to sign it up for the official immunization schedule, so that your child gets all necessary vaccinations for infants.

Moreover, check as soon as you can if the hospital issues the Chinese birth certificate for your child. If it doesn’t, ask the staff how and where to get the official certificate. Then get in touch with your embassy to find out how to officially register the birth of your child there.

If the parents wish for their child to have Chinese citizenship, at least one of them must be Chinese or they both must have settled in China and be of “uncertain nationality”. Being a permanent resident in China will not grant your newborn Chinese citizenship.

If you want for your child to receive your nationality that is other than Chinese, you will have to take care of some extra paperwork. You will need a non-Chinese birth certificate as well as a passport and a Chinese exit visa for your kid, so you can leave China without further trouble. Your embassy or consulate will issue the passport, so you can then get the visa from the local immigration authorities.

Please note: If one parent is a Chinese citizen, there may be further complications. China doesn’t recognize dual citizenship, but every child born in China to a Chinese parent is automatically a Chinese national. That is why you might need to officially reject your child’s Chinese citizenship first. After that, you can get their foreign passport. In such cases, please get in touch with the embassy responsible for the non-Chinese parent in advance and ask for legal advice.

InterNations GO!
by InterNations GO!
06 March 2019
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