China's price advantage in medical tourism for organ transplantation and rare disease treatment has failed to make it the top choice for international patients, but is often seen as the “last resort.” This phenomenon needs to be analyzed from multiple dimensions, including the medical trust system, policy compliance, service ecosystem shortcomings, and patient decision-making logic:
I、Core Contradiction: The “Trust Cost” of High-Threshold Medical Care Exceeds Price Sensitivity
Organ transplantation (especially liver and kidney transplantation) and rare disease treatment (such as spinal muscular atrophy and Fabry disease) are high-complexity, high-risk medical procedures. Patients and their families' core demands are not merely “low prices,” but rather the certainty of treatment outcomes, compliance with medical procedures, and the reliability of long-term post-operative care. Although China has a significant price advantage (e.g., organ transplant surgery costs are approximately one-third to one-half of those in the United States, and the prices of targeted drugs for rare diseases have been significantly reduced through medical insurance negotiations), international patients' concerns about these “hidden costs” far outweigh price differences.
1. The “International Certification Gap” in Medical Quality
When selecting a medical destination, international patients often prioritize international medical quality certification systems (such as JCI certification). As of 2024, only approximately 120 hospitals in China have obtained JCI certification (less than 1% of the total number of hospitals nationwide), and these are primarily general hospitals. The certification coverage rate for specialized institutions (such as organ transplant centers and rare disease treatment centers) is even lower. In contrast, leading institutions like the Mayo Clinic in the United States and the University Medical Center Hamburg-Eppendorf in Germany generally hold JCI or EU certifications, and their technical standards and procedural norms are widely recognized by global patients.
While some top Chinese hospitals have achieved international standards in organ transplantation technology (e.g., China leads the world in liver transplant procedures), the absence of third-party international certification leaves international patients skeptical about the stability of their techniques and long-term post-operative survival rates (e.g., 10-year kidney transplant survival rates).
2. The “data accumulation gap” in rare disease treatment
The core treatment for rare diseases (approximately 7,000 globally, with 121 defined in China) relies on precise diagnostic capabilities, drug accessibility, and long-term follow-up data. In recent years, China has included over 70 rare disease drugs in its medical insurance directory through negotiations (e.g., the price of nusinersen injection has been reduced from 700,000 yuan to 33,000 yuan). However, international patients face challenges such as:
• Diagnostic technology disparities: Genetic testing and biomarker identification for some rare diseases rely on databases dominated by Western countries (such as OMIM and Orphanet), while China's domestic databases lack sufficient sample sizes and international compatibility;
• Limited drug accessibility: Although China has accelerated the approval process for rare disease drugs (e.g., 126 approved in 2023), some new drugs (e.g., migasat for Fabry disease) still require “special import” or overseas procurement, which involves complex procedures and compliance risks;
• Lack of long-term follow-up: Rare disease patients require lifelong management, but most Chinese hospitals' follow-up systems focus on local patients, making it difficult to ensure cross-regional tracking of international patients.
II、 Policy and Compliance Barriers: The “Gray Area” Diminishes Appeal
Both organ transplantation and rare disease treatment are subject to strict legal and ethical regulations. While China's relevant policies have gradually improved, international patients still face significantly higher compliance risks compared to traditional medical tourism destinations (such as Thailand and Germany).
1. The “Legality Threshold” for Organ Transplantation
China has completely banned organ trafficking since 2015, with voluntary citizen donation being the only legal source. Although China's organ donation rate (4.4 per million population in 2023) has approached that of some European countries, international patients must meet strict ethical review criteria:
• Foreign patients must apply through China's Organ Transplant Resource Sharing System (COTRS) and prove that there are no better treatment options available in their home country;
• Some countries (such as the US and the EU) question China's legal framework for organ transplantation, even listing it as a “high-risk medical procedure,” which can lead to difficulties in obtaining insurance reimbursement or legal disputes upon returning home;
• In contrast, countries like Thailand and Malaysia have more lenient restrictions on organ transplantation for international patients (some allow self-funded organ procurement), though this raises ethical concerns, it objectively reduces patients' “compliance costs.”
2. “Cross-border medical restrictions” on rare disease treatment
China's management of cross-border medical care follows the “necessity principle,” which only allows patients with “serious illnesses that cannot be treated domestically” to seek medical treatment abroad. However, conversely, international patients entering China for rare disease treatment also face restrictions:
• Some countries require patients to provide medical proof that “China's treatment plan is superior to their own country's,” but China's rare disease treatment guidelines have not yet been widely adopted internationally;
• Rare disease medications are mostly imported or generic drugs, and international patients' medication use must comply with the approval scope of China's National Medical Products Administration (NMPA). If a drug is not available in China, it must be obtained through “compassionate use” or “clinical trial” channels, which involve cumbersome procedures;
• In contrast, countries like Germany and Switzerland, leveraging the EU's unified drug registration system (EMA) and relaxed cross-border medical policies, are better positioned to offer international patients “one-stop” rare disease diagnosis and treatment services.
III、Service Ecosystem Shortcomings: Insufficient Support Amplifies the Limitations of “Price Advantages”
The competitiveness of medical tourism depends not only on medical technology but also on comprehensive support across the entire chain, including language services, insurance coordination, and post-operative rehabilitation. China's supporting infrastructure in these areas remains in its infancy, leading international patients to “vote with their feet.”
1. Language and Cultural Barriers
Organ transplantation and rare disease treatment involve extensive specialized terminology (e.g., immunosuppressant dose adjustments, gene editing technology), and communication between international patients and Chinese medical teams relies on translation. However, the scarcity of professional medical translators often leads to information errors. For example, some patients misunderstood post-operative medication contraindications due to translation errors, increasing the risk of complications.
In contrast, countries like Thailand and India, which have developed medical tourism industries, have established mature “medical staff-translator-caregiver” integrated teams and even offer multilingual medical record management systems, significantly reducing communication costs.
2. Poor coordination between insurance and payment
International patients typically rely on commercial insurance or overseas medical funds to cover medical expenses, but most Chinese hospitals have not signed direct payment agreements with international insurance institutions (such as MSH or Allianz), forcing patients to cover costs upfront and then apply for reimbursement, resulting in significant financial pressure.
Patients with rare diseases face an even greater “cross-border healthcare coverage gap”: most countries' healthcare systems only cover institutions recognized by their own governments, making it difficult for Chinese hospitals' treatment costs to be included. This results in patients' actual out-of-pocket costs potentially exceeding those of treatment in their home countries (e.g., the total cost of organ transplantation for U.S. patients in China may still exceed costs in the U.S. due to additional expenses for cross-border transportation, accommodation, and insurance deductibles).
3. Lack of post-operative rehabilitation support
Organ transplant patients must take immunosuppressants for life and undergo regular monitoring for rejection reactions; rare disease patients (such as those with amyotrophic lateral sclerosis) require long-term rehabilitation training. Most Chinese hospitals lack a post-operative follow-up system for international patients and cannot provide ongoing services such as remote monitoring and medication guidance.
In contrast, German medical tourism agencies often collaborate with insurance companies to offer patients a comprehensive package including “treatment + rehabilitation + post-discharge care,” and even arrange for local doctors to continue follow-up care, addressing patients' concerns about post-treatment support.
IV、Conclusion: Price advantages must be combined with a “trust system” to be converted into competitiveness
China's price advantage in medical tourism for organ transplantation and rare disease treatment fundamentally reflects its “cost control capabilities,” but international patients' decision-making logic prioritizes the “risk-benefit” balance. To transform price advantage from a “last resort” into a “preferred option,” three key areas require breakthroughs:
1. Strengthen international certification and data transparency: Promote top-tier hospitals to obtain certifications such as JCI and EMA, and establish internationally recognized databases for organ transplantation and rare disease diagnosis and treatment;
2. Improve policy coordination and compliance safeguards: Streamline approval processes for international patients seeking medical treatment, and promote mutual recognition of clinical trial data from international multi-center trials for rare disease medications;
3. Build a comprehensive service ecosystem: Develop specialized medical translation services, international insurance direct payment systems, and post-operative remote follow-up services to reduce patients' “hidden costs.”
Only by achieving these breakthroughs can China's price advantage be truly transformed into the core competitiveness of medical tourism.