Public Hospitals vs. Private Hospitals: How Significant Are the Cost Differences for Cancer Treatment in China?

In China, the cost disparity for cancer treatment between public and private hospitals is substantial, primarily influenced by factors such as hospital type, treatment methods, medication/service choices, medical insurance coverage, and regional economic levels. The following comparative analysis across specific dimensions helps elucidate the core logic behind these differences:

I、Overall Cost Framework: Public Hospitals “Medicare-Dominated,” Private Hospitals “Primarily Out-of-Pocket”

The core advantage of public hospitals (especially top-tier tertiary hospitals) lies in extensive medical insurance coverage. Most basic treatments—such as surgery, conventional chemotherapy, and targeted drugs listed in the insurance directory—can be reimbursed through basic medical insurance (employee/resident insurance), with personal out-of-pocket costs typically ranging from 20% to 40%. In contrast, private hospitals (especially high-end for-profit institutions) heavily rely on out-of-pocket payments. Even when certain services are covered by commercial insurance, overall costs can still be several times higher than at public hospitals.

II、Specific Cost Comparisons by Treatment Stage

Cancer treatment typically progresses through distinct phases: surgery, radiotherapy/chemotherapy, targeted/immunotherapy, and long-term management. Cost disparities are particularly pronounced across these stages:

1. Surgical Treatment

Public Hospitals (Grade III A):

Costs primarily include surgical fees, anesthesia, hospitalization, diagnostics (e.g., CT/MRI), and postoperative care. For common radical surgeries like gastric or lung cancer resection, expenses range from approximately ¥30,000 to ¥80,000 (in Grade III A hospitals of first-tier cities). Costs may rise to ¥100,000–¥200,000 if imported instruments (e.g., staplers) are used or procedures involve complexity (e.g., organ transplantation).

After medical insurance reimbursement, the personal out-of-pocket expense is typically ¥10,000–40,000 (varies based on insurance type and regional reimbursement rates; e.g., Beijing employee insurance covers 70%–90%).

Private Hospitals (High-End):

Costs include surgical fees, premium accommodations (private rooms/suites), VIP nursing, expedited testing, and other ancillary services. Similar procedures generally range from ¥80,000 to ¥200,000 (basic package), with complex surgeries reaching ¥300,000 to ¥500,000.

Out-of-pocket expenses are nearly 100% (only partially covered by select high-end commercial insurance), requiring patients to bear the full cost.

2. Radiation Therapy (using IMRT as an example)

Public Hospitals:

Costs depend on the treatment area (e.g., head/neck, lungs), number of sessions (typically 20-30), and equipment type (conventional radiotherapy/IGRT/proton therapy). Conventional IMRT costs approximately ¥20,000–50,000 per course (whole-body treatment). Proton therapy, due to its expensive equipment (available only at a few top-tier public hospitals in China), can cost as high as ¥300,000–500,000 per course.

Medical insurance may cover a portion of the costs (e.g., 50%-70% for conventional radiotherapy; proton therapy may be limited to specific conditions or require out-of-pocket payment).

Private Hospitals:

These also offer IMRT or more advanced radiotherapy (e.g., Tomotherapy), but due to higher equipment maintenance and service costs, per-session fees may be 1.5 to 2 times those of public hospitals. For example, head IMRT at private hospitals costs approximately ¥15,000–30,000 per session (total cost for a 20-session course: ¥300,000–600,000), with most treatments requiring out-of-pocket payment.

3. Chemotherapy (including targeted/immunotherapy)

Public Hospitals:

Chemotherapy costs primarily consist of medication fees + intravenous injection/examination fees. For domestically produced chemotherapy drugs covered by medical insurance (e.g., paclitaxel, cisplatin), a single session costs approximately ¥2,000–5,000; For imported drugs (e.g., oxaliplatin, carboplatin) or targeted therapies (e.g., osimertinib for lung cancer, trastuzumab for breast cancer), costs are higher, though some are covered by insurance (e.g., osimertinib costs approximately ¥5,000/month after insurance reimbursement).

For advanced lung cancer (including targeted therapy), annual treatment costs at public tertiary hospitals range from ¥50,000 to ¥150,000 (out-of-pocket expenses after insurance reimbursement: ¥20,000–¥80,000).

Private Hospitals:

Chemotherapy regimens are similar to those in public hospitals, but drug selection is more flexible (e.g., prioritizing non-reimbursed new drugs or imported medications). Service fees apply (e.g., specialist consultations, private wards). For instance, while both settings may use Osimertinib, private hospitals may lack discounts (public hospitals benefit from centralized procurement price reductions). Including service fees, annual costs can rise to ¥100,000–250,000 (fully out-of-pocket). Costs escalate further for non-reimbursed novel drugs (e.g., certain PD-1 inhibitors).

4. Long-Term Maintenance Therapy and Management

Public Hospitals:

Primarily involves regular follow-ups (blood tests, imaging) and symptomatic treatment (e.g., pain management, nutritional support) at lower costs. For instance, quarterly check-ups cost approximately ¥500–2,000, totaling ¥2,000–8,000 annually (mostly covered by insurance).

Private Hospitals:

Offer more frequent follow-ups (e.g., monthly), personalized health management (nutritionists, psychological counseling), and advanced diagnostics (e.g., PET-CT scans). Annual costs may reach 20,000–100,000 RMB (fully out-of-pocket).

III、Core Reasons for Disparities

1. Medical Insurance Coverage: Public hospitals are the primary designated institutions for medical insurance, with over 90% of routine treatments covered. Private hospitals only partially collaborate with commercial insurance providers, and their medical insurance coverage is limited (e.g., special needs departments are typically excluded).

2. Service Costs: Additional services in private hospitals, such as VIP wards, one-on-one specialist consultations, and expedited testing, significantly increase costs.

3. Medication/Equipment Selection: Private hospitals favor high-cost imported drugs, non-reimbursable new medications, or advanced equipment (e.g., proton therapy). Public hospitals, constrained by insurance cost controls, prioritize cost-effective domestic drugs or listed medications.

4. Operational Model: Public hospitals are non-profit (except for some high-end private departments), with costs subsidized by the government; private hospitals operate for profit and must cover operational expenses through higher fees.

IV、Practical Selection Recommendations

1. Moderate Financial Means: Prioritize top-tier public hospitals (especially local insurance-designated facilities) to leverage insurance coverage and reduce out-of-pocket expenses. Basic treatment outcomes show no fundamental difference from private hospitals (with potentially more concentrated physician resources).

. Better Financial Circumstances: For enhanced services (e.g., private rooms, reduced wait times) or access to non-covered drugs/technologies (e.g., CAR-T cell therapy), consider private hospitals (verify coverage under commercial insurance beforehand).

. For critical illnesses (e.g., advanced cancer): Primarily utilize public tertiary hospitals (strong comprehensive diagnostic capabilities, more extensive insurance coverage). When necessary, balance effectiveness and cost through a “public treatment + private support” combination (e.g., post-operative rehabilitation at private facilities).

Summary

Overall, in cancer treatment, the out-of-pocket portion at public tertiary hospitals may be only one-third to one-fifth of that at private hospitals (varies by treatment modality). However, note that the core cost difference stems from balancing “medical insurance coverage” versus “service upgrades,” not purely treatment efficacy—public tertiary hospitals excel in foundational care and complex cases, while private institutions emphasize service experience and personalized needs. Patients should make comprehensive choices based on their condition, financial capacity, and treatment objectives.

Document dated 2025-09-16 09:54 Modify