China's healthcare system is not completely free, but through the combination of “basic medical insurance + basic public health services”, a universal system has been constructed to cover the entire population, with the majority of the population having access to basic medical services at a relatively low cost. However, through the combination of “basic medical insurance + basic public health services”, a universal system has been established to cover the entire population, so that most residents can obtain basic medical services at relatively low costs. The following is a detailed explanation of the policy in terms of free/low-cost policies, personal burden, and protection for special groups:
The scope of “free” medical care in China: basic public health services
China provides “basic public health services” as a public product free of charge to the entire population, covering the basic health needs of residents throughout their life cycle, including the following:
1. Free services for key populations
... children aged 0-6 years: free inoculation with national immunization plan vaccines (such as Hepatitis B, BCG, DPT, and 11 other vaccines), and free newborn disease screening (hearing, genetic metabolic disorders); ....
. Maternity: free early pregnancy health checkups, five maternity checkups during pregnancy, postnatal visits, and in some areas free folic acid (to prevent fetal neural tube malformations); .
. Elderly people: annual free medical checkups for elderly people aged 65 and above (including blood test, urine test, liver and kidney function, electrocardiogram, etc.); .
. Hypertension/Diabetes patients: free blood pressure and blood sugar measurement, and four face-to-face follow-up visits per year (guidance on medication and lifestyle intervention).
2. Universal free services
. Infectious disease prevention and control: free influenza vaccination (in some areas), new coronary vaccination (free until 2023); .
. Health education: community health service centers and township health centers provide free health knowledge lectures and publicity materials.
. Pre-pregnancy eugenic examinations: Some provinces provide free pre-pregnancy eugenic examinations (e.g., blood tests, urine tests, TORCH screening, etc.) for couples planning to become pregnant.
The “non-free” part of China's medical care: individuals are required to pay for it at their own expense or partially at their own expense
Most of China's healthcare services require individuals to pay for them, but the burden is greatly reduced by reimbursement through health insurance. They are categorized as follows:
1. Items covered by basic medical insurance (with partial out-of-pocket expenses)
. General outpatient services: outpatient fees at public medical institutions are paid out-of-pocket and then reimbursed through health insurance (about 50%-80% for employees' health insurance and about 50% for residents' health insurance); .
. Inpatient treatment: hospitalization costs are subject to a threshold (e.g., RMB 1,000-2,000 for tertiary hospitals), and the excess is reimbursed on a pro rata basis (about 70%-90% for employees' health insurance and 60%-70% for residents' health insurance); .
. Chronic disease outpatient clinic: hypertension, diabetes and other outpatient chronic diseases can apply for “outpatient slow” qualification, the reimbursement rate is higher than the general outpatient clinic (in some areas up to 70%-90%); .
. Basic examination and medication: routine examinations such as blood tests, CT tests, and medicines in the medical insurance catalog (e.g., general antibiotics, antihypertensive medicines) are partly paid for out-of-pocket expenses (full out-of-pocket expenses are required for medicines not listed in the catalog). 2.
2. Items outside the medical insurance catalog (full out-of-pocket expenses are required)
. High-end examinations and treatments: PET-CT, genetic testing (non-essential), proton heavy ion radiotherapy (cancer), etc.; .
. Imported and innovative drugs: anti-cancer drugs and rare disease drugs (e.g., some imported targeted drugs) that are not included in the negotiation catalog of medical insurance; .
. Non-essential medical services: aesthetic plastic surgery (e.g. breast augmentation, liposuction), high-end medical checkups (including early cancer screening packages), rehabilitation treatment (non-essential items), etc.
3. Costs of private medical institutions (full out-of-pocket expenses mainly)
. Private hospitals and high-end clinics usually have higher consultation fees, medicine fees, examination fees, etc. than public institutions and have limited health insurance coverage (only some international departments or cooperative programs are reimbursed).
“Free/low-cost” coverage for special groups
China has adopted policies such as medical assistance, subsidized insurance coverage, and special subsidies to favor low-income groups and people in difficulty and reduce their medical burdens:
1. Medical assistance recipients
. Low-income groups and persons in special hardship: full subsidization of participation in urban and rural residents' medical insurance (with the government bearing the cost of individual contributions); .
. Low-income marginalized family members and seriously ill people who are poor due to illness: partially subsidize their participation in the insurance (e.g., subsidy of 50-80%), and provide assistance for individual out-of-pocket expenses exceeding a certain amount after reimbursement by the basic medical insurance and the major disease insurance (ratio of 70%-90%).
2. Children's and students' coverage
. Children between the ages of 0 and 14: Some regions have implemented “free treatment” for major diseases such as leukemia and congenital heart disease (e.g., the cost of surgery for “congenital heart disease” is fully reimbursed). (e.g., full reimbursement of the cost of surgery for “congenital heart disease”).
. College students: included in the urban and rural residents' medical insurance, and some areas provide additional “student safety insurance” (covering accidental injuries and hospitalization for illnesses).
3. Military personnel and their families
Military personnel and their families Active-duty military personnel, retired military personnel and their families enjoy “free medical care” or “preferential medical care” (e.g., priority treatment in military hospitals, partial fee waivers).
Controversy and reality of "universal free medical care
Some countries (e.g., the United Kingdom and Canada) have implemented “universal free medical care” (i.e., residents do not have to pay out-of-pocket for medical care, which is fully covered by government taxes), but China has yet to realize this model, for a number of reasons, including:
. Large population base: with a population of 1.4 billion, China would face enormous financial pressure if healthcare were to be made free for all (in 2023, total healthcare costs will have reached RMB 8.5 trillion, accounting for 7.2% of GDP); .
. Diversification of medical needs: some high-end medical needs (e.g., aesthetics, gene therapy) cannot be covered by public finance; .
. The need for hierarchical diagnosis and treatment: to guide rational medical treatment through personal out-of-pocket payments (to avoid “big treatment for small illnesses” crowding out high-quality resources).
Summing up: China's “low-cost universal coverage” rather than “free for all”
The core of China's healthcare system is “basic protection, strengthening the grassroots, and sustainability,” which is realized through basic healthcare insurance, basic public healthcare services, and medical assistance. Through basic medical insurance, basic public health services and medical assistance, the system has achieved the goal of “medical care for all”, but has not realized “free medical care for all”. Residents are required to pay a portion of the cost for most medical services (the burden of which has been significantly reduced through health insurance), while special groups receive lower-cost or free medical services through policy favoritism. In the future, with the deepening of health insurance reform (e.g., optimization of DRG/DIP payment methods) and increased financial investment, the affordability of health care in China will continue to improve, but “low-cost universal health care” will remain the long-term direction.