China's healthcare institutions are mainly classified into three categories: primary healthcare institutions, such as community healthcare service centers and village clinics, which are responsible for basic medical diagnosis and treatments. Specialist public health institutions are responsible for public health matters including family planning and infectious disease control, and hospitals are mainly responsible for outpatient and inpatient treatment of more complex diseases.
Accessible healthcare, yet crowded hospitals
Unlike many other countries, most hospitals in China, including the most advanced and specialist hospitals, can accept patients directly without general practitioners’ referrals. Talented medical professionals also prefer to work in tier-three hospitals as they offer better research platforms and higher salaries. Consequently, Chinese patients tend to seek treatments directly at hospitals where they can meet specialists and consultants directly, which resulted in overcrowded hospitals, long queues in the early mornings and overnight, and constant burnout among medical staff. In 2022, hospitals in China received more than 8.4 billion patient visits, 1.1 billion more than a decade ago. Inpatient treatments are in very high demand in many specialist hospitals, with bed occupancy rates often exceeding 100 percent.Regional inequalities
Historically, medical service quality in China varied greatly between urban and rural areas. While most rural residents already had access to medical services in the 1970s, hospitals were mainly concentrated in provincial capitals and urban centers. Rural areas were often served only by village clinics and barefoot doctors without formal medical education.The gap in medical services between different regions of China largely persists until today. Many residents from rural areas and inland provinces need to travel hundreds of kilometers to provincial capitals or to prestigious hospitals in Beijing, Shanghai, and Tianjin to receive treatment for more complex illnesses. The lower rate of cross-province medical cost reimbursements and additional travel expenses added more financial burdens to individual patients, with many suffering from poverty as a result. This inequality also caused an outflow of the already strained medical insurance funds from poorer regions to the eastern provinces, where treatments are performed. Consequently, authorities in some provinces are encouraging the merger and expansion of “super hospitals”, some with more than 10,000 beds, to consolidate the best available medical resources and professionals within the province and provide the best treatments possible.
