Health Insurance in China: Public vs. Private

Published on September 30, 2025 and written by Cyril Jarnias

With a population exceeding 1.4 billion, China’s healthcare insurance structure demonstrates remarkable complexity, and the choice between public and private coverage generates ongoing debate. While the public system aims to provide basic protection for the majority, private services attract with their speed and perceived superior quality, creating a bifurcated healthcare landscape. This article will examine the fundamental differences between these two systems, exploring their respective advantages and the challenges they pose for a country undergoing rapid economic and social transformation.

Comparison Between Public and Private Coverage in China

Key Characteristics of Public and Private Coverage in China

Criterion	Public Coverage	Private Coverage
Economic Aspects	Low cost for insured individuals, covered by the state, employers, and employees. Often limited reimbursements, especially for specialized or higher-quality care.	Very high cost, accessible mainly to expatriates, executives, and affluent classes. Private insurance covers high-quality care, often in modern facilities.
Quality of Care	Generally good quality care in cities, but significant disparities with rural areas. Long wait times, limited comfort, frequent language barriers.	Very high-quality care, modern equipment, quick access, multilingual services, superior comfort. Private facilities are concentrated in major cities.
Covered Populations	Almost the entire population: urban employees (UEBMI), non-working urban residents (URBMI), rural residents (NCMS). Persistent inequalities based on region and social status.	Primarily expatriates, affluent classes, international executives, tourists, and certain workers with international insurance.
Advantages	Financial accessibility, broad basic coverage, state participation. Progressive access to modern and traditional medicine.	Quality and speed of care, comfort, personalization, access to international specialists. Better coverage for serious or chronic illnesses.
Disadvantages	Regional inequalities, waiting lines, sometimes limited coverage, under-equipped rural hospitals, frequent reliance on traditional medicine.	Very high cost, no state support, coverage limited to those with sufficient resources or specific insurance.

Recent Coverage Statistics

• Over 95% of the population benefits from some form of basic health insurance, thanks to the widespread implementation of the three main schemes (UEBMI, URBMI, NCMS).
• Healthcare expenditures continue to rise rapidly, with an increasing share allocated to the private sector.
• Costs in public hospitals remain low (general consultation starting at 10 RMB), while they can exceed 500 RMB in private or international facilities.

Influence of Government Policies

Public policies aim to strengthen universal coverage, reduce urban/rural inequalities, and encourage private sector investment in innovation (telemedicine, infrastructure modernization).

The state promotes telemedicine to improve healthcare access in remote areas, often through public-private partnerships.

The “Healthy Chinese Initiative 2030” plan sets ambitious goals for life expectancy and healthcare quality improvement, with massive investment expected from the private sector.

Policyholder Satisfaction

Private sector policyholders express higher satisfaction levels, thanks to the speed, quality, and comfort of care.

In the public sector, satisfaction is more variable: good in major cities, significantly lower in rural areas or for specialized care with long wait times.

Current Challenges

Funding: Increasing pressure on the public system due to population aging and rising chronic diseases.

Accessibility: Persistent inequalities between cities and countryside, prohibitive cost of private care for the majority.

Quality: Difficulty ensuring uniform standards nationwide, shortage of general practitioners, reliance on traditional medicine in some regions.

State Support: Proactive policies, but need to increase resources and modernize infrastructure.

Future Outlook

Rising prominence of the private sector and telemedicine, supported by the state to achieve national health goals.

Expected reforms to improve social benefit portability, rural healthcare quality, and chronic disease management.

Major challenges related to demographic aging and rapid urbanization, which will increase pressure on both systems.

Likely development of hybrid insurance products and customized offerings to meet the diversifying needs of the Chinese population.

Summary of Advantages and Disadvantages

System	Main Advantages	Main Disadvantages
Public	Accessibility, low cost, broad coverage	Regional inequalities, waiting lines, variable quality
Private	Quality, speed, comfort, personalization	High cost, limited access, no public support

Advantages and Disadvantages of Health Insurance for Expatriates in China

Advantages of Subscribing to Health Insurance as an Expatriate in China:

• Access to a private care network
  International health insurance provides access to private hospitals and clinics where care quality surpasses Chinese public facilities and often features internationally trained staff.
• International coverage
  These contracts typically cover care not only in China but also during temporary stays in other countries (including temporary returns to your home country), particularly useful for mobile expatriates or frequent travelers.
• English-language service (and sometimes French)
  Contract management, administrative procedures, and customer support are available in English. Some companies also offer French-speaking customer service, facilitating all steps from subscription to reimbursement.
• Freedom to choose medical practitioners and facilities
  Unlike the local system which often imposes a limited network, international insurance allows free choice of doctors and medical facilities.

Potential Disadvantages:

• High premium costs
  International health insurance costs significantly more than the Chinese public system. Amounts vary based on age, chosen coverage, and family situation. For example: an expatriate family might spend between €3,000 and over €10,000 annually for comprehensive high-end coverage.
• Administrative difficulties
  Despite multilingual service, some procedures can be lengthy or complex (examples: detailed medical documentation required for each reimbursable service; processing delays).
• Limitations on pre-existing conditions
  Some policies refuse or limit coverage for existing conditions prior to subscription; there may be waiting periods or specific exclusions depending on insurers.

Criterion	Chinese Public Health Insurance	International Health Insurance
Accessibility	Public network only	Access to private clinics/hospitals
Language	Primarily Chinese	English/French available
Quality & Comfort	Variable; lower standards	International standards
Coverage	Annual limit quickly reached	High or unlimited coverage
Coverage Outside China	No	Yes (depending on contract)
Price	Low	High

Concrete Examples & Statistics:

For serious hospitalization in an international private clinic in Beijing or Shanghai, one day frequently costs between 1,500 and 4,000 USD. Without appropriate insurance, these amounts remain entirely out-of-pocket once local limits are exceeded.

The public system reimbursement rate varies between 20% (urban employed residents) to 60% (rural residents), with limits quickly reached for serious conditions.

Key Takeaways:

Local Chinese insurance remains accessible but offers little protection against actual costs encountered in the international private sector sought by expatriates.

International health insurance provides maximum financial security but requires a substantial budget and careful attention to contract terms.

For many French expatriates in particular, it’s common to combine CFE + private supplemental insurance to obtain global flexibility AND possible maintenance with French Social Security upon return.

The Importance of International Health Insurance for Foreign Residents

The importance of international health insurance for foreign residents in China lies in its ability to address the limitations of the Chinese public healthcare system and provide guarantees tailored to expatriates’ specific needs.

Differences Between Chinese Public Coverage and Private Options:

Chinese Public Coverage	Private International Insurance
Low prices, access to local network	High prices, but extensive coverage
Procedures and communication in Chinese	Multilingual services and assistance
Variable quality across facilities	Access to high-end private hospitals
Low reimbursement ceilings	High ceilings, customizable guarantees
Care limited to China	Worldwide coverage, treatment abroad possible

Public System Gaps Addressed by International Insurance:

• Access to specialized services and private facilities meeting Western standards.
• Coverage for care abroad, including repatriation or treatments outside China.
• Platforms and assistance in foreign languages (French, English), facilitating procedures and understanding guarantees.
• Option to add coverage for vision, dental, maternity, or serious illnesses.

Costs and Claims Process for Expatriates:

Costs of international insurance are generally higher than local insurance but offer significantly better protection, particularly for hospitalization or specialized care.

The claims process is simplified through mobile applications, online platforms, and multilingual assistance. It’s possible to submit documentation remotely and obtain quick reimbursement.

Examples of Beneficial Situations:

• An expatriate needing complex surgery was treated at an international hospital in Beijing, with English-language support and full cost reimbursement.
• An expatriate family benefited from medical repatriation following a serious accident, fully covered by their international insurance, whereas Chinese public coverage would have offered no solution outside the territory.
• A retiree received long-term treatment for a chronic condition, with coverage for imported medications and French-language medical follow-up.

Testimonials from Foreign Residents:

“International insurance allowed me to consult an English-speaking specialist without delay, whereas the language barrier and public system waiting lists made care impossible.”

“After an accident, French-language assistance and online reimbursement management were crucial for my peace of mind. I couldn’t have handled the costs without this insurance.”

In Summary:

• International insurance is essential for expatriates in China wanting access to quality care, multilingual assistance, and security in case of serious medical issues, in China or abroad.