Health care across China is varied as the vast country itself. China has a few hospitals running to Western levels, all within major conurbations. Hong Kong is well supplied in this respect. But for every 1,000 live births, 25 infants do not survive 12 months. In western Europe, infant mortality is around five deaths per 1,000 live births. That shows how far the People’s Republic has to go.

The message has not been lost in a country that was among the first civilisations to tackle disease. It is now pouring record amounts of its new wealth into health services.

Criticism of traditional Chinese medicine overlooks its value in chronic and minor complaints. Western medicine can sit well with traditional Chinese therapies. Medical schools in China mix the two to good effect.

China does not run the fully state-funded cradle-to-grave system one might expect. Its basic medical insurance covers around half the population. This coverage pays about half the costs of health care. The remainder is paid either by patients or their health insurer. This product is known as “supplementary health insurance” and is the most widely sold health insurance in China.

There is growing space for Western insurers, according to Bupa International, which opened a Beijing office in 2006.

Louis Dudley, Bupa’s strategy and development director for overseas markets, says that the company was “actively involved” in health industry reforms in China. “We are encouraged that the market is supportive of private health insurers providing services beyond the Government’s basic coverage.”

He does not support a perception that government is unduly obstructive to Western industry. Backing that view is Stephen Ryan, strategy and marketing manager of Axa Asia. Relations can be difficult but certainly not impossible, he says.

“Long term, relationships need to be established and attention paid to detail, with no corner-cutting. Those guilty of arrogance and ignoring the regulators can expect the barriers to be put up.”

Where’s my GP?

Stop looking. Medical care is hospital-centred. Record keeping is limited, in most cases little more than a log book carried by the patient. Staff in most public hospitals speak only Chinese and tend to be overworked. Stretched staff, language problems and limited space mean services are difficult for foreigners to access.


Expats use private Western-style medical facilities in Beijing and Shanghai. In rural areas, private clinics are virtually non-existent. In the main cities, however, good quality care tends to be broadly available to all. But, as Mr Ryan added: “One might need a little local guidance to locate it and to make things happen.”

He said that for expats who only feel comfortable with Western environments, the choice is limited to those hospitals and clinics specifically developed to meet that demand.

“These medical facilities will refer to the high costs of recruiting and retaining expat medical professionals and providing that special environment and speed of treatment – while other commentators will use the term ‘over-charging’.”


An idea of hygiene levels that can exist in some state hospitals was revealed to me some years ago when a member of our group touring the country developed flu-like symptoms. He was taken direct to hospital where we, fellow journalists, asked to watch him undergoing moxibustion.

This consisted of burning a bunch of herbs attached to one end of an acupuncture needle while the other end was inserted in the appropriate part of the patient. Fine. But we were amazed when the doctor assembled a collection of needles, carelessly dropped them on a grubby floor, and continued immediately to plunge them into our colleague without so much as wiping them. Autoclaves? Forget them. But the patient recovered swiftly.

Cost of western-style care

Don’t presume that widely varied care standards means inexpensive treatment. Medical insurance premiums are high, while charges for some clinical procedures mirror those in the United States.

Some of the cost is due to patient transport. Some serious medical cases in the big and fast-growing expatriate population are airlifted to centres of medical excellence in Hong Kong or Singapore, but the airlift trend has diminished recently as local services have improved.

Air evacuation can cost US$50,000-$100,000 – or even more in some cases.

‘Adequate’ Chinese facilities

High insurance premiums are attributable to a shortage of suitable hospitals – and a reluctance to try cheaper options.

Costs in China are often on a par, or more expensive, than even in the US in some cases. This is mostly to do with the new hospitals serving the high net-worth expats.

They are often ‘Chinese’ branches and partnerships of established US and international hospital chains. They offer a very good level of service and range of treatment, often with all the latest equipment and technology.

Expats prefer these hospitals to the often adequate Chinese facilities. As there is still a shortage of the preferred option and significant demand, there is no incentive for the hospitals to reduce prices, particularly as patients are insured.

Do you need cover?

Medical insurance is very strongly advised, but it is not generally required as a condition of entry.

A few Chinese embassies require proof of health insurance before issuing certain visa types, such as those for foreign students.

It would be difficult to buy local Chinese health policies abroad, and inbound visitors and expats would normally rely on international medical or travel cover.

What to watch for in buying cover

There are three purchase routes. Not all providers who sell plans offering cover for mainland China are fully licensed there. Insurance companies offering health cover fall into three groups:

  • Legal international plans are policies offered by international medical insurance companies, or local companies working with an international partner. Can offer full worldwide cover and broad benefits, and are ideally suited for expats.
  • Unlicensed international plans are illegally sold into China from offshore insurance companies not registered to trade in China. These generally offer full benefits, and are often sold by reputable companies. But there is no legal recourse in China if there is a dispute. In addition, the government might intervene and stop local care providers from dealing with these companies.
  • Legal domestic plans. Expats need to take care that they are buying private medical insurance from a licensed insurance salesman. Expats should always confirm that their broker or agent is legally licensed to sell insurance in China, or purchase their plan directly from the insurance company.

Transfer of cover

Expats need to consider how long they will be residing in either Singapore or China before returning home.

“Portable” plans allow the policyholder to maintain coverage at home, or in another location. Without this facility, the policyholder risks being uninsurable for any chronic condition that develops while in the country in which cover was purchased.


Premiums in China are typically 10 per cent up on European levels. Premiums vary sharply, although plans are never precisely like for like.

Comprehensive plans broadly cover inpatient plus consultation charges and tests irrespective of whether the patient is admitted, as well as expenses such as road/air transport. Budget plans broadly cover only hospital inpatient fees.


Singapore is well equipped medically and some of its hospitals are recognised as centres of excellence serving South-east Asia. The sort of insurance plans and premiums required in China and Singapore are similar.

Clash of ideas

Western medical establishments tend to deride complementary therapies. For instance, Collins Dictionary of Medicine says that moxibustion has “no place in scientific medical practice”.

But increasing public demand in the West for complementary medicine tells another story. People have realised that even if Chinese-style medicine may not work, at least it is unlikely to do harm. That is more than can be said for much Western doctoring.