One of the most important things you need to consider before moving to China to live is whether you need to take out health insurance or not, and what type of policy to choose.
comparing insurance policies
This article is intended to help you understand what you will find in China, and to provide the information necessary for you to be able to decide whether to take out a health insurance policy and how to choose it. To do so, we are going to cover the following topics (you can click on the title to skip directly to the section that you are most interested in):
If you are looking for information on health insurance for short stays or for tourism, while this article may be useful to you, I recommend that you check out this other article.
Medical attention in China
In China, despite the existence of a public health care system, it is not at all similar to the one that exists in Europe (and other countries), where free and universal health care exists. The Chinese public health care system is not universal and is free to an even lesser extent.
In China, primary medical attention and public hospitals are run by the government, and benefit from a certain amount of funding. This makes being admitted and visiting a doctor relatively cheap (between 1 and 5 Yuan). Nonetheless, treatments and drugs are paid in full, and are quite expensive (often more expensive that private hospitals in the West).
One of the particularities of Chinese public hospitals is that their financing depends greatly on the sale of drugs, which makes it so that their prices tend to be much higher than in other countries (most of all for drugs produced abroad). This mainly happens because hospitals have a monopoly on the large majority of drugs. That means that pharmacies in China tend to have a very limited selection of drugs (normally traditional medicine), and the only way to obtain certain drugs is with a doctor’s prescription, which is only valid in the hospital in which it has been obtained.
Another aspect that must be taken into consideration is the large number of health care professionals in China who lack professionalism (or better said, who are unscrupulous), and act on purely financial interests. It is very common for doctors to prescribe you the most expensive treatment as well as unnecessary extras that they consider harmless. A clear example of this is their love of prescribing intravenous medicine, taking x-rays, and adding traditional medicine ingredients to prescriptions. In fact, it is a widespread practice that before an operation, you give extra money to a doctor so that they can “take extra care.” In addition, nurses tend to not care for patients unless you pay them, which makes it very common for you to see the family members of sick people pushing around beds or wheelchairs in the hospital.
In addition to public medical assistance, there are numerous private hospitals and clinics which are both national and international. Despite the fact that numerous centers do not charge for consultations, treatments and drugs tend to have exorbitant prices.
Why do I need health insurance in China?
As I mentioned in the previous section, medical attention in China is not free, and in many cases, can be more expensive than that of private hospitals in the West. Therefore, if you don’t have adequate health insurance, you can go bankrupt if you suffer from a minor illness or an accident. To get an idea, a minor surgery can cost up to multiple tens of thousands of Yuan.
In addition, you have to remember that in China, they are not going to attend to you if you don’t pay the bill upfront (often in cash) or in the case of certain international hospitals, before you demonstrate that you have health insurance that will cover the treatment.
In China, health care is a business. If you have an accident and you don’t have money or health insurance, as soon as they find out, they are going to kick you out of the hospital.
Hospitals in China
In China, it can be said that there are three types of hospitals: public hospitals, private hospitals, and international hospitals.
Public hospitals (except for rare exceptions) are far from meeting Western standards, are normally packed with people, the attention is poor, the facilities and hygiene in many cases leave a lot wanting, and their privacy is quite rare. In addition, you have to remember that staff will not speak a single word of English (some doctors might be able to say four or five phrases).
The operation of public hospitals is a bit chaotic:
- 1) You have to go to the main cash register to sign up (you can’t do it in advance).
- 2) You have to wait in a long line and pay the fee (normally less than 10 Yuan); they will give you a number for the specialist you have requested. Keep in mind that if you arrive at the hospital late, there might not be any more numbers left. If you haven’t previously been at this hospital, they will give you a card and a booklet where the doctor will note your medical history.
- 3) After you have received your number, you have to go to the section of the hospital of the specialist chosen and give the number to the reception.
- 4) You need to wait until they call you by number or name and go to the doctor they have assigned you. Be careful, as lots of people are going to try to get ahead of you. In addition, it is common that while you are talking to the doctor, people come in directly to ask things or to try to wait in line directly in the doctor’s office. In some hospitals, it is possible that they might not call you by number and you have to wait in line in front of the office.
- 5) After seeing the doctor, he/she will prescribe you drugs or will carry out tests, so you will have to go to the cash register once again and pay.
- 6) Once you have paid, you need to go to the pharmacy or the place to get your tests done and show your receipt.
- 7) Repeat numbers 3 to 6 as many times as necessary.
Private hospitals for both traditional and Western medicine operate in a manner similar to public ones. The only differences are that there are not as many people, the staff is much friendlier, the facilities are better, and at times, staff may even speak English. Obviously, all of this has a price.
International hospitals are obviously also private, meet all of the standards you are accustomed to, their staff, in the majority of cases, speaks fluent English, and normally offers excellent attention. However, considering that these hospitals tend to be frequented by expats with good health insurance, their prices can be exorbitant at times.
Types of health insurance in China
When moving to China, many people don’t worry about health insurance, as they think that the university or company welcoming them will provide one. However, you need to be careful about the health insurance they provide, as not all health insurance is equal. Below, I detail the most typical conditions of insurance policies in China.
- University health insurance policies: If you are going to work or study at a university, it’s normal for them to provide health insurance. However, university health insurance is far from ideal. This type of insurance only covers treatment at the university hospital. University hospitals are normally incapable of treating the majority of illnesses, and at the most, they are going to treat you if you have a cold or cut yourself. If the illness or intervention cannot be treated at the university hospital, you pay the free, visit a doctor, they will tell you that they can’t treat you, and will give you proof of this and send you to another hospital. Later, you go to one of the authorized public hospitals and after paying all of the bills, you go back to the university so that they pay you the percentage corresponding to your insurance.Obviously these insurance policies don’t cover international hospitals. This plus the bureaucracy makes them inconvenient, especially if you are sick or hurt (university hospitals are not capable of treating a fracture), and makes this insurance far from adequate.
This type of insurance is normally used by poor Chinese students to stock up on drugs to later give them to their families, as the drugs are free.
- Chinese health insurance: While there is a huge variety among Chinese health insurance policies, the majority of them, especially if they are cheap, only cover public hospital costs. While this type of insurance can be adequate for people who want to save money, it is not very recommendable, as the payment of medical costs is not immediate; rather, you pay out of your pocket first and then later file a claim with the insurance company to reimburse you. Obviously, the paperwork and contracts tend to be exclusively in Chinese.
- International health insurance: International health insurance tends to be the most convenient for expats, and as expected, is the most expensive. These insuance policies cover you at international hospitals and some private hospitals. In addition, if you live in one of the main cities in China, such as Shanghai, Beijing, or Guangzhou, among others, the majority of these insurance policies give you the option of the insurance company paying directly at international hospitals. That means that you won’t need to go to the cash register every time you go to the hospital, as your doctor’s bills will be sent directly to your insurance provider. Nonetheless, if you live in a second or third-tier city, you will have to pay first and then make a claim for reimbursement.
Table comparing health insurance types for China
|Name of plan||Global Medical Insurance||International Medical Insurance||Comprehensive|
|Geographic coverage||Global||Global excluding the United States||Global excluding the United States|
|Annual limit||from 1,000,000 USD to 8,0000,000 USD (lifetime limit)||from 1,000,000 USD to unlimited||from 1,500,000 USD to 2,400,000 USD|
|Minimum deductible||0 USD (in China)||0||160 USD (once per year)|
|Out-patient services||Depends on the plan (either everything covered or a maximum of 500 USD pre- and post-hospitalization, and 300 USD for tests)||Covered (some aspects are optional)||Covered (including traditional Chinese herbal medicine)|
|Direct billing in China||Beijing, Changsha, Chengdu, Chongqing, Guangzhou, Hangzhou, Qingdao, Shanghai, Shenyang, Shenzhen, Wuxi, Xiamen, Xi’an||502 centers in 51 Chinese cities||Beijing, Changsha, Chengdu, Chongqing, Dalian, Guangzhou, Nanjing, Shanghai, Shenyang, Shenzhen, Suzhou, Tianjin, Wuhan|
|Dentist||Optional||Optional||No, Prestige Plus plan|
|Annual medical checkup||Not mentioned||Optional||Included|
|Coverage of chronic conditions||The same as pre-existing medical conditions||The same as pre-existing medical conditions||Included, some exceptions|
|Coverage of pre-existing medical conditions||Depends on the plan (covered or moratorium of two years)||Reviewed on a case-by-case basis||Not included|
|Pregnancy||Only under the Platinum plan (10 month wait period)||Depends on the plan (12 month wait period)||No, Prestige Plan|
|Approximate annual cost (35 year-old)||From 1,100 USD to 5,000 USD||From 2,500 USD to 4,000 USD||2,700 USD|
|Online quote||Available upon filling out a form||Available upon filling out a form||Available upon providing personal and contact information|
|Pros||Basic plans very affordable||Very complete plans and very good coverage in China||Standard plans include many benefits|
|Contras||Limited coverage in China||Extra benefits somewhat expensive||Limited coverage outside of large cities|
|Request a quote from IMG now!||Request a quote from CIGNA now!||Request a quote from Axa now!|
The information contained in this table is for information purposes, and is a simplification of the information obtained on the websites of the insurance providers. Due to the complexity of health insurance policies, we recommend that you thoroughly read the conditions of the policy before purchasing it, as the information stated here may contain impressions.
How to evaluate the features of a health insurance policy
For people who are not familiar with international health insurance, reading a policy may be “Chinese” to you, quite literally. Below, I detail the most common vocabulary in health insurance policies so that you can actually understand what you are purchasing.
- Annual limit: This value is the maximum amount that the insurance provider will pay per billing period (one year). If you exceed this limit, you will have to start paying out of your own pocket.
- Deductible: This is the amount that you have to pay for medical treatment before the insurance provider begins to pay. For example, if your deductible is $1,000 USD, when you go to the doctor, you will pay for all treatment and consultations so long as the bill is less than $1,000 USD. As soon as the treatment costs more than $1,000 USD, the insurance provider will start to pay. That’s to say, you will only pay $1,000 USD and the remainder will be paid by your insurance.
- Direct Billing: Direct billing means that the hospital bills are sent directly to the insurance provider without you having to pay them beforehand.
- In-patient: These are treatments that require hospitalization, such as an operation.
- Out-patient: These are treatments that do not require hospitalization, such as visiting a specialist, dressing wounds, drugs, and rehabilitation, among others.
- Cost Share after deductible : This is the percentage of the cost of treatment that you have to pay after paying the deductible. In the table, 0% means that the insurance provider pays for treatment 100% once the deductible has been reached.
In China, health care is not free, and getting good medical treatment can be quite expensive. Because of this, in our opinion, it is more than recommendable to take out a good international health insurance policy. The risks you expose yourself to without insurance or with poor-quality insurance are too high, and can bankrupt you and your family.
There is no ideal insurance policy for everyone, and when you choose one, you will have to assess your specific needs, your budget, and the risks you want to expose yourself to.
Finally, we strongly recommend, taking into consideration the information in this article, that you thoroughly read the conditions and benefits of an insurance policy before purchasing it.