The essentials of expat health insurance in China
The average healthcare standards in China are still far from European standards. Some facilities will not even take the risk of treating you as a foreigner. You will automatically be directed to establishments with VIP or "foreign-run" rooms or to private facilities. The physicians and equipment are then top shelf, but so are the bills. International insurers rank China in the top 10 most expensive countries in the world.
|Healthcare expenditure per capita||€652|
|Annual indexation of health expenses||9,8%|
|Fund for French Abroad hospitalization reimbursement rate||31%|
|Number of insurance companies available||15|
|Annual cost of hospitalization coverage for a 30-year-old||€789|
|Annual cost of hospitalization coverage for a 50-year-old||€1264|
The Chinese healthcare system is in continuous reform. Universal healthcare coverage was initiated in the 2000s. It has been regularly revised (2009, 2011, and 2016 in particular), with new objectives set for 2020, then 2030. If these bring improvements for a significant number of Chinese, expatriates are not really concerned as their requirements are totally different.
Today, it’s possible to get good medical care in China, but the cost is high and constantly increasing, as the health system is highly privatized, or at least functions as such. Access to healthcare remains complex in many cases, and efficient assistance will often be helpful, to prevent a simple situation from getting out of hand.
If you’re planning to move to China, there are some important things to know about the country's healthcare system. We’ll explain, and also how expatriate health insurance works in China, a supplementary option to the local social-welfare system that will decrease your worries while you’re in China.
In the major Chinese cities, the healthcare situation is satisfactory. However, there are risks related to air pollution, especially for children and the more frail.
The risk of illnesses varies from one region to another. In Yunnan and Hainan, for example, the risk of malaria is very high, and protection against mosquito bites is a must.
Despite the existence of a few infectious diseases, living in China does not present a significant health risk. However, before leaving we do advise you to get a rabies vaccination, as stray animals are a real public health problem, and not only in the countryside.
If you plan to live in a rural area, a vaccination against Japanese encephalitis is also recommended.
Bring your usual medicines with you, as the equivalent medicines on the Chinese market are not always reliable. Counterfeits are widespread.
In the public sector, care is affordable, but of poor quality – even deplorable, in some places. You may face long waiting lines due to the lack of facilities and local functionality.
The language barrier could also be a problem – but note that there is a department for foreigners in the major hospitals. Otherwise, it’s best to use an interpreter if you do not speak the language.
Private health care is of excellent quality, but very expensive. French expatriates in China often resort to international hospitals and private clinics, as they respond better to their needs. They are equipped with the latest medical equipment and have competent bilingual staff. They are regularly checked and apply very strict rules and standards of hygiene.
Given the prices charged, access to them may be limited to people who can justify having sufficient private health insurance.
As the equipment varies from one city to another, in some cases you’ll need to consider traveling within the country, or to Hong Kong or your country of origin.
In China, there’s a marked lack of doctors, and there is no such thing as a “general practitioner/family doctor” – which means even the simplest consultations are carried out in the hospital. The hospital is the place for both minor and major procedures. According to the OECD, in 2017 there were just under 2 physicians per 1,000 inhabitants in China (in comparison, there were 3.4 per 1,000 inhabitants in France).
The majority of medical appointments, therefore, take place in hospitals, where a physician in the public sector might have 60 to 100 consultations per day. Patients swamp the hospitals for the best fully-covered care available, even if it means waiting in line for several hours. The few physicians in townships do not have a good reputation. In 2017, only 10% of physicians in rural areas had at least five years of medical training.
There is no way to schedule an appointment with public physicians; it’s first come, first served. The ticket system in place has led some to develop line-cutting “businesses,” increasing tensions in the waiting rooms. It’s not uncommon for hospitals to have extensive internal security. As an expatriate, you will be directed to the VIP services of public hospitals, where the rates can be up to 10 times higher than they are for locals. However, this will save you the two-minute consultation done in the same room where all the patients are waiting (goodbye confidentiality).
Beware of the over-perscription of healthcare by physicians. In the public sector, if the basic salary is fixed by the State, the variable salary depends on the services and prescriptions provided. With the excessive demands made on them, and the need for money, comes the temptation to take bribes. The medical profession (along with the teaching profession) is one of the most corrupt in China.
An expatriate health insurance plan will guarantee you access to private hospitals and competent physicians.
The consulates in Beijing, Shanghai, Guangzhou, and Wuhan have lists of reputable physicians, specialists, clinics, and hospitals for expatriates. Insurance companies also provide access to similar lists.
In addition, you can also contact the expatriate network in your area to get more information.
The language barrier could be a problem, depending on where you’re located. Most often, while health professionals speak English in private facilities, few speak other languages.
The Fund for French Nationals Abroad (CFE) has an agreement with a hospital in Shanghai. This type of agreement is, however, very variable, and the CFE often modifies it. With expat insurance, you have a choice between different private clinics and international hospitals that offer quality services with international professionals.
For major operations, a stay in Hong Kong should be considered, or even an evacuation to your country of origin. Hence the importance of expatriate health insurance that will cover these costs, where a local insurance will not.
Prices vary depending on the healthcare facility you choose. As an expatriate, be prepared to pay a steep price.
In general, a consultation with a general practitioner in a public hospital costs 15 CNY for a local, compared to 200 CNY for “VIP” (Western-style) service. In private hospitals, it will cost you between 200 and 1,200 CNY, depending on the emergency and your condition. A specialist consultation will cost between 600 and 2,100 CNY.
In the case of hospitalization in a public hospital, the consultation fee can vary between 180 and 1,500 CNY, determined by the room type. Depending on the severity and type of pathology, a patient's out-of-pocket expenses can reach 40% of the total bill. A night in a single room in a private hospital will cost 5,500 CNY on average. It is therefore recommended to take out a health insurance policy, whether you seek public or private treatment.
The market for Western medicines is not very developed in China; it will be common for you to be offered Chinese medicine and the traditional version of a medicine rather than Western medicine. Medicines are more expensive than in Europe due to transportation costs and customs duties imposed on importers, not to mention the agreements that physicians may have with certain laboratories. However, the government has recently worked to reduce the cost of several important prescription drugs (such as for hepatitis C), lowering prices by up to 60%.
Some common medication may simply not exist in China. Finally, beware counterfeit medicine.
Dental and vision care is better in private facilities, where the staff speaks languages other than Chinese. Care can be very expensive, so it’s better to include coverage of these costs in your insurance plan. For example, a standard dental treatment will cost between 240 and 260 CNY, and 6,300 to 7,200 CNY for a crown replacement.
Discover our experience in figures
As soon as you begin residing in China, social-welfare benefits from other countries, such as French Social Security, are no longer valid. When you work on Chinese territory, you are governed by Chinese law. For more information, read our brochure on social welfare and expatriates.
Generally speaking, Chinese social welfare is very limited compared to the coverage many expatriates are used to. It covers the risks of retirement, medical expenses, maternity, work accidents, and unemployment – but based on standards unlike what expatriates are used to.
For more details, see the CLEISS page (for French social security abroad).
The Chinese Social Insurance Law, which came into force on July 1, 2011, is the first law that deals with social protection at the national level. At the same time, since October 15, 2011, it became mandatory for all foreigners working in China to join Chinese national healthcare.
Deductibles vary by the municipality (Beijing, Shanghai, Guangzhou, etc.), but they average 32% for employers and 10% for employees.
CFE, the Fund for French Nationals Abroad is accessible to all EU citizens. It allows you to maintain a social-welfare protection similar to what is done in France. It offers illness, maternity, disability, death, and old-age benefits.
China is part of CFE’s zone 4, in terms of healthcare reimbursement. This is the second most expensive zone for health expenses.
CFE guarantees alone will not be sufficient; you also need complementary insurance.
For example, CFE will reimburse 31% of hospital bills in China, which leaves 69% of the bill to be paid by you.
Fiind more information on this subject in our section all about the CFE.
Please note: Due to the bilateral agreement, you will also have to join the local social-welfare system.
The “universal” health coverage offered by China has been in constant evolution, especially since 2011.
Initially full of divisions and imbalances, healthcare coverage evolved in 2016 into a unified insurance system for both urban and rural regions. The secondary goal of the 2016 reform was to convert all public hospitals to nonprofit structures by 2020. Public hospitals were, until then, profit-oriented, like private companies, which encouraged numerous abuses (in rates charged, favoritism, etc.).
In 2015, it was noted that 66% of hospital resources were dedicated to screening activities, preventive measures, and additional sales of medication and tests.
Currently, the maternity healthcare insurance system consists of three options:
- Urban Employee Basic Medical Insurance, also for the self-employed;
- Urban Resident Basic Medical Insurance; and
- The New Cooperative Medical System for Rural Residents.
These three types health insurance entitle women to a package of 41 services (including pregnancy-related services) offered in public facilities and financed by the state.
Virtually all employed women, unemployed women with an employed or self-employed spouse who pays voluntary contributions, or self-employed women are entitled to maternity benefits without a waiting period.
State employees are entitled to specific healthcare coverage, with no or a limited annual deductible.
For others, health coverage is financed by the insured, the employer, the central government, and local governments. Deductibles depend on your location and status.
Local health insurance is not adapted to expats' healthcare habits, and the cost of private medical care makes it essential to purchase expatriate health insurance in China.
In addition, your global insurance will be applicable in many countries, during travel or trips to your country of origin, and guarantees at least basic coverage in the case of an emergency abroad. Unlike local private insurance, you have the freedom to choose your own physicians and healthcare facilities in China.
French expatriate insurance can also complement CFE coverage, if you choose to join. The CFE's healthcare coverage is only a first basis of reimbursement, insufficient for the prices charged locally. With complementary expatriate insurance, you will enjoy reimbursement rates in line with the rates charged in your host country.
Finally, travel insurance will not work: many expatriates think that they can save on expat health insurance for a few weeks thanks to their travel insurance. But if there’s a problem, the insurer will ask you to justify your travel conditions, show a return ticket, your type of accommodation, social-welfare reimbursements, etc. If they find out that your stay has lasted more than 90 days, and is not a short trip, they will refuse to cover you.
Its possible to sign up for health insurance from China if you are already there. However, we always recommend you to do it before your departure to avoid a waiting period, have more options, register paperwork more easily, and take your time (rather than rush your decision).
Signing up for expatriate health insurance is more complex than for a traditional insurance, so we advise applying at least 30 days before your departure or the desired start date of your contract.
Taking out an expatriate health insurance policy does not exempt you from the obligation of signing up for local health insurance.
Our website allows you to collect online quotes and compare coverage. An adviser can then help you with the entire sign-up process.
If you are on a tight budget, hospitalization insurance alone will be the minimum essential to prevent a minor situation from escalating rapidly.
Reimbursement for routine healthcare is also useful, especially for access to Western pharmaceutical treatments. This will cover the higher fees of private-sector physicians or those specializing in foreign patients.
Enhanced coverage levels are tailored to the level of healthcare costs in China, and a 10% or 20% deductible can keep costs down without major financial risk.
Generally speaking, you will be asked for payment on site when consulting with a doctor and purchasing medication. It is then up to the insured person to file a claim for reimbursement.
With expatriate insurance, if you are hospitalized for more than 24 hours, the expatriate insurer will organize direct payment to the hospital/clinic.
Standard medical and vision/dental expenses must be paid up front. Reimbursement requests are easily made online (no more snail mail); the insurers all offer customer support platforms, and sometimes mobile applications, to manage your reimbursements.
In general, invoices of up to €1,000 can be sent digitally. Invoices over €1,000 (rare) will still have to be sent by mail.
Repatriation assistance is essential in China due to the unevenness of healthcare within the country.
It’s also useful when important medical procedures require evacuation to Hong Kong or your country of origin. All pathologies can be treated in Hong Kong, but at exorbitant rates – the insurance company may prefer to repatriate you to, say, France.
Repatriation insurance also offers extra comforts that would be welcome in case of a serious incident: paying a relative to travel to your bedside, organizing the care or transfer of children, medical advice and counseling, a return ticket in the event of a relative's death, etc.