China’s health insurance system covers roughly 95 percent of the population through two government-run schemes, backed by a critical illness layer and a medical assistance program for low-income households.1State Council Information Office. China’s Basic Medical Insurance Covers 95% of Population Enrollment reached over 1.32 billion people in 2024. Even so, patients still pay about 32 percent of total health spending out of their own pockets, which is why understanding what each layer covers, and what it doesn’t, is worth the time.2World Bank. Out-of-Pocket Expenditure (% of Current Health Expenditure) – China
The Two Public Schemes
Public insurance is organized around two programs, both overseen by the National Healthcare Security Administration (NHSA).
Urban Employee Basic Medical Insurance (UEBMI) is mandatory for employed urban workers. It covers outpatient visits, inpatient care, prescription drugs, and traditional Chinese medicine, and it generally reimburses more generously than the other public program because its funding base is larger.
Urban and Rural Resident Basic Medical Insurance (URRBMI) covers everyone else: rural residents, urban residents without formal employment, children, students, and retirees not enrolled in UEBMI. Enrollment is technically voluntary. In practice, heavy government subsidies and local enrollment drives push participation very high.
What You Pay In
UEBMI Contributions
UEBMI is funded through payroll contributions set at the city level, so rates differ by location. In major cities, the employer’s share of the medical contribution generally runs between about 7 and 10 percent of an employee’s salary, and the employee’s share sits around 2 percent.3PwC Worldwide Tax Summaries. China, People’s Republic of – Individual – Other Taxes – Section: Social Security Contributions Part of the employee’s contribution flows into a personal medical savings account that can be spent on outpatient visits, pharmacy purchases, and routine costs the pooled fund doesn’t fully cover.
URRBMI Premiums
URRBMI works differently. Individuals pay a flat annual premium rather than a percentage of income. In 2024, the NHSA raised the national floor for individual premiums to RMB 400 per person per year (roughly $55 USD), though actual amounts vary by locality.4PubMed Central. Redistributive Effects of China’s Urban-Rural Resident Basic Medical Insurance: A Theoretical Model and Empirical Analysis The government subsidizes these premiums heavily, and low-income households, people with disabilities, and other vulnerable groups can have their share reduced further or waived entirely.
What Public Insurance Covers
The National Reimbursement Drug List
Not every drug or treatment qualifies for reimbursement. The NHSA maintains a National Reimbursement Drug List (NRDL) that decides which medications the public system will help pay for. As of 2025, the list includes 3,159 drugs and is updated annually through expert evaluation and price negotiation with manufacturers. Some drugs on the list are fully reimbursable; others require a co-payment. Anything off the list comes entirely out of pocket.
Hospital Tiers and Reimbursement Rates
Hospitals are classified into three tiers. Tier 1 facilities are community health centers and clinics. Tier 2 hospitals are mid-level regional institutions. Tier 3 hospitals are the large, specialist-heavy facilities most people prefer for serious conditions. Reimbursement rates are deliberately set higher at lower-tier facilities to encourage patients to seek care locally rather than crowd the top hospitals.
Across all tiers and both schemes, inpatient reimbursement generally lands between 50 and 90 percent, with considerable variation by region and insurance type.5PubMed Central. Key Factors Associated with China’s Basic Medical Insurance Fund UEBMI enrollees typically see higher reimbursement than URRBMI enrollees for the same services. After the insurance share, you’re still responsible for deductibles, co-payments, and any expenses for non-listed drugs or services. That’s where the 32 percent out-of-pocket figure comes from.
Critical Illness Insurance and Medical Assistance
The basic schemes cap what they’ll reimburse in a given year. For anyone who blows past that ceiling because of a major illness, China has added a critical illness insurance layer that kicks in automatically, with no additional premium from the enrollee. It’s funded from surpluses in the basic insurance pools and reimburses at least 60 percent of qualifying expenses above the basic scheme’s annual cap.6PubMed Central. Effect of Critical Illness Insurance on Household Catastrophic Health Expenditure
Beneath the insurance system sits a medical assistance program aimed at families receiving minimum living allowances (known as “dibao” recipients) and other low-income households. Assistance can reduce or waive premiums, lower co-payments, or directly cover costs left over after insurance reimbursement. It’s administered locally, so generosity varies from one area to another.
Together the structure works in layers: basic insurance handles the first band of costs, critical illness insurance takes catastrophic expenses above that, and medical assistance catches people who can’t pay their remaining share.
Foreign Workers
China’s Social Insurance Law, which took effect in 2011, requires foreign nationals employed in China to participate in the social insurance system, including medical insurance.7Congressional-Executive Commission on China. Social Insurance Law of the People’s Republic of China Enforcement is uneven in practice. Some cities treat foreign employees identically to local workers, deducting contributions from their paychecks. Others haven’t fully implemented the requirement. Contribution rates and caps follow local rules, so obligations differ between, say, Shanghai and Chengdu.3PwC Worldwide Tax Summaries. China, People’s Republic of – Individual – Other Taxes – Section: Social Security Contributions
Most expatriates also carry private international health insurance. Public reimbursement can be difficult to navigate as a non-Chinese speaker, and many private or international hospitals don’t always accept public insurance cards.
Private Health Insurance
Private insurance functions as a supplement to the public system, not a replacement. It’s popular with expatriates, higher-income Chinese families, and anyone who wants access to private or international hospitals with shorter waits, English-speaking staff, or amenities the public system doesn’t offer. Private plans can also cover services the public system excludes, such as dental, vision, and mental health care.
Common products include critical illness policies that pay a lump sum on diagnosis of a covered condition, high-end medical plans with access to VIP wards and private clinics, and international plans built for expatriates that work across borders. Premiums range from a few hundred dollars a year for basic critical illness cover to several thousand for comprehensive international plans, depending on age, coverage level, and any pre-existing conditions.
Using Your Insurance Day to Day
At the Hospital With Public Insurance
Enrollees in UEBMI or URRBMI receive a social security card, or in some cities a digital equivalent on their phone, that they present when registering at a hospital. The card links to the insurance account, and the hospital bills the insurance pool directly for covered services. You pay only your share of deductibles and co-payments at the point of care.
Public insurance long worked smoothly only within the city or province where you were enrolled. Treatment elsewhere meant paying in full upfront and filing for reimbursement later. A nationwide cross-province direct settlement system now addresses this. Insured individuals can register with their home insurance agency, choose a designated medical institution in another province, and have their bills settled directly, paying only their personal share.8State Council of the People’s Republic of China. Direct Settlement Health Insurance to Grow Coverage now reaches designated hospitals in every county-level region.
At the Hospital With Private Insurance
Private insurers generally arrange direct billing with private and international hospitals. You show your card and the hospital bills the insurer without upfront payment. Public hospitals, including their VIP wards, often don’t accept private international insurance. In those cases you pay in cash or by card, collect the receipts, and submit a reimbursement claim afterward. Confirming billing arrangements with the specific hospital before a visit saves time and surprises.