For Patients April 2026

China’s Healthcare System Through an Oncologist’s Eyes: How a Government Purchases Treatment for 1.4 Billion People

During my trip to China and training at Duke Kunshan University, I specifically explored how the healthcare system itself is organized. In the 21st century, it is not enough to discover a new drug or technology. You also need to move it through the systems of procurement, payment, and quality control — and make sure that treatment bankrupts neither the family nor the state.

China is very interesting in this regard. It is a country with a massive healthcare load: more than 1 million medical facilities, ten billion annual medical visits, more than 300 million hospitalizations, and thirteen million healthcare workers. At the same time, the population is aging, and the annual number of new cancer cases in China is estimated at roughly 5 million.

This is why healthcare in China quickly becomes a conversation about money, management, and access to treatment. The same holds true everywhere — given the cost of oncology treatment. It is these mechanisms that often determine whether a modern drug, molecular testing, complex diagnostics, or care at a specialized center will actually be available.

Key Points

China has built a system where the state acts not just as a payer but as the main negotiator and purchaser of medical care.
Basic medical insurance (an analogue of Russia’s compulsory health insurance) covers about 95% of the population — 1.32 billion people in 2024.
In 2018 the key role in managing health insurance and negotiating prices was consolidated in the National Healthcare Security Administration (NHSA). This sharply strengthened the government’s negotiating position with drug manufacturers.
China actively uses price negotiations and centralized procurement. In various years, average price reductions for drugs entering the national reimbursement list were around 50–60%, and in 2024 the average reduction for 89 new drugs reached 63%.
In 2024, out-of-pocket spending by citizens accounted for 28% of total healthcare expenditure. For comparison, in the early 2000s the share of self-payment was around 60%.

Key Figures and Facts

In 2024 more than 1 million medical facilities were operating in China, of which 38,710 were hospitals in the conventional sense. Among these, 11,754 were public and 26,956 private. The main patient flow still stays in the public sector: in 2024 public hospitals accounted for 84% of all outpatient visits and 82% of hospitalizations.

Population aging is intensifying pressure on the system. According to China’s statistics, the share of people aged 65 and older grew from 10% in 2014 to 15% in 2024. For oncology this is crucial, since age itself is the main risk factor. The older the population, the higher the demand for diagnostics, systemic anticancer and supportive therapy, day hospitals, and long-term follow-up.

A separate reform track concerns how treatment is paid for. China is actively moving from fee-for-service to payment per completed case or per case group — an analogue of Russia’s KSG (clinical-statistical groups). The goal is to limit unjustified spending and standardize care with a more manageable budget. According to NHSA plans, by the end of 2025 case-group payment should cover all medical facilities providing inpatient care.

But any such system has a downside. When a hospital is given a fixed budget per case, it develops incentives to optimize costs. This can produce distortions: selection of more profitable cases, shifting costs to outpatient services, and difficulties in adopting expensive innovative drugs, since their cost falls on the clinic’s budget.

Limitations: What Does Not Change Yet

The Chinese model cannot be automatically transferred to Russia or any other country. Systems have different funding sources, different regulatory procedures, different procurement rules and patient routing, and simply different cultural contexts.

Lowering drug prices does not by itself solve every problem. It can broaden access but simultaneously puts pressure on manufacturers, clinics, and quality-control systems. In China there is already discussion of issues related to quality and the sustainability of supply under very tight procurement mechanisms.

Payment per completed case is also not an ideal solution. It helps control costs but can create clinically undesirable incentives. For example, a hospital may become less interested in a complex patient, in expensive diagnostics, or in a new drug if this worsens its financial result.

We have faced — and continue to face — these same issues in Russia. Clinics operating within compulsory insurance frequently select patients or technologies that are not financially unfavorable. Or consider targeted therapy and immunotherapy: a drug included in the reimbursement list and clinical guidelines does not automatically mean that a patient will receive it in a clinic. Our Chinese lecturer called this the “last mile” problem: drugs that have cleared the grinding mill of price negotiation and entered the national formulary can still remain only partially available inside medical organizations, because their use is paid out of that organization’s own budget — and therefore out of the salaries of medical and non-medical staff.

When a Second Opinion Is Especially Helpful

when the diagnosis is confirmed but the treatment strategy is unclear;
when an expensive or unusual regimen has been proposed and the patient does not understand why;
when necessary biomarkers have not been tested (e.g. HER2, MSI, ALK, BRAF, NTRK, or others depending on the tumor);
when doctors disagree or different treatment routes are being offered;
when standard options are already limited and clinical trials, rare-target therapy, or treatment abroad are being discussed;
when you need to understand which international data apply to your specific situation.

Source: lecture series at Duke Kunshan University as part of the Skolkovo Healthcare training program, and visits to medical organizations in Shanghai, Guangzhou, and Kunshan.

If you have an oncology diagnosis and a treatment strategy is now being chosen, you can come for a consultation or a second opinion — to go through your diagnosis, molecular profile, prior treatment, and understand which current data and treatment options, including those available abroad, apply to your situation.

Frequently Asked Questions

Is the Chinese healthcare model suitable for Russia?

There is no ready-made answer. The Chinese model is interesting as an example of a strong public purchaser, aggressive price negotiation, and tight cost management. But it cannot be transferred directly, because different countries have different funding, procurement, insurance, and patient-routing systems.

Why doesn’t a drug’s price equal access to treatment?

Because between price and actual prescription there are several stages — registration, inclusion in guidelines, reimbursement, procurement, availability at the hospital, the clinic’s willingness to prescribe, and clinical applicability to the specific patient.

Can you go to China for treatment?

Patients sometimes consider treatment abroad, including in China. But such a decision requires a careful review: diagnosis, stage, treatment goals, available regimens, document language, cost, logistics, and follow-up. It is better to assess this based on medical documents and a clear treatment plan, not on clinic advertising. Overall, Chinese medicine and technology made a very good impression — and, unfortunately, not all of these technologies are available in Russia.