24 Seeking medical care: How to save money and avoid unnecessary hassle

For an insured patient referred up step by step from primary care, the inpatient deductible at the higher hospital can be calculated continuously. The deductible is the stretch you pay yourself at the start of each hospital stay. Yibao (basic medical insurance) starts reimbursing only after that stretch is paid. The State Council document does not say how continuous calculation works in detail. Localities set that. Sichuan's method is to charge only the difference between the hospitals' deductibles. The county traditional Chinese medicine hospital has a deductible of 600 yuan. Transfer to the county people's hospital (deductible 800 yuan), and you only need to pay another 200 yuan. For an inpatient transferred down from a higher hospital back to primary care, no separate deductible is set again for the same illness in the same treatment period.

The document requires localities to open a gap in inpatient reimbursement across hospital levels, in principle about 10 percentage points at each step. On that gap, each step up to a higher hospital means you pay about 10% more of the reimbursable bill yourself. Take 10,000 yuan of reimbursable inpatient charges. If the reimbursement share drops from 80% to 70%, what you pay yourself goes from 2000 yuan to 3000 yuan. The extra 1000 yuan is a tenth of the total bill, but what you pay yourself is half again what you used to pay. Actual shares differ by place, and the deductible and the cap also move the gap. This is only an illustration using the document's 10 percentage points. Newly added yibao funds for the year also tilt toward primary care.

The lead hospital of a tight medical consortium must reserve a share of appointment slots and beds for primary care, and must take in, without delay, patients referred up from primary care. A tight medical consortium is a group of hospitals and community health institutions bound together to work as a set. A referral up from the community clinic therefore has its own slots and beds, and does not have to compete with people grabbing slots in the lobby. Medical institutions must set up a referral center or name a fixed department, with full coverage by 2027.

Whether cross-pool and cross-province care elsewhere is necessary is, in principle, assessed by staff at associate chief physician rank or above at a secondary or tertiary hospital. Crossing pooling areas means leaving the place where you are enrolled in yibao (basic medical insurance). Whether it is necessary to go elsewhere is, in principle, something a doctor of sufficient rank has to say. The reimbursement level for people who temporarily seek care out of province keeps a reasonable gap from institutions of the same level where they are enrolled. For the same illness seen elsewhere, the money that comes back is a step lower than at home.

The rules list looking up and copying the medical record as a patient's right. The scope covers the outpatient record, the inpatient record, lab slips, medical images, surgery and anesthesia records, pathology material, medical charges, and the rest of the file. Changing hospitals, having a second doctor look again, claiming on commercial insurance, and a real dispute all rest on these papers.

Regulations clearly state that “whenever a medical dispute arises and it is necessary to seal or unseal medical records, this must be done while both the patient and medical staff are present.” The sealed documents may be either originals or copies, which the hospital then stores. If the records are still being written, only the completed sections should be sealed first; the remainder can be sealed later. The hospital must produce a sealing list, signed or stamped by both parties, with each side keeping a copy. In cases where an adverse effect is suspected to stem from an IV, blood transfusion, injection, or medication, both parties must jointly seal and later unseal any related physical items. If testing is required, both parties must jointly appoint a qualified laboratory; should they fail to agree, the local health authority at the county level where the hospital is located will make the appointment. Should a transfusion-related problem be suspected and blood needs sealing, the hospital must notify the blood bank to send representatives to the scene. Additionally, there is a strict rule: “No organization or individual may alter, forge, conceal, destroy, or seize medical records.” Once a dispute is resolved or three years pass without any further claims, the hospital may unseal the documents on its own initiative (nationwide, effective 1 October 2018).

The National Health Commission's 2024 edition of the emergency-medicine quality-control indicators says emergency triage must "sort patients into four levels by how critical the condition is." "Level I is a critical emergency and needs treatment at once." "Level II is a severe emergency, and assessment and treatment often go on together." "Level III is an urgent case and needs to be seen within a short time." "Level IV is a non-urgent or less urgent case and is seen in order in the ordinary treatment area." Triage means that, on entering the emergency department, someone first rates how serious it is and sets the order of care. Beijing's implementation standard gives the response required at each level. Level 1: "assess and treat at once, and move the patient into the resuscitation room or the rescue room." Level 2: "monitor vital signs at once, start treatment within 10 minutes, and move the patient into the rescue room." Level 3: "treat ahead of level 4 patients, and have the patient wait in the ordinary treatment area; if the wait is longer than 30 minutes, assess again." Level 4: "seen in order, and the wait is long unless the condition changes; if the wait is longer than 4 hours, another assessment is allowed." In the Beijing standard, the manual rating indicators for level 1 include "acute disturbance of consciousness." Those for level 2 include "active or severe blood loss," "severe difficulty breathing," "chest pain that looks like a heart cause," and "severe pain from any cause (7 to 10 points)." Triage must "keep to the rule that critical and severe cases are seen first," and the entrance of the emergency department should have a triage area in a prominent place (the level standard is the national rule, and the response times are the Beijing standard).

The people the disease emergency-assistance system covers are "patients who suffer an acute, severe, or critical injury or illness inside China, who need emergency care, but whose identity is unclear or who cannot pay the corresponding fees." The fund pays both kinds of fees: "emergency fees incurred by a patient whose identity cannot be established," and "emergency fees left unpaid by a patient whose identity is clear but who cannot pay." The document also says "medical institutions of every kind, and their staff, must treat a patient with an acute, severe, or critical injury in time and effectively, and must not refuse, shift, or delay treatment for any reason." Pre-hospital emergency care has a rule too. The national pre-hospital medical emergency number is "120." An emergency center (station) "must not refuse, shift, or delay pre-hospital medical emergency service because of dispatch," and also "must not refuse or delay pre-hospital medical emergency service because of fees." Transport follows "the principles of nearness, urgency, meeting the professional need, and taking the patient's wishes into account" (nationwide, since 2013).

The assessment principle in the Classification of the Degree of Disability Caused by Human Injury is that it "shall take the outcome or the end result of treatment of the injury as the basis, and shall objectively rate the loss of tissue or organ and/or the degree of functional impairment." The standard says the timing "shall be after treatment of the primary injury, and of complications that are truly linked to it, has ended, or after the clinical result is stable." The standard "divides the degree of disability caused by human injury into 10 grades, from the first grade (a human disability rate of 100%) to the tenth grade (a human disability rate of 10%), with each grade 10% apart in disability rate." The basis of judgment is "destruction of the structure of human tissues and organs, functional impairment, and how far the person depends on medical care and nursing, with due regard to the effect of the disability on social contact and on psychological factors." Clauses in the tenth grade that relate to fractures include the following. The first is "a compression fracture of a single vertebral body (compression reaching 1/3) or a comminuted fracture." The second is "fractures, or a comminuted fracture, at more than a single site on the pelvis, healed with deformity." The third is "loss of 25% or more of function in any large joint of the limbs (excluding the ankle)." Disability of the same site and the same nature must not be counted twice. Where there is disability at more than a single site, each grade should be written separately (nationwide, in force from January 1, 2017).

The disability certificate is “the legal proof of a person’s disability status, disability category, and disability level, serving as a key basis for accessing national and local preferential policies.” Assessment follows the national standard GB/T 26341-2010. Applications are voluntary and administered locally. All seven disability types qualify for levels one through four. County-level associations handle applications and issuance based on evaluations conducted by provincially designated hospitals or specialized institutions. Approved cases are posted publicly in the village or community for five working days, and the county-level association completes its review “within ten working days.” No fee is charged for the certificate; assessment and photography costs are normally the applicant’s responsibility, though where conditions allow the local government may subsidize them, and for applicants in special hardship the relevant departments should be coordinated to reduce or waive them. The certificate lasts ten years and can be renewed at no cost; re-evaluation is possible if conditions change. If you disagree with the assessment result, you may apply for a new assessment at the prefecture-level disability association within ten working days. If you still disagree, the provincial disability assessment expert committee makes the final conclusion (effective nationwide since 1 January 2018).

Item 7 of the "Nine Guidelines on Integrity in Practice for Medical Institution Staff" (Guo Wei Yi Fa [2021] No. 41): "Maintain the order of care and do not undermine fairness in seeking care. Hold to the principle of equality and build a fair care environment together. It is strictly prohibited to use medical resources such as appointment slots, beds, and scarce drugs and consumables, or care arrangements such as tests and surgeries, to accept benefits or to profit privately at public expense." Item 8: "Build a harmonious relationship together, and do not accept 'red envelopes' from patients. Keep to medical ethics and discipline yourself strictly." The same item also says "it is strictly prohibited to ask for or accept from patients and their relatives and friends gifts, gift money, consumer cards, securities, equity, other financial products, and other money or goods." Meals and entertainment paid for by the patient side are the same: "it is strictly prohibited to attend banquets, or travel, fitness, entertainment, and similar activities, that they arrange, organize, or pay for." The document also requires medical institutions to carry out their main responsibility, carry out supervision, and "resolutely investigate violations." Satisfaction rating is written into the performance assessment of tertiary public hospitals. The basis is the State Council General Office's Opinion on Strengthening Performance Assessment of Tertiary Public Hospitals (Guo Ban Fa [2019] No. 4). The document says: "The performance assessment indicator system of tertiary public hospitals consists of indicators in 4 areas: medical quality, operational efficiency, sustainable development, and satisfaction rating." It also says: "Hospital satisfaction consists of two parts, patient satisfaction and staff satisfaction..." It goes on to say the aim is to "measure patients' sense of gain and staff motivation through satisfaction ratings by outpatients, inpatients, and medical staff." This rating also has a unified national platform: "The state establishes a satisfaction management system for public hospitals..." The timetable is: "By the end of March 2019, all tertiary public hospitals nationwide are brought onto the National Health Commission's satisfaction survey platform. Localities shall use that platform and bring the survey results into the performance assessment of tertiary public hospitals." Hospitals must also handle complaints. The basis is Article 2 of the Measures for Complaint Management of Medical Institutions (National Health Commission Order No. 3, in force 2019). Complaint management means patients "putting forward opinions, suggestions, or complaint requests" on medical service conduct, medical management, medical quality and safety, and the like. The hospital is responsible for investigating, handling, and giving feedback. "Medical institutions at level two and above shall set up a doctor-patient relations office or designate a department (together, the complaint management department) to carry out complaint management in a unified way." The duties of the complaint management department include "receiving complaints in a unified way, investigating and verifying the matters complained of, proposing handling opinions, and answering patients promptly." Medical institutions "shall encourage staff to actively gather patients' opinions and suggestions on medical services, medical quality and safety, and the like" (nationwide).

A January 2024 announcement from the National Healthcare Security Administration says the fee for a routine single-tooth implant is made of three parts. The first part is the medical service fee, charged as a flat fee. The flat fee covers "the consultation fee for the whole implant course, biochemistry tests and imaging fees, the implant placement fee, the crown placement fee, and the scanning, design, and modeling fee, and it does not include extraction, periodontal cleaning, root-canal treatment, bone grafting, or soft-tissue grafting." "In each locality, the medical service charge for a single routine implant at a tertiary public hospital is in principle no more than 4500 yuan." In economically developed regions, under the 2022 special price-control notice, it can be relaxed by at most 20%. The second part is the implant. In the national bulk purchase of January 2023, "the selected prices ran from 548 yuan to 1855 yuan, with an average a little over 900 yuan." The Sichuan healthcare security bureau, which led the purchase, reported that expensive imported brands fell from a median purchase price of 5000 yuan to about 1850 yuan, and the brands used in the largest amounts fell from about 1500 yuan to about 770 yuan. The third part is the crown, "with prices from 100 yuan to 656 yuan, and an average a little over 300 yuan." At a press conference in the second half of 2023, the National Healthcare Security Administration said local control measures were all in place by the end of April and the start of May, and that "the overall implant fee fell from an average of 15,000 yuan to about 6000 to 7000 yuan." On reimbursement: a 1999 document from the labor and social security ministry and other departments lists "dentures" (false teeth) and "non-functional cosmetic or orthopedic surgery" as not paid by basic yibao. In a 2019 reply to a political-consultative proposal, the National Healthcare Security Administration said, "Cosmetic items (including restoration and straightening of missing teeth, and similar care) are not in the scope paid by the yibao fund. Treatment items in dentistry are not excluded at the national level, and localities have generally brought them into the scope yibao pays" (nationwide, as of October 2026).

A negotiated drug is a drug the National Healthcare Security Administration priced with the manufacturer and then put in the yibao catalog. A 2021 policy explainer from the administration says the catalog is adjusted once a year, and the sequence became "into yibao first, and into the hospital after," so some negotiated drugs are "hard to get into the hospital." For that, the National Healthcare Security Administration and the National Health Commission issued Yi Bao Fa [2021] No. 28. The document says the dual channel is "a mechanism that supplies negotiated drugs through designated medical institutions and designated retail pharmacies" and "brings them into yibao payment at the same time." For a drug in the dual channel, "designated medical institutions and designated retail pharmacies apply a unified payment policy." Buying at a pharmacy and buying at a hospital follow the same reimbursement rules. Which drugs are included is, in principle, set by the provincial yibao department. Which pharmacies are included, the yibao department must "disclose to the public promptly and on its own initiative." The prescription is sent to the pharmacy through the prescription-transfer center in the yibao system, and the requirement is to "keep electronic prescriptions moving smoothly." In September of that year, Yi Bao Han [2021] No. 182 required that, for a negotiated drug the hospital cannot stock for the moment, the hospital "raise access to the drug through the dual channel and similar routes." Negotiated drugs used appropriately are listed separately and are not counted in the hospital's drug-share assessment. The document also says "the landing of negotiated drugs must not be affected on the grounds of a yibao total cap, a limit on how many drugs are in the institution's formulary, the drug-revenue share, or similar reasons." It also required that, before the end of November 2021, each prefecture-level city have at least 1 dual-channel retail pharmacy. The notice on the 2025 edition of the yibao drug catalog (Yi Bao Fa [2025] No. 33) repeats that sentence, "must not, on those grounds." The notice also says that, in principle, a negotiated drug must not be taken out of the dual channel just because it has been moved into the regular catalog. Designated pharmacies that dispense dual-channel drugs "must all receive this kind of prescription through the electronic prescription center." The new catalog takes effect on January 1, 2026 (nationwide, as of October 2026).

What you save is the time of each round trip to the hospital and of queuing to register. The Interim Measures for the Administration of Internet Diagnosis and Treatment say that online care can cover follow-up visits for only some common illnesses and chronic illnesses. The condition is that an in-person hospital has already made a clear diagnosis, the doctor has your records, and the follow-up is for that same diagnosis. The measures say "internet diagnosis and treatment must not be provided to a patient on a first visit." If the condition changes, or the doctor needs to examine you in person, the hospital must stop the online care at once and direct you to an in-person hospital. An online prescription needs the physician's electronic signature. After a pharmacist checks it, a third party may be entrusted to deliver the medicine to your home. Anesthesia drugs, psychotropic drugs, and other specially controlled drugs cannot be prescribed online. Prescribing online for a child 6 or younger requires a guardian and a physician in the relevant specialty to be present. Reimbursement by yibao is in the National Healthcare Security Administration's 2020 document Yi Bao Fa [2020] No. 45. It says that, for a follow-up prescription at an "internet-plus" designated hospital in the local pooling area, the consultation fee and the drug fee can be paid under the local yibao rules. The part you pay yourself can be paid, under the rules, from an employee yibao individual account. The fee for delivering the drugs is not in yibao. Localities may start with outpatient chronic and special diseases and gradually widen what is paid. The local yibao agency must publish the list of such designated hospitals. Yi Bao Fa [2019] No. 47 says that an internet follow-up at a public hospital, whichever rank of doctor sees you, is charged at the price of an ordinary outpatient consultation item (nationwide, as of October 2026).

The Regulations on the Supervision and Administration of Medical Security Fund Use say a designated hospital must "truthfully issue fee documents and related materials to the insured person." The insured person also has the right to require the hospital to issue them truthfully. The hospital must not over-test, must not charge twice for the same item, must not charge above the standard, and must not split an item into pieces to charge for it. For a drug or a service outside the scope the yibao fund pays, other than an emergency or a rescue, the insured person, or a close relative or guardian, has to agree. If these rules are broken, the yibao department orders a correction. If the yibao fund loses money, it orders the money returned, and then a fine of 1 to 2 times the loss. Using an item yibao does not reimburse without agreement, and refusing to correct it, draws a fine of 10000 to 50,000 yuan. The National Health Commission's 2019 Provisions on the Administration of Internal Price Conduct of Medical Institutions require hospitals to set up a bill system, including an electronic bill. When a patient needs it, the hospital must print it. The bill must state the name and code of the item, the drug, and the consumable, and also the unit price, the pricing unit, the date of use, the quantity, and the amount. Care charged by disease type, or by DRG (a bundled payment grouped by disease), is not in this requirement. The hospital must post, in a prominent place, the phone numbers for price inquiries and complaints. Complaints follow a rule that the first person asked is responsible, and the person who receives the complaint must record the content and the result. A report to the yibao department goes to the website, phone, fax, or mailing address it has published. It can be anonymous. Personal information in a report filed under a real name must be kept confidential. If the report is verified, the reporter is rewarded under national rules (nationwide, as of October 2026).