Key points
- China runs a mixed system: two public insurance schemes — one for urban employees, one for urban and rural residents — alongside mostly public hospitals.
- Coverage is near-universal: the 2009 reform built basic medical insurance up to 1.334 billion people covered by April 2024 (State Council).
- Care is delivered by public hospitals and primary care facilities, organised in a tiered system with healthcare alliances linking hospitals and clinics.
- Basic public health services are free, but hospital and outpatient care carry deductibles and co-payments; households paid 32.2% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database).
- Life expectancy at birth was 77.9 years in 2023, and health spending was 5.9% of GDP in 2023 (WHO Global Health Estimates; World Bank, WHO Global Health Expenditure Database).
Direct answer: China runs a mixed system: two public insurance schemes — Urban Employee Basic Medical Insurance for formally employed urban workers, and Urban and Rural Resident Medical Insurance for other urban and rural residents — alongside mostly public hospitals. Coverage is near-universal: the 2009 reform built basic medical insurance up to 1.334 billion people covered by April 2024 (State Council). Care is delivered by public hospitals and primary care facilities, organised in a tiered system with healthcare alliances linking hospitals and clinics. Basic public health services are free, but hospital and outpatient care carry deductibles and co-payments; households paid 32.2% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database). Life expectancy at birth was 77.9 years in 2023 — and healthy life expectancy 68.0 years — and health spending was 5.9% of GDP in 2023 (WHO Global Health Estimates, October 2026; World Bank, WHO Global Health Expenditure Database).
At a glance
| Item | Detail |
|---|---|
| Model | Mixed — social insurance, public provision |
| Who pays | Payroll contributions (employee scheme) plus government subsidies and individual premiums (resident scheme), with out-of-pocket payments on top |
| Who delivers | Mostly public hospitals and primary care facilities, organised in a tiered system; private hospitals encouraged to add supply |
| What is free at the point of use | Basic public health services (the national preventive and health-management package); essential medicines on the national list are reimbursed at higher rates |
| Life expectancy at birth | 77.9 years (2023, WHO Global Health Estimates) |
| Health spending | 5.9% of GDP (2023, World Bank, WHO Global Health Expenditure Database) |
| Source for the model and coverage | Commonwealth Fund — China country profile |
Figures are a snapshot checked 7 November 2026, not a live feed. No country is ranked as best.
How the system works
China launched a new round of healthcare reform in 2009, aiming to provide affordable and equitable basic healthcare for all by 2020, and has continued it since under the Healthy China 2030 strategy announced in 2016. The reform built basic medical insurance from three schemes — Urban Employee Basic Medical Insurance, the New Rural Cooperative Medical Scheme and Urban Resident Basic Medical Insurance — and in 2016 merged the two resident schemes into Urban and Rural Resident Medical Insurance. The National Healthcare Security Administration was established in 2018 to manage the schemes under one roof (BMJ Global Health, 2020).
The first point of contact is primary care, delivered through community health centres in cities and township health centres and village clinics in rural areas. Public hospitals provide specialist and inpatient care, organised in a tiered delivery system: healthcare alliances link hospitals with primary care facilities, and family doctors offer contracted services. Private hospitals are encouraged to increase the supply of care, and telemedicine is promoted for remote and poorer areas.
Who pays, and what people pay
The employee scheme is funded by payroll contributions from employers and workers; the resident scheme is funded by government subsidies plus individual premiums, with the government paying a larger share for people on low incomes. Two further safety nets sit alongside the schemes: Medical Financial Assistance, launched in 2003 for people who cannot afford premiums or care, and Catastrophic Medical Insurance, launched in 2012 for very high medical bills (BMJ Global Health, 2020). What people still pay is substantial: households paid 32.2% of all health spending out of pocket in 2023 (WHO Global Health Expenditure Database), through deductibles and co-payments on hospital and outpatient care and through medicines outside the reimbursed lists.
What is free, and what is not
The national basic public health services package — preventive care, health management and monitoring, and control of major communicable and chronic diseases — is free for all residents, and local governments can expand it. Medicines on the national essential medicines list are included in the insurance reimbursement lists at higher rates than other medicines. What is not free is the margin: deductibles and co-payments on hospital stays and outpatient visits, which vary by scheme and by locality, and care outside the reimbursed package. The boundary is set by which scheme covers the patient and where they seek care.
How it compares
China spends 5.9% of GDP on health (2023), below the OECD average of 9.3% (2024), and its life expectancy of 77.9 years is 3.2 years below the OECD average of 81.1 years (2023). China is not in the OECD tables, so its figures come from WHO and World Bank sources for 2023 rather than the OECD’s 2024 dashboards. Its distinguishing feature is the scale and speed of the coverage build: from fragmented schemes to basic medical insurance covering 1.334 billion people by April 2024, under one national administration since 2018 — while households still pay nearly a third of health spending directly. Compare countries side by side in the Health System Comparison tool, or read the other profiles in the country index.
Frequently asked questions
What are the two main insurance schemes?
Urban Employee Basic Medical Insurance, for formally employed urban workers and funded by payroll contributions, and Urban and Rural Resident Medical Insurance, for other urban and rural residents and funded by government subsidies plus individual premiums. The resident scheme was formed in 2016 by merging two older schemes, and the National Healthcare Security Administration has managed both since 2018.
Is healthcare free in China?
Basic public health services — the national package of preventive and health-management services — are free. Hospital and outpatient care are not: patients pay deductibles and co-payments that vary by scheme and locality, and households paid 32.2% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database).
What is Healthy China 2030?
The national health strategy announced in 2016, covering health across the life course with the health system, prevention and the wider influences on health. It sets a target of life expectancy of 79 years by 2030.