China’s healthcare system differs significantly from those of many other countries. Looking only at the surface, it is difficult to gain an in-depth understanding of China’s hospital grading system and the differences between hospitals of different grades. In this article, I will use the simplest logic and facts to help foreigners clearly understand what China’s hospital grades mean and how foreigners seeking medical care in China should choose among hospitals of different grades.
1. Three Types of Medical Institutions
In China, medical institutions can be divided into three types: clinics, outpatient departments, and hospitals.
The classification of these three types has relatively little to do with a physician’s specialty, competence, or reputation. It is basically determined by factors such as the size of the facility, the number of departments, and the number of physicians. Therefore, you cannot determine whether a physician or medical institution is reliable or well known simply based on which of these three categories it belongs to.
China has many well-known physicians who were previously specialists in various departments of public hospitals but later left those hospitals and established their own specialty clinics. These clinics may be very small, but because the physicians themselves have strong reputations, patients from across the country still travel to these small clinics for treatment.
A typical example is Dr. Gong Xiaoming, formerly of Peking Union Medical College Hospital. He was previously an associate professor in the Department of Obstetrics and Gynecology at Peking Union Medical College Hospital, one of the best-known obstetrics and gynecology departments in China. After leaving the public hospital system, he established his own gynecology clinic in Beijing and has provided patients around the world with minimally invasive or non-invasive treatments for gynecologic tumors and other conditions.
2. The Three Hospital Grades
Hospitals in China are divided into three major grades, and each major grade is further divided into three classes. In practice, however, most people in China pay little attention to these classifications except for hospitals at the highest level.
- Three major grades (from highest to lowest): Grade III, Grade II, and Grade I.
- Three classes (from highest to lowest): Class A, Class B, and Class C.
Based on this combination, you can see that the highest hospital classification in China is Grade III, Class A (often called “3A” or “Tier-3A” hospitals).
China has more than 40,000 hospitals, including nearly 2,000 Grade III Class A hospitals. Major cities such as Beijing, Shanghai, Guangzhou, Wuhan, Tianjin, Nanjing, Xi’an, Hangzhou, and Chengdu are home to many of China’s well-known Grade III Class A hospitals.
3. Huge Differences in Facilities Between Hospitals of Different Grades in China
Unlike developed countries, where medical standards and facilities tend to be relatively evenly distributed, hospitals in China can differ greatly in both medical standards and physical facilities depending on their grade.
The general population in China does not receive free healthcare. The broadly accessible medical insurance system currently consists mainly of employee medical insurance for people who are employed and resident medical insurance for ordinary residents who are not employed. Reimbursement rates vary depending on factors such as the disease, whether hospitalization is required, and the medical supplies used, but generally range from 50% to 90%.
In addition, the level of government financial support received by different public hospitals in China varies considerably. For example, city governments in Beijing, Shanghai, and Guangzhou have higher tax revenues and therefore can allocate more funding to hospitals. These hospitals consequently have greater financial resources to purchase more advanced diagnostic equipment or recruit more authoritative medical specialists.
When large Grade III Class A hospitals attract more highly regarded medical specialists, the number of specialists available at other hospitals naturally decreases. This is very similar to the “siphon effect” that is often discussed: major cities attract more medical specialists, while the medical capabilities of smaller cities become weaker.
Combined with differences in reimbursement methods and reimbursement levels, people often prefer to seek care at Grade III Class A hospitals with higher medical standards, which further accelerates the loss of patients from other hospitals.
4. The Tiered Healthcare System Is Not Strictly Enforced
In China, no matter how crowded Grade III Class A hospitals become, people still tend to prefer seeking care at these hospitals. One of the most important reasons is that China’s tiered healthcare system is not strictly enforced.
In the healthcare systems of many countries, family physicians serve as gatekeepers. This allows family physicians to function as a kind of “triage point,” managing most common medical conditions and referring patients who require specialist treatment.
In China, however, the vast majority of people do not have a family physician. Moreover, the hospital grading system was originally intended to support tiered healthcare, but for various historical reasons, this system has not been fully implemented. As a result: anyone can freely seek treatment at any hospital, and anyone can freely consult any physician.
The advantages and disadvantages of this are both very clear:
- Advantage: Any patient can seek out China’s best specialists in virtually any field of medicine, and there are no restrictions preventing patients from seeking care at large public hospitals.
- Disadvantage: Large public hospitals also have to provide basic medical services. Large numbers of patients with common illnesses occupy appointment and treatment capacity that could otherwise be used by patients who have a greater need for specialist care.
5. How Foreigners Should Choose Among Hospitals of Different Grades
Apart from a small number of private clinics and hospitals, foreigners seeking treatment in China generally have little reason to choose public hospitals other than Grade III Class A hospitals. It is also recommended to choose Grade III Class A hospitals in major tier-1 cities such as Beijing, Shanghai, Guangzhou, Chengdu, Nanjing, Wuhan, and Hangzhou.
These hospitals handle extremely large numbers of outpatient visits and surgical procedures every day, which means that physicians encounter very large numbers of cases within their specialties on a daily basis. In terms of surgery, the daily surgical volume of clinicians at Grade III Class A hospitals in China can be remarkable. Without exaggeration, many physicians perform more surgeries in a single week than physicians in the same specialty in developed countries perform in an entire year.
Take microtia, a congenital condition, as an example. Because of China’s large population, the overall patient population is also very large. As a result, China has more than 500 specialists who focus specifically on auricular reconstruction for microtia. Internationally renowned auricular reconstruction teams led by specialists such as Professor Guo Shuzhong and Professor Jiang Haiyue can perform more than 1,000 auricular reconstruction procedures each year. This number may even exceed the total annual surgical volume for such patients in some countries.
Because China has such a large population, both the number of patients and the range of diseases encountered are enormous. At the same time, institutional factors result in a large proportion of patients being concentrated in Grade III Class A hospitals. This provides clinicians with a sufficiently large patient base from which to gain experience and continuously improve their clinical skills.
Comments & Discussion
...