In Depth: Commercial Insurance’s Rise Exposes Chokepoints in China’s Medical System

Patients who buy their own coverage often find themselves unable to access innovative drugs and treatments because the state system isn’t geared up to deal with them

In late 2024, the distressed family of a mother undergoing treatment for breast cancer posted a video on social media describing how she was denied admission by two local public hospitals in Jiamusi, a city in the northeastern province of Heilongjiang, because she was using the commercial medical insurance she had bought herself rather than the state system.

After initially undergoing chemotherapy sessions at the Harbin Medical University Cancer Hospital, she was prescribed drugs and told to continue taking them at home for a year. The hospital is located in the provincial capital of Harbin, more than 300 kilometers from Jiamusi.

When she later sought treatment at the Jiamusi Cancer Hospital and the First Affiliated Hospital of Jiamusi University, both refused admission on the grounds that she was using commercial medical insurance (CMI) and not the state-run basic medical insurance (BMI). A doctor at the cancer hospital told her to return to the Harbin hospital where she was originally treated, while the university hospital said its pharmacy didn’t stock the drugs she was taking and that they would have to be supplied by a designated external pharmacy through the dual-channel system (双通道).

In China, hospitals are at the heart of the health care system — many patients go directly to hospital for consultation and treatment, unlike in Europe and the U.S., where there is a well-developed system of primary care and general practitioners or physicians are normally the first port of call.

Hospitals also dominate the dispensing of prescription drugs, with independent pharmacies mainly offering over-the-counter medication. But they