Hongkongers heading north to see a doctor? A one-article guide to understanding Mainland China's healthcare and social security systems

As more and more Hong Kong residents go north to live, work, or travel — and even choose to live long-term in the Greater Bay Area after retirement — their demand for mainland medical services has also increased. In Hong Kong, people are used to booking private clinics or waiting for appointments at public hospitals; upon arriving in the mainland, they may be baffled by unfamiliar terms like "Tier-3 Grade-A hospitals", "social security card", and "medical insurance reimbursement".

Should patients go to a community clinic or to a large hospital? How much can "medical insurance" help? Can Hong Kong residents access this protection? In fact, to seek care on the mainland you need to understand two major issues: first, where to seek care (the healthcare institution system); second, who pays for the care (the social medical insurance system). This article breaks down the mainland hospital system and explains how the mainland "medical insurance" operates. 

Mainland China's medical institutions are classified into three levels according to functions, tasks, and facility conditions. "Tier-3, Class-A hospitals" (known as "3A hospitals") are currently the highest-level hospitals; they have the most advanced medical equipment and the best medical teams, and can provide high-standard specialist medical services. Hong Kong residents can register in person at the hospital or make an appointment; appointment methods include phone, online, WeChat, mobile apps, and on-site booking.

Mainland medical institutions include the following three categories:

• Public hospitals: divided into three levels — primary level are community (subdistrict) hospitals, secondary level are county (district) hospitals, and tertiary level are municipal hospitals. For example, in Shenzhen, "Tier-3, Class-A hospitals" include The University of Hong Kong–Shenzhen Hospital, Peking University Shenzhen Hospital, Shenzhen People's Hospital, etc.
• Private hospitals: healthcare institutions established and funded by non-government (private) entities.
• Foreign-invested hospitals: healthcare institutions established with foreign investment. 

Mainland China's social insurance system is made up of the "five insurances": basic pension insurance, basic medical insurance (medical insurance), work-related injury insurance, unemployment insurance, and maternity insurance. Among them, "medical insurance" is the basic healthcare coverage that applies to the entire population; it establishes a fund pool through joint contributions from the government, employers, and individuals, and is also a service that citizens commonly use. The "social security card" is the key credential for citizens to access these benefits; when seeing a doctor or buying medicine, it is used as the "medical card" for immediate settlement and reimbursement.  

Mainland medical insurance one: Urban Employee Medical Insurance designed for "workers"

This is medical coverage designed for employees working in the mainland (including Hong Kong, Macau, and Taiwan residents) and retirees. Its contribution method is similar to Hong Kong's MPF, with employers and employees jointly contributing monthly to the medical insurance fund. Specifically, medical insurance contributions are based on the employee's wages (with upper and lower limits, called the "contribution base"), and are shared proportionally by both parties, generally with the employer bearing the larger share.

This insurance offers relatively comprehensive coverage. According to data from the National Healthcare Security Administration, the reimbursement ratio for inpatient expenses within the policy scope is about 84%. It not only covers inpatient major illnesses, but also ordinary outpatient services, emergency care, and chronic diseases such as hypertension and diabetes. In recent years, the medical insurance drug catalog has been continuously expanded, and many previously expensive imported targeted drugs and innovative medicines have been included in the reimbursement scope after national negotiations.

Additionally, once contributions reach the cumulative years specified by local governments (standards vary by location, generally 20–30 years), employees no longer need to pay after retirement and can enjoy medical insurance reimbursement benefits for life.

Mainland medical insurance two: Urban and Rural Resident Medical Insurance for "others"

This system covers a wide range of people, including rural residents, urban non-working residents, students and children in school, as well as unemployed Hong Kong, Macau, and Taiwan residents who have obtained a residence permit and Hong Kong, Macau, and Taiwan university students studying in the mainland; its aim is to ensure basic coverage for the entire population.

Urban and rural resident medical insurance uses an annual payment system. According to 2024 data, individual contributions are no less than RMB 400 per person per year, while government subsidies are no less than RMB 670 per person per year.

In terms of protection level, resident medical insurance is relatively basic but sufficient to meet basic medical needs. According to official data, the reimbursement ratio for inpatient expenses within the policy scope is about 68%, providing a reliable medical safety net for the unemployed, the elderly, and students.  

The basic principle is "with a job it follows the employer; without a job it follows the place of residence." For Hong Kong residents who live long-term in the Greater Bay Area but are not employed, it is necessary to obtain a "Residence Permit for Hong Kong, Macao and Taiwan Residents" in order to qualify for local residents' medical insurance.  

For Hong Kong residents who want to use medical services in the Mainland, they can consider purchasing Mainland medical insurance. Besides obtaining it through working in the Mainland, they can also purchase the basic medical insurance for employees via flexible-employment arrangements. If they only have the "Residence Permit for Hong Kong, Macao and Taiwan Residents," they can also buy the basic medical insurance for urban and rural residents. 

The following are four categories of flexibly employed persons:

1. Individual business operators
2. Part-time workers
3. Persons in new forms of employment (including those who obtain employment through new business platforms such as e-commerce, online ride-hailing, online food delivery, courier logistics, etc., but have not established an employment relationship with enterprises related to those platforms)
4. Other flexibly employed persons as stipulated by laws, regulations, and rules

But regardless of which type of medical insurance is purchased, Hong Kong residents must first apply for a residence permit. To obtain a residence permit, one needs to have resided in the Mainland for six months (those working in the Mainland can already purchase medical insurance directly without a residence permit, so here we only consider meeting the residence requirement). This means Hong Kong residents need to buy or rent a property in the Mainland or live with Mainland relatives for six months before they can apply for a residence permit to purchase medical insurance.

In addition to the residence permit, Hong Kong residents also need to open a Mainland bank card. After that they can fill out the medical insurance application form, make an online appointment with the local social security bureau to process it, or complete the procedure online via the designated webpage or app. 

As of the end of 2023, approximately 1.334 billion people in mainland China were enrolled in basic medical insurance, with a coverage rate remaining above 95%. For Hong Kong residents living in the Greater Bay Area, this means they can benefit from the convenience of a large protection network.

However, the mainland’s issue of "expensive medical care" has not been completely resolved, because medical insurance does not cover 100% — there are out-of-pocket amounts (deductibles / starting thresholds) and caps (ceilings), and some imported medicines still require self-payment. For Hong Kong residents seeking higher coverage, they may consider purchasing an additional commercial medical insurance policy as a supplement to mainland medical insurance.  

Further reading：
Seeking medical treatment in the mainland is becoming a trend — a comparison of cross-border medical insurance
[Moving between Hong Kong and the mainland] What to do if you get sick? See a comparison of cross-border outpatient insurance

Note: Specific policies are subject to the latest announcements by the local government; it is recommended to consult the local medical insurance bureau or tax authorities before enrolling to obtain the latest and most accurate information. 

Article last updated: July 24, 2025

This English version of this article has been generated by machine translation powered by AI. It is provided solely for reference purposes. In the event of any discrepancy or inconsistency between this translation and the original Chinese version, the Chinese version shall prevail.