Healthcare in Shanghai: public hospitals, international wards and insurance

Shanghai has excellent doctors, but the system works differently from back home: you pay up front, you often register like you're buying a ticket, and English is the exception.

The short version

• Public hospitals treat most patients in China. The best care is usually found in the big city-level hospitals, and Shanghai has plenty [1].
• Foreigners generally pay before treatment, even in emergencies, by cash or a payment app. A deposit can be required before admission [2].
• Many public hospitals run VIP or international wards with English-speaking doctors and nurses, at higher prices [1].
• Get commercial health insurance that works in China and covers medical evacuation. US Medicare won't help you here, and the US government doesn't pay medical bills abroad [2].
• For an ambulance, dial 120. For police, it's 110 [3].

How the system works

Back in the States, you see a primary care doctor and get referred to a specialist. In China, people usually skip that step and go straight to a hospital outpatient department. State-owned hospitals provide services for about 90% of patients, and outpatient care, including vaccinations, generally happens at hospitals [1].

The typical public hospital visit goes like this:

1. Register for the department you need (internal medicine, pediatrics, ENT and so on), at a kiosk, a counter or through the hospital's account in a payment app.
2. Wait for your number to be called. Popular departments at top hospitals get busy, and appointments with senior doctors can sell out [1].
3. See the doctor, who orders tests.
4. Pay for the tests, then do them.
5. Go back to the doctor with the results, then pay for and pick up your prescription at the hospital pharmacy.

It's fast and cheap by US standards, but it's a lot of back-and-forth in Mandarin. Bring a Chinese-speaking friend the first few times, or use a translation app.

Pay first, always

The State Department is blunt about this: public hospitals require prepayment before treating foreigners, payment in cash or by mobile payment app is often required before treatment, including in emergencies, and you may be asked for a deposit before admission [2]. Set up Alipay or WeChat Pay and keep a bank card with room on it. Don't expect a hospital to bill your US insurer later.

Your options in Shanghai

VIP and international wards

Many public hospitals in big cities have VIP wards, sometimes called gāogàn bìngfáng (高干病房). They have up-to-date technology and skilled staff, most of them also treat foreigners with English-speaking doctors and nurses, and they charge more than the rest of the hospital, though still often cheap by Western standards [1].

Shanghai's best-known teaching hospitals include Ruijin Hospital in Huangpu, affiliated with Shanghai Jiao Tong University's School of Medicine [4], and Huashan Hospital in Xuhui, affiliated with Fudan University's Shanghai Medical College [5]. Huashan's Eastern Branch in Jinqiao, Pudong, also called Shanghai International Hospital, opened in 2006 and mainly serves Pudong's expat community [5]. Our source for that is an encyclopedia entry, so call ahead to confirm which departments run in English today.

Private and international hospitals

Shanghai has a cluster of private hospitals and clinics aimed at foreigners, with English-speaking doctors, appointments and insurance billing. One example: Parkway Pantai, a subsidiary of Malaysia's IHH Healthcare, lists a Shanghai International Medical Center among its hospitals [6]. Private care costs much more than a public hospital, often close to US prices. Before you book, ask:

• Is the doctor licensed in China, and in what specialty?
• Does the clinic bill your insurer directly, or will you pay and claim?
• Which hospital would they transfer you to in an emergency?

If you're stuck, the US Consulate General in Shanghai can help US citizens in a medical emergency, though it won't pay your bills. It's at 1469 Huai Hai Zhong Road in Xuhui (+86 21-8011-2400) [2].

Health insurance

This is the part to get right before you land.

What your employer may provide

If you work for a company in Shanghai, ask HR two questions on day one:

1. Am I enrolled in China's social insurance? Foreign employees are often enrolled, and it includes a medical component. It works best at public hospitals in their regular departments, not at private clinics or VIP wards. Our guide to China's social insurance for Americans explains contributions.
2. Do I have commercial international cover? Many expat packages add a private plan that pays for international clinics, VIP wards and evacuation.

Buying your own

If you're self-employed, retired or a trailing spouse, you'll likely buy a plan yourself. Look for:

• Coverage in China, including the private hospitals you're likely to use
• Direct billing, so you're not fronting big bills
• Medical evacuation to Hong Kong, Singapore or the US. The State Department strongly recommends supplemental insurance that covers evacuation [2].
• Maternity and dental, if you need them; they're often add-ons
• US coverage, if you'll spend time stateside. Plans that cover the US cost a lot more.

What about Medicare and ACA plans?

Medicare generally doesn't cover care outside the US, and most ACA marketplace plans assume you live in the States. The State Department reminds travelers to check that their plan covers them overseas and that the US government doesn't pay medical bills [2]. If you're nearing 65, think about Medicare Part B enrollment timing before you move, since late enrollment can bring a lasting penalty. A US benefits adviser can check your situation.

Emergencies and the 120 ambulance

The emergency numbers in mainland China [3]:

There's no 911 here. Calls to 120 are answered in Chinese, so learn to say your address in Mandarin or keep it written in characters on your phone's lock screen. The State Department notes that ambulances in China are often slow to arrive [2]. For a serious problem in central Shanghai, a taxi or ride-hail to the nearest hospital emergency room can be faster. Know which one is closest to your home and your kids' school before you need it.

When you get there, expect to pay or leave a deposit before treatment [2]. Keep your passport, or a photo of it, on you; hospitals register foreigners by passport number.

A quick checklist for new arrivals

1. Get insurance that covers China and medical evacuation before you fly.
2. Set up Alipay or WeChat Pay for hospital payments.
3. Find your nearest public hospital with an international or VIP department, and a private clinic for routine care.
4. Save 120, your address in Chinese and your insurer's 24-hour number in your phone.
5. Bring several months of any prescription meds, with a doctor's letter, and ask a local doctor about equivalents.
6. Enroll in STEP so the consulate can reach you in an emergency [7].

For real-world recommendations on pediatricians and dentists, ask in our community group for Americans in China.

Sources

1. Wikipedia: Healthcare in China
2. US State Department: China international travel information
3. Wikipedia: Telephone numbers in China (emergency numbers)
4. Wikipedia: Ruijin Hospital
5. Wikipedia: Huashan Hospital
6. Wikipedia: Parkway Pantai
7. US State Department: Smart Traveler Enrollment Program (STEP)

Keep reading

• Air quality in Shanghai
• China's social insurance for Americans
• Moving to Shanghai as an American: visa routes
• Medicare when you live abroad