CHINA’S NHC Responds to Proposal on Lifting Restrictions for Diagnostic Testing in Clinics to Advance Tiered Healthcare

China’s National Health Commission (NHC) recently responded to a deputies’ proposal on “Lifting Restrictions on Diagnostic Testing Services in Clinics to Promote the Implementation of Tiered Healthcare”:

I. Current Work Status and Progress

Clinics are an integral part of China’s healthcare service system, primarily providing diagnosis and treatment for common and frequently occurring diseases as well as family doctor contract services.

The NHC attaches great importance to the construction and development of clinics. It has successively issued documents such as the Notice on Issuing the Opinions on Promoting the Sustainable, Healthy, and Standardized Development of Private Medical Institutions and the Interim Measures for Clinic Filing Management, continuously improving supportive policies in areas such as tax incentives and comprehensive industry supervision, optimizing the medical practice environment, and promoting the standardization and quality of clinics.

In recent years, private clinics have experienced rapid growth. By the end of 2023, there were 276,000 private clinics nationwide, a significant increase from 189,000 in 2018.

II. Response to the Proposed Suggestions

(1) On optimizing the policy environment, relaxing restrictions on diagnostic testing services, and promoting the adoption of small-scale medical equipment in clinics:

1.     The Basic Standards for Clinics (2022 Edition) stipulate that, in addition to basic equipment, clinics should be equipped with other devices corresponding to their clinical service scope.

2.     Clinics are encouraged to sign service agreements with third-party medical institutions to collaboratively carry out laboratory testing services and promote regional sharing of testing resources. Clinics that outsource testing to other institutions are not required to install the relevant equipment.

3.     The NHC has issued the Basic Standards and Management Specifications for Medical Laboratories (Trial), setting requirements for internal quality control and external quality assessment, while encouraging medical laboratories to provide testing services to primary-level medical and health institutions—on the premise of ensuring biosafety and testing quality.

(2) On improving the medical insurance payment system and expanding service coverage:

1.     In establishing and improving the basic medical insurance system, benefit policies have consistently favored primary-level medical institutions. General outpatient pooling has been widely established to cover common and frequent disease expenses at the grassroots level. By including general consultation fees and family doctor service fees in the reimbursement scope and promoting standardized management of long-term prescriptions, insured patients are encouraged to seek initial consultations at primary institutions. Currently, reimbursement rates at the primary level are generally 5–10 percentage points higher than those at secondary and tertiary institutions.

2.     Designated medical insurance management follows a principle of equality. The Interim Measures for the Administration of Designated Medical Institutions under Medical Insurance require simplified application procedures and optimized service processes, treating all public and private institutions—including clinics—equally. Those meeting the conditions may be included in designated medical insurance management.

3.     Local governments are encouraged to include appropriate traditional Chinese medicine (TCM) services within reimbursement coverage. Nationally, the medical insurance system currently defines excluded and partially reimbursed service categories. Based on this framework, each province determines its own reimbursement scope—including TCM and ethnic medicine services—according to economic conditions, fund capacity, and clinical needs. Most provinces have now included eligible TCM treatments such as acupuncture and therapeutic massage in the reimbursable service list.

(3) On promoting informatization and resource sharing:

The NHC has issued several documents, including the Notice on Accelerating the Mutual Recognition of Examination and Testing Results, the Three-Year Action Plan (2023–2025) for Nationwide Information Interconnection and Sharing among Medical and Health Institutions, and the Guiding Opinions on Further Promoting the Mutual Recognition of Examination and Testing Results among Medical Institutions. These aim to standardize diagnostic practices, promote mutual recognition of results, improve efficiency, and enhance patient experience.

As of 2024, 12 provinces have established provincial “imaging clouds,” and 22 provinces have built mechanisms for interconnection and information sharing of examination and testing results.

(4) On establishing a scientific evaluation system to guide the high-quality development of clinics:

Documents such as the Interim Measures for Clinic Filing Management specify detailed requirements for clinic establishment and supervision. Clinics are required to connect with local regulatory information platforms and upload operational data in a timely manner for oversight. Health and TCM authorities are leveraging information technology and big data to enhance supervision efficiency, incorporating clinics into local medical quality control systems.

(5) On encouraging licensed physicians to establish clinics:

1.     The filing-based management system for clinics continues to be optimized. According to the Regulations on the Administration of Medical Institutions, “clinics may commence practice after filing with the county-level health authority in accordance with the regulations of the health administrative department under the State Council.” The Interim Measures for Clinic Filing Management further detail the specific requirements for individual clinic establishment and filing procedures.

2.     The NHC actively promotes multi-site practice for physicians and encourages service provision at the grassroots level. The Physician Law and the Measures for the Administration of Physician Practice Registration provide institutional support for multi-site practice.

III. Next Steps

The NHC will further strengthen full-cycle and full-element supervision of clinic operations, encourage qualified physicians to open clinics, and continue promoting the high-quality development of the clinic sector.

At the same time, in collaboration with the National Healthcare Security Administration (NHSA), the NHC will continue refining medical insurance policies and measures to better leverage the advantages of the healthcare security system and meet the public’s medical and pharmaceutical needs.