外资医疗入华：拭目以待新篇章

9月7日，商务部、国家卫生健康委、国家药监局三部门发布《关于在医疗领域开展扩大开放试点工作的通知》（下称《通知》），拟允许在北京、天津、上海、南京、苏州、福州、广州、深圳和海南全岛设立外商独资医院（中医类除外，不含并购公立医院）。

松绑外资办医的信号一直在持续。在过去，相关部门正式规定外资投资国内医疗机构持股比例从不得高于30%，逐渐上升至70%。《通知》如顺利推行，将彻底解放试点地区外商投资中国医疗机构的股比限制。此外，本次特地提到需要药品监管、人类遗传资源、卫生健康主管部门与商务部等部门相互配合，表明本次开放也是在监管完善，协同合作的基础上进行的。

但是，在外资办医的政策一直存在反复的现象。2014年，原卫计委和商务部联合下发《关于开展设立外资独资医院试点工作的通知》，允许境外投资者通过新设或并购的方式在北京市、上海市、福建省等7个省市试点设立外资独资医院，并把审批权限下放到省级。但是，仅开放后的一年，在发改委和商务部下发的《外商投资产业指导目录》中，外资医疗机构即从“允许类”转为“限制类”，仅保留合资与合作形式。本次新政出台前一天刚颁布的负面清单，仍然规定外商投资医疗机构仍仅限于合资。这种政策不连续性对外资进入医疗市场的信心构成挑战。

此外，支付体系的不完善也是外资医疗机构面临的另一大障碍。作为公立医院服务差异化的补充，外资医院往往定价较高，难以全面纳入基本医保，商业健康保险是重要的支付渠道之一。但是，2022年我国商业健康险赔付支出在卫生总费用中的占比不足5%，发展速度也不及预期水平，一定程度上制约了外资医院的市场拓展与可持续发展。

因此，解决上述悬而未决的问题，对于激发外资医院入华热情、促进其在中国市场的立足与发展至关重要。

On September 7, the Ministry of Commerce (MOFCOM)，National Health Commission (NHC), and National Medical Products Administration (NMPA) issued the Notice on the Pilot Work of Expanding Openness in the Medical Industry ("Notice"). The Notice aims to permit the establishment of wholly foreign-funded hospitals in designated locations, including the cities of Beijing, Tianjin, Shanghai, Nanjing, Suzhou, Fuzhou, Guangzhou, Shenzhen, and the province of Hainan Island. However, the pilot does not allow these foreign-funded hospitals to practice traditional Chinese medicine or acquire public hospitals.

Over the years, China has gradually relaxed restrictions on foreign investment in healthcare. Initially, foreign ownership in domestic medical institutions was limited to 30 percent, later increased to 70 percent. If implemented, the Notice would completely remove foreign ownership caps in the designated pilot areas. Moreover, the involvement of key regulatory bodies such as NMPA, human genetic resources authorities, NHC, and MOFCOM indicates that the liberalisation will be carried out under thorough oversight.

However, inconsistencies in past policies have raised concerns. In 2014, a similar initiative allowed foreign entities to establish wholly foreign-funded hospitals in select provinces, either through new ventures or mergers and acquisitions, with approvals delegated to provincial authorities. Yet, a year later, the National Development and Reform Commission (NDRC) and MOFCOM issued the Catalogue for the Guidance of Foreign Invested Industries, which partially reversed these provisions. The status of foreign-funded healthcare institutions shifted from ‘permitted’ to ‘restricted’, which, along with the negative list issued just one day before the Notice, limits foreign investment in medical institutions to joint ventures. These measures have unsettled investor confidence, as foreign investment healthcare policies are inconsistent.

Another major challenge for foreign-funded medical institutions in China is the underdeveloped funding system for their services. Since their premium services are often not covered by basic medical insurance (BMI), commercial health insurance becomes one of the most important payment methods used. However, in 2022, commercial health insurance accounted for less than five percent of total health expenditure, limiting the growth potential of foreign hospitals. The slow development of the commercial insurance market continues to impact the long-term sustainability of foreign healthcare institutions.

Ultimately, to attract foreign investment in healthcare and ensure the successful integration of foreign-funded institutions into the Chinese market, funding for foreign healthcare providers must be addressed—either through BMI coverage or by developing the commercial health insurance market. Equally important, maintaining stable and consistent policies is key to sustaining investor confidence.