Key Takeaways
- China is strengthening a system of first contact, two-way referral, separation of acute and chronic care, and coordination between healthcare levels.[1][2]
- A referral can occur within one hospital, between institutions in the same medical network, across cities or from a hospital to rehabilitation or community care.
- International patients can often contact a hospital directly, but direct inquiry is not the same as clinical acceptance or a reserved admission.
- A useful referral package explains why the patient is being transferred, how urgent it is, what has already been done and which question the receiving team must answer.
- For unstable patients, transfer is a clinical operation requiring agreement, transport and handover; it should not be improvised as an ordinary taxi trip.
Content
“You need a larger hospital” is advice, but it is not yet a referral.
A functional referral connects two teams. The sending clinician states what the patient needs and what has already happened; the receiving service confirms that it can evaluate or treat the problem; records and responsibility move with the patient. China’s 2024 national referral policy asks medical institutions to establish referral functions, define rules, coordinate appointments and transfer relevant information.[1] Measures issued in 2026 continue that direction and call for referral centres or designated departments across medical institutions by 2027.[2]
The policy is national. The practical workflow still varies by city, hospital network, specialty and urgency.
Four Different Things People Call a “Referral”
A department-to-department referral happens inside one hospital. A patient registered with gastroenterology may be redirected to surgery, oncology or another subspecialty. Ask whether the original registration remains valid and whether the first doctor is sending an electronic note.
An upward referral moves the patient to a facility with greater or different capability—for example, from a community centre to a tertiary hospital, or from a general hospital to a specialised centre.
A downward referral transfers stable, recovery-phase or long-term care to a lower-level hospital, rehabilitation facility or community service. This is not “being discharged from care”; it is supposed to preserve continuity while moving routine work closer to the patient.[1]
A cross-regional referral involves another city or province. It may be appropriate for rare expertise or a treatment not available locally, but it adds questions about travel fitness, record transfer, appointment confirmation and follow-up at home.
Direct Booking and Formal Referral Are Not the Same
Many hospitals permit patients to book outpatient appointments without a primary-care referral. International or patient-service offices may also accept records directly. That access can be useful, but it creates three distinct stages:
- Administrative intake: files and identification were received.
- Clinical triage: a qualified clinician or department reviewed the question.
- Acceptance: the hospital offered a specific consultation, test, admission or treatment pathway.
An email saying “you may come for evaluation” is not necessarily a promise of surgery or admission. Ask for the campus, department, doctor, appointment type and conditions that still must be met.
What the Sending Clinician Should Provide
A referral note does not need to be long. It should be precise. At minimum, it should state:
- Patient identifiers that match the passport or local record
- Working and confirmed diagnoses
- The reason for referral and the exact clinical question
- Degree of urgency and any travel restriction
- Relevant examination findings and vital-sign concerns
- Tests already completed, with dates
- Treatment already given and the response
- Current medicines, allergies and important comorbidities
- Infection-control or mobility needs
- The sending clinician’s contact details
Attach the evidence the receiving team needs: reports, DICOM imaging, pathology material instructions, operative notes or discharge summaries. Do not replace original records with an unlabelled translation. Keep both and identify who prepared the translation.
What the Receiving Hospital Should Confirm
Before travel, obtain a reply that answers more than “records received.” The receiving service should ideally confirm:
- That the appropriate department has reviewed or accepted the referral
- The named clinician or responsible team
- Date, time, campus and registration route
- Whether the visit is outpatient, emergency or planned admission
- Additional tests or records required
- Whether a bed is actually reserved
- Interpreter and payment arrangements
- What happens if examination changes the proposed plan
For cross-city care, ask how long the patient should remain nearby and which symptoms should trigger emergency care before the appointment.
Stable Transfer Is Different From Emergency Transfer
A stable outpatient can usually travel with a companion and records. An unstable patient may require monitoring, oxygen, medication, trained staff or an ambulance. The sending and receiving clinicians should agree that the destination can accept the patient and what level of transport is needed.
Do not assume that a private car or ordinary ride-hailing trip is safe because the distance is short. Conversely, an ambulance is not proof that the receiving hospital has accepted the case or reserved a bed. Those are separate confirmations.
International transfer or medical evacuation adds aviation fitness, border documentation, escort level, insurer authorisation and ground-transport coordination. These arrangements need a medical transport plan, not just a flight booking.
The Referral Appointment: Bring a One-Minute Summary
At the first visit, begin with the referral question: “We were sent to assess whether this lesion requires surgery,” or “The local hospital cannot provide this intervention.” Then give the short chronology.
Ask the new team to document one of four outcomes:
- Care accepted by the receiving hospital
- More information required before a decision
- A different department or facility is more appropriate
- No transfer needed; continue with the sending team
If the new hospital orders additional testing, clarify who reviews the result and who remains responsible while waiting.
Downward Referral and Follow-Up
After acute or complex treatment, a good handover identifies which tasks can return to local care. National policy specifically promotes coordinated downward transfer for stable and recovery-phase patients and asks higher-level hospitals to support lower-level services.[1][2]
The discharge team should state what the receiving clinician may manage, what must remain with the specialist centre, and what finding requires re-referral. A useful plan includes medication changes, wound or rehabilitation instructions, laboratory thresholds, imaging dates and a route for clinical questions.
For an international patient returning home, send this plan to the home doctor before departure if possible. A Chinese referral network cannot replace a clinician who knows local emergency services and prescribing rules in the patient’s country.
Payment and Insurance Questions
Referral does not automatically guarantee insurance coverage. Ask whether the insurer requires a referral letter, pre-authorisation, a network facility or a particular transport provider. Confirm whether the receiving hospital bills directly or requires a deposit.
Keep referral notes, acceptance correspondence, itemised invoices and transport records. If the patient changes hospitals without telling the insurer, otherwise eligible costs may become harder to claim.
Medical disclaimer: This guide explains referral logistics and does not decide whether a patient is safe to travel or which hospital should accept care. Unstable or rapidly worsening symptoms require immediate clinical assessment and medically coordinated transfer where necessary.
Related Hospitals
A referral should name the exact institution, campus and department. No hospital is endorsed simply because it is a higher level or in another city.
Related Treatments
Referral may be for diagnosis, a second opinion, a procedure, rehabilitation or follow-up. The receiving team must confirm the actual scope before travel.
Related Guides
- Community Health Centres vs Tertiary Hospitals in China
- How to Choose a Hospital in China as an International Patient
- How to Share CT, MRI and Other Imaging Files
- Medical Emergencies During Travel in China
FAQ
Do international patients need a referral letter to see a specialist in China?
Not always. Many services accept direct inquiries, but a focused referral letter and complete records can improve triage and may be required by the hospital or insurer.
Does a referral guarantee admission?
No. The receiving hospital must confirm what it has accepted. An outpatient assessment, provisional opinion and reserved inpatient bed are different commitments.
Can one Chinese hospital transfer my records electronically to another?
Sometimes, particularly within a connected medical network, but systems are not universally interoperable. Carry or securely send your own complete copies as a backup.
Who decides whether an ambulance is needed?
The clinical team should assess stability and transport requirements in coordination with the receiving service. Cost or convenience alone should not determine transport for an unstable patient.
What is a downward referral?
It is a planned transfer of stable, recovery or long-term care from a higher-level hospital to a suitable lower-level or local service, with clinical information and return criteria.[1]
Sources
- National Health Commission: Strengthening First-Contact and Referral Services
- National Health Commission: Measures to Accelerate the Hierarchical Diagnosis and Treatment System (2026)
- National Health Commission: Guidance on Establishing a Hierarchical Diagnosis and Treatment System
- National Health Commission: Community Health Centre Service Capacity Standards (2022)
- National Health Commission: Tertiary Hospital Assessment Standards (2025 Edition)
Hero Image Review
The original image is retained because it depicts a referral sequence—clinician, records and receiving hospital—rather than a generic hospital visit. The dotted handover path and travelling patient support the article without naming a real institution or implying guaranteed acceptance.