How Medical Referrals Work in China

Understand direct booking, formal referral, hospital acceptance, record transfer, emergency transport and follow-up for international patients in China.

Key takeaways

China keeps tightening its tiered system: first contact at the community level, referral in both directions, separate handling of acute and chronic care, and coordination between levels.[1][2]
A referral can happen inside one hospital, between members of the same medical network, across city lines, or from a hospital down to rehabilitation or community care.
International patients can often email a hospital directly, but a reply from the international office is not clinical acceptance, and it certainly isn’t a reserved bed.
A referral package that works answers four things: why the patient is moving, how urgent it is, what has been done already, and which question the receiving team needs to settle.
Moving an unstable patient is a clinical operation. It needs agreement, suitable transport and a proper handover, and an ordinary taxi ride covers none of that.

Full guide

“You need a larger hospital” is advice. On its own, it moves the patient no closer to the next team.

A referral that works connects two teams. The sending clinician lays out what the patient needs and what has already happened; the receiving service confirms it can take the problem on; records and responsibility travel with the patient. China’s 2024 national referral policy tells medical institutions to set up referral functions, define their rules, coordinate appointments and pass along the relevant information.[1] Measures issued in 2026 push the same direction further and ask for referral centres or designated departments across medical institutions by 2027.[2]

The policy is national. How it plays out still depends on the city, the hospital network, the specialty and the urgency of the case.

Four Different Things People Call a “Referral”

A department-to-department referral stays inside one hospital. Someone registered with gastroenterology may end up redirected to surgery, oncology or another subspecialty. Two things to check: does the original registration still count, and has the first doctor put an electronic note into the system.

An upward referral sends the patient to a facility with greater or different capability—say, from a community centre up to a tertiary hospital, or from a general hospital across to a specialised centre.

A downward referral hands stable, recovery-phase or long-term care to a lower-level hospital, rehabilitation facility or community service. Nobody is being dropped from care here. The point is to keep things continuous while the routine work moves closer to where the patient lives.[1]

A cross-regional referral means another city or province. The trip can be worth it for rare expertise or a treatment nobody offers locally, but it raises its own questions: is the patient fit to travel, how do the records move, is the appointment actually confirmed, and who follows up back home.

Direct Booking and Formal Referral Are Not the Same

Plenty of hospitals let patients book outpatient appointments without a primary-care referral, and international or patient-service offices will often take records directly. That access helps. It also creates three stages people routinely blur together:

Administrative intake: the files and identification arrived.
Clinical triage: a qualified clinician or department has looked at the question.
Acceptance: the hospital has offered something specific—a consultation, a test, an admission or a treatment pathway.

An email saying “you may come for evaluation” does not, by itself, promise surgery or admission. Before anyone books travel, get the specifics in writing: campus, department, doctor, appointment type, and whatever conditions still have to be met.

What the Sending Clinician Should Provide

A referral note can be short. It has to be precise. At minimum, it should state:

Patient identifiers that match the passport or local record
Working and confirmed diagnoses
Why the patient is being referred, and the exact clinical question
How urgent it is, plus any travel restriction
Relevant examination findings and vital-sign concerns
Tests already completed, with dates
Treatment already given, and how the patient responded
Current medicines, allergies and important comorbidities
Infection-control or mobility needs
How to reach the sending clinician

Attach whatever evidence the receiving team will ask for: reports, DICOM imaging, pathology material instructions, operative notes or discharge summaries. If records were translated, keep the originals alongside and say who prepared the translation—an unlabelled translation standing in for the original helps no one.

What the Receiving Hospital Should Confirm

Before anyone travels, the reply needs to say more than “records received.” Ideally the receiving service confirms:

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 counts as outpatient, emergency or planned admission
Additional tests or records still required
A bed actually reserved, not merely expected
Interpreter and payment arrangements
What happens if examination changes the proposed plan

For cross-city care, also ask how long the patient should plan to stay nearby, and which symptoms should send them to emergency care before the appointment.

Stable Transfer Is Different From Emergency Transfer

A stable outpatient can usually travel with a companion and a folder of records. An unstable patient may need monitoring, oxygen, medication, trained staff or an ambulance. Both sides—sending and receiving—should agree the destination can take the patient and settle the level of transport before anyone moves.

A short distance does not make a private car or an ordinary ride-hailing trip safe. And an ambulance settles nothing about the far end: the receiving hospital may still not have accepted the case or held a bed. Each of these needs its own confirmation.

International transfer or medical evacuation adds more layers: fitness to fly, border documentation, escort level, insurer authorisation and ground transport at both ends. That calls for a medical transport plan. A flight booking alone won’t do.

The Referral Appointment: Bring a One-Minute Summary

Open the first visit with the referral question: “We were sent to assess whether this lesion requires surgery,” or “The local hospital cannot provide this intervention.” The short chronology comes after.

Ask the new team to write down one of four outcomes:

Care accepted by the receiving hospital
More information required before a decision
A different department or facility would fit better
No transfer needed; the sending team continues

If the new hospital orders additional testing, pin down two names before leaving: who reviews the result, and who stays responsible while everyone waits.

Downward Referral and Follow-Up

Once acute or complex treatment is done, a good handover spells out which tasks can move back to local care. National policy specifically promotes coordinated downward transfer for stable and recovery-phase patients, and it asks higher-level hospitals to back up lower-level services.[1][2]

The discharge team should say what the receiving clinician may manage, what must remain with the specialist centre, and which finding triggers a re-referral. A plan worth carrying includes medication changes, wound or rehabilitation instructions, laboratory thresholds, imaging dates and a channel for clinical questions.

For an international patient flying home, get this plan to the home doctor before departure where possible. No Chinese referral network can stand in for a clinician who knows the emergency services and prescribing rules of the patient’s own country.

Payment and Insurance Questions

A referral on its own guarantees nothing about coverage. Ask whether the insurer wants a referral letter, pre-authorisation, a network facility or a particular transport provider, and confirm whether the receiving hospital bills directly or expects a deposit.

Hold on to the referral notes, acceptance correspondence, itemised invoices and transport records. Patients who change hospitals without telling the insurer can find otherwise eligible costs suddenly much harder to claim.

Medical disclaimer: This guide covers referral logistics. It does not decide whether a patient is safe to travel or which hospital should accept care. Unstable or rapidly worsening symptoms call for immediate clinical assessment and medically coordinated transfer where necessary.

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 take direct inquiries. Even so, a focused referral letter and complete records help with triage, and the hospital or insurer may require them.

Can one Chinese hospital transfer my records electronically to another?

Sometimes, mostly within a connected medical network. The systems are not universally interoperable, so carry your own complete copies or send them securely as a backup.

Who decides whether an ambulance is needed?

The clinical team does, weighing the patient’s stability and transport requirements together with the receiving service. For an unstable patient, cost or convenience alone should never pick the vehicle.

What is a downward referral?

A planned handover of stable, recovery or long-term care from a higher-level hospital to a suitable lower-level or local service, with the clinical information and the criteria for sending the patient back up.[1]