COVID-19 Resurgence? China's Tertiary Hospitals Overcrowded, Small Hospitals Facing Bankruptcy Crisis

Illustration: Flu patients crowding top-tier hospitals across China. (Video screenshot)

[People News] Recently, news of overcrowded tertiary hospitals across China due to an influx of flu patients has sparked widespread public concern. At the same time, a large number of small- and medium-sized hospitals have gone bankrupt over the past year. Analysts point out that under increasing operational pressures, the Chinese government’s healthcare reform has not resolved the issue of difficulty accessing medical care. Instead, it has made healthcare even more expensive for the public.

According to Radio Free Asia, at the beginning of 2025, news of "flu overcrowding tertiary hospitals" trended on Baidu's hot search list. Social media platforms in China, such as Douyin, Kuaishou, and Xiaohongshu, have been flooded with reports of widespread respiratory virus outbreaks across the country. Videos uploaded by citizens show long queues of patients at hospitals late at night, leaving viewers alarmed.

• "The flu in Shanghai is already out of control! Hospitals are overcrowded. Parents, please protect your children and avoid crowded places! Last night at 10 PM, I took my daughter to the hospital for an ear infection and filmed these scenes."
• "The flu in Nantong is out of control! Hospitals are full. Please protect your children."
• "(Woman) The flu has caused pneumonia, and I’ve been so feverish I can’t distinguish reality from dreams. It’s around 40 degrees Celsius. (Man) Even with injections, the fever keeps climbing and doesn’t go down. It’s a persistent fever." (Henan Province)

Overcrowded Tertiary Hospitals and Widespread Viral Infections

On January 3, Zhang Ye, director of the Infectious Diseases Department at a tertiary hospital in Central China, told the Chinese industry media Medical Community that outpatient visits nearly doubled from early to mid-December 2024 and have now increased fivefold.

According to the Chinese Center for Disease Control and Prevention's report for the 52nd week of 2024, acute respiratory infections are rising rapidly. Various viruses, including influenza A, human metapneumovirus (HMPV), Mycoplasma pneumoniae, and COVID-19, are spreading swiftly in China.

From week 46 to week 52, the positivity rate for flu viruses in outpatient and emergency visits rose from 3.7% to 30.2%. Among hospitalized severe acute respiratory infection cases, the flu virus positivity rate reached 17.7% in week 52. Official reports reveal that over 99% of positive flu cases are H1N1 influenza A subtypes. Additionally, human metapneumovirus (HMPV) infection rates are higher than those of COVID-19, rhinoviruses, and adenoviruses, with detection and hospitalization rates at 6.2% and 5.4%, respectively.

A report by state broadcaster CCTV on December 27 noted that doctors observed the coexistence of multiple respiratory viruses, with possibilities of cross-infection. It’s also possible for individuals to be infected with multiple respiratory diseases simultaneously.

Peng, a Shanghai resident, told Radio Free Asia that his daughter and friends were showing symptoms resembling both COVID-19 and the flu. Despite multiple hospital visits, they haven’t recovered, and doctors are unable to pinpoint the cause:
"It seems like all kinds of viruses are out there this time, and even the doctors are confused."

Shandong Province has also been heavily affected by respiratory infections. A local resident, Liu, speculated:
"They’re saying it’s influenza A or something like that. We suspect it might be a variant of COVID-19."

Gu, a resident of Wuhan, reported a similar situation to Radio Free Asia, stating that local hospitals and community clinics are packed: "There are so many people getting injections at the hospitals. Even the community clinics are completely full."

Official Downplays Virus Infections; Experts Criticize Lack of Data on Severe Cases and Mortality Rates

Amid a surge in multiple viral infections and overcrowded hospitals, Chinese authorities are downplaying the severity of the situation. On January 3, Chinese Foreign Ministry spokesperson Mao Ning stated at a regular press briefing that winter is a "high season for respiratory infections" and that "the scale and intensity of related diseases are lower than last year."

However, Newsweek recently reported that media outlets in countries like India, Indonesia, and Japan have warned their citizens to remain cautious and reconsider travel to China, as the surge in respiratory illnesses resembles the spikes seen during the COVID-19 pandemic.

Newsweek particularly highlighted that human metapneumovirus (HMPV), first identified in 2001, currently lacks a targeted vaccine. This virus, which causes flu-like symptoms, can lead to severe respiratory problems in children and vulnerable groups. However, the World Health Organization (WHO) appears to lack sufficient data to accurately predict the scope and severity of a potential HMPV outbreak in China.

Dr. Lin Xiaoxu, a former director at the U.S. Army Research Institute's virology lab, told Radio Free Asia that HMPV is a common virus with low pathogenicity and no evidence of mutations. He found it odd that Chinese authorities are specifically emphasizing HMPV this year: "One possibility is that China might currently have other more severe respiratory viruses, but the government is neither conducting thorough testing nor sharing information. Instead, they are spotlighting HMPV as a media focus."

Dr. Lin also raised concerns about the lack of information on the severity and mortality rates of the current infections:
"The key issue is that the authorities are withholding this information. It’s the public sharing these reports. What people need to observe is whether there are any highly pathogenic new viruses or if a genuine epidemic is forming."
He noted that with little official data available, it’s difficult to make accurate judgments, but citizens must remain vigilant.

Centralized Procurement Sparks Complaints Over Poor-Quality Drugs and Medical Supplies

As respiratory illnesses surge across China, citizens are also facing hidden increases in healthcare costs. According to a survey by China’s 21st Century Business Herald, demand for flu medications like oseltamivir and baloxavir marboxil has skyrocketed. In some pharmacies, the price of baloxavir marboxil, covered by medical insurance at approximately 222 yuan per box, has surged to 300 yuan per box, and it’s even unavailable in some locations.

"This morning, I went to a nearby pharmacy to buy a few boxes of flu medicine, but they were out of stock," said Gu, a Wuhan resident. She told Radio Free Asia that she had visited numerous pharmacies without finding baloxavir marboxil. She also criticized the poor effectiveness of hospital-prescribed medications: "The medicine prescribed by the hospital doesn’t work and doesn’t cure the illness," she said. She noted that effective medications are often unavailable through insurance:
"The good medicine is more expensive, and the doctors can’t prescribe it. You have to buy it out-of-pocket because it’s not covered by medical insurance."

Gu’s comments reflect a broader issue of dissatisfaction among Chinese citizens regarding the quality of drugs obtained through centralized procurement. Online, many have pointed out that the prices of centrally procured drugs are becoming so low that they barely exceed packaging costs, raising concerns about poor-quality drugs affecting treatment efficacy. Some netizens criticized the overemphasis on reducing prices for effective drugs, while large amounts of funding are directed toward ineffective ones, such as Lianhua Qingwen.

A healthcare worker recently posted a video complaining about the effects of medical insurance reforms, particularly the DRG (Diagnosis-Related Group) payment model, which has put hospitals at risk of closure. The centralized procurement of drugs and medical supplies has resulted in extremely low prices, leading to inferior quality. Examples include urinary catheters breaking easily, with half left inside the bladder, and other recurring issues like peritoneal tubing leaks causing peritonitis, deep vein guidewires stuck in blood vessels, IV sets breaking, and needles bending.

Why Are Hospitals in China Closing or Going Bankrupt in Large Numbers?

Amid the winter viral outbreaks and overcrowded major hospitals, many small and medium-sized hospitals in China are going bankrupt. An article in Sanlian Life Weekly published on January 6 highlighted that over 1,200 hospital-related bankruptcy records were found on the National Enterprise Bankruptcy and Reorganization Information Network for 2024. This marks a significant increase compared to 800 records in 2023 and 500 in 2022, indicating a sharp rise in hospital bankruptcies. The article noted that in 2024, most bankrupt hospitals were small and privately owned, though some public hospitals were also affected.

According to Chinese medical media outlet Medical Observation, Yu Xiaobao, vice president of the Private Hospital Management Division of the Chinese Hospital Association, previously reported that over 2,000 private hospitals had gone bankrupt due to operational difficulties since the outbreak of the COVID-19 pandemic.

Root Causes of Hospital Closures. Dr. Lin Xiaoxu attributes the wave of hospital bankruptcies to the depletion of the medical insurance fund by the Chinese government in recent years: “During the pandemic, they overdrawn funds in advance, using up these resources. Now, with the insurance fund running out of money, many private hospitals are unable to receive reimbursements through the insurance system. Private hospitals collapse first, while public hospitals find other ways to stay afloat.”

Official data released by China’s National Health Commission on July 6, 2022, revealed that in 2020, public hospitals in 20 provinces had reported losses, accounting for 62.5% of the total. Among 753 public tertiary hospitals nationwide, 43.5% faced financial losses.

A medical blogger, “Morning Blogger on Medical Chats,” predicts that by 2025, hospitals in China will face widespread salary cuts and layoffs: “Salary cuts and layoffs will become a normalized trend for hospitals… The wave of hospital losses has not yet truly arrived. Since the mask mandates began, hospitals have been in a frenzy of expansion. Comprehensive and traditional Chinese medicine hospitals especially have initiated projects at a rate 1.5 times higher than in previous years. Towering new buildings are being constructed, but most hospitals have not considered the operational costs behind them.”

The blogger added that due to policy reforms, including centralized procurement and DRG/DIP (Diagnosis-Related Group/Diagnosis-Intervention Packet) payment systems, hospitals are seeing a tightening of premium revenues. Combined with stagnant patient volumes and rising medical service costs, hospital infrastructure, staffing, and bed space have turned into financial burdens. Salary reductions and layoffs, the blogger claims, have become unavoidable choices for hospitals.

Public Sentiment: Healthcare Reforms Are Not Benefiting Citizens

The Sanlian Life Weekly article further pointed out that as China’s population decreases, a major source of public hospital income—the medical insurance fund—will also decline, placing greater financial pressure on hospitals. This will likely result in higher medical costs for patients, worsening the already prevalent issue of expensive healthcare for ordinary citizens.

Mr. Peng from Shanghai shared his recent experience: “When we went to the hospital, they said there was an issue with the network, and we couldn’t use the insurance card. So, we had to pay out of pocket. I’ve been seeing doctors recently, and many medications aren’t covered by insurance; they’re very expensive.” He criticized the healthcare system: “Whether it’s the medical insurance or healthcare reform, it’s not for the benefit of the people. Unlike other countries with free healthcare… They’re great at putting on a show, but behind the scenes, it’s a complete mess.”

In recent years, the Chinese government has aggressively promoted healthcare reforms. Following the pandemic, protests against these reforms erupted in cities like Wuhan and Dalian, known as the “White Hair Movement.” Experts at the time explained to Radio Free Asia that China’s severe aging problem and prolonged lockdowns had caused significant shortfalls in the medical insurance fund. The reforms effectively increased personal expenses while reducing insurance payouts.

In June 2024, the State Council issued the 2024 Key Tasks for Deepening Medical and Healthcare System Reform, which emphasized advancing the “Sanming Medical Reform Experience.” This included expanding centralized procurement of drugs and medical consumables, adjusting medical service pricing, reforming the insurance payment system, and restructuring public hospital salary systems.

However, many healthcare professionals in China remain skeptical about these measures. A healthcare blogger named Xu Ran remarked that after the Sanming Medical Reform, public hospital salary reforms would further impoverish the public healthcare system: “No matter how dedicated doctors and nurses are to saving lives, they still need to make a living. The annual salary system is no different from the old collective meal-sharing system decades ago. Collective meal-sharing will inevitably impoverish the entire healthcare system. Top specialists will leave, taking their patients with them to private hospitals.”

The Sanlian Life Weekly article also highlighted that in developed countries, personal healthcare expenses typically account for about 10% of total healthcare costs, while government spending constitutes around 80%. However, according to 2023 data, personal healthcare expenses in China accounted for 27.3%, while government spending was only 26.7%. The government’s contribution, which should be the primary source of funding, was lower than personal spending, signaling insufficient public investment in healthcare.

Note: The names of Gu, Peng, and Liu have been changed for safety reasons.