In the same pooling area (where you are enrolled), a lower hospital level reimburses a higher share, a gap of about 10 percentage points

The document requires that, for the same inpatient bill, a lower hospital level reimburses a higher share. Localities have to open a gap between levels, about 10 percentage points for each step up. On a bill of 10000 yuan, if the share paid back drops from 80% to 70%, what you pay yourself goes from 2000 yuan to 3000 yuan. Newly added yibao (basic medical insurance) funds also tilt toward primary care.

Cost

No money. The hard part is holding back from running to a large hospital.

Benefit

The document requires localities to open a gap in inpatient reimbursement across hospital levels, in principle about 10 percentage points at each step. On that gap, each step up to a higher hospital means you pay about 10% more of the reimbursable bill yourself. Take 10000 yuan of reimbursable inpatient charges. If the reimbursement share drops from 80% to 70%, what you pay yourself goes from 2000 yuan to 3000 yuan. The extra 1000 yuan is a tenth of the total bill, but what you pay yourself is half again what you used to pay. Actual shares differ by place, and the deductible and the cap also move the gap. This is only an illustration using the document's 10 percentage points. Newly added yibao funds for the year also tilt toward primary care.

Notes

For the same inpatient bill, the difference you pay yourself between primary care and a tertiary hospital can be a few thousand yuan. An illness that can be finished at primary care should not be taken up the ladder. That does not mean every illness has to be seen at the community clinic.

Sources · 1

1. 国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. gov.cn/zhengce/zhengceku/202604/content_70650…：「因地制宜适当拉开参保人员在不同等级医疗卫生机构的住院报销水平，原则上统筹地区内医疗卫生机构住院报销比例逐级拉开10个百分点左右的差距。」「具备条件的地方，可按分级诊疗导向酌情拉开参保人员在不同等级医疗卫生机构的门诊报销水平。」