Highlighting the importance of compassionate care, a difficult decision often arises for families: should a terminally ill loved one continue conventional treatment, or spend their remaining days with greater dignity? Li Ming recently faced this very challenge. His father had been diagnosed with esophageal cancer, and despite surgery within six months of diagnosis, the cancer spread post-operatively. "The cancer later spread to his lungs and bones; he became very thin and couldn't eat," Li Ming recounted. In March 2025, he admitted his father to a palliative care ward at a rehabilitation hospital in Beijing. He recalled the daily cost included a 2,000 yuan bed fee and several hundred yuan for medication. The hospital also provided emotional support and companionship for both the patient and family.
Cao Feng, director of the Palliative Care Center at Beijing Geriatric Hospital, noted that previously, expenses like bed fees, medications, and supplies for palliative care could be reimbursed through standard medical insurance. However, unique humanistic care services such as psychological comfort and spiritual support lacked a unified billing standard. Recently, the Beijing Municipal Medical Insurance Bureau and the Beijing Municipal Human Resources and Social Security Bureau announced that starting July 11, a new independent billing item, "Palliative Care Fee," will be implemented. This fee will encompass multiple humanistic care services and be included in Class A medical insurance reimbursement. Experts interviewed believe this addition to insurance coverage underscores the importance of compassionate care in palliative medicine, though its impact on practice remains to be seen.
How Much Does the New Fee Cover? "Patients receiving palliative care have irreversible primary diseases. Our goal is to control symptoms, alleviate subjective pain, guide families in preparing for the end of life, and provide bereavement support—services not captured in traditional medical billing," said Cao Feng. According to the notice, the new "Palliative Care Fee" covers the human resources and basic material resources needed for patient assessment, diagnosis, graded nursing, psychological counseling, and emotional support, at a standard rate of 200 yuan per day, funded by the government.
Shi Yongxing, head of the expert group at the Shanghai Palliative Care Service Management Center, stated that Beijing's new fee incorporates humanistic care into the existing palliative care reimbursement system. He emphasized that palliative care is essentially "medicine plus humanity," and the National Health Commission's 2025 "Palliative Care Practice Guide" lists psychological support and humanistic care as key components. In 2024, the National Healthcare Security Administration first designated "palliative care" as a separate pricing item, clarifying it cannot be billed simultaneously with consultation or graded nursing fees. Subsequently, several regions began establishing their own palliative care fee structures. In June, a "Palliative Care Fee" was included in Class C insurance in Shanxi, meaning patients bear the cost, with prices ranging from 152 to 254 yuan per day depending on the facility level.
Notably, Beijing's new "Palliative Care Fee" is not tiered by hospital level. "The intention is to ensure the service is available in all institutions, with uniform and standardized content and quality," explained Dong Wei, director of the Palliative Care Center at Beijing Puhuangyu Community Health Service Center. Lu Jiehua, a senior professor at Renmin University of China, who has conducted in-depth research on palliative care, noted that most patients prefer tertiary hospitals, while secondary and primary hospitals attract patients through affordability and proximity. With the same pricing, he said, these hospitals must now focus on developing distinctive palliative care features.
Cao Feng pointed out that pricing differences previously existed between hospital levels. "For example, consultation fees are 100 yuan per day in tertiary hospitals but lower in community hospitals." Yao Hanzhi, a doctor at a palliative care center in a Beijing tertiary public hospital, believes the 200 yuan per day rate is more suitable for community hospitals and may be a stretch for tertiary hospitals. A key question is: how well does the 200 yuan per day reimbursement cover actual costs? Reports indicate that palliative care prices across China currently range from 200 to 280 yuan per day, with only a few cities offering insurance reimbursement. Zhuzhou, Hunan, increased prices while including palliative care in its insurance, charging 510-650 yuan for severe cases and 380-480 yuan for mild cases, with maximum reimbursement rates of 93% for employees and 85% for residents.
Shi Yongxing believes Beijing's 200 yuan per day fee is a universal, basic, and safety-net measure. "It likely doesn't cover the full cost. For instance, emotional guidance, if billed at psychological consultation rates, would exceed this amount," an anonymous doctor from a Beijing tertiary hospital's palliative care center told China News Weekly. Tong Yi's 96-year-old grandfather, hospitalized for terminal kidney cancer at Beijing Longfu Hospital's palliative care ward since June 15, incurs daily costs of 1,000 yuan for medical care, 170 yuan for the bed, and 285 yuan for nursing. After insurance, the family pays 12,000-13,000 yuan per month out-of-pocket. "This is a good start. The insurance system has taken the first step by paying for palliative care. The 200 yuan per day standard will likely be refined based on practical experience," Cao Feng said. Lu Jiehua suggests exploring differentiated subsidies for different hospital levels in the future.
How was the 200 yuan per day standard determined, balancing cost coverage and insurance fund capacity? "The current focus is on historical costs. Beyond this, the insurance system should also consider the savings from avoiding expensive end-of-life treatments, which can strain the fund. A portion of these savings could be allocated to incentivize palliative care," suggested Wang Yue, a professor at the Department of Medical Ethics and Law, Peking University School of Health Humanities.
Forming a Cost-Sharing Mechanism Unlike traditional medical services, the outcomes of humanistic care in palliative care are difficult to quantify, making pricing a persistent challenge. "These services don't produce visible reports like lab tests," said Cao Feng. Before the "Palliative Care Fee," many hospitals provided these services for free. "Many hospitals lost money on this. Our hospital estimated monthly losses of about half the total treatment cost per patient," Yao Hanzhi stated. Some institutions attempted independent pricing, but with limited success. "Even with independent pricing, profit wasn't guaranteed. With only 10 out of 50 patients opting for the service, hospitals still lost money, and they faced social pressure," Yao added.
Cao Feng believes that for Beijing's Class A insurance model to be adopted nationwide, each province must assess its economic capacity to set appropriate standards. Shi Yongxing revealed that Shanghai will soon include palliative care in its Class A basic insurance, also at 200 yuan per day. Wang Yue suggests that future cost-sharing mechanisms for palliative care should involve commercial insurance, long-term care insurance, and medical charity projects, in addition to basic medical insurance.
System-Wide Challenges After the inclusion of the "Palliative Care Fee" in Class A insurance, what other issues need attention? Dong Wei noted that demand is high; her center receives over ten inquiries daily. The new fee is expected to raise awareness and willingness to use palliative care, requiring healthcare institutions to prepare for increased demand. Beijing has been expanding its palliative care system, with 1,800 beds established by the end of 2025. According to the Beijing Municipal Health Commission's "2026 Action Plan for Higher-Level Medical Services," 30 community health centers will add home-based palliative care services. However, many families report that beds remain scarce. "I contacted a community hospital with a clean environment and good service, but there were over ten people ahead of me on the waiting list. It took nearly a month for them to call, but by then, my father had passed away," Li Ming said.
Shi Yongxing pointed out that China's palliative care hardware lags behind international standards. The World Health Organization recommends 1.5 palliative care institutions per 100,000 people, while Shanghai, at the end of 2025, had only 1.09 per 100,000. "Hospitals calculate the financial return per bed, and palliative care is often not a 'must-do' service. With low returns, many hospitals rely on the dedication of their managers to offer it. Specific legislation for palliative care services is urgently needed," Wang Yue concluded.