China
The most populous system in the register, building hospice care through national pilots, which tests whether policy-led expansion can overcome tight opioid control and missing financing.
9 domains reviewed · 9 high-confidence · 0 dated estimates · 9 material gaps
WHO region: Western Pacific. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 9 of 9
- Hospice: 4 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 13
- Sources behind this dossier
- 18
- Newest source 2026
Lessons from China
- Moving palliative care into primary care adds little opioid access when the national formulary lists few morphine forms. Formulary scope has to follow where services are placed.180,179
- National pilots run by local governments spread hospice policy quickly but left uneven regional coverage. Scale-up needs equity measures and a matching payment mechanism.182,183
- Without insurance payment, palliative programs depended on philanthropy or patients who could pay. Reimbursement is what makes services sustainable for hospitals.181,182
- Scaling hospice through national pilots without a dedicated insurance payment leaves many hospice services outside reimbursement, so payment reform needs to travel with service expansion.182
- A national prognosis threshold for hospice can be narrowed in practice when local payment rules also limit coverage to locally insured residents at urban providers.182
- Faith-based volunteer groups working inside hospitals, such as Buddhist assisted chanting, can offer companionship and ritual care that families value at and after death.480
- Repeating a national census of pediatric palliative teams can show whether workforce and geographic coverage are changing over time.672
Palliative care
Is morphine available in China?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
National opioid consumption rose from 2013 to 2024 but stayed low against estimated need and below the Asian average. The national essential medicines list includes only morphine, in few forms, and fewer than half of primary care hospice units in one pilot province stocked strong opioids.179,180
Did primary care opioid stocking outside the studied province follow the same pattern?
Help answer it:Search PubMedHow does China regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
Opioids are classified as narcotic and psychotropic substances, which curbs misuse and also limits medical use. State limits on prescription duration were reported as one reason opioids were rarely used outside palliative programs.180,181
What do current stocking, prescription duration and dispensing rules say, and have they changed since 2017?
Help answer it:Search PubMedWho can prescribe morphine in China?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
Narcotics must be prescribed by a physician who has had special training and is authorized by their hospital, on a national red paper prescription, per a 2016 hospital report. China has no nationwide nurse prescribing rights, only regional pilots. In one province, fewer than a third of primary care hospice services stocked strong opioids in 2023.268,269,180
What does the current national regulation require to qualify as a narcotics prescriber, and may primary care physicians prescribe?
Help answer it:Search PubMedHow does palliative care reach patients in China?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
The first national hospice programme and service guidelines came in 2017, followed by three batches of national pilots. National policy sets a hospital, community and home model and leaves implementation to local governments, and provider practice varies widely by region.182,183,181
How many pilot cities run working home and community hospice services?
Help answer it:Search PubMedWho pays for palliative care in China?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
No dedicated insurance payment scheme exists for hospice care, so fee-for-service leaves many services unreimbursed. Programs have relied on philanthropy or patient payment, and later pilot plans moved toward bed-based payment.182,181
Has bed-based hospice payment spread beyond local pilots, and who pays for home care?
Help answer it:Search PubMedHow are palliative care clinicians trained in China?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
Palliative care was not an accredited specialty as of 2017 and was rarely taught in medical schools. Training initiatives have had limited effect without stronger health and education sector backing.181,182
Has a palliative medicine specialty or subspecialty been recognized since 2017, and by which body?
Help answer it:Search PubMedHow does China prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
China's mean opioid consumption in 2020 to 2022 (168 S-DDDpm) was less than half the Asian average, and the national Essential Medicines List included only morphine. In one province, primary care hospice institutions stocking strong opioids rose from 22.5% to 30.2% between 2019 and 2023 while consumption fell. Long-term methadone participants in Guangdong reported economic hardship and gaps in dose adjustment and emergency treatment continuation.180,669
Is naloxone available outside hospitals in China, and how do narcotic prescription controls affect primary care hospice prescribing?
Help answer it:Search PubMedHow do children get palliative care in China?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
A 2025 census counted 36 pediatric palliative teams covering 16 of 31 provinces, down from 45 teams in 2019, while total team members rose from 300 to 513. Among 368 physicians treating children with cancer, 29.4% had palliative training and 42.7% felt burdened by their inability to control children's suffering at end of life.672,673
Are child-appropriate opioid formulations on the Essential Medicines List, and how many children do the 36 teams reach each year?
Help answer it:Search PubMedHospice care in China
How the hospice model works here, who can use it, who pays and who it reaches. Covered 4 of 4.
What does hospice care look like in China?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
China's national hospice program started with 2017 guidelines and pilots in five districts, expanded in pilot batches in 2019 and 2023. Hospice is delivered through hospice departments and wards in hospitals and community health centers and some integrated medical and elderly care institutions, under a 2024 national standard for geriatric hospice wards. Policy is government-driven, and Chinese sources use hospice and palliative care interchangeably.182,306,307
How much hospice care is delivered at home versus in wards?
Help answer it:Search PubMedWho can get hospice care in China?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
Official Chinese guidelines define hospice care for terminally ill patients, typically those with a life expectancy of six months or less. Local payment rules can narrow access further: Dalian's 2020 bed-based payment policy covers only locally insured patients at urban inpatient providers. Shanghai physicians report that they usually start end-of-life talks only once expected survival is under three months.182,362
How are the six-month criterion and local insurance limits applied at referral across pilot cities?
Help answer it:Search PubMedWho pays for hospice care in China?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
No dedicated medical insurance payment scheme exists for hospice care, and fee-for-service leaves many essential services outside reimbursement. The 2023 national pilot plan set out a per-bed-day payment approach, and some local schemes limit payment to locally insured patients.182
How many pilot cities pay hospice by bed-day, and what share do patients pay out of pocket?
Help answer it:Search PubMedHow many people reach hospice in China?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
By the end of 2023, national hospice pilots covered 185 cities or districts and over 4000 institutions had hospice departments. Policy analysis confirms rural-urban gaps, financial burdens for low-income and uninsured people, and weak services for children and non-cancer patients.306,182
What fills the gap in China
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Family caregiving
Migrant workers caring for a parent with terminal cancer described filial piety as both a resource and a requirement for secrecy, including about the parent's prognosis. Oncology nurses at a rural Henan county hospital reported that filial piety complicated communication and decisions, often leading to overtreatment, while financial limits further affected care.481,482
Single-site evidence- Faith communities
At a Buddhist assisted chanting association housed in a Shenzhen hospital, volunteers provide 24-hour continuous recitation of Amitabha Buddha's name for the dying and after death. Patients, families and volunteers described companionship, peace, acceptance of death and relief of financial burden.480
Single-site evidence
Sources cited here
- 179Li M, Liu X, Ye D, et al.
Opioid Consumption and Unmet Need in China, 2013-2024: a Longitudinal National Study. Journal of Pain and Symptom Management 2026 (epub August 2026). National opioid consumption rose but stayed low against estimated need. Abstract read.
- 180Fan Y, Ye Z, Jiang M, et al.
Opioid consumption, availability, and policy alignment in primary hospice and palliative care in China: a multicomponent comparative analysis. Supportive Care in Cancer 2026;34(3). Consumption below the Asian average; fewer than half of primary care hospice units stocked strong opioids; national essential medicines list includes only morphine; strict narcotic classification. Abstract and full text read.
- 181Yin Z, Li J, Ma K, et al.
Development of Palliative Care in China: A Tale of Three Cities. The Oncologist 2017;22(11):1362-1367. Prescription duration limits; few hospitals offering palliative care; many services outside national insurance; palliative care not an accredited specialty. Abstract and full text read.
- 268Fang X, Zhu LL, Pan SD, et al.
Safe medication management and use of narcotics in a Joint Commission International-accredited academic medical center hospital in the People's Republic of China. Therapeutic and Clinical Risk Management 2016;12:535-44. Single hospital (Zhejiang) describing national narcotics rules: trained, hospital-authorized physicians; national red paper prescription; per-prescription day limits. Full text read.
- 269Zhang X, Shi Q
Research on nurses' prescription rights in China: a bibliometric analysis via CiteSpace. Medicine (Baltimore) 2026;105(22):e49018. States China has no nationwide nurse prescribing rights, only regional pilots. Abstract read.
- 182Li L, Gong X.
Developing supportive policy environments for hospice care in China: a quantitative policy evaluation based on the PMC-Index model. BMC Palliative Care 2025;24(1):248. First national hospice programme and guidelines in 2017, three batches of national pilots, delivery design left to local governments, no dedicated insurance payment scheme. Full text read.
- 183Zhang S, Wang J, Song S, et al.
Disparities in hospice and palliative care services: evidence of healthcare provider practice in various regions of China. BMC Public Health 2025;25(1):4064. National Health Commission pilots from 2017, expanded 2019; substantial regional disparities in provider practice. Abstract and full text read.
- 669Tang X, Xiong W, Chen W, et al.
Benefits and challenges experienced by participants on long-term methadone maintenance treatment in China: a qualitative study. BMC Med 2024;22(1):18. Interviews with 21 long-term participants at six methadone clinics in Guangdong; not palliative care specific. Abstract read.
- 670Park IH, Tao L, Chen Y, et al.
Pre-Post Changes in Anticipatory Grief Following a Blended Narrative Nursing Intervention Among Family Caregivers of Patients With Terminal Cancer. Am J Hosp Palliat Care 2026. Single-group pre-post study of 63 caregivers from five Chinese hospice and palliative care institutions; no control group. Abstract read.
- 671Zhao Y, Zhang J, Low WY
Pediatric End-of-Life Decision-Making in Mainland China: Case-Based Analysis of Illness Narratives. Am J Hosp Palliat Care 2026. Qualitative analysis of 12 pediatric end-of-life cases; small sample. Abstract read.
- 672Cai S, Peng X, Guo Q, et al.
The Development Status and Five-Year Evolution of Pediatric Palliative Care in Mainland China. J Pain Symptom Manage 2025;71(2):307-315.e1. National census of pediatric palliative care teams in 2025 compared with 2019, run by the PPC subspecialty group of the Chinese Medical Association Pediatrics Society; self-reported by the field's own network. Abstract read.
- 673Zhang A, Zhou X, Wang J, et al.
Physicians' Perspectives and Attitudes Toward Palliative Care for Cancer Children in Mainland China. J Pain Symptom Manage 2025;71(2):316-326.e4. ADAPT survey of 368 physicians treating children with cancer in 25 provinces. Abstract read.
- 306Wu Y, Li C, Liu S, et al.
Advancing Geriatric Hospice Care in China: An Interpretation and Critical Analysis of the New National Standard WS/T 844-2024. Aging Med (Milton) 2026;9(4):438-442. Policy commentary on the 2024 national standard for geriatric hospice care wards, with background on national hospice pilots and service counts. Full text read.
- 307Wang L, Zhao S, Xing F, et al.
Evolution and textual quantitative analysis of China's palliative care policies: a three-dimensional analytical framework approach. Front Public Health 2025;13:1624446. Policy tool analysis of 36 national hospice and palliative care policy documents in China. Abstract read.
- 362Zhong J, Zhao W, Lai X.
Chinese physicians' experiences with end-of-life communication and hospice care transition: a qualitative study with content analysis. BMC Palliat Care 2025;24(1):282. Interviews with 18 physicians from 8 Shanghai hospitals; covers one city only. Full text read.
- 480Li SL, Jing J, Zhang J, et al.
Assisted chanting and Buddhist end-of-life care in contemporary China. Palliat Support Care 2026;24:e194. Qualitative interviews with 34 volunteers, patients and family caregivers at one Buddhist assisted chanting association housed in a Shenzhen hospital. Abstract read.
- 481He L, van Heugten K
Chinese Migrant Workers' Care Experiences: A Model of the Mediating Roles of Filial Piety. Qual Health Res 2020;30(11):1749-1761. Qualitative study of 24 migrant workers caring for a parent with terminal cancer, focused on filial piety and secrecy. Abstract read.
- 482Song C, Feng M, Chen Y, et al.
"The unseen struggle" - Nurses' perspectives on challenges to quality of death in rural Chinese cancer patients: A qualitative study. Int J Nurs Stud 2025;170:105163. Interviews with 17 oncology nurses at one county-level hospital in northern Henan; nurse perspective only. Abstract read.