Tertiary hospital in China: what Grade 3A and the other hospital grades mean

A "Grade 3A" hospital in China is a tertiary (三级) hospital whose accreditation review gave it grade A (甲等). Two separate labels sit behind that phrase. The level (级) says which tier of the health system a hospital is planned to occupy. The grade (等) is the result of a periodic review run by health authorities. This page explains both from the official texts, and it does not rate or recommend any hospital.

Level and grade are two different labels

The Ministry of Health's Interim Measures for Hospital Accreditation define hospital accreditation as a process in which the hospital evaluates itself, keeps improving, and accepts the health administration's evaluation of how well it has performed the functions and tasks of its planned level (规划级别), in order to determine the hospital's grade (等级). The level comes first, and the grade is measured against it. The section on the interim measures below explains that they may since have been replaced.

The current national standard is the Tertiary Hospital Accreditation Standards (2025 edition). Its usage notes say the standard applies to tertiary hospitals and that secondary hospitals may use it as a reference. They also give review results as grade A (甲等), B (乙等) or C (丙等). The combined label appears in the standard too, in an indicator saying Grade 3A general hospitals (三级甲等综合医院) should set up a psychiatry department.

Label	Chinese	What the national texts use it for
Level (tier)	级, for example 三级 (tertiary) and 二级 (secondary)	The planned role of the hospital in the health system
Grade	等, for example 甲等 (A), 乙等 (B), 丙等 (C)	The outcome of an accreditation review
"Grade 3A"	三级甲等	Read as: a tertiary hospital with grade A

What the tertiary level is meant to do

The General Office of the State Council set out functions by level in its guiding opinions on tiered diagnosis and treatment (国办发〔2015〕70号). They say city tertiary hospitals mainly provide care for acute, critical and complex conditions. City secondary hospitals mainly receive patients referred from tertiary hospitals who are in recovery after an acute illness, in recovery after surgery, or stable after a critical illness. County hospitals mainly provide care for common conditions within the county, emergency treatment of critically ill patients, and referral of complex conditions to higher-level hospitals. The same passage says primary care institutions, rehabilitation hospitals and nursing homes provide treatment, rehabilitation and nursing for chronic, convalescent, geriatric and late-stage cancer patients whose diagnosis is clear and whose condition is stable.

That passage names tertiary and secondary hospitals, county hospitals and primary care institutions. It does not name the lowest hospital level, so this page does not define it.

The standard adds expectations for tertiary hospitals specifically:

Public tertiary hospitals should in principle be run by provincial or municipal governments. A few counties with high economic strength and large populations may run one themselves or together with a prefecture-level government.
Tertiary hospitals should be built to a high standard, with reference to ten listed functions, among them a referral and consultation centre for critically ill patients in the region, an emergency medical rescue centre, a support centre for primary care institutions, and a preferred centre for training medical staff.
The aim behind these functions is stated as serious illness not requiring patients to leave their province (大病不出省).

The National Health Commission's notice issuing the 2025 standard gives the purpose in similar terms: to guide tertiary hospitals to carry out their functional role, focusing on acute, critical and complex cases, and to contribute to specialty services, technical innovation, training and support for primary care institutions.

Who reviews hospitals and under which law

The State Council's Regulation on the Administration of Medical Institutions, in its 2022 revision, sets the basis. It provides for a national accreditation system in which committees of experts evaluate a medical institution's practice and service quality, following accreditation measures and standards written by the State Council's health administration. Health administrations at county level and above organise the committees. Committee members are experts in hospital management, medical education, clinical care, medical technology, nursing and finance, and the health administration appoints them.

The Detailed Rules implementing the Regulation add three points. The evaluation covers an institution's basic standards, service quality, technical level and management level. Accreditation includes periodic review and irregular key inspections. The Detailed Rules also give accreditation of Chinese medicine, integrated Chinese and Western medicine, and ethnic medicine institutions to committees set up by the Chinese medicine administrations.

How a review worked under the interim measures

The Ministry of Health's Interim Measures for Hospital Accreditation lay out the procedure in more detail:

The review cycle is four years.
A periodic review combines written evaluation, evaluation of medical statistics, on-site evaluation and social evaluation.
The health administration reaches a conclusion within 30 working days after receiving the review report, and the conclusion is announced publicly for a period that is generally 7 to 15 days.
Conclusions are grade A, grade B or unqualified. Grade A and B hospitals receive a certificate and a mark, and the certificate is valid for the length of the review cycle.
An unqualified hospital gets a rectification period of 3 to 6 months. A re-review then returns grade B or unqualified.
A new hospital can seek its first review only after three years of practice under its licence.
While a certificate is valid, the health administration revokes the conclusion in listed cases, for example major defects in medical ethics, quality or safety, or falsified review materials.

The measures were issued on 21 September 2011 as document 卫医管发〔2011〕75号. This page could not confirm from an official record whether they have since been formally replaced. The older text lists no grade C, while the current standard does, and this page does not reconcile the two.

The current national standard

The National Health Commission issued the Tertiary Hospital Accreditation Standards (2025 edition) on 29 May 2025 as document 国卫医政发〔2025〕4号. The notice says the earlier edition and its implementing rules (国卫医政发〔2022〕31号) stopped applying from the date of issue. The notice that introduced that earlier edition had itself replaced the edition before it. Pages describing older editions may therefore be out of date.

Key points from the standard's own text:

Structure. It has 97 sections and 232 indicators in two parts. Part One, the prerequisites, has 4 sections and 29 items. Part Two, monitoring indicators for medical service capacity and quality and safety, has 93 sections and 203 items. The on-site inspection part was removed in this revision.
Cycle. The review cycle is four years.
Provincial rules. Provincial health administrations draft their own implementing rules on the basis of the national standard. They may decide the range of indicators used, but at least 60 percent of the standard's indicators should in principle be included. An overly detailed thousand-point scoring method, or a disguised version of it, is not to be used.
Grade thresholds. A review result of grade A requires that the share of review items met is at least 90 percent. Grade B requires at least 80 percent and grade C at least 70 percent.
Data checks. Provincial administrations may check the data hospitals submit, and at least 20 percent of the items are verified. A data value that differs by 10 percent or more from the verified value counts as an error. Data a hospital cannot back up, or that is found to be false, also counts as an error. If erroneous items make up more than 10 percent of the items checked, the case is handled as a breach of a prerequisite.

The prerequisites and "grade undetermined"

If a hospital breaches a prerequisite during its review cycle, its next review is postponed by one year. During the postponement its previous grade is cancelled and it is managed as "grade undetermined" (未定等). After receiving a hospital's review request, the provincial administration must ask relevant departments and the public whether the hospital has any of the listed problems, and the consultation lasts at least 7 working days.

The prerequisites are grouped under four headings: bed scale and departments; lawful practice and standardised service; public-interest duties and professional integrity; and safety management and major incidents. Examples of listed items include forging, selling, renting or lending a Medical Institution Practising Licence, using staff without health technical qualifications for medical technical work, and a tertiary general hospital not setting up paediatrics, infectious disease, pathology, geriatrics and public health or disease prevention departments as required.

What a grade does not tell you

The standard ties each grade to the share of review items a hospital meets. The usage note that sets the thresholds does not describe comparing one hospital against another. A grade is therefore an administrative result for one hospital in one review cycle. It is not a ranking, it is not a finding about any particular doctor or department, and it is not a recommendation. Provincial implementing rules can change which indicators are used, so provinces may not all use the standard in exactly the same way.

What this page did not establish

The lowest hospital level: the national texts read here do not set out a standard for it.
Any hospital's grade: this page does not state or check the grade of any named hospital.
Provincial rules: they were not collected, so local cycle lengths and indicator ranges are unknown.
The original web page of the National Health Commission for the notice could not be read. The notice and the standard were read from the Fujian Provincial Health Commission's republication, which names the National Health Commission as the source.
The standard's indicators were not reviewed one by one.

Questions people ask

Is Grade 3A the highest grade in China?

The standard sets out grades A, B and C by the share of review items met, with A requiring 90 percent or more. The official texts read for this page describe no grade above A.

How often is a hospital reviewed?

The current standard sets a four-year review cycle. The older interim measures also set a four-year cycle. A hospital with a prerequisite breach has its review postponed by one year.

What does "grade undetermined" mean?

It is the status used while a review is postponed because of a prerequisite breach. The standard says the hospital's previous grade is cancelled during the postponement.

Is a tertiary hospital better than a secondary hospital?

The official texts describe different roles for the two levels. City tertiary hospitals focus on acute, critical and complex cases, and city secondary hospitals receive referred patients in recovery stages. The grade is a result against the standard, not a comparison between hospitals, and this page does not rank hospitals. Questions about your own appointment, fees or insurance claim are for the hospital or your insurer to answer.

Sources

Each source above was read on the date shown. This page is an unofficial summary of general administrative information. It is not published by the bodies named above, and it is not medical advice. If it differs from the official texts, the official texts prevail, and rules may change after the check date.