Legal warnings posted on the door of a private, for-profit hospital in eastern China tracked its descent into financial failure.

中国东部一家私立营利性医院的大门上张贴着法律警告，记录了它陷入财务失败的过程。

Huiren Hospital in the city of Suqian was warned for failing to pay employees. Four months later, a judicial summons said it still had not paid back wages. Finally, in September a paper taped across its entrance declared the building closed.

宿迁市的汇仁医院曾因拖欠员工工资而受到警告。四个月后，法院传票称该医院仍未支付工资。最终在去年9月，一张贴在医院大门口的封条宣告大楼关闭。

The hospital, once known for treating men with infertility or sexually transmitted diseases, had been hollowed out. The furniture and equipment were gone. There was no staff.

这家曾以治疗男性不育症或性病闻名的医院已变得空空荡荡。家具和设备都不见了。没有工作人员。

Public and private hospitals across China are suffering financially. During the Covid-19 pandemic, their expenses swelled from the enormous cost of mass testing — a core component of the government’s campaign to prevent the spread of the coronavirus. At the same time, hospitals generated less revenue because patients avoided crowded waiting rooms for fear of contracting the virus.

中国各地的公立和私立医院正在面临财务困难。新冠病毒大流行期间，政府开展了防止新冠病毒传播的运动，大规模病毒检测是那场运动的核心部分，检测的巨额成本导致医院的开支激增。与此同时，由于患者避免在拥挤的候诊室里感染病毒，医院的收入减少了。

After pandemic restrictions lifted, hospitals encountered a new problem: an economy slumping from a collapse in the real estate sector. People put off noncritical care to save money, and local governments failed to provide much-needed financial support to public hospitals.

疫情防控措施解除后，医院遇到了一个新问题：房地产市场崩盘引发了经济下滑。人们为了省钱，推迟了非紧急疾病的治疗，地方政府也没有钱为公立医院提供急需的财政支持。

Hospitals are also facing a more fundamental challenge. As China’s population ages, health care costs are increasing faster than the money flowing into the country’s insurance funds. The government, in turn, is engaged in a campaign to reduce spending. Hospitals have been left in the lurch when insurance has not fully reimbursed them for certain procedures or medications.

医院还面临一个更根本的挑战。随着中国人口老龄化，医疗费用的增长速度超过了医保基金进款的速度。接下来是政府开始努力削减支出。医保不完全报销某些手术或药物的费用后，医院陷入了困境。

Over the past two decades, the number of hospitals in China has more than doubled. Private health care facilities, in particular, grew eightfold. Many hospitals took on loans to expand, serve more patients and offer more services. But as the money coming in slowed, some institutions struggled to repay debts.

中国的医院数量在过去20年里增加了一倍多。私立医疗机构增长的速度更快，在20年里翻了三番。许多医院为了扩张、服务更多患者和提供更多服务而贷款。但随着收回资金的速度放慢，一些医疗机构在偿还债务上遇到了困难。

The hospital boom coincided with China’s economic rise, resulting in more people living healthier and for longer. The average life expectancy has increased more than 15 years since the 1970s, while the infant mortality rate was below 0.5 percent in 2023, down from 30 percent in the 1950s.

医院的繁荣与中国经济的崛起同步发生，这使得更多人活得更健康，寿命更长。自20世纪70年代以来，中国的人均预期寿命增加了15年以上，婴儿死亡率已从20世纪50年代的30%下降到2023年的0.5%以下。

But the country’s recent economic struggles have wreaked havoc on the business of hospitals, an acute problem in a country where people mostly receive medical care in hospitals.

但中国最近的经济困难已对医院的业务造成破坏，这对大多数人主要在医院看病的国家来说是一个严重的问题。

More than 200 hospitals have publicly declared bankruptcy in the past five years, compared with seven in the previous five years, according to a national bankruptcy database. Nearly all of the bankruptcies involve private hospitals. The closings represent a small number of China’s total hospitals — nearly 40,000 at the end of 2023. But the trend is worrisome, experts said.

国家破产数据库的数据显示，过去五年里已有200多家医院公开宣布破产，而此前五年只有七家。几乎所有宣布破产的都是私立医院。关门的医院只占中国医院总数的一小部分，截至2023年底，中国总共有近4万家医院。但专家们说，这个趋势令人担忧。

“This is just the beginning, and there will be more,” said He Bin, an independent Chinese medical industry analyst.

“这只是开始，以后会越来越多，”中国医疗行业的独立分析师贺滨说。

Hospitals borrowed heavily in recent years. Public hospital debt nearly quadrupled from 2011 to 2021, according to the China Health Statistics Yearbook.

近几年来，医院背负大量债务。据《中国卫生统计年鉴》，公立医院的债务在2011年到2021年期间几乎翻了两番。

In November, the Affiliated Hospital of the Medical College of Jiaying University, a public hospital in Meizhou in southern China, said it had hired an accounting firm to help liquidate its assets. A month earlier, local media said the hospital was suspending operations. Members of the medical staff who had not been paid for 10 months were told to resign.

去年11月，中国南方城市梅州的一家公立医院——嘉应学院医学院附属医院表示，已聘请了一家会计师事务所来帮助清算资产。一个月前，当地媒体报道，这家医院暂时停诊。已经10个月没拿到工资的医务人员被要求辞职。

A woman who answered the phone at the hospital in December said it was no longer operating, but she declined to explain why.

去年12月，一名在医院接听电话的女士说，医院已经停诊，但拒绝解释原因。

The hospital had invested $16 million for a new building in 2021, hoping to gain China’s highest classification for hospitals. But its revenue plummeted during and after the pandemic. In financial reports, the hospital said business revenue fell by half in 2023.

这家医院希望被评为中国最高等级的医院，2021年盖了新楼，主体建筑和配套设备总投资达1.2亿元。但医院的收入在新冠疫情期间和疫情后大幅下降。医院在财务报告中表示，2023年的业务收入同比减少了一半。

The country must “prudently resolve the long-term debt problems of hospitals,” Lei Haichao, director of China’s National Health Commission, said last month in an article for a Chinese Communist Party magazine. The National Health Commission told all local government officials in June to pay close attention to budget deficits, long-term debt and unpaid wages.

中国国家卫生健康委员会主任雷海潮上个月在中共杂志上发表文章说，需要“稳妥化解长期债务问题”。国家卫健委在去年6月下发的一份通知中要求，所有地方政府官员“密切关注收不抵支、长期债务、拖欠薪酬等”问题。

To hospital workers, the financial woes are all too real.

对医院工作人员来说，财务困难真实存在，让他们深受影响。

Nana Yang, who works at a public hospital in Zhejiang Province in eastern China, said her pay had been slashed for the first time in her 12-year career. The hospital also cut staff meal allowances, and her department stopped providing free drinking water.

在中国浙江省一家公立医院工作的杨娜娜（音）说，她最近遭遇了在那家医院工作12年来的第一次减薪。医院还削减了员工的餐补，她所在的科室已不再提供免费饮用水。

Public hospital jobs had been considered stable, Ms. Yang said. The pay was lower, but salaries increased over time.

杨女士说，公立医院的工作曾一直被认为是稳定的。虽然工资较低，但工作时间长了也会涨上去。

宿迁市儿童医院因财务问题倒闭，经历了清算拍卖但无人竞标，目前仍然继续运营。

In September, a laboratory worker at a private hospital in Fuyang City in eastern China told the mayor of being owed five months’ pay. The mayor’s office responded that the hospital’s operations were “poor” and suggested a payment plan until “the funds were sufficient.”

去年9月，中国东部阜阳市一家私立医院的化验室工作人员向市长投诉说，她已被拖欠了五个月的工资。市长办公室的回复是医院运营状态“较差”，并表示将提供一个付款计划，直到“资金宽裕”。

The hospitals’ financial problems are being exacerbated by China’s demographic crisis: As a bulging number of older people are adding costs, fewer younger people are paying into the insurance system.

中国的人口危机加剧了医院的财务问题：老年人口的增长导致了医疗费用的增加，但缴纳医保的年轻人口却越来越少。

For most of China’s 1.4 billion people, health care costs are paid under one of two insurance programs. The main one, which covers more than two-thirds of the population, serves rural residents and self-employed or unemployed individuals in urban areas, including children and older adults. It is government-subsidized, although people are expected to contribute by paying insurance premiums.

中国14亿人口中的大多数人靠两个医疗保险计划中的一个支付医疗费用。主要的医疗保险计划覆盖了全国三分之二以上的人口，包括农村居民以及城市的个体经营者或失业者，包括儿童和老年人。虽然政府为这个计划提供补贴，但参保者也需要缴纳医保费。

But the number of people paying into the program has declined for four straight years. Economic struggles are causing more people to go without insurance. Health officials in a city in southern China warned that “giving up health insurance is like not wearing a seatbelt on the highway.”

但缴纳医保费人数已连续四年下降。经济困难正在导致越来越多的人弃保。中国南方某市的卫生官员警告说，“放弃医保就好比‘高速上不系安全带’。”

Liu Junqiang, a sociology professor at Tsinghua University, has estimated that the insurance funds will run out of money in the 2030s. In 2019, he proposed lifting the retirement age and getting medical expenses under control, steps the government has taken.

清华大学社会学教授刘军强估计，医保基金将在下个十年耗尽。他曾在2019年建议推迟退休年龄，控制医疗费用的增长，政府已采纳了这些建议。

China has decreased how much hospitals are reimbursed, contributing to their money problems, according to a former accounting official at a hospital in southeastern Sichuan Province. He asked not to be identified for fear of retribution.

据曾在四川东南部一家医院从事财务工作的官员说，政府已经降低了医院的报销金额，这是医院出现资金问题的原因之一。他因为担心遭到报复要求不具名。

The government has also created a centralized system for buying prescription drugs. That has reduced overall costs by creating fierce price competition among companies — drawing a public backlash about the quality of medication.

政府还设立了一个集中采购处方药的系统，通过在药企之间引发激烈价格竞争，从而降低了总体成本，但也引发了公众对药品质量的强烈不满。

At the same time, patients are turning to cheaper alternatives than a trip to the hospital. Community clinics, the inexpensive backbone of China’s health care system before the hospital boom, are back in vogue, while telehealth visits with a doctor are growing in popularity.

与此同时，患者正在转向比去医院更便宜的替代方案。社区诊所是医院繁荣之前中国医疗保健系统的廉价支柱，现在又重新流行起来，远程医疗也越来越受欢迎。

Mr. He, the medical industry analyst, said it was especially painful because public hospitals had expanded at their fastest rate in the past decade. And some of them spent extravagantly to try to gain higher classifications, which could draw more revenue. They invested in new buildings, he said. One hospital even bought a piano for its lobby.

医疗行业分析师贺先生说，这让公立医院的处境尤其艰难，因为它们在过去十年的扩张速度最快。有些公立医院为了获得更高的评级花了很多钱，高评级能给它们带来更高的收入。医院投资盖了新楼，他说。一家医院甚至买了一架钢琴放在大厅里。

“But the hospitals did not foresee that the economy would suddenly start to decline,” Mr. He added.

“但是医院没有预见到经济会突然开始衰退，”何先生补充道。