“Dying to Survive” struck a chord with many Chinese people. In the film, high-priced cancer drugs developed in the United States were unaffordable for ordinary patients with chronic myeloid leukemia, leaving them to struggle between illegal Indian generic drugs and the hope of survival.

The film is based on real-life events. Lu Yong, known as the “Drug Hero,” was prosecuted for cross-border purchasing of generic “Gleevec” on behalf of others. Over a thousand patients with chronic myeloid leukemia signed a joint petition in his support, and Lu was ultimately acquitted.

The Gray Areas of the Law and the Gap in Medical Standards Between China and the United States, Beyond the Dilemmas Portrayed in “Dying to Survive,” Have Also Spawned a Rapidly Growing Market—Cross-Border Healthcare.

According to Research and Markets, the cross-border healthcare market is projected to reach $150 billion by 2026. China stands as one of the key source countries in the global cross-border healthcare market.

Cancer patients, older unmarried women, and couples struggling with infertility—those traveling to the United States for treatment have diverse reasons, as well as their own fears and anxieties.

Some do it for the next generation, some seek the right to choose, and others simply strive with all their might in the face of death.

San Francisco, USA, is approximately 9,486 kilometers from Beijing, with a direct flight taking about 12 hours. Although both cities lie at around 40 degrees north latitude, their climates differ markedly: Beijing’s July heat is oppressive and unbearable, while San Francisco’s evenings are cool enough to require a jacket.

To care for her ailing mother, Shen Rui flew this route twelve times over the past two years. In late 2014, her mother was diagnosed with hematologic cancer. After a year and a half of chemotherapy in China, her condition worsened. The side effects of the chemotherapy drugs caused her body to grow progressively weaker, with continuous damage to various organs. The kidneys suffered the most severe damage; at its worst, she “lacked even the strength to chew food.”

“Every year, the United States launches numerous new drugs with superior efficacy and significantly reduced toxic side effects, but these new drugs are not available in China… American new drugs offer a chance at saving lives.” This is not only the conclusion drawn from her research data, but also the advice given by her mother’s attending physician in China.

In 2018, the prestigious medical journal The Lancet published a report on global cancer survival trends from 2000 to 2014, covering data from 37.5 million patients across 71 countries over a 15-year period. In terms of survival rates for common cancers, the United States is arguably far ahead; its five-year survival rates for melanoma, lymphoma, prostate cancer, and other malignancies are 30%–40% higher than those in China.

Shen Rui took her mother to Stanford Hospital and, outside of treatment hours, arranged for her to stay with relatives in California. Some of her former classmates who had settled in the United States also helped with caregiving.

At Stanford Hospital, the treatment team for Shen Rui’s mother comprised an attending physician, two nurses, a cardiologist, and a nephrologist. This multidisciplinary team provided coordinated care, ongoing monitoring, and collaborative management. The therapeutic regimen incorporated two new medications: an injectable biologic antibody and the chemotherapy agent Polymast.

“Actually, Polymast is an upgraded version of domestic chemotherapy drugs. While the domestically produced drugs have significant side effects and, although effective, act slowly, Polymast works rapidly with virtually imperceptible side effects,” recalled Shen Rui.

In late 2017, Shen Rui suddenly received a WeChat message from his mother in the United States: “The male nurse who was treating me today suddenly opened the door to the treatment room, holding a tray with both hands, followed by more than ten nursing staff members. Your father and I were momentarily stunned, unsure of what was happening. We only heard them singing ‘Happy Birthday’ in unison. It turned out that when I had provided my date of birth earlier, it coincided with today’s date. They were so thoughtful as to bring a birthday cake and even led such a large group to offer their congratulations. This profound sense of human warmth was surprising, heartwarming, and endearing. I am at a loss for words and can only express my deepest gratitude.”

The treatment team devised stage-specific therapeutic plans based on the condition of Shen Rui’s mother. By the time of her follow-up examination this July, it was announced that no further cardiac monitoring would be required for the next year, and her renal indicators remained stable, bringing immense relief to the entire family.

Looking back on the past two years of treatment, Shen Rui has had a difficult journey. “The thing I’ve worried about most all along was that the medication might not work in the United States and that my income would be insufficient to cover my mother’s treatment.” Fortunately, the former concern has been alleviated by evidence of efficacy, and she is still able to manage the latter, though she declines to disclose the total costs incurred during this period.

According to previous reports by The New York Times, patients traveling to the United States for cancer treatment through intermediaries can expect medical costs ranging from $700,000 to $1 million, excluding accommodation, food, and other expenses that are higher than those in China, as well as intermediary fees.

There is also a subset of patients who do not necessarily need to travel abroad to access U.S. treatment regimens.

Tian Fang is also a family member of a cancer patient. In late 2017, his father was diagnosed with adrenocortical carcinoma at one of China’s leading oncology hospitals. This is a rare cancer, with an incidence rate of only one in a million. After careful consideration of various factors, he temporarily forgone seeking medical treatment abroad and instead chose to have his father undergo adrenalectomy for an adrenal tumor in Beijing.

During this process, he gradually realized that due to the extremely low incidence of adrenocortical carcinoma, doctors in China have very limited understanding of this type of cancer.

“At that time, I just wanted to consult with American doctors about whether there were any better treatment options for adrenocortical carcinoma and seek a joint consultation with international experts.” To this end, he contacted endocrine tumor specialists at Massachusetts General Hospital and the Dana-Farber Cancer Institute in the United States through a cross-border medical institution for an online consultation.

Unexpectedly, both American physicians reported that it was likely not adrenal cortical carcinoma, and they provided more than ten detailed criteria to support their assessment.

Given the time constraints and prior diagnostic opinions from several hospitals in China, he had already arranged to purchase mitotane—widely recognized as the most effective treatment—and commenced therapy for adrenocortical carcinoma. During this period, his father’s condition continued to deteriorate.

Combining these approaches, he engaged two additional American pathologists and requested expedited processing. One month after the initiation of mitotane therapy, it was confirmed that the previous diagnosis of adrenocortical carcinoma had been a misdiagnosis; his father actually had lung adenocarcinoma with metastasis to the adrenal gland. However, due to the absence of visible lesions in the lungs, markers for lung cancer were not tested during the initial pathological examination at a hospital in China.

“During the four to five months I spent seeking medical care in China, I booked appointments with more than 30 specialists. My overall impression was that Chinese doctors are extremely busy; for a specialist consultation fee of 100 yuan, you only get about five minutes of conversation,” recalled Tian Fang. On the other hand, he believes that Chinese doctors are somewhat “hesitant to use new drugs and lack extensive experience with immunotherapies.” After his father was diagnosed with lung cancer, genetic testing revealed high PD-1 expression in his body and no other sensitive targetable gene mutations. This made him eligible for Merck’s immune checkpoint inhibitor Keytruda (pembrolizumab, commonly known as “K-drug”). However, the attending physician consistently advised against using immunotherapy alone, insisting instead on administering two cycles of conventional chemotherapy first, followed by a combination regimen of immunotherapy plus chemotherapy.

"During the treatment of Shen Rui’s mother, the standard care model in Chinese hospitals consisted of one attending physician plus one resident physician from the same department; it was impossible to have a multidisciplinary treatment team composed of physicians from different specialties, as is common in the United States."

It is hardly fair to blame Chinese hospitals for this, as doctors in China may have to treat ten to twenty times more patients per day than their American counterparts. Due to the heavy concentration of high-quality medical resources in first-tier cities, these top-ranked hospitals across the country are flooded with critically ill patients from all regions. After all, seeking medical treatment abroad is an option available only to a very small minority; the exorbitant costs, often ranging from hundreds of thousands to millions of yuan, deter the majority of critically ill patients and their families. According to the National Bureau of Statistics, in 2016, the average annual wage for employees in urban non-private entities was 67,569 yuan, while that for employees in urban private entities was 42,833 yuan. These premier hospitals in China represent essentially the best healthcare resources accessible to the general public.

“If it had been confirmed as adrenal cortical carcinoma at the outset, we might have later considered seeking treatment in the United States. However, once lung cancer was confirmed, we felt it unnecessary, as China already has relatively standardized treatment protocols for more common cancers and boasts excellent physicians,” said Tian Fang.

But he remained grateful for having pursued a “dual-track” approach—seeking medical opinions in both China and the United States—which ultimately prevented significant delays in his treatment.

For U.S.-based consultation services, he spent a total of $6,000 on initial consultations and an additional $3,000 to purchase a one-year follow-up service. “I only reach out when I have questions, roughly once a month, but I still value having an additional source of information.”

For others, the United States represents opportunities they never had.

In 2015, Xu Jinglei appeared on A Date with Luyu and offered a highly viral definition of egg freezing: “the only regret medicine in the world.”

In China, egg freezing remains in a legal gray area. The recent regulation, the Technical Norms for Human Assisted Reproductive Technology, permits only married women with fertility difficulties to access this medical service. With no legal avenues available domestically, unmarried women seeking egg freezing are compelled to travel abroad.

In reality, this “regret medicine” does not always work—opinions on the efficacy of egg freezing vary. According to data from Reproductive Medicine Associates of New York, among the hundreds of patients served by the clinic between 2013 and 2014, only 24% successfully conceived after thawing their own eggs.

California’s Reproductive Sciences Medical Center (RSMC) stated that a clinic’s operational procedures and the diagnosis of infertility may both influence success rates, with one of the most critical factors being the age at which eggs are frozen—the younger the patient, the higher the success rate.

However, for older women who have no immediate plans to marry but wish to preserve the possibility of having children in the future, egg freezing is virtually their only option.

Han Xiaoyang is a divorced white-collar worker in Shanghai. After turning thirty, her parents’ patience with her has all but vanished. For her, a woman who has achieved modest success, reproductive anxiety is one of her greatest sources of distress.

“Finding a suitable partner for a second marriage is inherently more difficult, especially as I was approaching the age of 35—a threshold marked by gradually declining ovarian function. However, I have become even more cautious in selecting a partner than before, determined not to be led by others.” After making up her mind, she underwent a series of procedures, including medical examinations, oral contraceptive use, ovulation induction injections, and surgery, before traveling to the United States for oocyte cryopreservation, where 12 healthy eggs were retrieved.

“This trip cost 140,000 yuan, with an annual storage fee of $600 thereafter. But she feels at ease, saying, ‘Now I’ll just wait for my Mr. Right to appear.’”

“The reasons why people choose to freeze their eggs seem to be changing. Six or seven years ago, we saw that most women who chose egg freezing were concerned about their future fertility. Now, many women around the age of 35 are coming to us, hoping to take control of their reproductive timeline,” said Dr. Alan Copperman, a reproductive specialist at Reproductive Medicine Associates of New York, in a previous interview with TIME.

In vitro fertilization (IVF) is a more mature assisted reproductive technology, with significantly higher success rates compared to oocyte cryopreservation followed by fertilization. Due to the well-established legal and regulatory framework in the United States, IVF outcomes are better assured, leading many Chinese couples facing fertility challenges to seek treatment there. In 2016, 10% of Chinese medical tourists traveling to the U.S. did so for this purpose. According to reports from the U.S. Centers for Disease Control and Prevention (CDC), in 2016, 463 assisted reproductive technology clinics across the country performed 263,577 IVF cycles, resulting in 65,996 live births.

With technological advancements, the latest cases provided by RSMC show that the success rate of in vitro fertilization (IVF) for women aged 35 and younger is as high as 75%, remaining at approximately 50% up to age 44.

Just a few years ago, for most Chinese people, cross-border medical care—whether for critical illness treatment or assisted reproductive services—was nothing more than a distant dream.

Traditional cross-border medical institutions typically offer intermediary-style services, assisting patients with visa applications, medical record translation, and hospital arrangements in the United States. Meanwhile, multinational hospitals have established offices in China to accept appointments and referrals. However, these services often come with exorbitant fees.

As mentioned above, such medical expenses for cancer patients range from 700,000 to 1 million yuan.

The primary reason is that Chinese nationals are unable to purchase U.S. health insurance, requiring them to cover the full cost of expensive medical care out-of-pocket, with labor costs being particularly exorbitant. For example, for a dressing change using the same medication, having a hospital nurse perform the procedure costs between $300 and $400, whereas purchasing the medication at a CVS pharmacy in the U.S. and performing the dressing change oneself costs only $44.

In addition, factors such as visa requirements, language barriers, and information asymmetry have made this option entirely unfeasible for many Chinese patients.

However, with the rise of numerous internet-based medical services, technological advancements, and the easing of U.S. visa restrictions, the population able to access cross-border healthcare is gradually expanding; it is no longer an option exclusive to high-net-worth individuals.

“New technologies represented by AI and big data are improving the efficiency of medical R&D, while cooperation between China and the United States is also driving healthcare services toward greater accessibility,” said Chen Jie, co-founder of the cross-border incubator Crossover Hub, in an interview with reporters.

Remote consultation serves as one example. The U.S.-based physician that Tian Fang ultimately secured for her father was contacted through MORE Health, a cross-border medical institution previously reported by TMTPost. Its founder, Dr. Robert Warren, is a Fellow of the American College of Surgeons and the former Chief of Surgical Oncology at the University of California, San Francisco Medical Center.

He told reporters that by leveraging remote consultations and MH’s legal prescribing authority in the United States, MORE Health enables patients to avoid arduous long-distance travel to the U.S. while collaborating with local oncologists to provide multidisciplinary consultations and access to legally prescribed U.S. medications. The basic workflow for its consultation service is as follows: patients submit medical records, pathology slides, and other relevant information; MORE Health uses its proprietary platform to translate the information and screen physicians; a case manager with a biomedical background then helps connect the patient with one or two suitable U.S.-based physicians, completing the consultation and follow-up within three months.

“Medical care in the United States is more patient-centered, which means it serves as an excellent complement to critical care treatment in China.” According to data provided by Dr. Warren, the proportion of individuals using MORE Health services is rising year by year, with an annual growth rate exceeding 100%.

Massachusetts General Hospital and Dana-Farber Cancer Institute, mentioned above, along with MD Anderson Cancer Center, which is listed among MORE Health’s partners, are all among the top hospitals in the United States. For ordinary patients, however, it is difficult to access these medical resources without traveling to the U.S. in person unless they receive assistance from an intermediary organization.

On the other hand, except for a few severe cases, drugs do not account for the majority of treatment costs. Chen Jie pointed out that hospitalization remains the primary component of China’s overall medical expenses, accounting for approximately 30% of total spending, followed by outpatient and prescription drug costs, which represent around 19% and 18%, respectively. In addition, a study by the Center for Healthcare Service Governance Research at Tsinghua University shows that China’s total healthcare expenditure has been growing rapidly after entering an aging society, with a trend toward exponential growth. A significant driver of this increase is the rising hospitalization rate for chronic diseases among the elderly due to population aging.

“If advanced health management technologies can be leveraged to reduce hospitalization rates, the problem of exorbitant medical costs can be fundamentally addressed. This also marks a shift from the previous model of passive treatment to proactive health management,” said Chen Jie.

Shao Xuhui, former Vice President of Yahoo and a Silicon Valley investor, also stated that advancing early diagnosis is a more significant technological trend for effectively reducing healthcare costs than focusing on treatment.

“For example, with fourth-generation gene sequencing, DNA strands pass through nanopores, enabling single-cell sequencing, longer read lengths, faster speeds, and lower costs.” This means the technology can truly enter clinical settings and even households, allowing for rapid individual sequencing. In contrast, second- or third-generation technologies require batching dozens to hundreds of samples, with waiting times ranging from several days to a week. Shao Xuhui has previously invested in AXbio and Quantapore, both of which are fourth-generation gene sequencing companies. “I believe such companies will provide breakthrough support for treatment, monitoring, and early diagnosis.”

For another example, microelectronic devices can monitor human vital signs continuously over extended periods and even enable proactive intervention for chronic diseases such as diabetes.

“The highest treatment costs are often associated with severe or chronic diseases, which could see a significant reduction in expenses if detected early,” said Shao Xuhui.

It is worth noting that although the United States is one of the countries with the most advanced medical technology in the world, Americans also have a demand for cross-border healthcare. According to previous reports by the BBC, many Americans are risking violation of the law by traveling to Cuba, which has been on bad terms with the United States for many years, to seek a newly released cancer treatment—the non-small cell lung cancer vaccine for lung cancer.

Due to the U.S. technological embargo against Cuba, under the leadership of former President Castro, Cuba mobilized more than 20,000 scientists and technical personnel to research innovative drugs, with this non-small cell lung cancer vaccine serving as a prime example. It combats cancer by stimulating an immune response against proteins in the blood that trigger lung cancer growth. After the induction phase, patients require only one injection per month.

Since the vaccine’s launch, Cuban doctor Elia Neninger has used it to treat hundreds of patients; in the United States, however, it remains under testing, and U.S. patients cannot receive treatment domestically.

“We have fundamental differences with many countries on issues such as freedom of speech and individual liberties, but this does not hinder our cooperation in areas that can benefit the people of both nations.” This remark by Kelvin Lee, Chair of Immunology at Roswell Park Comprehensive Cancer Center in Buffalo, New York, while evaluating Cuba’s vaccine, applies equally to any other country. After all, in the face of death, national borders become insignificant; we are all simply racing against time.