中國「飛刀費」走出灰色地帶：一堂醫療政策與稅務課

For years, a practice known colloquially as the "flying knife fee" (飞刀费) operated in a grey zone of China's healthcare system: experienced surgeons from major hospitals would travel to smaller facilities to perform operations, receiving cash payments directly from patients or host hospitals outside any formal billing system. Now, regulators are moving to bring these payments into the light — requiring that fees go through proper channels and are subject to tax.

Knowledge point: why the grey zone existed

The practice emerged from a structural mismatch. Top surgeons are concentrated in tier-1 city hospitals, but patients in smaller cities need complex procedures. Official hospital-to-hospital consultation fees were often too low to incentivize travel. The result was an underground market where quality care reached underserved areas — but without legal protections, tax compliance, or quality accountability.

The "flying knife" arrangement created risks for all parties: patients had no formal recourse if something went wrong, surgeons faced potential legal liability for practicing outside their registered institution, and hospitals in receiving cities could not properly account for the activity.

What formalization means

The new regulatory direction aims to create a legal channel: surgeons can still travel and operate, but fees flow through institutional agreements, are taxed as professional income, and come with clear liability frameworks. This is a classic formalization problem seen in many regulated professions: when official prices are too low, parallel markets emerge; raising official prices or creating flexible channels can shrink the grey zone.

The broader lesson: underground economic activity often signals a pricing or institutional failure, not simply wrongdoing. Fixing the rules can be more effective than policing the violations one by one.