Commercial health insurance – A new power to push China healthcare reform forward? Background: The coverage and payment level of China basic medical insurance grew rapidly during the healthcare reform. Those growth leads huge pressure to the financing mechanism. How to well allocate limited budget is a challenge. Thus the government started to buy commercial health insurance for some critical diseases for people since 2012. In 2014, the State Council further published 2 notifications to encourage commercial insurance agencies to take more responsibility in healthcare. Method: This article searched and reviewed the studies for the medical insurance system of China, US (the country with the largest commercial insurance system) and UK (typical universal welfare country), then compared social environment (population, age structure and etc.), economic status, government structure and medical insurance system among the 3 countries, to discuss the possibility that commercial health insurance can solve the challenge in the reform. Results and discussion: Those factors compared are different and decide that commercial health insurance will play different role. Although China government wish to provide universal basic medical insurance like UK, while the limited inputs pushed the government have to consider US mode. The policies from the State Council in 2014 encouraged commercial insurance agencies “comprehensive interfere in the management of medical insurance”, and “give more preference to commercial insurance”. However commercial health insurance is hard to relieve the financial pressure in the reform: 1. Currently commercial insurance agencies are only allowed to interfere in critical diseases and will face high risk (and potential loss); 2. The government only allow state-owned agencies to participate, hence government still needs to pay the bill for the potential loss; 3. Unlike US, all Chinese residents should participate basic medical insurance, and the financial pressure will continue to increase due to aging population.