OBJECTIVES: Rural patients in China requiring cardiac and vascular interventional treatment typically have to travel to an urban “tier3” hospital for treatment instead of using their local “tier2” hospital due to lack of equipment. To understand the economic drivers of improved patient access in China a pilot study was initiated. METHODS: Data were collected on patient numbers, clinical and social groups, insurance type, reimbursement rates, and travel costs as well as distance travelled for a period six months before and after installation of equipment in the tier2 hospital. RESULTS: The hospitals chosen were Fengnan Hospital (tier2) and Gongren Hospital (tier3) in Tangshan City and were only 13KM apart. Tier3 hospital patients are reimbursed  55%, 65% and 80% for rural patients (43%), urban resident (29%) and urban workers (18%) respectively. 10% of patients are not covered by insurance and pay all costs. Tier2 hospital patients are reimbursed 70%, 75% and 85%.  In the tier3 hospital during the 6 months before the equipment was installed, 1700 patients were treated at an average cost to the patient of 2905 CNY. In tier 2 hospital in the six months following installation, 107 patients were treated at an average cost of 1925 CNY/patient, saving 980 CNY direct cost per patient or 34%. In addition travel costs were reduced by 31 CNY/patient. CONCLUSIONS: The variation in reimbursement strategy for tier2 and tier3 hospitals offer the best financial opportunity for improving access to treatment for patients, however further work is needed to compare regional differences and also the effect of patients having to travel greater distances.