OBJECTIVES: China is the third largest pharmaceutical market in the world. The aim of this study was to describe Chinese reimbursement process, assess current policies and provide the authors’view of Europeans difficulties to understand the Chinese market access.  METHODS: A review was done using the latest-released official documents published by January 2014, to collect information regarding Chinese healthcare reimbursement pathways with the perspective of market access. Information was analysed based on authors’expertise, summarising the general pathway, and comparing with European routine.  RESULTS: Three stakeholders participate in Chinese market access process: Ministry of Health (MoH) (supporting introduction of new healthcare technologies), National Development and Reform Commission (referencing prices based on technical information), and Bureau of Human Resources and Social Security (representing budget holders; focusing on cost containment). Differences between Chinese process and European routine result in European hardly understanding Chinese market access process: 1>in China, key opinion leaders introduce the dossier whereas in Europe, companies introduce the dossier. 2>in China, completely new healthcare technologies need real life pilot studies (RLPS) pre-requisitely to address the feasibility and impact of introduction, whereas in Europe, RLPS studies are requested after a granted market access. 3>in China, reimbursements start from regional level as pilot in 3 regions before becoming national whereas in Europe they start from national before regional contact. 4>in China, the three stakeholders negotiate internally reimbursements, prices and access conditions, whereas in Europe, companies negotiate with payers. 5>Chinese MoH has an envelope for direct funding of healthcare technologies through procurement, whereas no comparable envelope held by similar stakeholders in Europe. CONCLUSIONS: Chinese market access is difficult for European to understand because of fundamental differences in the paradigm sustaining pricing and reimbursement (P&R). Clarifying the rational for the differences in paradigm is a prerequisite for European understanding of the P&R in China.