China is known as the land of cheap knock-offs, where you can get some kind of version of pretty much anything at a low, low price. But while you may love your fake Uggs (Fuggs?), your pirate TV box, and your slightly wonky "Louis Vuitton,” there are a few things you really shouldn't scrimp on. Sometimes it’s worth paying a little extra for a better product, while at other times, being thrifty can be downright hazardous to your health. Read on for five things not worth scrimping on as an expat in China.

1) Healthcare

Your health is something you should take seriously at all times, but especially when living abroad. You can save a heap of money going to local Chinese hospitals, but while they are fine for minor issues, such as chest infections, persistent coughs, and vaccinations, I wouldn’t recommend them for anything more serious. If you have kids in China, it's definitely worth investing in international health insurance or just sucking it up and paying extra at a foreign hospital if they have something more serious or if you want a second opinion.

The fact is that Chinese hospitals, especially outside of first-tier cities, are still a bit behind their Western counterparts. While the biggest public hospitals in cities like Shanghai and Beijing have some of the best equipment and expertise, most local hospitals simply don't have the tools or talent to tackle serious health issues to the standard you might expect.

I learned this the hard way last year. I went to a Chinese hospital with some stomach pains and was rapidly diagnosed with early-stage cancer. I was then pressured to pay 12,000 RMB (on the spot) for surgery to cut the “cancer” out. I left and immediately made an appointment at an international hospital, where I was reassured that I didn't have cancer and that a simple course of antibiotics would fix my problem.

It’s possible that, rather than genuinely misdiagnosing me, the doctor in the local hospital was using the fear of cancer to try and push an expensive surgery on me. Either way, it taught me a valuable lesson: when it comes to your health, it's worth paying more.

2) Milk

You’ve probably heard of China’s baby milk formula scandal of 2008, where at least six babies died and thousands more were made sick by infant formula laced with the chemical melamine. Still to this day, foreign and Chinese parents alike will happily pay extra for imported formula. Fair enough, but did you know that some regular Chinese milk is also of questionable quality?

While the overall situation has improved greatly in recent years, national standards for both protein and bacterial content fall below those in the West for the cheapest milk you’ll find on supermarket shelves here. At present, the protein content of China’s raw milk must be at least 2.8%, compared to the standard 3% in Europe and the U.S., while bacterial content of regular-grade raw milk is set at a maximum of 200,000 CFU/mL, double the maximum in many Western countries. Premium-grade Chinese milk meets Western standards, however, and pasteurized milk must contain even lower bacterial levels post-processing, typically under 20,000 to 30,000 CFU/mL.

If you’re just buying milk to slosh into your morning coffee, you’re probably fine with the cheap stuff. If you’re buying it for your kids to drink, however, it’s worth shelling out a bit more.

3) Fresh air

I can't tell you how many expats I know who get regular chest infections or have even developed asthma since moving to China. The culprit is largely the amount of pollutants in the air, especially in cities close to manufacturing hubs.

While things have improved slightly in recent years as China has made efforts to move away from its reputation as the “world’s factory” and punish the most prolific polluters, many cities still regularly suffer from air quality that is defined as “unhealthy” and even occasionally “hazardous” by WHO standards.

PM 2.5 levels are what you need to pay attention to, as these tiny particles wreak the most long-term damage on your lungs. You can combat the effects of pollution in China by wearing a mask outside and installing several air purifiers in your home. As with anything that comes with serious health consequences, however, it’s worth paying more for both.

If COVID taught us anything, it’s that not all masks are made equal. A flimsy cloth or disposable mask will protect you from exactly nothing when it comes to air pollution. Instead, buy the tight-fitting 3M version that comes with a built-in filter and change it at least every few days.

You can also find tons of indoor air purifiers on Taobao claiming to magically clean your air with little more than a fan and a sponge for 50 RMB. Do your homework and go for something from a reputable brand that’s been tried and tested. A decent Chinese air purifier, for example from Xiaomi, will set you back about 800 RMB, while you’re looking at least double that for a premium international brand like Blueair.

4) Anything for kids

When it comes to toys or really anything that a child may be in close contact with and/or put in their mouth, it's always better to spring a bit extra for products made in countries with higher safety standards. China has seen scandals from toy race cars coated in lead-based paint to rattles that pose choking hazards to fake eyeballs filled with kerosene (seriously). Even things you wouldn’t expect, such as shoes and backpacks, have been found to contain high levels of toxic chemicals.

Again, when it comes to your health (or, even more importantly, the health of your children), it's better to be safe than sorry.

5) Pets and vets

If you want a pet in China and insist on buying one rather than adopting, paying more money is not necessarily an indication that the animal is healthy – or even that it's the breed advertised. However, reputable breeders who have built up a good reputation will usually charge more as their overheads are bigger than the puppy farms that subject their dogs to unspeakable horrors. If you buy from the latter, you’re not only perpetuating an inhumane and irresponsible trade, you’re also likely to get a very sick pet. Ever heard of the One Week Puppy?

Also, resist the temptation to buy any animal on the street. While you may feel you’re doing a good deed paying 200 RMB and rescuing a tiny kitten from a cardboard box, you’re actually just encouraging the owner to do the same thing next time his cat has a litter. There’s also a high chance that your new friend has what’s known colloquially as “cat AIDS” and is just days or weeks away from dying. If you’re not fussy about breed and age, you can get beautiful animals practically for free (and definitely disease-free) from reputable shelters.

Once you have your pet, be aware that the quality of veterinary care in China mirrors the hospital situation. While the public vets in China’s biggest cities do an excellent (and very cheap) job with anything run-of-the-mill, it’s often worth paying more for an international practice if it’s something serious or you don’t know what’s wrong. Compared to vet prices in the West, they’re still cheap as chips anyway.

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Keywords: expat in China