July 25, 2016

Disclaimer: This paper is the product of professional research performed by staff of the U.S.-China Economic and Security Review 

Commission, and was prepared at the request of the Commission to support its deliberations. Posting of the report to the Commission’s 

website is intended to promote greater public understanding of the issues addressed by the Commission in its ongoing assessment of U.S.-

China economic relations and their implications for U.S. security, as mandated by Public Law 106-398 and Public Law 113-291. However, 

the public release of this document does not necessarily imply an endorsement by the Commission, any individual Commissioner, or the 

Commission’s other professional staff, of the views or conclusions expressed in this staff research report.

Matt Snyder, Policy Analyst, Economics and Trade

with

Nicole Stroner, former Research Intern, Economics and Trade

Chinese Tourism and Hospitality 

Investment in the United States
U.S.-China Economic and Security Review Commission 

Table of Contents

Executive Summary....................................................................................................................................................3

Overview ....................................................................................................................................................................4

Chinese Tourism by Sector ........................................................................................................................................5

Education Tourism .................................................................................................................................................6

Medical Tourism and Birth Tourism....................................................................................................................10

Chinese Investment in the U.S. Hospitality Sector ..................................................................................................12

U.S. and Chinese Efforts to Boost Tourism .............................................................................................................15

Future Trends ...........................................................................................................................................................16

Implications for the United States............................................................................................................................20
U.S.-China Economic and Security Review Commission 3 

Executive Summary

International Chinese tourism has expanded rapidly in the past 20 years. The United States has been a major 

beneficiary of this trend. In 2015, tourism accounted for 57 percent of all U.S. service exports to China and 15

percent of U.S. exports to China overall.1 China’s share of tourism spending in the United States has grown almost 

five-fold in less than ten years, increasing from roughly 3 percent in 2005 to more than 13 percent in 2015.

2 Today 

China is the second-largest source of tourism spending in the United States and the largest source of international 

tourists globally. This increase in Chinese tourism has been driven by China’s rising income levels and facilitated 

by U.S. and Chinese efforts to remove travel barriers such as insufficient U.S. embassy visa facilities and long 

waiting times for Chinese passports.

The United States has become a top destination for Chinese education and medical travel. Through the quality of 

its academic institutions, the United States attracts more Chinese students than any other country, and China is the 

largest source of foreign students in U.S. schools.3 The United States also appears to attract many Chinese citizens 

for medical procedures, particularly childbirth, and this trend may continue as Chinese birth travel to Hong Kong 

has recently become restricted.

Despite this growth, the future expansion of Chinese tourism faces potential limitations. Passenger aviation between 

the United States and top Chinese cities is nearing caps created by U.S.-China treaties. In 2015, U.S. airlines had 

only nine remaining weekly flights to China’s three largest cities available to them under the U.S.-China Air 

Transport Agreement. Negotiations to provide more flights have been put on hold over concerns that U.S. airlines 

do not have fair access to take-off and landing times at Chinese airports. U.S. tourism vendors have also largely 

been unable to sell outbound travel from China despite Chinese joint venture programs designed to open this sector.

In spite of these hurdles, there is potential for greater travel from China to the United States. More than threequarters of Chinese tourists to the United States come from Beijing, Shanghai, and Guangzhou.4 As incomes rise in 

other cities, more tourists from more destinations may be able to travel to the United States.

In addition to the growth of Chinese tourism in the United States, looser Chinese restrictions on outbound 

investment have sparked dramatic growth in Chinese investment in the U.S. hospitality sector, which increased by 

an estimated factor of six in 2015 compared to 2014.5 Chinese insurance companies have dominated this investment, 

driven by a desire to secure stable foreign assets to diversify their China-heavy portfolios.
U.S.-China Economic and Security Review Commission 4 

Overview

Chinese outbound tourism has increased dramatically over the past two decades. Buoyed by growing middle class 

incomes and looser travel regulations, total Chinese international travel increased nearly ten-fold from ten million 

departures per year in 2000 to 98 million in 2013 (see Figure 1).*6 Since 2012, China has been the largest source

not only of outbound international tourists, but also of tourism-related expenditures: according to Chinese 

government statistics, Chinese tourists in 2015 spent $164.8 billion overseas.7 Chinese spending abroad has also 

increased at a faster rate than any other country in the world, growing 40 percent from 2011 to 2012 and 28 percent 

from 2013 to 2014.8

Figure 1: Chinese and U.S. Outbound Tourists, 1995–2013

Source: World Bank, “International Tourism, Number of Departures.”

http://data.worldbank.org/indicator/ST.INT.DPRT/countries?display=default

Chinese visits to the United States constitute a large and rapidly growing share of the U.S. tourism industry. While 

significantly more Chinese tourists visit nearby destinations such as Hong Kong,† South Korea, or Thailand, a 

growing number of Chinese tourists traveled to the United States over the past decade.9 As Figure 2 shows, since 

2007 the number of Chinese visitors to the United States grew by 451 percent, and total expenditures by Chinese 

tourists increased nearly four-fold.10 Today China is the United States’ second-largest source of foreign tourism 

expenditures‡ behind Canada, with Chinese tourism spending in the United States totaling $24 billion in 2014 and 

increasing quickly (see Figure 3).

11 According to a U.S. Department of Commerce survey, many Chinese visitors 

travel to the West Coast and the Middle Atlantic,

§ with each region claiming 50 percent and 33 percent of Chinese 

tourist spending respectively in 2014.12

 

* According to World Bank data, the United States was the largest source of international travelers in 1995. China’s outbound tourism for 

2015 is estimated to be as high as 130 million departures. In 2015 the United States reached 73 million departures. Wolfgang Arlt, 

“China’s Outbound Tourism in 2015: Another Year of Resilient Growth and New Trends,” Forbes, December 30, 2015.

http://www.forbes.com/sites/profdrwolfganggarlt/2015/12/30/2015-year-of-resilient-growth-and-further-segmentation-of-chinasoutbound-tourism/#47f232d71d46; U.S. Department of Commerce, U.S. Citizen Traffic to Overseas Regions, Canada, & Mexico, 2015. 

http://travel.trade.gov/view/m-2015-O-001/index.html.

† Although Hong Kong is a part of mainland China, it is treated as a foreign destination by China for the purposes of travel and trade.

‡ Expenditures by foreign tourists in the United States are estimated by the Bureau of Economic Analysis based on survey data. U.S. 

Department of Commerce Bureau of Economic Analysis, Industry Economic Accounts Information Guide. 

http://www.bea.gov/industry/iedguide.htm#ttsa.

§ The Middle Atlantic, as defined by the U.S. Department of Commerce, refers to New York, New Jersey, and Pennsylvania.

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U.S.-China Economic and Security Review Commission 5 

Figure 2: Chinese Tourism by Visits and Expenditures in United States, 2007–2014

Source: U.S. Department of Commerce, National Travel and Tourism Office Yearly Market Profile: China and U.S. Visits Trend Line. 

http://travel.trade.gov/outreachpages/download_data_table/2014_China_Market_Profile.pdf.

Figure 3: Top Five Sources of U.S. Foreign Tourism Expenditures, 2011–2014

Source: U.S. Department of Commerce, National Travel and Tourism Office, International Travel Receipts and Payments Program. 

http://travel.trade.gov/pdf/2014-Top-10-Markets.pdf. 

Chinese Tourism by Sector

Under international and U.S. balance of payments standards, tourism is broadly defined to include travel and related 

expenses for business purposes—including employees traveling on behalf of their employers, self-employed 

business travel, and seasonal or short-term workers—and travel and expenses for personal purposes, such as 

vacation, education, and medical services.13 As Figure 4 shows, growth in Chinese travel to the United States has 

increased in nearly all of these sectors, particularly in education and vacation tourism. This dramatic uptick in 

Chinese tourism has been accompanied by a remarkable increase in Chinese investment into the U.S. hospitality 

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U.S.-China Economic and Security Review Commission 6 

sector. This paper examines key aspects of the growth of Chinese outbound tourism, factors that facilitate the growth 

of Chinese hospitality investment, and opportunities for further growth in Chinese tourism to the United States.

Figure 4: Chinese Tourism in the United States by Purpose, 2009–2014

Source: U.S. Department of Commerce, National Travel and Tourism Office, Yearly Market Profile: China.

http://travel.trade.gov/outreachpages/download_data_table/2014_China_Market_Profile.pdf

Education Tourism

The United States is the top destination for Chinese students studying abroad for postsecondary education (see 

Figure 5).

14 Despite the high costs associated with studying in the United States as a foreign student, the United 

States attracts more Chinese students than the next two highest-ranked destination countries combined. In 2013,

more than 260,000 Chinese students traveled to the United States—an amount equal to 37 percent of all Chinese 

college students studying abroad.

15 In 2014 more than 350,000 Chinese students traveled to the United States to 

attend U.S. primary and secondary schools and universities.16 As of 2015, 31 percent of all foreign students studying 

in the United States came from China, making it the largest single source of U.S. international students.17 Globally,

China is the largest source of international post-secondary students in the world, contributing more than 700,000 

college students worldwide in 2013—almost four times the number of students from India, which is the next highest 

source.18 At the same time, China has faced considerable difficulty reclaiming the students it sends overseas. As of 

2011, the latest year for which data are available, 63.5 percent of Chinese students who studied abroad did not return 

to China, opting instead to remain abroad.19

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U.S.-China Economic and Security Review Commission 7 

Figure 5: Outbound Flows of Chinese Tertiary Students by Destination Country, 2013

Source: Unesco Institute for Statistics, “Global Flow of Tertiary-Level Students.” http://www.uis.unesco.org/Education/Pages/internationalstudent-flow-viz.aspx.

The United States attracts Chinese students for several reasons, including: 

 Global competitiveness. U.S. academic institutions are often perceived as offering the highest-quality 

education available worldwide. According to Hansi Men, an immigration lawyer at Streit & Su Law Firm,

“Most people in China still think America is number one. Many parents ... take their children to America 

to show them top schools like Yale and Harvard.”20 U.S. colleges tend to dominate both U.S. and Chinese 

global college rankings. In 2015, U.S. colleges accounted for 53 of U.S. News and World Report’s top 100 

rankings of global universities and 51 of the top 100 spots in a similar ranking by Shanghai-based Academic 

Ranking of World Universities (ACRWU).

21 Chinese colleges by comparison claimed only three of the top 

100 rankings from U.S. News and World Report and none from ACRWU’s top 100.22 Chinese interest in 

top U.S. universities is high enough to create a need for Mandarin-language guided tours of universities 

like Massachusetts Institute of Technology (MIT) and Harvard.

23

 Prestige. Chinese students also appear to study abroad to gain prestige. According to a survey conducted 

by China Youth Daily, 61 percent of parent and student respondents reported the purpose of studying abroad 

is to improve a student’s social status.24 The prestige of U.S. schools is reinforced by the practices of 

China’s senior officials, many of whom send their children to top U.S. colleges. Chinese President and 

General Secretary of the Chinese Communist Party Xi Jinping’s daughter enrolled in Harvard in 2010,

while the son of former Chongqing party boss Bo Xilai studied at the Harvard Kennedy School of 

Government.

25 As of 2012, at least five of the nine members of the Politburo Standing Committee had 

children or grandchildren who have studied in the United States.26 The cost and prestige associated with the 

United States’ best schools can make a degree the “ultimate status symbol,” according to Orville Schell, 

director of the Asia Society’s Center on U.S.-China Relations.27

 Difficulty gaining access to top Chinese schools. For Chinese students outside of major cities, obtaining 

access to China’s best universities is difficult, since Chinese universities hold open more application spaces 

for students from their home provinces. For example, a university in Beijing will have a larger quota for 

students from Beijing and accept lower test scores on China’s National Higher Education Entrance Exam 

(known as the gaokao) for Beijing applicants than students applying from outside the city. This poses a 

significant challenge, as many of China’s top-rated schools are located in cities like Beijing or Shanghai. 

Acceptance rates for out-of-province students are significantly lower. For example, in 2013 Peking 

University and Tsinghua University—both prestigious schools based in Beijing—accepted 84 out of every 

10,000 Beijing applicants, ten out of every 10,000 Shanghai applicants, and only two out of every 10,000 

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U.S.-China Economic and Security Review Commission 8 

Guangdong applicants.* 28 For students denied access to China’s best schools, U.S. institutions can be an 

attractive alternative.

 Flexibility. U.S. universities also offer significantly more flexibility in course selection than Chinese 

schools. Chinese academic institutions frequently determine which subjects a student will take based on his 

or her test scores.29 The ability to chart one’s own academic course abroad has been cited as a draw for

many Chinese students to the United States.30 At the secondary education level, teaching experts have also 

noted that Chinese teaching is often dominated by rote learning and preparation for tests.31 Schools are 

ranked by the test scores of their students; teachers, education administrators, and even local government 

officials receive job evaluations based on student test scores.32 This focus on test scores incentivizes 

educators to deliver a curriculum focused on test preparation.33 Some Chinese teachers and officials see

U.S. education, by contrast, as better promoting independent judgment and creativity. Ni Minjing, head of 

the Shanghai Education Commission’s basic education department, once noted that compared to their U.S. 

counterparts, Chinese students “have fewer opportunities to do scientific experiments and exercise 

independent thinking.”34

U.S. academic institutions, and the tourism sector as a whole, benefit significantly by the presence of Chinese 

students, who contributed at least $8 billion to the U.S. economy in 2013.

35 Chinese students typically pay full

tuition or, in some cases, additional surcharges that can offset reduced funding for U.S. public universities.36 For 

example, Purdue University charges international students a $1,000 surcharge above tuition, and University of 

Illinois at Urbana-Champaign imposes a $2,500 surcharge.37 In an effort to compensate for reduced public funding, 

colleges such as the University of Washington have increased admission offers to international students—many of 

them from China—who pay three times as much as in-state students.38 The three top public U.S. schools for foreign 

students have all seen recent increases in international admissions. Arizona State University’s(ASU) foreign student 

population has more than doubled from 2010 to 2014, the international student population at University of Illinois 

at Urbana-Champlain increased 40 percent from 2010 to 2015, and Purdue University increased its international 

student population by 37 percent from 2010 to 2015.39 Chinese students constitute the largest group of foreign 

students at each of these schools—36 percent at ASU, 51 percent at Urbana-Champlain, and 48 percent at Purdue.

40

U.S. demographics also push U.S. colleges to admit more international students. The population of prime customers

of U.S. colleges—U.S. citizens or residents aged 18—has declined almost nine percent from 2009 to 2014 (from 

4.6 million to 4.2 million people).41 Looking ahead, the U.S. college-bound population will continue to decline for 

the next 17 years, shrinking 5 percent from 2016 to 2033 (4.19 million 18-year-olds and 3.97 million respectively).42

As the U.S. population declines, U.S. schools may lean more heavily on international students to fill classrooms.

A small but growing number of Chinese students travel to the United States for primary and secondary education

at public and private schools. As of November 2015, there were 34,578 Chinese K-12 students enrolled in the 

United States—an increase of 290 percent from 2010.43 Chinese students currently account for roughly half of the 

nearly 67,000 international students enrolled in U.S. primary and high schools.44 Some analysts believe Chinese 

students enroll in U.S. secondary schools to avoid tight competition for China’s best high schools and increase their 

chances of attending U.S. universities.45

Total spending by Chinese students in the United States has increased dramatically during the past five years. As 

Figure 6 shows, expenditures from Chinese students in the United States quadrupled between 2007 and 2013, 

growing on average 27 percent per year.46 Similarly, the number of Chinese students enrolled in U.S. academic 

institutions has also increased: in 2014, more than 350,000 Chinese tourists came to the United States for the main 

purpose of education, a 900 percent increase from 34,000 Chinese tourists in 2008, the earliest year for which data 

are available.

47

 

*

 Under the quota system, Chinese students from other provinces have to score better than home-province students to attend their 

universities due to different minimum score requirements. For example, a student from Guangdong will have to score better than a 

student from Beijing on the gaokao to attend a prestigious Beijing university. Yiqin Fu, “China’s Unfair College Admissions System,” 

Atlantic, June 19, 2013. http://www.theatlantic.com/china/archive/2013/06/chinas-unfair-college-admissions-system/276995/.
U.S.-China Economic and Security Review Commission 9 

Figure 6: Chinese Tourist Expenses in the United States, 2007–2013

Source: U.S. Department of Commerce, National Travel and Tourism Office, 2014 Market Profile: China.

http://travel.trade.gov/outreachpages/download_data_table/2014_China_Market_Profile.pdf

The Chinese government has recently curtailed some China-based English-language programs designed to prepare 

Chinese students for study overseas, which may make it more difficult for Chinese students to study in the United 

States. These programs typically operate autonomously in Chinese public schools and are run with help from 

overseas partner schools and companies. Chinese students can attend these programs as an alternative to traditional 

Chinese schools, although attendance fees are typically higher to support foreign teachers. As of December 2015, 

the city of Beijing reportedly stopped approving new English-language secondary education programs designed to 

prepare students for study overseas.48 In Shanghai, the government has also placed budgetary pressure on these 

programs by reducing admission fees, making it more difficult for the schools to hire the English-speaking teachers 

they rely on.

49 These efforts seem to be based on a concern that Chinese students who participate in Englishlanguage programs will bypass the state-controlled Chinese curriculum; the restrictions come amid government 

warnings that Chinese professors should limit the spread of “Western ideas” in Chinese universities.50 The Chinese 

government may also seek to push back against study abroad in an effort to improve the reputation of its domestic 

schools as an increasing number of Chinese students choose international over domestic study.

51

Chinese students have been associated with several cases of academic dishonesty often brought about by poor 

performance or English language skills.52 Like all foreign students, Chinese students who struggle academically in 

the United States face losing their student visas and returning to China which can incentivize them to compromise 

their academic integrity. A recent survey of U.S. public universities conducted by the Wall Street Journal found 

that international students in general are more likely to be associated with cheating in U.S. colleges, with 5.1 cases 

of cheating reported per 100 international students versus one case of cheating per 100 U.S. students.53 In the survey, 

faculty members singled out cheating among Chinese students as a particular problem, often driven by poor 

language skills.54 In 2015 roughly 8,000 Chinese students were expelled from U.S. schools, mostly for poor 

academic performance, though some were expelled for cheating.

55 A survey of 2,700 expelled Chinese students in 

the United States released in 2016 found that 40 percent had been dismissed for poor grades, 33 percent for academic 

dishonesty, and 8 percent for low attendance.56

What appears unique to Chinese students is the array of China-based firms that help them misrepresent application 

materials to U.S. universities and cheat on college exams once they matriculate. Chinese-run businesses send 

advertisements in Chinese to Chinese students studying in the United States offering to complete homework or 

exams for a fee.57 These firms offer Chinese stand-ins for exams, paper-writing services, and have doctored 

application materials to U.S. schools, including high school grades, letters of recommendation, and admission 

essays.58 The extent of this problem is difficult to ascertain. An estimate from 2014 suggests that roughly 10 percent 

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U.S.-China Economic and Security Review Commission 10 

of all Chinese applications contain falsified material.59 It appears Chinese officials have had difficulty licensing 

education agencies and cracking down on dishonest practices. In 2014, the government licensed 454 agencies to do 

business; however, official estimates placed the number of nonaccredited agencies in Beijing alone at over 1,000.60

Some U.S. universities find it difficult to screen out fraudulent application material for international students given 

the limited number of available staff to review international applications. For example, at the University of Iowa, 

four to five transcript evaluators were responsible for verifying the applications of roughly 1,000 foreign prospective 

students each for the fall 2015 term.61

Some Chinese test prep companies have also provided SAT answers or test questions to students to give them an 

advantage as they seek to study in the United States. Because the College Board—the non-profit that administers 

the SAT—recycles test questions from earlier tests, Chinese and other foreign test prep companies can collect 

questions and answers from past tests and compile them into guides that contain answers and questions that may 

appear in future tests.62 According to Reuters, in June 2013 a Chinese website provided test content that appeared 

in 4 of the 18 SAT exams the College Board had in its inventory for international testing.63 Since October 2013, 

Reuters has identified 14 instances worldwide of SAT content being publicly exposed before an international testing 

session.64 In addition to China, tests were also compromised in Egypt, Saudi Arabia, and South Korea. While the 

College Board reduced the number of tests taken in these three countries—a measure meant to reduce opportunities 

to game the test—it did not initially do so in China. China is the College Board’s largest overseas market.65

However, the College Board canceled tests in China in January 2016 after it discovered that Chinese test-takers had 

already seen test material.

66 The College Board has taken some steps to protect tests from test prep companies by 

banning non-students, such as prep-center tutors from taking the test.67 However, the practice of recycling test 

material continues, which allows some foreign companies to obtain material that will be included on future SATs.68

The SAT’s chief competitor, the ACT, has also canceled tests for June 2016 in Hong Kong and South Korea after

it received evidence that the contents of the test had been compromised.69 This was the first time the ACT had 

canceled a test for an entire country.70

Medical Tourism and Birth Tourism

While exact statistics are hard to obtain, an increasing number of Chinese citizens visit the United States for medical 

attention—particularly for difficult procedures or childbirth. For example, the Mayo Clinic reports the number of 

Chinese patients it treated in 2014 had doubled from the year before, and according to the University of San 

Francisco Medical Center, it has seen roughly 25 percent annual growth in Chinese patients for the last several 

years.71

It is difficult to determine the motives of Chinese patients, but superior medical care appears to drive some affluent 

Chinese to the United States for medical treatment. According to one Chinese couple that traveled to Seattle for 

childbirth, they selected a U.S. hospital because the care they received there was more “personal” and afforded them 

more choices in terms of procedures.72 By contrast, the Chinese medical system is perceived as overstretched and 

lacking attentive care or trustworthy diagnoses; in a 2013 survey of 250,000 Chinese, 66.8 percent of respondents 

did not trust Chinese medical professionals’ diagnoses or treatment.73 As of 2012, China had roughly 1.6 doctors 

per 1,000 citizens, significantly below the average of 3.2 for Organization for Economic Co-operation and 

Development (OECD) countries.*74 Chinese physicians also receive modest civil service salaries and augment their 

income through costly surgical procedures, incentivizing misdiagnosis.

75 Distrust of Chinese physicians is so great 

that it has manifested as widespread violence against medical professionals. According to the China Hospital 

Association, in 2012 doctors and nurses on average suffered 27 serious physical assaults per hospital in China, an 

increase of 35 percent from 2006.76

Anecdotal evidence suggests even wealthy Chinese can receive substandard treatment.77 According to Cai Qiang, 

the CEO for Saint Lucia Consulting, a Beijing-based overseas medical consultancy, patients often require political 

connections for top-quality medical care. Mr. Cai remarked, “Unless you are a very powerful person, you will not 

get the best medical service in China.... If you just have money and you want to be treated by a top doctor you still 

need to pull some strings. Even so, the time and care doctors can give you is very limited.”78 Many of China’s best 

 

*

 The OECD includes Japan, the United States, and most of the countries of Western Europe. OECD member countries are often regarded 

as economically developed countries internationally.
U.S.-China Economic and Security Review Commission 11 

hospitals devote entire wings to the care of government officials, leaving wealthy patients without connections to 

receive diminished care.79 A patient at one of China’s top 1,000 hospitals waited five hours to see a doctor who saw 

him for five minutes and recommended a dangerous surgery to treat a tumor; the patient later opted to travel to San 

Francisco for radiation therapy.80 Another wealthy patient took her epileptic daughter to top Chinese hospitals in 

Beijing, Shanghai, and Guangzhou, but was only able to receive a few minutes of attention from doctors who told 

her there was no effective treatment.

81 She later sought treatment in Japan, where she received a thorough 

examination and medication.

82

Chinese patients also go abroad for cancer treatment. Saint Lucia Consulting reports that 80 percent of its customers 

who seek treatment overseas do so for life-threatening diseases, the most common of which are lung, breast, and 

skin cancer.83 The United States appears to treat cancer patients more effectively than China—according to the 

National Cancer Prevention and Research Center in Beijing, the five-year survival rate of Chinese cancer patients 

is only 30 percent, compared to 60 percent for the United States.84

Delays in Chinese drug approval may also drive patients to the United States. China is particularly slow to approve 

foreign drugs, and currently only has enough regulatory capacity to process about 6,000 new drugs a year.85 China 

receives more than 10,000 new drug applications to review per year, and the current administrative backlog stands 

at more than 21,000 applications.86 Rather than wait for new treatments to be approved—which can take years—

some Chinese patients receive new medication overseas.87 For example, Hope Noah Health Management Co., a 

Beijing foreign medicine consultancy, reports that many of its patients with hepatitis C travel to the United States 

to take an effective oral treatment that has not yet been approved by the Chinese government.88

Chinese medical tourism consultancies have emerged to help Chinese patients select U.S. hospitals to best meet 

their needs. Some firms charge roughly $10,000 to help patients find an overseas hospital and arrange medical and 

travel plans.89 This appears to be a growing industry: one consultancy noted the number of its clients had doubled 

from 2012 to 2013.90 For childbirth alone there are estimated to be 500 agents in China helping patients find 

treatment abroad.91

The United States attracts many Chinese visitors for childbirth. According to state-owned China Central Television, 

Chinese birth tourism to the United States increased from 4,200 visits in 2008 to more than 10,000 in 2012.92 While 

many Chinese patients choose to give birth in the United States for medical reasons, others may do so to obtain 

U.S. citizenship for their children or, until recently, to circumvent China’s “one-child” policy. Prior to 2015, the 

Chinese government imposed a heavy fine on parents who had a second child, and failure to pay the fine would 

exclude the child from most education and state benefits.93 Some Chinese saw giving birth abroad as a way to avoid 

this fee, although China’s birth policies vary by province and in some cases additional children born abroad cannot 

register in China’s national registry or gain access to education and state benefits.94 Obtaining U.S. citizenship can 

also be risky. China does not recognize dual citizenship for Chinese nationals, and if the foreign citizenship of a 

Chinese infant is discovered, it must be revoked to maintain Chinese citizenship.

95 In the long term, giving a child 

U.S. citizenship can open doors to the U.S. public education system, and after reaching the age of 21, a child can 

sponsor his or her parents for U.S. residency.96

Traveling to the United States for the purpose of giving birth is not illegal under U.S. law. During the visa process,

consular officers may ask for proof that travelers can pay for the procedure and that they have arranged for a hospital 

to accept them. Many Chinese expectant mothers, however, do not disclose the purpose of their travel to consular 

officers either for fear they will be rejected for a visa or—reportedly—because a consultancy advised them not to.97

Providing false information to a consular officer under oath constitutes fraud under U.S. law.98

Many “maternity hotels” have emerged in the western United States to tend to Chinese citizens after childbirth.

Some of these establishments have come under scrutiny recently for evading taxes or defrauding hospitals, leading 

to raids of roughly 20 locations in March 2015 in the Los Angeles area.99 No arrests were made during these raids.

100

Historically, many Chinese mothers have looked closer to home when opting to give birth abroad. Hong Kong in 

particular was a popular destination for mainland Chinese mothers until 2013. In 2010, roughly half of the 88,000 

babies born in Hong Kong were from mainland Chinese mothers.101 Children born in Hong Kong receive the “right 

of abode,” which gives them free access to Hong Kong’s education system; Hong Kong residency, which grants 
U.S.-China Economic and Security Review Commission 12 

visa-free access to significantly more countries than would a Chinese passport;

*

and greater political freedom 

associated with Hong Kong residency.

102 Children born in Hong Kong were also exempt from China’s one-child 

policy.

103 The popularity of Hong Kong among mainland mothers sparked a backlash from Hong Kong residents,

and in 2013 Hong Kong Chief Executive CY Leung banned mainland couples from booking childbirth appointments 

at Hong Kong hospitals.

104 Since the ban was put in place, mainland Chinese birth tourism to Hong Kong has 

significantly declined. After 2013 only about 800 Chinese mothers traveled to Hong Kong per year to seek residency 

for their children (usually by appearing at a Hong Kong hospital as an emergency case), down from a peak of over 

35,000 per year before the ban.105 It is not clear to what degree they have been diverted from Hong Kong to the 

United States.

Chinese Investment in the U.S. Hospitality Sector

As Chinese tourism to the United States steadily increases, Chinese investment in U.S. hotels and hospitality 

properties has grown dramatically, with a sharp jump in 2015. Chinese hospitality investment in the United States 

in 2015 is estimated to have reached at least $2.4 billion, more than double the combined Chinese hospitality 

investment for the previous five years and more than six times the value of such investment in 2014 (see Figure 

7).106

Figure 7: Tracked Chinese Investment in U.S. Hospitality Sector, 2010–2015

Source: Rhodium Group, “China Investment Monitor.” http://rhg.com/interactive/china-investment-monitor.

Chinese investors tend to focus on hotels in cities that are attractive to Chinese tourists. As depicted in Figures 8 

and 9, most Chinese hotel investment has been concentrated in the top two U.S. cities for Chinese tourism: New 

York and Los Angeles.107 These cities feature direct flights to Shanghai, Beijing, and Guangzhou, from which more 

than three-quarters of Chinese visitors to the United States originate.

108 Chinese investors have also remodeled U.S.

hotels to cater to Chinese visitors. After purchasing the Waldorf Astoria New York in 2015, Chinese investors 

incorporated a restaurant serving Chinese haute cuisine; some analysts more broadly remarked that Chinese 

investors may use their hometown advantage to better cater to Chinese needs, such as providing better Chineselanguage services, traditional Chinese breakfast options, Chinese bankcard services such as China Union Pay and 

AliPay, and Chinese-language entertainment.

109 A Hotels.com survey found all of these features to be the “most 

important” to Chinese travelers.110

 

*

 Hong Kong residency provides visa-free entry to 152 countries, compared with 43 for mainland Chinese citizens. Jennifer Polland, “The 

Countries with the Most Powerful Passports,” Business Insider, June 26, 2014. http://www.businessinsider.com/the-countries-with-themost-powerful-passports-2014-6. 

0

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U.S.-China Economic and Security Review Commission 13 

Figure 8: Chinese Hotel Investment in Top Five U.S. Cities, 2014–2015

Source: Rhodium Group, “China Investment Monitor.” http://rhg.com/interactive/china-investment-monitor

Figure 9: Top Five Most Visited U.S. Cities by Chinese Tourists, 2013

Source: U.S. Department of Commerce, 2015 Top Markets Report, Travel and Tourism.

http://trade.gov/topmarkets/pdf/Travel_and_Tourism_Top_Markets_Report.pdf

Looser Chinese regulations on outbound finance facilitated the rapid increase in investment in 2015. Prior to 2014, 

outbound investment greater than $100 million was subject to a review and approval process by the Ministry of 

Commerce of the People’s Republic of China (MOFCOM). On October 6, 2014, MOFCOM waived this approval 

requirement through its Outbound Investment Administrative Rules and replaced it with a simple notification 

requirement.

*111 According to analysts, this simpler administrative process boosted global Chinese outbound hotel 

 

* Under the new regulations, an outbound investment in excess of $100 million requires only notification to MOFCOM of the transaction 

unless the investment is in a country that does not have diplomatic relations with China or a country under UN inspections. Outbound 

investment in excess of $1 billion still requires approval from the National Development and Reform Commission, however the removal 

of the MOFCOM review is anticipated to greatly reduce the time required to win government approval of outbound investment which 

0 500 1,000 1,500 2,000 2,500

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Washington, DC

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New York

Los Angeles

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U.S.-China Economic and Security Review Commission 14 

investment from less than $1 billion in 2014 to more than $5 billion in 2015.112 As shown in Figure 10, prior to 

2015 most Chinese investment in the hospitality sector tended to fall below the $100 million threshold that would 

trigger a MOFCOM review.113 The removal of this review encouraged much larger purchases in 2015.

Figure 10: Average Dollar Value of Chinese Hospitality Investment 

Transactions in the United States, 2010–2015

Note: The red line corresponds to the $100 million MOFCOM review threshold.

Source: Rhodium Group, “China Investment Monitor.” http://rhg.com/interactive/china-investment-monitor.

Chinese insurance companies made the two largest Chinese hospitality investments in 2015. In February, Anbang 

Insurance Group purchased the Waldorf Astoria New York for $1.95 billion—the largest amount paid for a single 

hotel in U.S. history.114 That same month, Beijing-based Sunshine Insurance purchased the New York Baccarat 

hotel for $230 million.115 Chinese investors paid top dollar for these purchases. The Baccarat sale was the second 

highest on a price-per-room basis in New York, at $2 million per room.116 The Waldorf Astoria sold for significantly 

less—$1.38 million per room—but Anbang Insurance still outbid two undisclosed competing parties.117 Anbang is 

attempting to expand its collection of U.S. hospitality properties in 2016. The company purchased a portfolio of 

U.S. luxury hotels including the Essex House in New York and the Hotel del Coronado in San Diego for $6.5 billion

from the Blackstone Group, a U.S. investment firm.118 A group led by Anbang also offered $14 billion for American 

hospitality firm Starwood hotels in March 2016, an offer which was later retracted but, if accepted, would have 

been the largest acquisition of a U.S. company by a Chinese firm in history.119 Reportedly, Chinese regulators were 

close to rejecting Anbang’s bid for Starwood as it would give Anbang too many foreign assets (see below for limits 

on foreign acquisitions imposed on Chinese insurers by the Chinese government).120 Additionally, some analysts at 

Bloomberg, Reuters, and the New York Times suggested that the acquisition could be reviewed by the Committee 

on Foreign Investment in the United States (CFIUS) although most believed that Anbang would pass such a 

review.121 Anbang is also purportedly highly leveraged and could face liquidity problems by buying difficult-to-sell 

assets such as hotels while running up against short-term liquidity demands from the financial products it offers its 

customers.122 Starwood ultimately agreed to a bid from Marriott.123

Chinese insurance companies have been encouraged by the government to invest overseas as a way to diversify 

their risk away from the Chinese real estate market and make them more resistant to downturns in Chinese asset 

markets.124 In 2013, the government cleared insurers to put up to 30 percent of their net wealth into foreign assets.125

Prior to 2012, insurers were permitted to invest only in China or Hong Kong.126 This left them overly exposed to 

fluctuations in the Chinese economy, particularly Chinese real estate, the value of which some analysts considered 

 

could take months under the previous system. O’Melveny & Myers LLP, “New MOFCOM Rules to Further Facilitate China Outbound 

Investments,” September 22, 2014. http://www.omm.com/new-mofcom-rules-to-further-facilitate-china-outbound-investments/.

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U.S.-China Economic and Security Review Commission 15 

overvalued.127 Prime real estate purchases in U.S. cities such as New York and Boston are seen as safe investments 

that will provide reliable returns regardless of fluctuations in Chinese markets.128 The acquisition of U.S. hotels 

appears to be part of a larger trend of acquisition of foreign real estate by Chinese insurers. A forecast by real estate 

services firm Cushman and Wakefield predicts Chinese insurers will acquire $73 billion worth of overseas real 

estate in the next five years.129

Beyond single-asset purchases, Chinese companies have also attempted to acquire equity stakes in U.S. hospitality 

firms. In addition to Anbang’s bid for Starwood hotels, Hainan Airlines purchased a 15 percent share of Red Lion 

hotels for an estimated $21.5 million in June 2015.

130 HNA Group—the Chinese consortium that owns Hainan 

Airlines—significantly expanded its holdings of U.S. hotels by purchasing 100 percent of U.S.-based Carlson 

Hotels in April 2016.131 This purchase gives HNA ownership of roughly 1,400 hotels in 115 countries, including 

brands such as Radisson, Park Plaza, and Country Inn and Suites.132 The purchase price was not disclosed; however,

Bloomberg estimated earlier this year that Carlson Hotels could sell for as much as $2 billion.133

Chinese hospitality acquisitions and potential acquisitions have triggered some security concerns. For example, the 

security implications of Anbang Insurance’s purchase of the Waldorf Astoria prompted Anbang to seek a review 

from CFIUS.134 Given the Waldorf Astoria’s role in housing foreign leaders to the United Nations, many experts 

expected the purchase might come under review given the possibility of Chinese espionage.135 Although no public 

evidence of surveillance at the hotel has surfaced, President Barack Obama chose not to stay at the Waldorf Astoria 

in 2015.

136 Many analysts speculated this break with tradition—the president traditionally stays at the hotel during 

the UN General Assembly—was motivated by security concerns regarding Anbang’s government ties.

137 Wu 

Xiaohui, the chairman of Anbang Insurance, is well connected to the Chinese government and part of Deng 

Xiaoping’s family through his marriage to Deng’s granddaughter. 138 Deng Xiaoping’s family still carries

considerable influence in Chinese politics.139 Anbang’s board includes other well-connected businessmen such as 

Chen Xiaolu, a former member of the People’s Liberation Army and son of the war hero and former foreign minister 

Chen Yi.

140 Anbang announced it will extensively remodel the hotel, prompting concerns that surveillance 

infrastructure may be installed.

141 CFIUS ultimately approved the transaction in February 2016.142

U.S. and Chinese Efforts to Boost Tourism

The United States and China have held a series of promotional events designed to boost tourism flows. These 

promotion efforts are likely to increase as presidents Obama and Xi declared 2016 to be “U.S.-China Tourism 

Year,” which will feature several events to jointly promote tourism.143

Both the United States and China have taken administrative steps to boost tourism flows. Since 2002, China has 

worked to make it easier for Chinese citizens to obtain passports for travel.144 While in the past travel abroad was 

tightly restricted by Chinese authorities, today Chinese citizens can visit the United States for travel either in groups 

or individually.145 For the majority of Chinese citizens, the Chinese government has implemented a fast-track 

passport system that requires officials to issue passports within 15 days of an application or provide an explanation 

for the delay.

146 As of 2014, this new system has been applied to 89 percent of China’s prefectures; however, areas 

with high Muslim or Tibetan populations, such as Xinjiang*and Tibet, still use a much slower passport process.147

The United States has taken administrative steps to boost Chinese tourism, most notably through a 2014 reciprocal 

visa agreement. 148 With the rise in Chinese tourism to the United States, visa processing times increased 

significantly as limited embassy staff attempted to meet a growing demand.149 As depicted in Figure 11, business 

and tourism visas issued to Chinese travelers increased five-fold to 2.2 million annually from 2008 to 2015.

150 This 

increased demand for visas resulted in significantly longer wait times for Chinese tourists—over 100 days in 2010 

and 70 in 2011.151

 

*

 In August 2015, Chinese authorities announced they would streamline the Xinjiang passport system, though the extent of these changes 

is still not clear. China Daily, “Xinjiang to Streamline the Application Process of Passport,” August 7, 2015. 

http://www.chinadaily.com.cn/china/2015-08/07/content_21526055.htm.
U.S.-China Economic and Security Review Commission 16 

Figure 11: U.S. Business and Tourism Visas Issued to Chinese Travelers, 2008–2015

Source: U.S. Department of State, Immigrant Visa Statistics. http://travel.state.gov/content/visas/en/law-and-policy/statistics/nonimmigrant-visas.html.

Slow visa processing appears to deter Chinese tourism, as a significant number of Chinese travelers base their travel 

plans on the ease of obtaining a visa. According to a Hotels.com survey, 25 percent of 3,000 Chinese respondents 

who had recently traveled reported that difficult visa procedures would stop them from visiting a destination.152

Chinese travelers cite visa policies as their second most important factor in choosing where to travel, according to 

a White House briefing.153

The 2014 visa agreement removed a key constraint in Chinese travel to the United States by extending the validity 

period of tourism visas from one to ten years—the longest period allowed under U.S. law.

154 This significantly 

decreased the administrative resources needed to process visas, as repeat travelers do not have to apply for visas 

annually.

Prior to the visa agreement, in response to the long wait times, the United States expanded embassy capabilities to 

process tourism visas. In 2012, President Obama issued an executive order to increase nonimmigrant visa processing 

staff in China by 40 percent and mandated that 80 percent of all nonimmigrant visa applicants receive an interview 

within three weeks of applying for a visa.155 These measures appear to have been successful in reducing the wait 

for a tourism visa. According to the Department of State, interview wait times for nonimmigrant visas averaged less 

than one week in U.S. embassies in China in 2012 and 2013.156

Future Trends

While tourism flows from China have dramatically increased and the United States and China have each taken steps 

to reduce administrative barriers to travel, there is still significant room for growth. Comparatively, Chinese travel 

to the United States only accounts for as little as 2 percent of Chinese international tourists.

157 While the United 

States compares well with countries a similar distance from China—such as Western Europe—most Chinese 

tourists opt to travel to nearby countries such as South Korea and Thailand, as shown in Figure 12.

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2008 2009 2010 2011 2012 2013 2014 2015
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Figure 12: Outbound Chinese Travel Agency Tourism by Destination, First Three Quarters of 2014

Source: China National Tourism Administration via TravelChinaGuide.com. 

http://www.travelchinaguide.com/tourism/2014statistics/outbound.htm. 

An impasse in U.S.-China negotiations over aviation access may limit Chinese travel to the United States in the 

future. The current U.S.-China aviation agreement places a hard cap on the number of flights between the United 

States and China’s largest cities.

158 The U.S.-China Air Transport Agreement of July 9, 2007, defines the number 

of direct flights per week (known as “frequencies”) each country may operate between the two countries. Under the 

agreement, U.S. airlines are permitted to operate up to 160 trips per week to Guangzhou, Beijing, and Shanghai.159

If a U.S. airline wishes to run a route to one of these cities, it applies to the U.S. government for one of the permitted 

frequencies under the agreement. Once all 160 frequencies have been apportioned, no new flights can be scheduled. 

Due to travel increases, U.S. airlines have claimed nearly all frequencies to Guangzhou, Beijing, and Shanghai. As 

of January 2015, only nine spare U.S. weekly frequencies to these cities had not been apportioned.160 This shortage 

of frequencies marks a significant barrier to greater tourism between the United States and China. In 2014, 99 

percent of all direct flight capacity between the United States and China went through these three cities, and as 

many as 76 percent of all Chinese passengers to the United States come from them.

161 Moreover, not only are most 

U.S.-China frequencies already apportioned, they also appear to be almost fully utilized by both U.S. and Chinese 

airlines.162 On average, U.S. airlines ran 128 flights from the United States to Guangzhou, Beijing, and Shanghai in 

July and September of 2015.163 This left them with room for only 32 more weekly flights under the agreement. 

Chinese airlines are also approaching the limit of their apportioned flights, running an average of 148 flights to the 

United States from these three cities out of an administrative cap of 180 frequencies.164

While the number of permitted frequencies has been increased in the past, negotiations to increase them are currently 

stalled due to U.S. concerns that Chinese authorities are discriminating against U.S. carriers and awarding the most

attractive takeoff and landing time slots to Chinese airlines.165 In May 2015, Chinese negotiators offered to increase 

U.S.-China frequencies, but U.S. officials declined to pursue further negotiations until China presented a plan to 

ensure U.S. airlines had equal access to time slots.166 Although it is difficult to obtain comprehensive evidence that 

U.S. airlines have been denied access to favorable time slots, in at least one case a U.S. airline was forced to 

significantly alter its routing to China after receiving an unworkable time slot: in 2010, American Airlines canceled 

its Chicago to Beijing service the day it was to be launched after receiving a Chinese time slot requiring a 2:20 a.m.

departure from Beijing and a 4:00 a.m. Beijing arrival on the return flight.

167

There have also been examples of corruption playing a part in the distribution of Chinese time slots. Chinese 

authorities have arrested at least nine managers of state-owned China Southern Airlines on allegations of bribing

Chinese aviation officials.168 In 2010, the Chinese government arrested Zhang Zhizhong, the CEO of Beijing Capital

International Airport, as part of an antigraft investigation into allocation of time slots.

169 Zhang was later convicted 

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U.S.-China Economic and Security Review Commission 18 

for accepting $740,000 in bribes.

170 Huang Dengke, an official responsible for approving new airline routes, was 

arrested in 2009 for selling favorable time slots to Chinese middlemen. 171 Si Xiamin, the chairman of China 

Southern Airlines, has noted that paying bribes for Chinese time slots is not limited to his airline, but rather is an 

issue across the industry.172

Finally, travel to and from China’s top cities has in many cases exceeded the designed passenger capacity of Chinese 

airports. As shown in Table 1, China’s two most trafficked airports (Beijing Capital International and Guangzhou 

Baiyun International) exceeded their capacity in 2014, and Shanghai Pudong and Shanghai Hongqiao are using 87 

and 95 percent of their designed capacity, respectively. Significant airport expansion is planned in each of China’s 

top three cities and will effectively double travel capacity in Beijing and Guangzhou, but will not be complete until 

the end of the decade. In the meantime, the number of Chinese visitors to the United States is anticipated to increase 

by roughly two million (nearly 69 percent) from 2016 to 2020 (Figure 13).173 Both domestic and international flights 

to these airports have increased. At Beijing Capital International Airport for example, domestic flights increased 58 

percent from 2008 (42.5 million flights) to 2015 (67.4 million flights). International flights grew 69 percent over 

that same period (13.4 million flights in 2008 versus 22.58 million flights in 2015). 174 This growth will put 

significant pressure on the U.S. and Chinese governments to increase frequencies for their airlines. While 

expansions are underway, China’s airports can only service so many flights—this may limit the number of operating 

routes in the near future. 

Table 1: Passenger Traffic versus Current and Planned Capacity of China’s Top Four Airports

Airport Passengers in 

2014

Designed

Passenger 

Capacity

Planned Expansion

Beijing Capital 

International Airport 86 million 76 million Construction of new airport with 72 million passenger capacity by 2025

Guangzhou Baiyun 

International Airport 55 million 40 million Additional 40 million passenger capacity by 2020

Shanghai Pudong Airport 52 million 60 million Additional 20 million passenger capacity by 

2019

Shanghai Hongqiao 

Airport 38 million 40 million N/A

Source: Various.

175

Despite limits on U.S.-China flights, analysts anticipate U.S.-Chinese tourism to more than double over the next 

five years.176 Rising Chinese incomes—slowing economic growth notwithstanding—will likely give more Chinese 

citizens the means to travel abroad in the future. As depicted in Figure 14, Chinese gross domestic product (GDP) 

per capita has increased more than three-fold from 2005 to 2014.177 While growth may slow in the future, the 

International Monetary Fund (IMF) currently predicts China’s GDP per capita will increase 46 percent from 2015 

to 2020 (from $8,280 to more than $12,000).178
U.S.-China Economic and Security Review Commission 19 

Figure 13: Forecast of Chinese Visitors to the United States, 2015–2020

Source: U.S. Department of Commerce, Forecast of International Travelers to the United States by Top Origin Countries, October 2015. 

http://travel.trade.gov/view/f-2000-99-001/forecast/Forecast-COUNTRIES.pdf.

Figure 14: Chinese GDP per Capita, 2005–2014

Source: World Bank, “GDP Per Capita (Current US$).” http://data.worldbank.org/indicator/NY.GDP.PCAP.CD?page=1. 

Due to the costs of trans-Pacific travel, the average household income of Chinese travelers to the United States 

tends to be slightly higher than that of Chinese travelers to other countries. According to the World Tourism Cities 

Federation, the average annual income of Chinese international tourists was $21,000 in 2013.179 As shown in Figure 

15, the average and median incomes of Chinese visitors to the United States have consistently been higher (on 

average $71,000 and $44,000 from 2008 to 2014, respectively). 180 While the United States remains a more 

expensive vacation destination than most Asian countries, as Chinese incomes rise, more Chinese tourists will have 

the resources to make the trip.

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U.S.-China Economic and Security Review Commission 20 

Figure 15: Average and Median Household Income of Chinese Travelers to the United States, 2008--2014.

Source: U.S. Department of Commerce, National Travel and Tourism Office, Market Profile: China, Yearly Report 2009 to 2014. 

U.S. travel agencies would benefit from greater market access to sell travel packages to this steadily increasing 

source of tourists. Foreign companies are currently banned from selling outbound travel to Chinese citizens in 

China, except as part of a limited pilot program that creates joint ventures with Chinese companies.181 To date, 

relatively few companies have participated in this program. Three companies—American Express Business Travel 

(United States), JTB (Japan), and TUI (Germany)—created joint ventures to sell outbound travel under the 

program.

182 American Express appears to have created a successful partnership in China: it has maintained a joint 

venture with China International Travel Service since 2002 and has been deemed the best corporate travel company 

in China five years in a row by a jury of Chinese government and travel industry experts organized by Chinese 

travel website Travel Weekly China. 183 To date, no other companies obtained permission from the Chinese 

government to create a joint venture, although it is not clear why this has been so.

184 In addition to the joint venture 

program, the Shanghai Free Trade Zone also allows joint venture foreign tourism firms to sell outbound travel

packages to Chinese customers; even so, once again there has been little success in setting up joint ventures. As of 

2015, only one company has succeeded in setting up a travel agency joint venture under the Shanghai Free Trade 

Zone.

185 While Chinese companies can sell travel packages both to Chinese tourists going to the United States and 

U.S. tourists traveling to China, most U.S. companies appear to still be unable to create China-based outlets to sell 

outbound travel packages to Chinese citizens.

186 Fully opening Chinese outbound travel would give U.S. travel 

agencies an opportunity to sell outbound travel to the largest global source of international tourists.

Implications for the United States

The tourism industry is the United States’ largest service export, earning roughly $220.6 billion from international 

tourists in 2014187 and making up an entire percentage point of U.S. GDP.* Tourism is also a vital component of 

U.S. exports to China—in 2015, U.S.-China tourism accounted for 57 percent of all U.S. service exports to China 

and 14 percent of U.S. exports to China overall.188 Growth in Chinese tourism will significantly increase U.S. 

service exports to China and U.S. exports overall. Asthe second-largest source of tourism expenditures in the United 

States, Chinese visitors are a significant commercial opportunity for U.S. businesses.189 Including airfare and 

education costs, Chinese travelers spent on average $10,800 per trip to the United States in 2014.190 Rising income 

 

*

 This number was calculated by using $220.6 billion of revenue from tourism in the United States and the U.S. Department of Commerce 

Bureau of Economic Analysis estimation of GDP in 2014. Select USA, “The Travel, Tourism and Hospitality Industry in the United 

States.” http://selectusa.commerce.gov/industry-snapshots/travel-tourism-and-hospitality-industry-united-states.html; U.S. Department 

of Commerce – Bureau of Economic Analysis, National Economic Accounts. http://data.worldbank.org/indicator/NY.GDP.MKTP.CD.

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U.S.-China Economic and Security Review Commission 21 

levels in China and decreased administrative hurdles have also made China one of the fastest rising sources of 

tourism spending in the United States, increasing 44 percent from 2013 to 2015.

191

Looking forward, while Chinese tourism has already grown substantially, there are opportunities and challenges to 

further growth. Increasing Chinese income and consumption provides the United States with a growing source of 

international visitors, and the relatively untapped markets outside of Beijing, Shanghai, and Guangzhou suggest a 

large portion of the Chinese population still does not regularly travel to the United States. However, U.S. and 

Chinese negotiators have not succeeded in raising the impending cap on Chinese-U.S. flights. This cap stands to 

limit Chinese travel to the United States. Additionally, despite two Chinese joint venture pilot programs, U.S. travel 

companies still do not appear to have sufficient market access to tap into Chinese international travelers through 

outbound tourist sales. 

At a sectoral level, Chinese travel to the United States for the purposes of education has increased dramatically and 

provides significant fiscal support for U.S. academic institutions from primary to tertiary education.192 Several 

China-based firms have emerged to help Chinese students misrepresent application materials and cheat on exams 

such as the SAT. The SAT could reduce the effectiveness of this cheating by ending the practice of recycling test 

material, although this would significantly increase the cost of the exams.193 Medical tourism also appears to be on 

the rise, although it is difficult to track this trend in the absence of reliable data. When done within the parameters 

of U.S. law, growth in both of these sectors has a positive effect on the U.S. economy—particularly education 

tourism, which provides U.S. education institutions with valuable financial resources.

Although the number of Chinese citizens coming to the United States for the purposes of birth tourism is difficult 

to determine, efforts can be made to prevent fraud during the visa application process. This could be done by making 

the consequences of lying to consular officers—which include being barred from travel to the United States—more 

publicly known in China through media communication, while reminding applicants for visas that travel for medical 

purposes is permitted under U.S. law.194

Accompanying the increase in Chinese tourism to the United States, Chinese investment in the U.S. hospitality 

sector has increased dramatically following Chinese regulatory reforms that encourage Chinese insurance agencies 

to invest abroad and looser administrative review for overseas Chinese investment. Chinese hospitality investment 

will likely continue to grow until Chinese investors have sufficiently diversified their portfolios, and may grow 

alongside Chinese travel to the United States as Chinese investors seek to cater to U.S.-bound Chinese tourists.
U.S.-China Economic and Security Review Commission 22 

Endnotes

1

 U.S. Department of Commerce, International Data: International Transactions, International Services, and International Investment 

Position Tables. http://www.bea.gov/iTable/bp_download_modern.cfm?pid=11.

2 U.S. Department of Commerce – Bureau of Economic Analysis, International Data, U.S. International Trade in Services, June 16, 2016. 

http://www.bea.gov/iTable/iTable.cfm?reqid=62&step=1#reqid=62&step=6&isuri=1&6210=1&6200=51. U.S. Department of 

Commerce – Bureau of Economic Analysis, International Data, International Transactions Tables, June 16, 2016. 

http://www.bea.gov/international/bp_web/tb_download_type_modern.cfm?list=11&RowID=28.

3

 Project Atlas (Institute of International Education), “International Students in the United States,” 2015. 

http://www.iie.org/Services/Project-Atlas/United-States/International-Students-In-US.

4

 OAG Aviation Worldwide Limited, “Is It Time for China-U.S. Open Skies?” December 2014. 

http://www.oag.com/sites/default/files/Dec2014_China_US_OpenSkies.pdf.

5

 Rhodium Group, “China Investment Monitor.” http://rhg.com/interactive/china-investment-monitor.

6

 World Bank, “International Tourism, Number of Departures.” http://data.worldbank.org/indicator/ST.INT.DPRT.

7

 Bloomberg Business, “Chinese Tourist Spending Hit Record Last Year amid Income Gains,” January 27, 2015. 

http://www.bloomberg.com/news/articles/2015-01-27/chinese-tourist-spending-hit-record-last-year-amid-income-gains; World Tourism

Organization, “China – The New Number One Tourism Source Market in the World,” April 4, 2013. http://media.unwto.org/en/pressrelease/2013-04-04/china-new-number-one-tourism-source-market-world.

8

 Bloomberg Business, “Chinese Tourist Spending Hit Record Last Year amid Income Gains,” January 27, 2015. 

http://www.bloomberg.com/news/articles/2015-01-27/chinese-tourist-spending-hit-record-last-year-amid-income-gains; World Tourism 

Organization, “China – The New Number One Tourism Source Market in the World,” April 4, 2013. http://media.unwto.org/en/pressrelease/2013-04-04/china-new-number-one-tourism-source-market-world.

9

 U.S. Department of Commerce – National Travel and Tourism Office, 2014 Market Profile: China, June 2015. 

http://travel.trade.gov/outreachpages/download_data_table/2014_China_Market_Profile.pdf.

10

 U.S. Department of Commerce – National Travel and Tourism Office, 2014 Market Profile: China, June 2015. 

http://travel.trade.gov/outreachpages/download_data_table/2014_China_Market_Profile.pdf.

11

 U.S. Department of Commerce – National Travel and Tourism Office, International Travel Receipts and Payments Program. 

http://travel.trade.gov/pdf/2014-Top-10-Markets.pdf.

12 United States Department of Commerce – National Travel and Tourism Office, Yearly Market Profile: China, June 2015. 

http://travel.trade.gov/outreachpages/download_data_table/2014_China_Market_Profile.pdf.

13 International Monetary Fund, Balance of Payments and International Investment Position Manual, 2009. 

https://www.imf.org/external/pubs/ft/bop/2007/pdf/bpm6.pdf. U.S. Department of Commerce, Comprehensive Restructuring of the 

International Economic Accounts: New International Guidelines Redefine Travel. http://travel.trade.gov/pdf/restructuring-travel.pdf

14 Unesco Institute for Statistics, “Global Flow of Tertiary-Level Students.” http://www.uis.unesco.org/Education/Pages/internationalstudent-flow-viz.aspx.

15 Unesco Institute for Statistics, “Global Flow of Tertiary-Level Students.” http://www.uis.unesco.org/Education/Pages/internationalstudent-flow-viz.aspx.

16 United States Department of Commerce – National Travel and Tourism Office, Yearly Market Profile: China, June 2015. 

http://travel.trade.gov/outreachpages/download_data_table/2014_China_Market_Profile.pdf;

17 Project Atlas (Institute of International Education), “International Students in the United States,” 2015. 

http://www.iie.org/Services/Project-Atlas/United-States/International-Students-In-US.

18 Unesco Institute for Statistics, “Global Flow of Tertiary-Level Students.” http://www.uis.unesco.org/Education/Pages/internationalstudent-flow-viz.aspx.

19 David Shambaugh, China’s Future, Polity Press, 2016, 85.

20 Megan Willett, “Chinese Tourists Are Flooding into the U.S. Thanks to a New Visa Rule,” Business Insider, January 21, 2015. 

http://www.businessinsider.com/chinese-tourists-to-us-on-the-rise-2015-1.

21 Academic Ranking of World Universities, “Academic Ranking of World Universities 2015.” 

http://www.shanghairanking.com/aboutus.html; U.S. News and World Report, “Best Global University Rankings 2016.” 

http://www.usnews.com/education/best-global-universities/rankings?int=a27a09. 

22 Academic Ranking of World Universities, “Academic Ranking of World Universities 2015.” 

http://www.shanghairanking.com/aboutus.html; U.S. News and World Report, “Best Global University Rankings 2016.” 

http://www.usnews.com/education/best-global-universities/rankings?int=a27a09.

23 Dian Zhang, “Cambridge Ready for Increase in Tourists Delivered by New Nonstops from China,” Cambridge Day, June 18, 2014. 

http://www.cambridgeday.com/2014/06/18/cambridge-ready-for-increase-in-tourists-delivered-by-new-nonstops-from-china/.

24 Manny Salvacion, “Majority of Chinese Students Study Abroad to Enhance Social Status: Online Survey,” Yibada, June 12, 2015. 

http://en.yibada.com/articles/38107/20150612/chinese-students-study-abroad-social-status.htm.

25 Andrew Higgins, “Chinese Communist Leaders Denounce U.S. Values but Send Children to U.S. Colleges,” Washington Post, May 19, 

2012. https://www.washingtonpost.com/world/asia_pacific/chinese-communist-leaders-denounce-us-values-but-send-children-to-uscolleges/2012/05/18/gIQAiEidZU_story.html.

26 Andrew Higgins, “Chinese Communist Leaders Denounce U.S. Values but Send Children to U.S. Colleges,” Washington Post, May 19, 

2012. https://www.washingtonpost.com/world/asia_pacific/chinese-communist-leaders-denounce-us-values-but-send-children-to-uscolleges/2012/05/18/gIQAiEidZU_story.html.

 
U.S.-China Economic and Security Review Commission 23 

 

27 Andrew Higgins, “Chinese Communist Leaders Denounce U.S. Values but Send Children to U.S. Colleges,” Washington Post, May 19, 

2012. https://www.washingtonpost.com/world/asia_pacific/chinese-communist-leaders-denounce-us-values-but-send-children-to-uscolleges/2012/05/18/gIQAiEidZU_story.html.

28 Yiqin Fu, “China’s Unfair College Admissions System,” Atlantic, June 19, 2013. 

http://www.theatlantic.com/china/archive/2013/06/chinas-unfair-college-admissions-system/276995/.

29 Sarah Svoboda, “Why Do So Many Chinese Students Choose U.S. Universities,” BBC, June 2, 2015. 

http://www.bbc.com/news/business-32969291.

30 Sarah Svoboda, “Why Do So Many Chinese Students Choose U.S. Universities,” BBC, June 2, 2015. 

http://www.bbc.com/news/business-32969291.

31 Xu Zhao, “Questionable Education Lessons from China,” Education Week, January 21, 2014. 

http://www.edweek.org/ew/articles/2014/01/22/18zhao_ep.h33.html.

32 Xu Zhao, “Questionable Education Lessons from China,” Education Week, January 21, 2014. 

http://www.edweek.org/ew/articles/2014/01/22/18zhao_ep.h33.html.

33 Brook Larmer, “Inside a Chinese Test-Prep Factory,” New York Times, December 31, 2014. 

http://www.nytimes.com/2015/01/04/magazine/inside-a-chinese-test-prep-factory.html.

34 Dan Levin, “Chinese Educators Look to American Classrooms,” New York Times, September 2, 2013. 

http://www.nytimes.com/2013/09/03/science/chinese-educators-look-to-american-classrooms.html?_r=0.

35 United States Department of Commerce - National Travel and Tourism Office, 2014 Market Profile: China, June 2015. 

http://travel.trade.gov/outreachpages/download_data_table/2014_China_Market_Profile.pdf.

36 Tamar Lewin, “Taking More Seats on Campus, Foreigners Also Pay the Freight,” New York Times, February 4, 2012. 

http://www.nytimes.com/2012/02/05/education/international-students-pay-top-dollar-at-us-colleges.html.

37 Tamar Lewin, “Taking More Seats on Campus, Foreigners Also Pay the Freight,” New York Times, February 4, 2012. 

http://www.nytimes.com/2012/02/05/education/international-students-pay-top-dollar-at-us-colleges.html.

38 Tamar Lewin, “Taking More Seats on Campus, Foreigners Also Pay the Freight,” New York Times, February 4, 2012. 

http://www.nytimes.com/2012/02/05/education/international-students-pay-top-dollar-at-us-colleges.html.

39 University of Illinois at Urbana-Champaign, “Fall 2015 International Statistics.” 

http://isss.illinois.edu/download_forms/stats/fa15_stats.pdf; Beth Guidicessi, “ASU Ranks No. 4 for International Students,” ASU Now

(Arizona State University), November 16, 2015. https://asunow.asu.edu/20151116-global-engagement-asu-ranks-no-4-internationalstudents; Purdue University, “International Students and Scholars Enrollment and Statistical Report 2015,” Fall 2015. 

http://www.iss.purdue.edu/ISSOffice/Reports.cfm. 

40 University of Illinois at Urbana-Champaign, “Fall 2015 International Statistics.” 

http://isss.illinois.edu/download_forms/stats/fa15_stats.pdf; Purdue University, “International Students and Scholars Enrollment and 

Statistical Report 2015,” Fall 2015. http://www.iss.purdue.edu/ISSOffice/Reports.cfm; and Beth Guidicessi, “ASU Ranks No. 4 for 

International Students,” ASU Now (Arizona State University), November 16, 2015. https://asunow.asu.edu/20151116-globalengagement-asu-ranks-no-4-international-students.

41 Luke Juday, “The Demographics of Declining College Enrollment,” University of Virginia Demographics Research Group, October 2, 

2014. http://statchatva.org/2014/10/02/the-demographics-of-declining-college-enrollment/.

42 United States Census Bureau, “Annual Estimates of the Resident Population by Single Year of Age and Sex for the United States: April 

1, 2010 to July 1, 2015.” https://www.census.gov/popest/data/national/asrh/2015/index.html.

43 Mirriam Jordan, “U.S. Schools Draw More Chinese,” Wall Street Journal, December 17, 2015. http://www.wsj.com/articles/u-s-schoolsdraw-more-chinese-1450400223.

44 Mirriam Jordan, “U.S. Schools Draw More Chinese,” Wall Street Journal, December 17, 2015. http://www.wsj.com/articles/u-s-schoolsdraw-more-chinese-1450400223.

45 Mirriam Jordan, “U.S. Schools Draw More Chinese,” Wall Street Journal, December 17, 2015. http://www.wsj.com/articles/u-s-schoolsdraw-more-chinese-1450400223.

46 United States Department of Commerce – National Travel and Tourism Office, 2014 Market Profile: China, June 2015. 

http://travel.trade.gov/outreachpages/download_data_table/2014_China_Market_Profile.pdf.

47 United States Department of Commerce – National Travel and Tourism Office, Yearly Market Profile: China, June 2015. 

http://travel.trade.gov/outreachpages/download_data_table/2014_China_Market_Profile.pdf; United States Department of Commerce –

National Travel and Tourism Office, Yearly Market Profile: China, May 2010. 

http://travel.trade.gov/outreachpages/download_data_table/2009_China_Market_Profile.pdf.

48 Te-Ping Chen, “China Curbs Elite Education Programs,” Wall Street Journal, December 20, 2015. http://www.wsj.com/articles/chinacurbs-elite-education-programs-1450665387.

49 Te-Ping Chen, “China Curbs Elite Education Programs,” Wall Street Journal, December 20, 2015. http://www.wsj.com/articles/chinacurbs-elite-education-programs-1450665387.

50 Russell Leigh Moses, “Why China’s Education Crackdown May Be More Than It Seems,” Wall Street Journal, February 5, 2015. 

http://blogs.wsj.com/chinarealtime/2015/02/05/why-chinas-education-crackdown-may-be-more-than-it-seems/.

51 Te-Ping Chen, “China Curbs Elite Education Programs,” Wall Street Journal, December 20, 2015. http://www.wsj.com/articles/chinacurbs-elite-education-programs-1450665387.

52 Koh Gui Qing, “How an Industry Helps Chinese Students Cheat Their Way into and through U.S. Colleges,” Reuters, May 25, 2016.

http://www.reuters.com/investigates/special-report/college-cheating-iowa/.

53 Miriam Jordan, “Foreign Students Seen Cheating More than Domestic Ones,” Wall Street Journal, June 5, 2016. 

http://www.wsj.com/articles/foreign-students-seen-cheating-more-than-domestic-ones-1465140141.
U.S.-China Economic and Security Review Commission 24 

 

54 Miriam Jordan, “Foreign Students Seen Cheating More than Domestic Ones,” Wall Street Journal, June 5, 2016. 

http://www.wsj.com/articles/foreign-students-seen-cheating-more-than-domestic-ones-1465140141.

55 Mandy Zuo, “8,000 Chinese Students in the U.S. Expelled for Low Grades, Academic Dishonesty, Breaking Rules,” South China 

Morning Post, May 29, 2015. http://www.scmp.com/news/china/money-wealth/article/1812115/roughly-3pc-chinese-students-usexpelled-low-grades-academic.

56 WholeRen Education Research Center, “WholeRen White Paper On Dismissal Issues of Chinese Students in the United States 2016,”

May 2016. http://www.wholeren.com/wp-content/uploads/2016/06/2016whitepaper_EN.pdf.

57 Koh Gui Qing, “How an Industry Helps Chinese Students Cheat Their Way into and through U.S. Colleges,” Reuters, May 25, 2016.

http://www.reuters.com/investigates/special-report/college-cheating-iowa/.

58 Koh Gui Qing, “How an Industry Helps Chinese Students Cheat Their Way into and through U.S. Colleges,” Reuters, May 25, 2016.

http://www.reuters.com/investigates/special-report/college-cheating-iowa/.

59 Timothy Pratt, “Concerns Rise about Cheating by Chinese Applicants to U.S. Colleges,” Hechinger Report, July 1, 2014. 

http://hechingerreport.org/concerns-rise-cheating-chinese-applicants-u-s-colleges/.

60 Yojana Sharma, “New Push to Tighten Up on Study Abroad Agents,” University World News, November 21, 2014. 

http://www.universityworldnews.com/article.php?story=20141119225443787.

61 Koh Gui Qing, “How an Industry Helps Chinese Students Cheat Their Way into and through U.S. Colleges,” Reuters, May 25, 2016.

http://www.reuters.com/investigates/special-report/college-cheating-iowa/.

62 Renee Dudley, “As SAT Was Hit by Security Breaches, College Board Went Ahead with Tests That Had Been Leaked,” Reuters, March

28, 2016. http://www.reuters.com/investigates/special-report/college-sat-one/.

63 Renee Dudley, “As SAT Was Hit by Security Breaches, College Board Went Ahead with Tests That Had Been Leaked,” Reuters, March

28, 2016. http://www.reuters.com/investigates/special-report/college-sat-one/.

64 Renee Dudley, “As SAT Was Hit by Security Breaches, College Board Went Ahead with Tests That Had Been Leaked,” Reuters, March 

28, 2016. http://www.reuters.com/investigates/special-report/college-sat-one/.

65 Renee Dudley, “As SAT Was Hit by Security Breaches, College Board Went Ahead with Tests That Had Been Leaked,” Reuters, March 

28, 2016. http://www.reuters.com/investigates/special-report/college-sat-one/.

66 Valerie Strauss, “SAT Canceled in Some Asian Test Centers Because of Security Breach,” Washington Post, January 21, 2016. 

https://www.washingtonpost.com/news/answer-sheet/wp/2016/01/21/sat-canceled-in-some-asian-test-centers-because-of-securitybreach/.

67 Renee Dudley, “How Asian Test-Prep Companies Swiftly Exposed the Brand-New SAT,” Reuters, March 28, 2016. 

http://www.reuters.com/investigates/special-report/college-sat-one/.

68 Renee Dudley, “How Asian Test-Prep Companies Swiftly Exposed the Brand-New SAT,” Reuters, March 28, 2016. 

http://www.reuters.com/investigates/special-report/college-sat-one/.

69 Steve Steclow, “ACT Cancels Entrance Exam in South Korea, Hong Kong after Test Leak,” Reuters, June 10, 2016. 

http://www.reuters.com/article/us-usa-college-cheating-idUSKCN0YX008.

70 Steve Steclow, “ACT Cancels Entrance Exam in South Korea, Hong Kong after Test Leak,” Reuters, June 10, 2016. 

http://www.reuters.com/article/us-usa-college-cheating-idUSKCN0YX008.

71 Fanfan Wang, “Desperate Chinese Seek Medical Care Abroad,” Wall Street Journal, September 5, 2014. 

http://www.wsj.com/articles/desperate-chinese-seek-medical-care-abroad-1409959941.

72 Amy Nordum, “Medical Tourism on the Rise as Chinese Patients Seek Care at U.S. Hospitals, American Companies Court China’s 

Healthcare Market,” International Business Times, November 25, 2015. http://www.ibtimes.com/medical-tourism-rise-chinese-patientsseek-care-us-hospitals-american-companies-court-2174706.

73 Xinhua, “Over 87 Percent Look to Rebuild Doctor Patient Trust: Survey,” November 12, 2013. 

http://news.xinhuanet.com/english/health/2013-11/12/c_132881026.htm.

74 Organization for Economic Co-operation and Development, “OECD Health Statistics 2014, How Does China Compare?” 

http://www.oecd.org/els/health-systems/Briefing-Note-CHINA-2014.pdf.

75 Fanfan Wang, “Desperate Chinese Seek Medical Care Abroad,” Wall Street Journal, September 5, 2014. 

http://www.wsj.com/articles/desperate-chinese-seek-medical-care-abroad-1409959941.

76 Gary Jones, “Why the Chinese Are Beating Up and Even Killing Their Doctors,” Week, May 19, 2014. 

http://www.theweek.co.uk/china/57772/why-chinese-are-beating-and-even-killing-their-doctors.

77 Fanfan Wang, “Desperate Chinese Seek Medical Care Abroad,” Wall Street Journal, September 5, 2014. 

http://www.wsj.com/articles/desperate-chinese-seek-medical-care-abroad-1409959941.

78 Fanfan Wang, “Desperate Chinese Seek Medical Care Abroad,” Wall Street Journal, September 5, 2014. 

http://www.wsj.com/articles/desperate-chinese-seek-medical-care-abroad-1409959941.

79 Amy Nordum, “Medical Tourism on the Rise as Chinese Patients Seek Care at U.S. Hospitals, American Companies Court China’s 

Healthcare Market,” International Business Times, November 25, 2015. http://www.ibtimes.com/medical-tourism-rise-chinese-patientsseek-care-us-hospitals-american-companies-court-2174706.

80 Amy Nordum, “Medical Tourism on the Rise as Chinese Patients Seek Care at U.S. Hospitals, American Companies Court China’s 

Healthcare Market,” International Business Times, November 25, 2015. http://www.ibtimes.com/medical-tourism-rise-chinese-patientsseek-care-us-hospitals-american-companies-court-2174706.

81 Alice Yan, “A Cut Above: Chinese Agencies Offer Overseas Medical Treatment—For a Price,” South China Morning Post, June 2, 

2015. http://www.scmp.com/news/china/money-wealth/article/1814711/cut-above-chinese-agencies-offer-overseas-medical-treatment.

82 Alice Yan, “A Cut Above: Chinese Agencies Offer Overseas Medical Treatment—For a Price,” South China Morning Post, June 2, 

2015. http://www.scmp.com/news/china/money-wealth/article/1814711/cut-above-chinese-agencies-offer-overseas-medical-treatment.
U.S.-China Economic and Security Review Commission 25 

 

83 Fanfan Wang, “Desperate Chinese Seek Medical Care Abroad,” Wall Street Journal, September 5, 2014. 

http://www.wsj.com/articles/desperate-chinese-seek-medical-care-abroad-1409959941.

84 Alice Yan, “A Cut Above: Chinese Agencies Offer Overseas Medical Treatment—For a Price,” South China Morning Post, June 2, 

2015. http://www.scmp.com/news/china/money-wealth/article/1814711/cut-above-chinese-agencies-offer-overseas-medical-treatment.

85 Benjamin Shobert, “Reforms to China’s Drug Approval Process Are More Important than Ever,” Forbes, November 11, 2015. 

http://www.forbes.com/sites/benjaminshobert/2015/11/11/reforms-to-chinas-drug-approval-process-are-more-important-thanever/#7a413fdc629e.

86 Benjamin Shobert, “Reforms to China’s Drug Approval Process Are More Important Than Ever,” Forbes, November 11, 2015. 

http://www.forbes.com/sites/benjaminshobert/2015/11/11/reforms-to-chinas-drug-approval-process-are-more-important-thanever/#7a413fdc629e.

87 Alice Yan, “A Cut Above: Chinese Agencies Offer Overseas Medical Treatment—For a Price,” South China Morning Post, June 2, 

2015. http://www.scmp.com/news/china/money-wealth/article/1814711/cut-above-chinese-agencies-offer-overseas-medical-treatment.

88 Alice Yan, “A Cut Above: Chinese Agencies Offer Overseas Medical Treatment—For a Price,” South China Morning Post, June 2, 

2015. http://www.scmp.com/news/china/money-wealth/article/1814711/cut-above-chinese-agencies-offer-overseas-medical-treatment.

89 Fanfan Wang, “Desperate Chinese Seek Medical Care Abroad,” Wall Street Journal, September 5, 2014. 

http://www.wsj.com/articles/desperate-chinese-seek-medical-care-abroad-1409959941.

90 Fanfan Wang, “Desperate Chinese Seek Medical Care Abroad,” Wall Street Journal, September 5, 2014. 

http://www.wsj.com/articles/desperate-chinese-seek-medical-care-abroad-1409959941.

91 International Medical Travel Journal, “China, USA: Chinese Birth Tourism to USA Is Booming,” May 7, 2015. 

http://www.imtj.com/news/?entryid82=458173.

92 Rachel Lu, “Look Who’s Walking: Chinese Birth Tourism Goes Stateside,” Foreign Policy, April 25, 2014. 

http://foreignpolicy.com/2014/04/25/look-whos-walking-chinese-birth-tourism-goes-stateside/.

93 Matt Sheehan, “Born in the USA: Why Chinese ‘Birth Tourism’ Is Booming in California,” Huffington Post, April 1, 2015. 

http://www.huffingtonpost.com/2015/05/01/china-us-birth-tourism_n_7187180.html.

94 Gary Chodorow, “Shady Chinese Agencies Promoting U.S. Birth Tourism-Part 1: Undercover Investigation,” U.S. & China Visa Law 

Blog, September 9, 2012. http://lawandborder.com/undercover-investigation-into-shady-chinese-agencies-promoting-u-s-birth-tourism/.

95 Gary Chodorow, “Choosing between U.S. and Chinese Citizenship: Pros and Cons,” U.S. & China Visa Law Blog, April 20, 2014. 

http://lawandborder.com/advantages-of-us-naturalization-versus-keeping-chinese-citizenship/.

96 Sophia Yan, “Why Chinese Moms Want American Babies,” CNN Money, February 9, 2015. 

http://money.cnn.com/2015/02/08/news/china-birth-tourism/.

97 Victor Kim, “‘Maternity Tourism’ Raids Target California Operations Catering to Chinese,” Los Angeles Times, March 3, 2015. 

http://www.latimes.com/local/lanow/la-me-ln-birth-tourism-schemes-raids-20150303-story.html.

98 Cornell University Law School – Legal Information Institute, 18 U.S. Code § 1546 Fraud and Misuse of Visas, Permits, and Other 

Documents. https://www.law.cornell.edu/uscode/text/18/1546.

99 Michael Winter, “Feds Raid Chinese ‘Birth Tourism’ Rings in California,” USA Today, March 3, 2015. 

http://www.usatoday.com/story/news/2015/03/03/california-chinese-birth-tourism-raids/24338087/.

100 Michael Winter, “Feds Raid Chinese ‘Birth Tourism’ Rings in California,” USA Today, March 3, 2015. 

http://www.usatoday.com/story/news/2015/03/03/california-chinese-birth-tourism-raids/24338087/.

101 Agence France-Presse, “Hong Kong to Ban Pregnant Mainlanders from Giving Birth in City,” Telegraph, April 17, 2012. 

http://www.telegraph.co.uk/news/worldnews/asia/hongkong/9208376/Hong-Kong-to-ban-pregnant-mainlanders-from-giving-birth-incity.html.

102 Asia Sentinel, “Hong Kong Bans Birth Tourism,” May 1, 2012. http://www.asiasentinel.com/society/hong-kong-bans-birth-tourism/.

103 Asia Sentinel, “Hong Kong Bans Birth Tourism,” May 1, 2012. http://www.asiasentinel.com/society/hong-kong-bans-birth-tourism/.

104 Hong Kong Government Information Centre, “Press Releases: Government Reaffirms Its Strict Enforcement of the ‘Zero Quota’ 

Policy,” December 28, 2012. http://www.info.gov.hk/gia/general/201212/28/P201212280415.htm.

105 Emily Tsang, “Mainland Women Gatecrashing Hong Kong’s Maternity Wards, 3 Years after CY Leung’s ‘Zero-Quota’ Policy,” South 

China Morning Post, April 24, 2016. http://www.scmp.com/news/hong-kong/health-environment/article/1938268/mainland-womengatecrashing-hong-kongs-maternity.

106 Rhodium Group, “China Investment Monitor.” http://rhg.com/interactive/china-investment-monitor.

107 Rhodium Group, “China Investment Monitor.” http://rhg.com/interactive/china-investment-monitor; U.S. Department of Commerce, 

2015 Top Markets Report, Travel and Tourism. http://trade.gov/topmarkets/pdf/Travel_and_Tourism_Top_Markets_Report.pdf

108 OAG Aviation Worldwide Limited, “Is It Time for China-U.S. Open Skies?” December 2014. 

http://www.oag.com/sites/default/files/Dec2014_China_US_OpenSkies.pdf.

109 Esther Fung, “Hotel Assets New Darling of Chinese Investors,” China Real Time (Wall Street Journal blog), November 12, 2014. 

http://blogs.wsj.com/chinarealtime/2014/11/12/china-hotel-assets-new-darling-of-investors/; Florence Fabricant, “With Le Chine, the 

Waldorf Astoria Welcomes Haute Cuisine from China,” New York Times, October 27, 2015. 

http://www.nytimes.com/2015/10/28/dining/waldorf-astoria-la-chine-chinese-cuisine.html?_r=0. 

110 Eliza Ronalds-Hannon, “The Services Chinese Tourists Want but Aren’t Getting from Western Hotels,” Skift, August 23, 2013.

https://skift.com/2013/08/23/the-services-chinese-tourists-want-but-arent-getting-from-western-hotels/.

111 O’Melveny & Myers LLP, “New MOFCOM Rules to Further Facilitate China Outbound Investments,” September 22, 2014. 

http://www.omm.com/new-mofcom-rules-to-further-facilitate-china-outbound-investments/.

112 Mark Wynne Smith, “Hotel Investment Outlook 2016,” Jones Lang LaSalle, January 2016. http://www.jll.com/Documents/hio2016/JLL%20-%20Hotel%20Investment%20Outlook%202016.pdf

113 Rhodium Group, “China Investment Monitor.” http://rhg.com/interactive/china-investment-monitor.
U.S.-China Economic and Security Review Commission 26 

 

114 Chelsey Dulaney, “Waldorf Astoria Hotel Sale Completed,” Wall Street Journal, February 11, 2015. 

http://www.wsj.com/articles/waldorf-astoria-hotel-sale-completed-1423705536.

115 Nadja Brandt, “Starwood to Sell NYC’s Baccarat Hotel to Chinese Insurer,” Bloomberg News, February 9, 2015. 

http://www.bloomberg.com/news/articles/2015-02-09/starwood-to-sell-nyc-s-baccarat-hotel-to-chinese-insurer.

116 Nadja Brandt, “Starwood to Sell NYC’s Baccarat Hotel to Chinese Insurer,” Bloomberg News, February 9, 2015. 

http://www.bloomberg.com/news/articles/2015-02-09/starwood-to-sell-nyc-s-baccarat-hotel-to-chinese-insurer.

117 Craig Karmin, “Hilton to Sell Waldorf Astoria to Chinese Firm,” Wall Street Journal, October 6, 2014. 

http://www.wsj.com/articles/hilton-to-sell-waldorf-astoria-new-york-to-chinese-insurer-1412601586.

118 “Blackstone to Sell Strategic Resorts and Hotels to Anbang,” CNBC, March 14, 2016. http://www.cnbc.com/2016/03/13/blackstone-tosell-strategic-hotels-resorts-to-anbang-sources.html.

119 Mike Stone, “Marriott Wins Back Sheraton-owner Starwood with New Offer,” http://www.reuters.com/article/us-starwood-hotels-m-amarriott-idUSKCN0WN13N; Arash Massoudi, “China Groups Seal Record Trove of M&A Deals,” RT, April 1, 2016. 

https://next.ft.com/content/9583e8ea-f70c-11e5-803c-d27c7117d132.

120 Ding Feng, “Regulator Said Close to Rejecting Insurer’s Plan for Foreign Hotel Investments,” Caixin, March 22, 2106. 

http://english.caixin.com/2016-03-22/100923282.html.

121 Steve Solomon, “If Starwood Makes a Deal with Anbang, Can It Be Done?” New York Times, March 30, 2016. 

http://www.nytimes.com/2016/03/31/business/dealbook/if-starwood-makes-a-deal-with-anbang-can-it-be-done.html. Greg Roumeliotis, 

“China’s Anbang Abandons $14 Billion Bid to Buy Starwood Hotels,” Reuters, April 1, 2016. http://www.reuters.com/article/usstarwood-hotels-m-a-anbang-idUSKCN0WX2PE. Tara Lachapelle, “Anbang Muscles In on Marriott,” Bloomberg, March 14, 2016. 

http://www.bloomberg.com/gadfly/articles/2016-03-14/starwood-investors-await-sweetened-marriott-bid-after-anbang-offer.

122 Gabriel Wildau, “Anbang Global Shopping Spree Fueled by Leverage,” Financial Times, March 29, 2016. 

http://www.ft.com/intl/cms/s/0/506115ee-f1ad-11e5-a609-e9f2438ee05b.html#axzz47cWigWI0.

123 Mike Stone, “Marriott Wins Back Sheraton-owner Starwood with New Offer,” http://www.reuters.com/article/us-starwood-hotels-m-amarriott-idUSKCN0WN13N.

124 Kenneth Rapoza, “What’s Behind China Life Insurers Buying Up American Real Estate?” Forbes, April 9, 2015. 

http://www.forbes.com/sites/kenrapoza/2015/04/09/whats-behind-china-life-insurers-buying-up-american-real-estate/2/.

125 Kenneth Rapoza, “What’s Behind China Life Insurers Buying Up American Real Estate?” Forbes, April 9, 2015. 

http://www.forbes.com/sites/kenrapoza/2015/04/09/whats-behind-china-life-insurers-buying-up-american-real-estate/2/.

126 Samuel Shen, “China Widens Investment Options for Insurers,” Reuters, October 23, 2012. http://www.reuters.com/article/us-chinainsurance-funds-idUSBRE89M08320121023.

127 Mike Patton, “The China Syndrome: Is China Headed for a Financial Meltdown?” Forbes, April 23, 2015. 

http://www.forbes.com/sites/mikepatton/2015/04/23/the-china-syndrome-is-china-headed-for-a-financial-meltdown/.

128 Kenneth Rapoza, “What’s Behind China Life Insurers Buying Up American Real Estate?” Forbes, April 9, 2015. 

http://www.forbes.com/sites/kenrapoza/2015/04/09/whats-behind-china-life-insurers-buying-up-american-real-estate/2/.

129 Business Insider, “Chinese Insurers to Spend $73B on Global Property Market,” Real Deal, December 1, 2015. 

http://therealdeal.com/2015/12/01/chinese-insurers-to-spend-73b-on-global-property-market/.

130 Hui-yong Yu, “China’s HNA Group Buys 15 Percent of Red Lion Hotels,” Bloomberg Business, June 16, 2015. 

http://www.bloomberg.com/news/articles/2015-06-16/china-s-hna-group-buys-15-of-red-lion-hotels.

131 Brendan McDermid, “China’s HNA Group Agrees to Buy Carlson Hotels,” Reuters, April 28, 2016. http://www.reuters.com/article/uscarlson-hotels-m-a-hna-idUSKCN0XP011.

132 Brendan McDermid, “China’s HNA Group Agrees to Buy Carlson Hotels,” Reuters, April 28, 2016. http://www.reuters.com/article/uscarlson-hotels-m-a-hna-idUSKCN0XP011.

133 Brendan McDermid, “China’s HNA Group Agrees to Buy Carlson Hotels,” Reuters, April 28, 2016. http://www.reuters.com/article/uscarlson-hotels-m-a-hna-idUSKCN0XP011.

134 Natalie Rodriguez, “CFIUS Clears $1.95B Waldorf Sale to Chinese Insurance Co.” Law 360. 

http://www.law360.com/articles/617431/cfius-clears-1-95b-waldorf-sale-to-chinese-insurance-co.

135 David McLaughlin, “Waldorf Sale to Chinese Firm Risks U.S. Review over Spying Concerns,” Insurance Journal, November 9, 2014. 

http://www.insurancejournal.com/news/east/2014/11/09/346343.htm.

136 David Leveille, “Are Waldorf Astoria Hotel Rooms Bugged,” Public Radio International, September 14, 2015. 

http://www.pri.org/stories/2015-09-14/are-waldorf-astoria-hotel-rooms-bugged.

137 David Leveille, “Are Waldorf Astoria Hotel Rooms Bugged,” Public Radio International, September 14, 2015. 

http://www.pri.org/stories/2015-09-14/are-waldorf-astoria-hotel-rooms-bugged.

138 Ding Feng, “What’s Driving Insurer Anbang’s Big Bang?” Caixin Online (English edition), February 4, 2015. 

http://english.caixin.com/2015-02-04/100781458.html

139 Ding Feng, “What’s Driving Insurer Anbang’s Big Bang?” Caixin Online (English edition), February 4, 2015. 

http://english.caixin.com/2015-02-04/100781458.html

140 David Barboza, “Chinese Return to the Waldorf, with $2 Billion,” New York Times, October 8, 2014. 

http://dealbook.nytimes.com/2014/10/08/chinese-return-to-the-waldorf-with-2-billion/.

141 David Leveille, “Are Waldorf Astoria Hotel Rooms Bugged,” Public Radio International, September 14, 2015. 

http://www.pri.org/stories/2015-09-14/are-waldorf-astoria-hotel-rooms-bugged.

142 Natalie Rodriguez, “CFIUS Clears $1.95B Waldorf Sale to Chinese Insurance Co.” Law 360. 

http://www.law360.com/articles/617431/cfius-clears-1-95b-waldorf-sale-to-chinese-insurance-co.

143 White House Office of the Press Secretary, “Fact Sheet: President Xi Jinping’s Visit to the United States,” September 25, 2015. 

https://www.whitehouse.gov/the-press-office/2015/09/25/fact-sheet-president-xi-jinpings-state-visit-united-states.
U.S.-China Economic and Security Review Commission 27 

 

144 Chicago Economic Review, “Travel Restrictions Eased,” January 1, 2002. http://www.chinaeconomicreview.com/node/30536.

145 Gabrielle Jaffe, “How the Chinese Learned to Embrace Individual Travel,” Atlantic, October 21, 2013. 

http://www.theatlantic.com/china/archive/2013/10/how-the-chinese-learned-to-embrace-independent-travel/280737/.

146 Human Rights Watch, “One Passport, Two Systems.” https://www.hrw.org/report/2015/07/13/one-passport-two-systems/chinasrestrictions-foreign-travel-tibetans-and-others.

147 Human Rights Watch, “One Passport, Two Systems.” https://www.hrw.org/report/2015/07/13/one-passport-two-systems/chinasrestrictions-foreign-travel-tibetans-and-others.

148 U.S. Department of State, “The United States and China to Extend Visas for Short-term Business Travelers, Tourists, and Students,” 

November 10, 2014. http://www.state.gov/r/pa/prs/ps/2014/11/233904.htm.

149 U.S. Department of State, Immigrant Visa Statistics. http://travel.state.gov/content/visas/en/law-and-policy/statistics/non-immigrantvisas.html.

150 U.S. Department of State, Nonimmigrant Visa Issuances by Visa Class and Nationality. http://travel.state.gov/content/visas/en/law-andpolicy/statistics/non-immigrant-visas.html.

151 Gary Chodorow, “Obama’s Executive Order on Planning for Improved U.S. Visa Processing in China,” U.S. & China Visa Law Blog, 

January 28, 2012. http://lawandborder.com/obamas-executive-order-on-planning-for-improved-u-s-visa-processing-in-china/.

152 Hotels.com “Chinese International Travel Monitor 2014.” 

https://press.hotels.com/content/themes/CITM/assets/pdf/CITM_UK_PDF_2014.pdf.

153 The White House Office of the Press Secretary, Fact Sheet: Supporting American Job Growth and Strengthening Ties by Extending 

U.S./China Visa Validity for Tourists, Business Travelers, and Students, November 10, 2014. https://www.whitehouse.gov/the-pressoffice/2014/11/10/fact-sheet-supporting-american-job-growth-and-strengthening-ties-extendi.

154 The White House Office of the Press Secretary, Fact Sheet: Supporting American Job Growth and Strengthening Ties by Extending 

U.S./China Visa Validity for Tourists, Business Travelers, and Students, November 10, 2014. https://www.whitehouse.gov/the-pressoffice/2014/11/10/fact-sheet-supporting-american-job-growth-and-strengthening-ties-extendi.

155 The White House Office of the Press Secretary, Executive Order Establishing Visa and Foreign Visitor Processing Goals and the Task 

Force on Travel and Competitiveness, January 19, 2012. https://www.whitehouse.gov/the-press-office/2012/01/19/executive-orderestablishing-visa-and-foreign-visitor-processing-goals-a.

156 U.S. Department of State, The United States and China to Extend Visas for Short-term Business Travelers, Tourists, and Students,

November 10, 2014. http://www.state.gov/r/pa/prs/ps/2014/11/233904.htm.

157 TravelChinaGuide.com, “China Outbound Tourism in 2014.” http://www.travelchinaguide.com/tourism/2014statistics/outbound.htm.

158 U.S. Department of State, U.S.-China Air Transport Agreement of July 9, 2007. http://www.state.gov/e/eb/rls/othr/ata/c/ch/114749.htm.

159 U.S. Department of State, U.S.-China Air Transport Agreement of July 9, 2007. http://www.state.gov/e/eb/rls/othr/ata/c/ch/114749.htm.

160 U.S. Department of Transportation, Notice of Action Taken Re: Delta Air Lines, Inc., January 16, 2015. 

http://www.regulations.gov/#!documentDetail;D=DOT-OST-2015-0005-0003.

161 OAG Aviation Worldwide Limited, “Is It Time for China-U.S. Open Skies?” December 2014. 

http://www.oag.com/sites/default/files/Dec2014_China_US_OpenSkies.pdf.

162 Fang Yan, “U.S.-China Aviation Talks Hit Stumbling Block on Airport Access,” Reuters, August 13, 2015. 

http://www.reuters.com/article/us-usa-china-aviation-idUSKCN0QI0OO20150813.

163 Fang Yan, “U.S.-China Aviation Talks Hit Stumbling Block on Airport Access,” Reuters, August 13, 2015. 

http://www.reuters.com/article/us-usa-china-aviation-idUSKCN0QI0OO20150813.

164 OAG Aviation Worldwide Limited, “Is It Time for China-U.S. Open Skies?” December 2014. 

http://www.oag.com/sites/default/files/Dec2014_China_US_OpenSkies.pdf.

165 Fang Yan, “U.S.-China Aviation Talks Hit Stumbling Block on Airport Access,” Reuters, August 13, 2015. 

http://www.reuters.com/article/us-usa-china-aviation-idUSKCN0QI0OO20150813.

166 Fang Yan, “U.S.-China Aviation Talks Hit Stumbling Block on Airport Access,” Reuters, August 13, 2015. 

http://www.reuters.com/article/us-usa-china-aviation-idUSKCN0QI0OO20150813.

167 Terry Maxon, “The Trouble with Getting Takeoff and Landing Slots in China,” Dallas Morning News, April 27, 2010. 

http://aviationblog.dallasnews.com/2010/04/the-trouble-with-getting-takeo.html/.

168 Charlotte So, “Watchdog Acts on Landing-Slot Corruption,” South China Morning Post, July 15, 2010. 

http://www.scmp.com/article/719763/watchdog-acts-landing-slot-corruption.

169 Charlotte So, “Watchdog Acts on Landing-Slot Corruption,” South China Morning Post, July 15, 2010. 

http://www.scmp.com/article/719763/watchdog-acts-landing-slot-corruption.

170 BBC, “Beijing Airport’s Ex-Boss Jailed for Corruption,” December 8, 2011. http://www.bbc.com/news/world-asia-china-16082573.

171 Peng Pu, “The Routes of Corruption,” Global Times, August 4, 2010. 

http://www.lifeofguangzhou.com/node_10/node_37/node_82/2010/08/05/128097303879043.shtml.

172 Charlotte So, “Watchdog Acts on Landing-Slot Corruption,” South China Morning Post, July 15, 2010. 

http://www.scmp.com/article/719763/watchdog-acts-landing-slot-corruption.

173 U.S. Department of Commerce, Forecast of International Travelers to the United States by Top Origin Countries, October 2015. 

http://travel.trade.gov/view/f-2000-99-001/forecast/Forecast-COUNTRIES.pdf.

174 “Number of Passengers of the Beijing Capital International Airport from 2008 to 2015,” Statistica.com. 

http://www.statista.com/statistics/256624/passenger-throughput-of-beijing-capital-international-airport/.

175 Bradley Perret, “Guangzhou Baiyun Airport Begins Expansion Work,” Aviation Week, August 8, 2012.

http://aviationweek.com/commercial-aviation/guangzhou-baiyun-airport-begins-expansion-work; Dominic Jackson, “Work Begins on 

New Satellite Terminals at Pudong Airport,” Shanghaiist, December 30, 2015. 

http://shanghaiist.com/2015/12/30/work_begins_on_pudong_airport_expansion.php; William Dennis, “Congestion Facing Chinese 
U.S.-China Economic and Security Review Commission 28 

 

Airlines away from Big Three Airports,” Aviation International News, September 23, 2013. http://www.ainonline.com/aviationnews/air-transport/2013-09-23/congestion-forcing-chinese-airlines-away-big-three-airports; Statistica.com, “Leading Airports in China 

in 2014 by Passenger Throughput.” http://www.statista.com/statistics/258220/leading-airports-in-china-by-passenger-throughput/; Li 

Derun, “March 11 Hongqiao Airport Press Conference Highlights.” 

http://www.shanghai.gov.cn/shanghai/node27118/node28689/node28691/userobject22ai38120.html; and Shanghai Airport Authority, 

“Pudong Airport to Have World’s Biggest Satellite Hall.” http://en.shairport.com/2015-06/16/content_21020392.htm.

176 U.S. Department of Commerce, Forecast of International Travelers to the United States by Top Origin Countries, October 2015. 

http://travel.trade.gov/view/f-2000-99-001/forecast/Forecast-COUNTRIES.pdf.

177 World Bank, “GDP Per Capita (Current US$).” http://data.worldbank.org/indicator/NY.GDP.PCAP.CD?page=1.

178 International Monetary Fund, “Report for Selected Countries and Subjects.” 

http://www.imf.org/external/pubs/ft/weo/2015/02/weodata/weorept.aspx?pr.x=26&pr.y=2&sy=2013&ey=2020&scsm=1&ssd=1&sort=

country&ds=.&br=1&c=924&s=NGDPDPC&grp=0&a=.

179 World Tourism Cities Federation Ipsos, Market Research Report on Chinese Outbound Tourist Consumption, August, 2014. 

http://www.ccilc.pt/sites/default/files/relatorioturistachines.pdf.

180 U.S. Department of Commerce – National Travel and Tourism Office, 2009 Market Profile: China, May 2010.

http://travel.trade.gov/outreachpages/download_data_table/2009_China_Market_Profile.pdf. Travel and Tourism Office, 2010 Market 

Profile: China, May 2011. http://travel.trade.gov/outreachpages/download_data_table/2010_China_Market_Profile.pdf; U.S.

Department of Commerce – National Travel and Tourism Office, 2011 Market Profile: China, May 2012. 

http://travel.trade.gov/outreachpages/download_data_table/2011_China_Market_Profile.pdf; U.S. Department of Commerce – National 

Travel and Tourism Office, 2012 Market Profile: China, August 2013. 

http://travel.trade.gov/outreachpages/download_data_table/2012_China_Market_Profile.pdf; U.S. Department of Commerce – National 

Travel and Tourism Office, 2013 Market Profile: China, June 2014. 

http://travel.trade.gov/outreachpages/download_data_table/2013_China_Market_Profile.pdf; U.S. Department of Commerce – National 

Travel and Tourism Office, 2014 Market Profile: China, June 2015.

http://travel.trade.gov/outreachpages/download_data_table/2014_China_Market_Profile.pdf.

181 Chinese Ministry of Commerce, Interim Measures for the Supervision and Administration of the Pilot Operation of the Outbound 

Tourism Business by Sino-Foreign Joint Venture Travel Agencies, August 29, 2010. 

http://www.lawinfochina.com/display.aspx?lib=law&id=8489&CGid.

182 European Union SME Center, “The Tourism Market in China,” September 22, 2015. http://www.eusmecentre.org.cn/report/tourismmarket-china. 

183 American Express Global Business Travel, “CITS American Express Business Travel Wins the 2015 Corporate Travel Management 

Company of the Year Award,” August 5, 2015. https://www.amexglobalbusinesstravel.com/blog/cits-american-express-global-businesstravel-wins-2015-corporate-travel-management-company-year-award-travel-weekly-china/.

184 European Union SME Center, “The Tourism Market in China,” September 22, 2015. http://www.eusmecentre.org.cn/report/tourismmarket-china.

185 European Union SME Center, “The Tourism Market in China,” September 22, 2015. http://www.eusmecentre.org.cn/report/tourismmarket-china.

186 CITS.com, “Leading Enterprise in China’s Tourism Industry!” http://www.cits.net/.

187 Select USA, “The Travel, Tourism and Hospitality Industry in the United States.” http://selectusa.commerce.gov/industrysnapshots/travel-tourism-and-hospitality-industry-united-states.html; U.S. Department of Commerce – Bureau of Economic Analysis, 

National Economic Accounts. http://data.worldbank.org/indicator/NY.GDP.MKTP.CD.

188 U.S. Department of Commerce, International Data: International Transactions, International Services, and International Investment 

Position Tables. http://www.bea.gov/iTable/bp_download_modern.cfm?pid=11.

189 U.S. Department of Commerce – National Travel and Tourism Office, International Travel Receipts and Payments Program. 

http://travel.trade.gov/pdf/2014-Top-10-Markets.pdf.

190 U.S. Department of Commerce – National Travel and Tourism Office, 2014 Market Profile: China, June 2015. 

http://travel.trade.gov/outreachpages/download_data_table/2014_China_Market_Profile.pdf.

191 U.S. Department of Commerce – Bureau of Economic Analysis, International Data, U.S. International Trade in Services, June 16, 

2016. http://www.bea.gov/iTable/iTable.cfm?reqid=62&step=1#reqid=62&step=6&isuri=1&6210=1&6200=51. U.S. Department of

192 Miriam Jordan, “U.S. Schools Draw More Chinese,” Wall Street Journal, December 17, 2015. http://www.wsj.com/articles/u-s-schoolsdraw-more-chinese-1450400223.

193 Renee Dudley, “As SAT Was Hit by Security Breaches, College Board Went Ahead with Tests That Had Been Leaked,” Reuters, 

March 28, 2016. http://www.reuters.com/investigates/special-report/college-sat-one/.

194 Gary Chodorow, “Shady Chinese Agencies Promoting U.S. Birth Tourism-Part 3: Policy Responses,” U.S. & China Visa Law Blog,

March 4, 2015. http://lawandborder.com/shady-chinese-agencies-promoting-u-s-birth-tourism-part-3/.