Public health and healthcare issues in China have historically attracted individuals and organizations to engage the health sector. The growth of health philanthropy in post-Mao China raises questions regarding the role of the state in the development of China’s health philanthropy. Through a historical overview of health philanthropy in China as well as an examination of the functions and effectiveness of health-related philanthropic actors in the contemporary era, this study has identified the state as a major factor in the development of China’s health philanthropy. Indeed, even though the post-Mao reform dynamics have expanded space for health-related charity organizations, the state continues to have commanding height in health philanthropy in terms of status, funding, services, and influence. The state dominance in turn negatively affects the registration, financing, and capacity building of private foundations and NGOs in this area. Whether the state will dominate health philanthropy in the future to a large extent hinges upon how much extra space it is willing to concede in order to accommodate the dynamics in China’s philanthropic sector.