Objective To identify factors associated with health‐care system satisfaction in China. Context Recent research suggests that socio‐demographic characteristics, self‐reported health, income and insurance, ideological beliefs, health‐care utilization, media use and perceptions of services may affect health‐care system satisfaction, but the relative importance of these factors is poorly understood. New data from China offer the opportunity to test theories about the sources of health‐care system satisfaction. Design Stratified nationwide survey sample analysed using multilevel logistic regression. Setting and participants: 3680 Chinese adults residing in family dwellings between 1 November 2012 and 17 January 2013. Main outcome measure Satisfaction with the way the health‐care system in China is run. Results We find only weak associations between satisfaction and socio‐demographic characteristics, self‐reported health and income. We do, however, find that satisfaction is strongly associated with having insurance and belief in personal responsibility for meeting health‐care costs. We also find it is negatively associated with utilization, social media use, perceptions of access as unequal and perceptions of service providers as unethical. Conclusions To improve satisfaction, Chinese policymakers – and their counterparts in countries with similar health‐care system characteristics – should improve insurance coverage and the quality of health services, and tackle unethical medical practices.