Background The record-filing process in China’s cross-region healthcare is similar to the “pre-authorization” in the EU, which is the requirement for patients to seek healthcare services outside the affiliated regions. Policymakers are increasingly designing policies that encourage patient choice and giving them the freedom to choose healthcare providers without “pre-authorization”. Some pilot regions in China tried to provide patients with the freedom to choose healthcare services freely without a record-filing process. This study aims to evaluate the effects of the removal of the record-filing process and to provide pieces of evidence for policy decisions on the cross-region healthcare system. Methods In this study, a difference-in-difference model that controlled for potential confounding was applied to ascertain the changes in cross-region inpatient visits, medical expenditures, health insurance payments and medical cost per-visit following the removal of the record-filing process by using cross-region inpatient claim data in the reform region and nonreform region after the policy intervention. Results The number of cross-region inpatient visits and total medical expenditures of cross-region healthcare costs increased significantly by 40.93% ( P =0.010) and 32.41%( P =0.005), respectively. Total health insurance payments increased by 3.83% and were not significant ( P =0.693). The average medical cost per visit for cross-region patients in the treated group was 6.44% lower than that in the control group, also not significantly ( P =0.162). Conclusions The findings suggest that giving patients freedom without a “policy barrier” could significantly encourage more patients to seek healthcare services outside the affiliated regions and increase the total medical expenditures. While the financial concerns of the health insurance funds could be reduced effectively if a higher co-payment was used for cross-region patients.