Breaking the Prisoner's Dilemma in Grassroots Imaging Services: How Non-Public Healthcare Found a Solution

Healthcare has always been a critical issue affecting people’s livelihoods, and the high-quality development of hospitals has consistently remained a key national priority. Over the years, hospital development across different regions and tiers has been uneven, presenting both opportunities and challenges. The private healthcare sector has also faced considerable difficulties, particularly private hospitals, with more than 2,000 institutions exiting the market in 2021 alone.

In light of the current state of non-public healthcare development, many attribute failures to a lack of policy support. However, this is not the case; the state has consistently maintained a supportive stance toward non-public healthcare, including private hospitals. This year, the "Opinions on Further Improving the Healthcare Service System" issued by the General Office of the State Council also mentioned that social medical institutions can take the lead in forming or participating in medical consortia. This reflects the hope that non-public healthcare will play a complementary role, filling functional gaps left by public hospitals. In practice, however, many private medical institutions either fail to meet development requirements in terms of medical service capabilities and thus cannot effectively supplement public hospitals, or they struggle for survival amid limited medical resources, intense competition, and constrained government support.

Nevertheless, a small number of private healthcare providers have successfully carved out their niche. By specializing in disciplines such as medical imaging, laboratory testing, pathology, and oncology, and delivering ultra-high-quality medical services, they have maintained their competitiveness even during the industry downturn, with some even listing on the secondary market.

Third-party medical imaging centers are a typical example, emerging to address the insufficiency of imaging service capacity within the healthcare system. They serve as an effective complement to public hospitals, facilitating the high-quality development of regional hospitals by providing specialized imaging services.

More importantly, they possess the service capability to drive the “group-based and chain-operated” development of medical imaging. By reshaping the supply-and-demand structure of imaging services, they achieve a multi-party win-win outcome for public healthcare institutions, non-public healthcare providers, the government, and even patients.

Unlike the surging demand for medical imaging services overseas, radiology departments in China’s primary-care hospitals are often viewed as peripheral—mere auxiliary units that have long been neglected.

When purchasing imaging equipment, hospitals rarely consider factors such as return on investment or how to optimize equipment utilization in their decision-making process. Instead, they are more concerned with superficial demands, such as whether the equipment can attract patients and enhance the hospital’s image. For an individual hospital, rather than acquiring low-end equipment merely to break even, it is more advantageous to invest in high-end equipment to bolster its competitiveness.

However, hospitals embroiled in fierce competition can never remain isolated from its effects. Such competition resembles a prisoner’s dilemma: given the limited total number of patients in a region, if one hospital purchases high-end equipment, another must do the same to maintain its competitiveness, triggering an “arms race.” Yet, the critical shortage of physicians in primary care remains largely unaddressed.

Due to the lack of support from a standardized physician education system, cultivating doctors within a single hospital is a long-term investment process with difficult-to-quantify returns. Even if excellent physicians are developed during this process, hospitals may not have the capacity to retain them. Therefore, compared to the risky endeavor of physician training, configuring imaging equipment that delivers immediate results is clearly a more prudent choice.

This cycle repeats, with hospitals investing substantial funds in equipment purchases, yet still lacking the personnel to operate these devices. As a result, a large amount of equipment remains idle in hospitals, failing to deliver their intended utility and value.

To address this situation, the key to solving the problem lies in introducing a third party for resource alignment. This is where the value of third-party imaging centers comes into play. By separating imaging services and providing equal access to equipment, personnel, and other resources to medical institutions within the region, these centers leverage a regional resource-sharing model to strengthen the foundation of grassroots imaging services.

The so-called regional medical imaging sharing center model refers to the integration of medical resources within a given area into a healthcare consortium, establishing a regional medical imaging sharing center. The center implements centralized operational management of imaging equipment, radiologists, and medical imaging services within the region. By adopting the service model of “primary-level acquisition, centralized diagnosis,” it extends the high-quality diagnostic capabilities of the main center to all primary healthcare institutions.

First, to break down management and revenue barriers, the region implements sharing of equipment, personnel, information, and benefits. The advantage of this model lies in eliminating various barriers between different hospitals within the region, enabling unified management of imaging equipment, personnel, and information across the entire area, thereby maximizing the safe and efficient utilization and operation of relevant resources.

Secondly, medical consortiums can integrate limited physician resources and extend them to primary care settings through internet and artificial intelligence technologies, enabling hospitals in remote areas to access diagnostic and treatment capabilities provided by high-quality physicians, thereby promoting the implementation of tiered diagnosis and treatment.

Furthermore, a unified training system for radiologists can be established. When imaging centers within a region are scattered and fragmented, the teaching efficiency of senior physicians is low, the number of trainees they can mentor is extremely limited, and the training lacks standardization. With the establishment of a regional medical imaging sharing center model, the expertise of senior physicians can be standardized and disseminated to a larger cohort of learners through “outreach and inbound” teaching approaches, thereby fundamentally addressing the issue of healthcare resource supply.

In practice, pioneers in third-party imaging centers such as RadNet and Alliance Healthcare Services have long demonstrated the cost and standardization advantages brought by large-scale imaging management. In China, a typical example is the “Xinyu Medical Imaging Sharing Center Model,” developed with the participation of RIMAG, a domestic third-party imaging center operator.

The so-called medical imaging medical consortium integrates medical resources within the same region. It typically forms a healthcare alliance comprising tertiary hospitals, secondary hospitals, community hospitals, and township hospitals within a given area, establishing a regional medical imaging sharing center with a spatial layout that ensures full coverage across “city-county-township” levels.

Taking the Xinyu Medical Imaging Sharing Center model as an example, nearly all diagnostic examinations available at provincial-level hospitals can now be performed at Xinyu Municipal Hospital, with maximized utilization of equipment capabilities. For instance, the number of CT and MRI examinations for secondary anatomical regions has increased from over 70 and 40, respectively, to more than 110 and 80. Meanwhile, the expansion of diagnostic services has facilitated the adoption of new clinical diagnostic and therapeutic techniques, with more than 10 new technologies introduced since 2018.

In terms of interoperability, 100% of test results within the center’s system are mutually accessible and recognized. Building on the existing foundation of four municipal hospitals (Xinyu People’s Hospital, Xinyu Traditional Chinese Medicine Hospital, Xinyu Maternal and Child Health Hospital, and Mining Industry Hospital), one county-level hospital (Fenyi County People’s Hospital), and three township health centers, nine additional township data connectivity platforms were newly established in 2020, all of which have been incorporated into the management of the Imaging Center.

On this basis, patients can access equipment-based examination services at any hospital within the shared center. For instance, if a patient undergoes imaging at a primary township medical institution, the Imaging Center can issue a diagnostic report within 30 minutes. The patient can then present this diagnostic report for treatment at any hospital within the central service system, while the Municipal Imaging Diagnostic Center also provides consultations for complex and difficult cases. This sharing model has essentially achieved mutual recognition of medical imaging diagnostic results within the county, providing imaging examination and diagnostic support for the construction of medical consortia; it has initially established a preliminary tiered diagnosis and treatment model characterized by "township-level examinations, county-level diagnoses, vertical integration, and information connectivity."

Furthermore, the “shared model” has enhanced internal management efficiency. Following the integration of personnel from the DR, CT, and MRI departments across various hospitals, the center established and improved measures and records for imaging quality control, critical value reporting, senior physician-guided interpretation by junior physicians, interpretation of difficult cases, and disease reporting. Concurrently, administrative management systems were implemented, including duty rosters, shift handovers, morning meetings, departmental affairs meetings, medical error registration, and cadre performance evaluations. Additionally, systems for quality and safety management, the three-tier physician responsibility system, report review, discussion of difficult cases, and critical value reporting were established.

The patient experience has also improved, alongside enhanced working conditions for medical staff. These improvements are mainly reflected in better clinical environments, optimized care processes, reduced consultation times, assured quality of care, and lower medical costs. In terms of waiting times alone, CT and MRI examinations at Xinyu People’s Hospital have been reduced from the original one day and two to three days, respectively, to just 0.5 days currently. This reduction in queuing time for diagnostic tests has helped alleviate the difficulty of accessing medical care: patients can now receive services from top national experts locally, without needing to travel elsewhere, thereby saving on out-of-town medical expenses and reducing both financial and psychological burdens.

The emergence of the regional medical imaging sharing center model has opened up new avenues for business development in third-party imaging centers. Under the traditional expansion logic, the revenue scale of third-party imaging centers depends on the coverage area of medical institutions. However, by leveraging the advantages in building and managing regional medical imaging sharing centers, new commercial footholds can be explored.

This is a win-win choice. By adopting a regional approach, the platform-based mindset of third-party imaging centers aggregates fragmented medical resources into a unified whole, enabling capabilities that individual hospitals cannot achieve on their own.

During this process, hospitals fully leveraged imaging resources, a regional talent development system was established, physicians enhanced their professional capabilities and income, patients enjoyed more convenient and higher-quality services, and third-party imaging centers achieved a new profitable business model.

Reviewing the various business models of third-party imaging centers, whether they alleviate the imaging workload of public hospitals or undertake the construction of regional medical imaging sharing centers, their core function is to supplement the deficiencies of the public healthcare system and bring incremental value to the entire ecosystem.

As this logic proves viable, all non-public medical institutions may stand to benefit.