Digital DNA Empowers Integration of Public and Commercial Health Insurance: WeDoctor Builds a New Multi-Payer Ecosystem

On March 23, at a press conference held by the National Health Commission (NHC), Mao Qun’an, Director of the Department of Planning and Information of the NHC, stated that, according to incomplete statistics, more than 7,700 hospitals at the secondary level and above have established appointment-based diagnosis and treatment systems and provide online services. The number of internet hospitals built across China has exceeded 1,100.

Mao Qunan pointed out that “Internet + Healthcare” has gradually shifted from an “optional” to a “mandatory” component in many medical institutions, evolving from a “nice-to-have” into a “critical necessity.” Internet-based healthcare has become an integral part of medical services, providing the public with better and more convenient experiences during diagnosis and treatment.

Since 2020, in the fight against the epidemic, digital medical services provided by platform-based internet hospitals have broken down temporal and spatial barriers. These services have facilitated the screening of mild cases and patient triage, particularly addressing the needs of chronic disease patients for follow-up visits and medication refills. By collaborating with the existing healthcare system and leveraging complementary strengths, they have delivered convenient and efficient medical services to the public. During this period, the number of users and online consultations on national internet healthcare platforms grew exponentially. According to survey data from iiMedia Research, 74.4% of Chinese internet users utilized internet healthcare services during the epidemic, and 67.1% reported an increased acceptance of such services.

As the user value created by digital healthcare services gains widespread recognition, a diversified payment system is also accelerating its formation.According to public reports, during the pandemic last year, WeDoctor, a digital healthcare service platform, took the lead nationwide in enabling online medical insurance payments for internet hospitals. At its peak, WeDoctor’s General Internet Hospital handled 97% of Wuhan’s online follow-up visits for chronic diseases, effectively reducing the risk of cross-infection associated with offline medical visits and ensuring that patients with chronic conditions received their medications on time and in accordance with standard protocols throughout the pandemic.

Driven by the pandemic environment, and in response to and to meet the public’s growing demand for digital healthcare services, the state has rapidly and proactively introduced supportive policies. A series of policy documents, including the “Opinions on Deepening the Reform of the Medical Security System” and the “Guiding Opinions of the National Healthcare Security Administration on Actively Promoting Medical Insurance Payment for ‘Internet+’ Healthcare Services,” have all put forward requirements to advance online medical insurance payment and foster the development of new business models and innovations in “Internet+” healthcare.

At the press conference on the 23rd, Xiong Xianjun, Director of the Department of Pharmaceutical Services Management under the National Healthcare Security Administration, stated that all provinces (autonomous regions and municipalities) across China have issued policies regarding pricing and medical insurance reimbursement for “Internet+” medical services. The categories of “Internet+” medical services primarily include online follow-up consultations, remote consultations, and remote monitoring.Deep integration with medical insurance will further enhance the affordability of digital healthcare services, allowing an increasing number of people to enjoy the health benefits brought by technology.

The gradual opening of medical insurance policies presents both opportunities and challenges for the industry. As the primary payment mechanism for formal medical services in China, basic medical insurance covers over 95% of the population, naturally establishing itself as the most stringent and highest-standard payer. Gaining approval from medical insurance authorities requires healthcare providers to demonstrate high efficiency and compliance across all aspects, including physician qualifications, quality of medical services, and the security of medical insurance funds.Particularly against the backdrop of mounting pressure on medical insurance funds and increasingly stringent cost-containment measures, the ability to enhance the operational efficiency of these funds has become a critical prerequisite for digital healthcare services to integrate with medical insurance payment systems.

WeDoctor, dedicated to the digitalization of serious medical services, has also provided a benchmark for industry research and reference. In Tai’an, Shandong Province, WeDoctor leveraged its internet hospital to implement China’s first city-level digital chronic disease management model with direct medical insurance reimbursement, while offering full-process intelligent medical insurance supervision featuring “pre-event alerts, in-process control, and post-event audits.” Over the course of more than one year, the average prescription cost per chronic disease visit in the area decreased by 12.7%, medical insurance expenditures were reduced by over 10%, and patients’ out-of-pocket expenses dropped by more than 5%.

In Tianjin, WeDoctor has spearheaded the establishment of the Tianjin Primary Care Digital Health Consortium by leveraging its internet hospital platform and coordinating with 267 primary healthcare institutions across the city. This initiative has achieved unified management, shared responsibility, benefit sharing, and standardized services. It is vigorously driving the reform of diagnosis-related group (DRG) payment under medical insurance and the implementation of a health-centered accountable care system, thereby enabling primary care settings to provide preventive care for pre-disease conditions, diagnostic services for illnesses, treatment for minor ailments, referral for severe diseases, and management of chronic conditions.

Digital healthcare services have also driven the development of commercial health insurance. For a long time, China’s healthcare system has suffered from a single-payer structure, placing a heavy burden on public medical insurance. With a penetration rate of less than 5%, commercial health insurance has enormous unmet demand; however, it faces numerous pain points, including the lack of policyholders’ health data and insufficient post-underwriting health management resources and services.By deeply integrating with the national medical insurance system, digital healthcare service platforms will effectively empower commercial health insurance, establish an integrated payment system combining public and private insurance, and promote the deep convergence and development of insurance and health management.

Taking WeDoctor as an example, leveraging its advantages in integrating medical insurance, consolidating healthcare resources, and providing medical services and health management, WeDoctor collaborates with commercial insurance institutions to develop customized, cost-effective health insurance products for users. Its regional health insurance product, “Qilu Bao,” launched in Shandong Province, provides additional commercial health coverage for local residents enrolled in basic medical insurance. This supplement expands the scope of coverage under basic medical insurance, alleviates pressure on medical insurance expenditures, and significantly reduces the financial burden on patients. Currently, the launch of similar inclusive health insurance products (“Huimin Bao”) in various local markets has been widely welcomed by users, fully demonstrating the public’s demand for more diverse payment options in healthcare services.

The “Outline of the ‘Healthy China 2030’ Planning” proposes to improve a multi-tiered medical security system with basic medical insurance as the main body, supplemented by various other forms of supplementary insurance and commercial health insurance, aiming for a mature and well-established national health insurance system by 2030. It is evident that the immense value brought by the inherent “digital genes” of digital healthcare to payers such as medical insurance and commercial insurance is becoming increasingly prominent. Digital healthcare platforms are emerging as key participants in building this multi-tiered medical security system, which will further accelerate the establishment of a diversified payment system and drive the overall digital transformation of China’s healthcare system.