China Research Hospital Association's Internet Hospital Branch Establishes Insurance Payment & Industrial Finance Working Group to Break Industry Barriers

After years of exploration, the payment bottleneck in internet healthcare has yet to be truly broken; neither medical insurance reimbursement nor commercial insurance payment has achieved scale. Meanwhile, constrained by the long growth cycle characteristic of the healthcare industry, internet healthcare companies still require sustained capital support.

In response to the current state of these two major industries, the Insurance Payment and Industrial Finance Working Group was established in Zhuhai on August 23 by the Internet Hospital Branch of the Chinese Research Hospital Association. The working group’s initial cohort includes more than 20 representatives from enterprises and public institutions, such as officials from the National Health Commission’s Information Service Platform for the Promotion and Application of Health Technologies, business leaders from select public hospitals, as well as founders and senior executives from internet healthcare companies, healthcare informatics firms, and insurance companies.

As part of the inaugural China Internet Hospital Conference, the academic group concurrently hosted a sub-forum on internet insurance payment and industrial finance during its founding ceremony. The discussions focused on topics such as how insurance payment mechanisms can integrate with internet-based healthcare, and how capital and technology can facilitate the development of internet healthcare.

The Internet Insurance Payment and Industrial Finance Research Group was established under the leadership of Wang Haitao, Executive Vice President of the Internet Hospital Branch of the Chinese Research Hospital Association and Executive Deputy Director of the Training Center at Peking Union Medical College, Chinese Academy of Medical Sciences. At the sub-forum held on August 23, Wang Haitao elaborated on the value, significance, and strategic plan for the establishment of the research group.

Wang Haitai Introduces the Insurance Payment and Industrial Finance Working Group

Wang Haitao introduced that since its inception in 2014, the internet healthcare sector has seen most companies still in their early stages; however, opportunities and challenges currently coexist. The opportunities stem from post-pandemic policy support and user growth, while the challenges arise from increasingly intense competition.

Since the beginning of this year, internet diagnosis and treatment services have rapidly integrated with medical insurance. Regions such as Beijing, Shanghai, and Hubei have achieved online follow-up visit reimbursement settlements within a short period. “Many hospitals are eager to showcase their first internet diagnosis and treatment bills covered by medical insurance, as this is a significant milestone,” said Wang Haitao. He believes that the payment side provides the most critical support and constraint for the service side. The inclusion of medical insurance payment signifies the emergence of payers willing to cover internet healthcare services, indicating that the industry’s characteristics and value are beginning to materialize.

Wang Haitao introduced that, against this backdrop, the branch has decided to establish a Working Group on Insurance Payment and Industrial Finance. The group aims to pool collective wisdom and efforts through policy interpretation, industry exchanges, and industrial linkages, thereby jointly facilitating the rapid development of internet-based healthcare. “We hope to provide a broader perspective for all stakeholders through platform-based initiatives.”

Among the first batch of members admitted to the study group are relevant officials from the Health Technology Promotion and Application Information Service Platform of the National Health Commission, heads of related departments at public hospitals such as the First Affiliated Hospital of China Medical University and the First Affiliated Hospital of USTC, as well as founders and senior executives from internet healthcare companies, healthcare IT firms, insurance enterprises, and investment institutions, totaling more than 20 individuals. “Our membership is capped at 50, with the aim of truly building an inclusive, open, and innovative platform.”

Over the next five months, the study group will conduct industry research, including surveys of enterprises, hospitals, and physicians, to explore the development and pilot implementation of activity formats. In the following year, the group will establish exclusive branded activities, such as industry courses, city salons, and industry reports, to demonstrate its influence and social value within the sector. Within three years, the study group aims to build an influential activity brand.

To facilitate the promotion of internet medical technology projects, Dr. Zhao Yanhua from the National Health Technology Promotion and Application Information Service Platform introduced the platform’s basic functions and promotion strategies at a sub-forum.

The National Health Technology Promotion and Application Information Service Platform, hosted by the Migrant Population Service Center of the National Health Commission, leverages information technology to integrate business processes for health technology promotion, dynamic management of health technologies, and project construction and implementation. It serves as an information-sharing platform that facilitates real-time and efficient communication between suppliers and demanders of health technologies.

Zhao Yanhua introduced that, in light of the actual conditions of internet healthcare, the platform can select and promote technical projects submitted by enterprises. At the promotion level, the platform will facilitate project visibility through 21 different models, including expert-led promotion, conference-based promotion, demonstration projects, and publications.

At the sub-forum, Shi Yun from SPP, a strategic partner of Sun Life Financial in Canada, introduced the North American model of internet-based health management, providing references for insurance payment mechanisms in China’s internet healthcare sector.

According to Shi Yun, the Best Doctors model in North America is a typical example of integrating healthcare with the internet and insurance. The Best Doctors network connects 50,000 physicians worldwide, enabling patients to quickly identify the most suitable top-tier doctors via the internet and access their treatment recommendations. If patients or their family members have purchased insurance, they can use the Best Doctors service free of charge; otherwise, an annual membership fee is required.

In addition to the Best Doctors network, insurance companies have also integrated with other telemedicine service systems. For example, Sun Life Insurance has developed its own Lumino Health Virtual Care platform, through which insured customers can access 24-hour telemedicine services via the internet.

Manulife’s Health Service Navigator system follows a similar model: upon purchasing insurance, customers effectively receive a pass that grants them access to the company’s healthcare management network, where they can consult with various physicians.

Furthermore, Manulife has launched the Vitality program, under which an Apple Watch is issued to customers upon enrollment to record their lifestyle behaviors and health data, providing a reference for subsequent premium calculations.

Liu Hui, General Manager of VCBeat, also analyzed global trends in digital health development at the sub-forum, aiming to provide practitioners with a broader perspective.

Liu Hui introduced that digital health refers to an industrial cluster that collects, stores, analyzes, and transmits various types of consumer and patient data in daily life and medical scenarios, providing users with healthcare products and services throughout their entire lifecycle. Digital health encompasses concepts from numerous fields, including mobile health, telemedicine, healthcare informatization, and medical big data.

In recent years, the global digital health sector has exhibited four major development trends: first, investment activity remains robust, with digital health becoming the second most capital-active sector after biopharmaceuticals; second, major global pharmaceutical companies are entering the digital health space through R&D collaborations, commercial partnerships, and mergers and acquisitions; third, IT firms, e-commerce platforms, and retail chain giants are actively expanding their presence in the digital health domain; and fourth, digital health is achieving policy breakthroughs on a global scale.

“Given the rapid and profound transformations in the digital health industry, relying solely on images and text makes it difficult to capture the full picture. Thus, VCBeat Orange Industry Think Tank was established, with the aim of mapping industrial changes through data,” introduced Liu Hui. The VCBeat Orange Industry Think Tank aggregates over 500 high-quality global media sources in healthcare and life sciences, updates hundreds of events daily, and provides continuous coverage across 32 sub-sectors within the three major domains of digital health. It offers a comprehensive, multi-dimensional analysis of industry trends from perspectives including policy, market dynamics, investment and financing, and product development.

During the panel discussion session of this sub-forum, participating guests from Chaoqian Technology, Chunyu Doctor, VCBeat, Dongying Finance, Guoan Guangchuan, Haokinqing Internet Hospital, Kingdee Medical, Miao Health, PICC Health, Renqian Medical Management, WeDoctor Group, The First Affiliated Hospital of USTC, Sinosoft, Zhongwei Baiyi, and Zhuojian Technology, among others, drew on their respective expertise to discuss issues such as payment barriers and collaboration barriers within the industry.

On-Site of the Sub-Forum on Insurance Payment and Industrial Finance

Conference attendees noted that in the field of internet healthcare, improving insurance payment mechanisms can better address patient needs, increase consultation volumes at internet hospitals, and compel internet medical institutions to optimize their services, thereby fostering a virtuous cycle within the industry. Meanwhile, as internet hospitals are supervised by provincial regulatory platforms, full-process regulatory data facilitates improved efficiency in monitoring medical insurance funds. Commercial insurers and health management platforms can also drive service and product innovations tailored to the needs of internet hospital users, thereby enhancing their competitiveness.

However, as insurance coverage gradually expands, certain practical challenges have emerged, such as inconsistent reimbursement processes and standards among insurers, as well as varying interface requirements for healthcare providers, all of which hinder the overall operational efficiency of the industry. In promoting the establishment of these standards, industry organizations can play a more significant role than individual enterprises.

Furthermore, investment institutions remain optimistic about internet healthcare, particularly projects with advantages in model innovation and payment innovation, as well as those leveraging advanced digital technologies.

Wang Haitao believes that in the field of internet healthcare, medical insurance still adheres to the principles of providing basic coverage and ensuring broad accessibility, with commercial insurance playing a complementary role in the future. The combination of medical insurance payments, commercial insurance payments, and out-of-pocket payments will jointly improve the payment loop for internet healthcare, which is consistent with offline medical services.

However, internet-based healthcare is a novel service model, and the corresponding forms of commercial insurance will be more flexible. Meanwhile, continuous exploration and practice at both the policy and industry levels are required to establish standards for assessing online consultation practices and defining the scope of reimbursement under commercial insurance.

“Payment barriers and collaboration barriers have long persisted in the internet healthcare industry,” said Wang Haitao. Payment barriers emerged during the transition from offline to online services, while collaboration barriers arose during the shift from internal hospital resources to external resources. Barriers and resistance are not necessarily negative; they can be addressed by leveraging trends, clarifying strategic directions, and optimizing tactics. Specifically, breakthroughs in these barriers are expected by focusing on key areas: quality and safety, cost and revenue, industrial development and upgrading, and efficiency and satisfaction. Moving forward, the study group will also connect its members with more high-quality resources and foster partnership-based collaborative relationships among them.