Gao Jiechun: Internet Healthcare Must Shift from Single-Payment to a Cyclical Subsidy Model
On December 10, the Yinchuan Smart Internet Hospital, jointly established by Haodf Online and the Yinchuan Municipal People’s Government, officially opened. At the inauguration ceremony, Gao Jiechun, Director of the Institute of Hospital Management at Fudan University, addressedThe Concept and Development Trends of Internet HealthcareDelivered a speech. The following highlights were compiled by VCBeat (WeChat Official Account: vcbeat):
Director, Institute of Hospital Management, Fudan University Gao Jiechun
In China, the difficulty of accessing medical care has long been a familiar topic. As China’s healthcare system has evolved to its current state, its changes and development trends have taken on a clear shape: moving from individualized treatment to population-based health management, cross-regional medical care has become inevitable. The key challenge facing internet healthcare is how to enable resource sharing, rather than merely pursuing so-called standardized and orderly utilization.
For every patient, from birth to death, all medical information obtained during visits to any hospital must be fully documented in their medical records. This includes details such as the timing of the first vaccination after birth, diagnoses of diseases, medications administered, all laboratory test reports, X-ray images, and more. This comprehensive collection constitutes the health record—a repository containing all health-related data throughout an individual’s lifetime.
However, in China, every discussion about health records revolves around what data should be included in them. In fact, as long as health records are placed on the internet, everything will be recorded. The databases of the internet are limitless; we can select from them according to our needs. This is what constitutes an internet-based health record.
In the era of internet healthcare, hospitals are shifting from a model centered on large institutions to one based on collaborative network services, leveraging health clouds and telemedicine to serve patients. Under this model, the physical location of major hospitals becomes less critical; any area with internet connectivity can function as a hospital service center.
Internet-based healthcare is clearly defined, although its definition has currently been generalized and distorted. Its services should encompass health education, medical information inquiries, electronic health records, disease risk assessment, online disease consultation, and remote consultations, using the internet as the platform and technological means. Particular emphasis should be placed on e-prescriptions and telemedicine.
What is the difference between telemedicine and remote consultation? In remote consultation, the patient remains under the care of the physician at the patient’s end, and the legal entity responsible is the local medical institution, not the party providing the remote consultation. Telemedicine, by contrast, involves a physician issuing an electronic prescription locally to a patient located elsewhere. The question arises: in this model, where does the legal liability for medical practice reside? This is an urgent issue that internet-based healthcare needs to address.
Internet healthcare encompasses a concept with a rather ambiguous definition: mobile health. Mobile health essentially migrates services from PC-based platforms to mobile devices, enabling operations that previously required a computer to be performed more conveniently via smartphones and iPads. Although the processing of mobile data offers greater convenience, it remains fundamentally an extension of internet healthcare, with only the application scenarios having changed.
Another concept is home health and medical monitoring, which is essentially an extension of internet-based healthcare. Its core lies in connecting wearable devices to medical institutions via the internet, enabling patients to receive monitoring and management at home. However, unlike chronic disease management, home health and medical monitoring involves remote physician intervention and guidance for all examinations. The shift from passive medical care to proactive health inevitably includes a transition from disease treatment to disease prevention.
After clarifying these concepts, what medical innovators should truly consider is how to advance toward genuine internet-based healthcare in the future. There have been numerous pilot programs for multi-site physician practice, taking various forms. Companies should not be content with merely providing health management and consultation services; instead, they must explore how to unlock the potential capabilities of internet hospitals. Therefore, the most pressing issue at present is how to establish a distinct Chinese model for internet-based healthcare.
First, regarding principal liability and supervision: many people exaggerate the risks of internet-based healthcare. However, the change in delivery medium does not alter the legal relationship between physicians and patients. Furthermore, physicians are never the legal entities; hospitals are. All third-party platforms must be affiliated with hospitals.
Second, Information Sharing and Privacy Protection. Historically, ownership of medical records has consistently resided with hospitals, preventing patients from taking their records with them. However, any physician who discloses patient privacy and causes harm shall be held legally liable.In fact,Online Medical HistoryOfflinePaper Medical RecordsIn comparison, the latter is moreSusceptible to tampering. Any modification to an electronic medical record leaves a trace in the backend, which constitutes the most authentic and objective medical documentation. Future privacy protection should not conflict with information sharing. The rise of third-party internet platforms will play a significant role, and naturally, the responsibilities they bearalsoLarger.
Third, policy coordination. The rise of internet hospitals is an unstoppable trend, and the challenges of regulation cannot be overlooked. It is the government’s responsibility to regulate the vast number of online medical services and e-pharmacies. The biggest bottleneck lies in health insurance reimbursement. Therefore, there is still much work to be done for internet hospitals. Building consensus and taking action are far more important than securing financing; funds must be allocated to critical and appropriate areas.
Finally, the business model of internet healthcare must evolve beyond simple direct payments. It requires a multi-payer ecosystem involving government funding, hospital contributions, insurance coverage, and patient out-of-pocket payments, ultimately forming a sustainable cycle. The shift from single-source payment to a cyclical subsidy model necessitates the active participation of insurance companies and a multi-pronged approach. Only under the premise of mutual benefit for all stakeholders can the healthcare industry achieve continuous development.