"Healthy China" Solution: Join Top-Tier Partners to Rebuild the Primary Healthcare Ecosystem!

Primary care serves as the gateway to the healthcare industry and holds immense commercial value. Yet, how barren and fragile is the current primary care market? It fails to uphold the critical mandate of national healthcare reform from above, while struggling to meet the public’s demand for medical services from below. Its services lack both breadth and depth—how, then, can any commercial value be realized?

Today, there is an institution that aims to reconstruct the primary healthcare system, claiming that its underlying ecosystem has taken shape and has already attracted collaborations with companies such as BMJ, GE, IBM, and China Merchants Venture Capital. If your new technology or product is sufficiently “disruptive”—so much so that it can significantly enhance the service capabilities of grassroots physicians and primary care institutions—and if it can establish a business model where insurance providers cover the costs:

Therefore, at this very moment, the Guangdong Family Doctors Association invites you to join the “Healthy China” solution, partnering with leading technology companies and capital to jointly build and share a primary healthcare market that offers both breadth and depth of service.

BMJ is committed to enhancing primary care capabilities, supporting the Healthy China initiative.

——Kong YuyanManaging Director, BMJ China

Partnering with the Guangdong Family Doctors Association to contribute to Healthy China.

——Li DewenZhongke Zhaoshang Investment Management Group Co., Ltd. | Co-President of Guangdong Yuechuang

On June 18, at the “Healthy China” sub-forum of the “2016 Boao Forum for Chinese Entrepreneurs,” Dai Tao, Deputy Director of the Science and Technology Development Research Center under the National Health and Family Planning Commission, stated, “Many reforms may satisfy some stakeholders, but healthcare reform has ended up satisfying no one: doctors are dissatisfied, patients are dissatisfied, and the government is also dissatisfied.”

As soon as this statement was made, WeChat Moments erupted with cheers, as if the frustration held back for years had finally been released. However, from another perspective, it also regretfully illustrates that this round of healthcare reform, launched in 2009, has fallen into a predicament where progress is extremely difficult.

From August 19 to 20, the National Conference on Health and Wellness was held in Beijing. With the attendance of President Xi Jinping and other members of the Standing Committee of the Political Bureau of the CPC Central Committee, the conference was of a very high level. The central leadership also made clear statements, elevating national health to the level of a national strategy.

Xi Jinping emphasized that the current reform of the medical and health care system has entered deep waters, reaching a critical phase requiring determined efforts to tackle hard issues. He pointed out that, in advancing the construction of a Healthy China, it is essential to adhere to the path of health development with Chinese characteristics and properly address several major issues. We must uphold the correct policy direction for health work, focusing on primary care, driven by reform and innovation, prioritizing prevention, placing equal emphasis on traditional Chinese medicine and Western medicine, integrating health into all policies, and promoting joint participation and shared benefits among the people.

What is the Key Focus? Primary Care!

What is the driving force? Reform and innovation!

Wu Yuxiong, Executive Vice President of the Guangdong Family Doctors Association, stated that developing primary care is the most important pathway to achieving a Healthy China, and this has been the sole focus of the association’s work in recent years.

“In fact, healthcare reform has faced significant resistance. Therefore, we started with low-end applications to circumvent regulatory scrutiny, leveraging new technologies and innovative business models to tap into new markets and develop niche segments. This approach helps primary healthcare institutions deliver a broader range of medical services, thereby increasing their revenue to ensure survival and growth,” said Wu Yuxiong.

Over the past few years, Wu Yuxiong has conducted field research across multiple provinces and municipalities in China. Coupled with the strong reception by local governments of his launched products, such as U-Care and Guardian, it has become evident that the government’s two fundamental needs are both urgent and genuine:

Wu Yuxiong stated that focusing on these two areas would directly address the government’s key pain points. Following the National Health and Wellness Conference, he engaged in extensive reflection and concluded that providing the government with a comprehensive “Healthy China” solution would guide his future work strategy.

So, what is the “Healthy China” holistic solution?

To be precise, only the first step has been initiated, namelyIt provides the most critical component of the overall “Healthy China” solution—establishing a primary healthcare service system—which can be further deconstructed into the “underlying ecosystem” and various “specialized services” that grow upon this foundation.

To rebuild the primary healthcare system, the premise is that the existing primary healthcare system is flawed.

The decline of once-bustling village clinics and township health centers from the 1980s, 1990s, and earlier, coupled with the sparse patient flow in urban community health centers, stands in stark contrast to the reality of overnight queues for registration at large tertiary Grade A hospitals. This juxtaposition perhaps illustrates the loss of control within the overall healthcare system and the absence of primary care more effectively than numerous quantitative data reports.

The situation, in which top-tier tertiary hospitals are overcrowded and highly profitable, while primary healthcare institutions suffer from brain drain or fail to attract qualified medical professionals—leading to a continuous decline in their service capacity—has also made it difficult for China’s healthcare system to accommodate innovative products and technologies.

For large tertiary hospitals, there is a lack of economic incentive to drive innovation; furthermore, their operational and business models make it difficult for them to embrace and foster innovation, often even creating conflicts.

Because existing large hospitals and specialized hospitals mix non-standardized medical services with those that can be standardized and streamlined, this complicates the operational systems of healthcare institutions. As a result, most costs are spent on daily operations rather than patient care, leading to high operating expenses.

This situation urgently calls for innovation in business models, and the first step toward such innovation is to differentiate among various business models, ensuring that healthcare institutions’ resources, processes, and revenue models are aligned with the nature of diseases and the precise protocols of treatment.

Compared with institutions adopting the hybrid expert-led and value-added services models, hospitals and physician clinics that exclusively apply the value-added services model can typically provide medical services at 40%–60% lower costs.

[Note: The analysis of the current business models of healthcare institutions in the book The Innovator's Prescription aptly illustrates the conflict between innovative healthcare, represented by mobile health, and the existing healthcare system. This will not be elaborated further here.]

However, it appears that few hospitals are willing to divest medical services that can be standardized and proceduralized. Moreover, it is evident that despite repeated national directives restricting the expansion of large hospitals, many such institutions continue to grow in size.

So, should we pin our hopes for innovation on primary care? Unfortunately, primary healthcare institutions are already struggling to meet their own basic needs. Without enhancing their service capabilities, even tilting medical insurance reimbursement ratios in favor of primary care will yield minimal results. Even with a mandatory first-contact policy at the primary level, if these facilities cannot resolve patients’ health issues, such compulsory policies will merely become a formality.

Therefore, the Association’s starting point is to focus on two key pillars of primary healthcare—diagnostic and therapeutic capabilities for thousands of common diseases, and nursing care—with the aim of enhancing services provided by primary-care physicians and grassroots medical institutions, thereby rebuilding the foundational ecosystem of the primary healthcare system.

To this end, the Guangdong Family Doctor Association independently developed a General Practice Information System, which serves two primary functions:

The “General Practice Information System” primarily comprises an Expert Guidance System and a Clinical Decision Support System. The Expert Guidance System is divided into two components: cloud-based and terminal-based. The cloud component aggregates a large pool of experts, including those featured in the annual “Lingnan Famous Doctors Directory” and star-rated family physicians, while the terminal component serves primary care physicians (or primary healthcare providers). Primary care physicians conduct outpatient consultations at the terminal end and upload patient medical records to the platform in real time. When encountering conditions beyond their scope of practice, they can immediately consult with experts on the platform, thereby reducing misdiagnosis rates and rapidly enhancing their clinical competencies through hands-on guidance. Furthermore, the platform connects with major hospitals, enabling primary care physicians to facilitate bidirectional referrals. During the referral process, mutual evaluations among physicians at different levels of care, combined with doctor-patient mutual assessments, form a comprehensive performance appraisal system for primary care physicians.

The Clinical Decision Support System (CDSS) within the General Practice Information System primarily adopts the Best Practice (BP) system from the BMJ Group to provide clinical decision support for primary care physicians. This helps them rapidly and effectively enhance their diagnostic and treatment capabilities, master the latest medical knowledge, avoid misdiagnosis and missed diagnoses, and standardize treatment protocols. On this basis, strict clinical guidelines are established, transforming indiscriminate prescribing and testing into pre-authorization requirements, thereby preventing overmedicalization. It also defines clear boundaries for basic medical insurance coverage, promotes service homogenization among primary care physicians, and addresses the challenges associated with “initial consultation at the primary care level and tiered diagnosis and treatment.”

The BMJ also features specialized medical education content. Taking the “BMJ Digital Training Program for General Practitioners/Primary Care Physicians” as an example, its three distinct tools—online learning, best clinical practice, and examinations—are essential instruments and effective means for building the generalist competencies of primary care physicians, holding particular promise for rapidly enhancing their clinical proficiency.

The rationale for positioning nursing care as another key pillar is supported by data showing that long-term care insurance in the United States accounts for nearly one-third of the overall life insurance market. This figure fully underscores the importance of nursing care throughout the entire healthcare service continuum, both in terms of medical quality and the commercial value of healthcare services.

Consequently, the Guangdong Family Doctor Association developed a third-party nursing platform called “UHu,” which consolidates nurses’ fragmented availability to collaborate with primary healthcare institutions in providing home-based nursing services to residents. This initiative has not only revitalized existing social nursing resources but also expanded capacity, significantly reducing the societal burden while enabling home-based nursing and elderly care. Launched in Zhuhai in September 2015, the platform overcame initial skepticism and has since rapidly expanded its operations to multiple regions across China, including Guangzhou, Shanghai, Beijing, Nanjing, Wuhan, and Dongguan.

For the population with mental disorders, the Guangdong Family Doctors Association has launched “Guardian,” a cloud-based service platform for Internet-plus mental health. By leveraging business partnerships and expert guidance via the cloud, the platform enhances the clinical capabilities of primary care psychiatrists. It enables a large number of general practitioners to acquire psychiatric qualifications through short-term training, thereby engaging them in the prevention and treatment of mental disorders. This approach shifts the majority of mental disease prevention, treatment, and rehabilitation services from hospitals down to the primary care level.

Meanwhile, by providing real-time dynamic monitoring of patients with severe mental disorders, the Shouhu Platform addresses the challenge of poor medication adherence. This approach not only significantly prevents incidents of violence or harm caused by such patients but also effectively reduces disease relapses and subsequent repeated hospitalizations, thereby saving substantial medical costs for society. Since its launch, the Shouhu Platform has received widespread acclaim from comprehensive social governance departments, health and family planning authorities, psychiatric hospitals, primary care physicians, and caregivers, leading to its extensive adoption. It is expected to fundamentally transform the landscape of mental health prevention and treatment in China.

The Guangdong Family Doctors Association, in collaboration with the China Medical and Health Development Foundation and the Guangdong Mental Health Center, has jointly launched a large-scale public welfare initiative titled “Compassionate End-of-Life Care Across China.” The program plans to hold 1,000 free training sessions across the country within two years, aiming to train 150,000 nurses, primarily those working on the front lines in intensive care units (ICUs), oncology departments, geriatrics departments, and primary care settings. Training sessions have already been conducted in multiple provinces and municipalities nationwide.

Nowadays, many terminally ill patients often undergo repeated resuscitation efforts in large hospitals, which not only increases medical expenses but also exacerbates their suffering. The "Good Death Care China Initiative" advocates for terminally ill patients to return to primary care settings and their homes. Under the care of trained nurses, this approach alleviates symptoms and controls pain through physiological nursing and psychological counseling, thereby reducing or eliminating patients' psychological burdens and negative emotions. This improves the quality of life for terminally ill patients, helping them reach the end of life with peace and dignity.

Following preliminary trials, the foundational ecosystem of the primary healthcare system under the Guangdong Family Doctors Association has begun to take shape, driven by the General Practice Information System and independently developed new products such as UHu and Shouhu.

Today, platforms such as UHu have aggregated a large number of physicians, nurses, and clients. By leveraging the UHu platform, offline primary healthcare institutions can transcend the limitations of physical distance and service scope, thereby undertaking a substantial volume of home-based nursing services. Meanwhile, UHu’s evaluation system serves as an effective quality management tool for home-based nursing care and has generated significant revenue for primary healthcare institutions.

In Wu Yuxiong’s view, the so-called “Healthy China” holistic solution, despite its grandiose label, ultimately boils down to developing primary healthcare.

To this end, in addition to building the underlying ecosystem, the Guangdong Family Doctors Association will seek out and collaborate on technologies conducive to the development of primary care worldwide, jointly creating a comprehensive solution for “Healthy China.” Currently, it has reached collaborations with companies such as BMJ from the UK, and GE and IBM from the US, on multiple cutting-edge global technologies and products.

For instance, GE’s Automated Breast Ultrasound (ABUS) system, with its automated breast volume imaging technology, represents a revolution in ultrasound. This device offers one-touch standardized operation, eliminating the reliance on highly skilled physicians required for manual ultrasound. General nurses can become proficient in operating ABUS after just one week of training. By deploying these systems in primary care settings or health examination centers, patients can undergo examinations locally. Complete breast images are then uploaded to a cloud platform for remote diagnosis by specialists at major hospitals, thereby enabling the decentralization of breast cancer screening to the primary care level.

New technologies and products such as ABUS, after being widely adopted in primary healthcare institutions, will rapidly strengthen the basic medical service system.

Of course, there are still significant gaps in the overall “Healthy China” solution that need to be filled with more new technologies and products. Only by integrating a sufficiently robust underlying ecosystem with a rich array of proven, specialized medical technologies can local governments be helped to establish and develop primary healthcare service systems.

Any new technology or product that meets the following three conditions will have broad prospects for survival and development in the primary healthcare market:

Wu Yuxiong stated, “Ultimately, it all comes down to one core principle, which also serves as the starting point for the three aforementioned points: enabling primary healthcare institutions to deliver a broader range of medical services and increase their revenue, thereby ensuring sustainable and healthy development. The Guangdong Family Doctors Association warmly welcomes such new medical technologies and products to integrate into the overall ‘Healthy China’ solution, jointly building and sharing a primary healthcare market that offers both breadth and depth of service.”