Why Local Governments Intervened Twice in Hospital Appointment Systems Since the Launch of China's New Healthcare Reform

Since the launch of the new healthcare reform in 2009, local governments have intervened forcefully in the appointment registration sector on two separate occasions: first in October 2009, and again this February. Although these two governmental actions appear similar, their underlying motivations differ significantly. This article provides an in-depth analysis and interpretation of these differences.

In October 2009, the former Ministry of Health issued the “Opinions on Implementing Appointment-Based Diagnosis and Treatment Services in Public Hospitals,” requiring all public tertiary hospitals to provide real-name appointment registration services. Consequently, health and family planning authorities at the provincial and municipal levels successively launched unified appointment registration platforms to standardize local fee-based registration markets. Since 2016, with the rise of internet healthcare and the national rollout of the “Healthy China” strategy and the “Internet Plus” action plan, some local governments have tightened regulations on hospital registration services at public hospitals to address irregularities such as unauthorized online appointment slot additions, introducing local unified mobile hospital apps.

I. Similarities and Differences Between the Government’s Two Major Interventions in the Appointment Registration Market

In March 2009, the “Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical and Health Care System” were issued, marking the beginning of a new round of healthcare reform that emphasized the public-welfare nature of medical services. In October of the same year, the Ministry of Health issued the “Opinions on Implementing Appointment-Based Diagnosis and Treatment Services in Public Hospitals,” which standardized various online registration platforms affiliated with public hospitals, restricted fee-charging registration activities conducted by intermediary agencies in collaboration with public hospitals, and safeguarded the image and public-welfare orientation of public hospitals. Since 2010, under the leadership or authorization of local health and family planning authorities, provincial- and prefecture-level unified appointment registration platforms have been established across China, providing free appointment registration services, with free access becoming the mainstream model.

In 2015, China’s healthcare reform entered a critical and complex phase. On one hand, the government issued a series of urgent healthcare policies, with the volume equaling the total of the previous five years combined; these policies were not only numerous but also high-level and broad in scope. On the other hand, public dissatisfaction with medical services surged, marked by frequent incidents of violence and verbal abuse against healthcare workers, while online tools for paid appointment reservations and additional registration slots disrupted the order of the registration market. Against this backdrop, on January 27, 2016, a young woman from Northeast China shouted at scalpers inside Guang’anmen Hospital of Traditional Chinese Medicine, sparking strong public resonance regarding the chaotic state of the registration market and exerting significant policy pressure on health and family planning authorities. In response, local health and family planning commissions across the country reined in third-party appointment reservation apps and launched unified, government-led appointment reservation platforms.

II. Unified Local Appointment Registration PlatformWebTerminal Features

Since 2009, the local unified appointment registration platforms promoted by local Health and Family Planning Commissions have featured the following characteristics:

First is comprehensiveness: virtually all provinces, municipalities directly under the Central Government, autonomous regions, and sub-provincial cities (major provincial capitals and the five cities with independent planning status) have established dedicated websites for unified appointment registration platforms.

Second, the operational models differ, comprising two approaches: direct government-led development and government-authorized operations. Under the government-authorization model, vendors include telecommunications carriers and appointment registration service providers, among others;

Third, there is a significant disparity in the number of hospitals connected to local platforms. As these platforms were established on a free, public-welfare basis without dedicated funding to facilitate integration with hospital information systems, most platforms have limited hospital connectivity and low utilization rates.

III. Local Physician PlatformAppTerminal Features

In 2015, with the rise of internet healthcare, mobile hospital vendors using appointment registration as an entry point actively promoted nationwide mobile hospital platforms directly connected to hospital information systems. For instance, Neusoft’s “Daxiang Jiuyi” focused on the future, striving to streamline hospital care processes, continuously upgrade functionalities, create new value for patients and hospitals, and help hospitals embrace the “Internet+” initiative.

“Smart Healthcare, Healthy Jinhua” is a typical example of local “Pocket Hospital” platform apps. This project was jointly developed by the Jinhua Municipal Health and Family Planning Commission and the “Daxiang Jiuyi” (Elephant Medical Care) app. By launching the “Daxiang Jiuyi” app, nine public hospitals at or above the Grade II Class A level in Jinhua’s urban area have achieved inter-hospital coordination within the city, ensuring that smart healthcare benefits not only tertiary (Grade III) hospitals but also grassroots medical institutions.

It is reported that the “Daxiang Juyi” App will subsequently integrate more primary healthcare institutions, including community health service centers, township health centers, physical examination centers, and pharmacies, to provide comprehensive mobile health services for the general public in the region. This initiative aims to make access to high-quality physicians “more” available and effectively expand the reach of reputable hospitals, making them appear “larger.”

Meanwhile, some other internet healthcare apps focus solely on securing additional appointment slots with specialists, effectively becoming “scalpers” under the guise of technology.

In alignment with the “Healthy China” strategy and the “Internet Plus” action plan proposed in 2015, local governments have issued directives to establish unified local mobile hospital apps. These initiatives aim to leverage a unified mobile healthcare platform to enable integrated functionalities such as centralized appointment scheduling, tiered diagnosis and treatment, referral services, and health management. The specific characteristics are as follows:

First, there is a diversity of formats, categorized into standalone provincial- and municipal-level mobile hospital apps and those leveraging existing national mobile hospital platforms. The majority adopt the format of regional standalone apps, such as in Liaoning and Guizhou.

Second, the funding models are diverse, encompassing government procurement of services, Public-Private Partnership (PPP) models, and a model where manufacturers develop solutions free of charge under government authorization.

Third, the scope of integration varies. In cities such as Beijing and Shanghai, only municipal-level hospitals under the jurisdiction of the Municipal Health and Family Planning Commission are included, excluding military hospitals, hospitals affiliated with central government ministries, and district-level hospitals. In contrast, regions such as Tianjin and Jilin have promoted comprehensive integration ranging from tertiary Grade A hospitals to primary healthcare centers, thereby enabling functionalities such as tiered diagnosis and treatment.

As local governments promote the trend of mobile healthcare, more local governments will drive the development of mobile healthcare apps in the future.

IV. The Future Landscape of Appointment Registration

Registration serves the dual purpose of visit enrollment and payment for medical services. In the future, as regions promote the elimination of drug markups in public hospitals, gradually increase fees for medical services such as registration, implement differentiated pricing and mandatory tiered registration policies based on disease types, and reduce outpatient services while transitioning to full appointment-based systems in tertiary hospitals, the registration market and its order will be significantly improved.

Appointment registration serves as the entry point for medical services and a key commercial gateway for internet healthcare startups. While the government’s vigorous promotion of local mobile health platforms has its policy rationale, these platforms lack the motivation and mechanisms for iterative functional upgrades typical of internet apps. Moreover, they create a crowding-out effect on commercial mobile health platforms, thereby slowing down the marketization of healthcare. It is essential to “render unto Caesar what is Caesar’s, and unto God what is God’s.” The government should leverage market forces more effectively, promoting the rational allocation of medical resources through models such as licensing or public-private partnerships (PPP).

(The author of this article is Dong Yi, a self-media creator in the “Internet+” healthcare sector. He currently has 18,000 followers on his self-media account and hopes that more people will begin to use mobile healthcare solutions to address their medical needs.)