Why There’s No ‘Dianping’ for Hospitals: Two Key Reasons

“Why Is There No ‘Dianping’ for Hospitals?” is a question posed by Zhihu users, which I find quite intriguing. Since the establishment of Dianping.com in 2003 as an independent third-party consumer review platform for the restaurant industry, well-developed standards and systems for reputation-based evaluations have taken shape in this sector. However, in the healthcare industry, which is equally vital to people’s lives, no similar “Dianping-style” platform has emerged for rating hospitals and physicians. Beyond the lack of consensus on fundamental framework issues—such as how to establish evaluation criteria, who should organize the assessments, and who should conduct them—I would like to explore the reasons for the absence of such platforms from another perspective.The healthcare sector has not achieved full-scale“Free Economy”Reviews generate a relatively clear word-of-mouth marketing effect, aligning with the bottom-up market-building business model characteristic of a free-market economy. The reason why the healthcare sector has not produced a typical free-market phenomenon like “Dianping” is, in my view, precisely because the current healthcare landscape does not operate under a fully realized “free-market economy.”

So why did the catering industry give rise to “Dianping”? In a word, the catering industry is currently the sector in China with the most pronounced characteristics of a free-market economy. I once read an article titled “A 30-Year Historical Review of Reform and Opening-Up in China’s Catering Industry,” which provided a relatively detailed account of the state of the catering sector during the late 1970s and 1980s, following the launch of reform and opening-up policies. Over the course of three decades since these reforms began, the industry has grown from a scale of over RMB 5 billion in the 1970s to its current size of RMB 2–3 trillion. Throughout this process, the catering industry has undergone substantial commercial expansion and intense competition, progressing through stages of initial development, quantitative growth, chain operations, and brand strategy. It is precisely this competitive environment that has generated greater demand for user-centric word-of-mouth reviews.

Today’s restaurant reviews, in pursuit of better reputational impact, often exhibit characteristics of commercial reputation manipulation, such as fake orders, hired reviewers to post fabricated comments, and deletion of negative reviews, including paid ranking placements. Although these practices have drawn considerable criticism, they are generally understood as part of market competition. Where there is healthy competition, unhealthy competitive practices inevitably arise. What governments, platforms, and consumers can do is minimize the negative impacts caused by such unhealthy competition. Therefore, using word-of-mouth for marketing and oversight serves as an effective industry self-regulation measure, helping users distinguish truth from falsehood. The exposure by CCTV’s “3·15” Gala of merchants on the food delivery platform Ele.me illustrates this very point.

“Treating Diseases and Saving Lives”and“Profiting from Disease Treatment”Not on the same level of discussionFor a restaurant or many businesses in other sectors, the notion that “the purpose of running a business is to make money” is entirely justifiable. However, for a medical group or healthcare organization, the idea that “opening hospitals or clinics is for profit” strikes people as particularly awkward.

I have previously encountered introductions to the founders of the “Putian network,” who emerged from China’s barefoot doctor system. This system was originally established to address basic healthcare needs, particularly in rural areas. These practitioners generally possessed limited medical expertise. After the barefoot doctor system was abolished, those with business acumen among them began exploring ways to monetize their rudimentary medical skills, giving rise to a model that addressed primary healthcare demand through commercial means. Patients seeking primary care are often individuals with limited education and low income. From the perspective of universal ethical standards, employing commercial tactics to address the healthcare needs of such vulnerable populations constitutes “deception.” Consequently, it is easy to conclude that pursuing commercial profits primarily through drug sales is unethical.

But here lies the question: if illicit food workshops on Ele.me can be shut down, why can’t Putian-affiliated hospitals be banned? The answer comes down to what is “above board.” Whether something constitutes fraud in the healthcare sector is a concept difficult to define comprehensively. But even if it were clearly defined, so what? Healthcare is a scarce resource. On one hand, the state advocates marketization; yet when true market forces come into play (as with the Putian group), people tend to view these operators as mere profiteers. From an economic perspective, is making money inherently wrong? Morally, however, profiting from patients becomes reprehensible. (I am not being subversive; I also agree that this is wrong.)

The same logic applies to mobile health companies specializing in online consultations. However, consider this: if a renowned physician can save lives, are ordinary people truly willing to pay a significant premium for their services? The current development status of online consultation platforms has already confirmed that the answer is no (though there are many reasons for this). The reason is simple: medical practice is a typical consulting industry, and pricing is most challenging in this sector. Even firms like McKinsey find it difficult to set prices for corporate consulting services, let alone ordinary patients attempting to determine the value of physicians’ services.

Thus, consultations are not profitable; revenue relies solely on drug sales. Excessive prescribing, however, crosses a red line. This is the current state of healthcare. One reason for this situation is that “treating diseases and saving lives is the fundamental duty of healthcare professionals.” Since seeing more patients does not generate “official” economic benefits, why should physicians participate in performance evaluations?

“Why is there no ‘Dianping’ for hospitals?” This is an internet topic. Reviews are intended to address issues of reputation and information dissemination; however, in the context of basic healthcare, society does not strongly endorse the concept of free competition itself (much like the public’s rejection of the Putian hospital network). Consequently, such mass-oriented reviews struggle to gain broad-based consensus on reputational assessments from either the supply side or the demand side. Therefore, reviews of hospitals and physicians constitute a “niche review” demand. As for how large this “niche review” market can become, I believe it depends on two prerequisites: the pace of healthcare liberalization in China and the size of China’s middle-class population.

On one hand, China is moving further along the path of liberalization, which is a very positive signal. With the advancement of healthcare marketization and the development of physicians’ independent practice, a new wave of medical organizations will emerge. Consequently, the middle class will focus not only on the act of seeking medical care itself but also on enhanced experiential aspects. These emerging medical organizations will inevitably place greater emphasis on addressing patients’ evolving needs for improved care experiences.

On the other hand, primary care remains an unresolved challenge worldwide. Since launching healthcare reform in 2010, the Obama administration in the United States has sought to address issues in public healthcare. This sector cannot be marketized, as the right to life is a fundamental human right for every individual. Allowing the poor and the rich to compete for a train ticket merely affects whether they can return home for the Lunar New Year, which does not violate current moral baselines of humanity. However, openly allowing the wealthy and the impoverished to compete for access to medical treatment is fundamentally unacceptable to nearly everyone. From this perspective, healthcare should not be subjected to free-market principles. As President Obama stated, “Our healthcare system must include a basic public healthcare component that serves the broad population.” The same holds true for China.

A meaningful “Hospital and Physician Review” platform will only emerge when the middle class is highly developed, basic healthcare needs are effectively met, and people have more medical choices. I believe this scenario is not impossible—for instance, with advancements in intelligent healthcare, medical automation, and the engineering of medical services—but it will likely be a protracted historical process.

Author Introduction:

Wang Zhe, CTO of Xingshulin, a mobile health startup dedicated to serving the physician community. He holds a Master’s degree in Software Engineering from the University of York in the United Kingdom and is currently pursuing an on-the-job doctoral degree. He has previously worked at Microsoft (China) R&D Center, Lattice Voice (UK) Ltd., and ThoughtWorks (Beijing) Co., Ltd.