Government Halts Doctors' Manual Appointment Add-Ons: A Catalyst for Fairer Healthcare Access and Digital Health Innovation

 

Recently, the National Health and Family Planning Commission organized relevant entities to discuss the establishment of a fair and orderly medical treatment environment, while simultaneously introducing eight measures aimed at cracking down on “appointment scalpers.” The measures emphasize unified management of hospital appointment slots and abolish the practice of doctors manually adding extra appointments.

Eight Measures

1. Implement comprehensive appointment-based registration for non-emergency services. With municipal hospitals as pilot units, expand non-manual appointment channels and enhance patient guidance services to proactively provide consultation, direction, instruction, and assistance for appointment scheduling.

2. Establish a hierarchical referral network among medical institutions. Develop a referral mechanism between primary care facilities and higher-level hospitals to ensure priority access for referred patients and timely treatment for those with complex, critical, or severe conditions.

3. Launch a service model featuring renowned expert teams. Initiate pilot programs for renowned expert team services to enhance the work efficiency of leading specialists and ensure that patients receive the most appropriate treatment.

4. Coordinate the allocation of general outpatient appointments across municipal hospitals. For patients unable to secure a general outpatient appointment at one municipal hospital, referrals can be made to available general outpatient slots in the same specialty at other municipal hospitals, ensuring timely access to appropriate medical services.

5. Strictly manage additional appointment slots. Centralize the management of appointment sources, eliminate doctors’ manual issuance of additional appointment slips, and leverage the hospital information system to enforce strict control over additional appointments.

6. Implement the “real-name registration” system for appointment scheduling. All appointment bookings through various channels must be made under real names using valid identity documents, and strict controls must be enforced to prevent ticket scalpers from monopolizing appointment slots with fake IDs.

7. Strengthen publicity, guidance, and order maintenance. Enhance public education to guide patients toward appropriate healthcare-seeking behavior and ensure orderly medical consultations. Establish a coordinated mechanism with public security authorities to strictly crack down on illegal activities involving the use of forged documents for appointment registration and ticket scalping.

8. Establish a system for monitoring, reporting, and penalizing the unauthorized use of hospital medical resources. Implement public reporting mechanisms, collaborative investigation procedures, and joint handling protocols. Publicize hotline numbers for supervision and reporting, and impose strict penalties on hospital staff involved in the illegal resale of appointment slots.

Subsequently, we came across a document titled “Notice on Cracking Down on Healthcare Professionals Colluding with Commercial Companies to Secure Additional Appointment Slots for Illicit Gains.” I anticipate that this policy will soon be rolled out nationwide, or at least across large and medium-sized cities. Such practices—adding extra appointment slots, queuing, and queue-jumping—typically emerge only when registration demand is extremely high, a phenomenon predominantly observed in first-tier cities like Beijing, Shanghai, Guangzhou, and Shenzhen, as well as provincial capitals. Most grassroots hospitals and county- or city-level hospitals are not directly affected by this issue; nevertheless, there may be some potential, deeper-reaching implications. Consequently, some misinformed members of the public have echoed the views of so-called “experts” and commentators, claiming that this development bears negative market sentiment, represents a major setback for mobile healthcare, and will severely impact appointment booking platforms, as illustrated in the figure below:

However, the true experts in this world are those who take action, not those who pretend to understand while spreading alarmist rhetoric from the sidelines. Moreover, without investigation, there is no right to speak. Below, I will categorize and summarize the availability of additional appointment slots across major mainstream registration platforms.

1. WeDoctor (formerly Guahao.com): Users can directly register and book appointments. Identity card numbers must be linked during registration. For connected hospitals, the platform displays appointment availability (typically for slots one week in advance). The platform has integrated with hospital registration systems; however, as registration policies vary by institution, users must review the specific rules displayed for each hospital beforehand. Successful online appointments grant priority queuing status at the hospital.
2. Haodaifu: This feature allows individual physicians to enable appointment-based referrals. Once enabled, patients can book appointments online. After booking, they can receive an additional consultation slot by presenting the SMS referral note (typically free of charge; however, certain service packages on the platform may provide indirect financial benefits to physicians). This process essentially constitutes a manual addition of consultation slots by the physician.
3. Chunyu Doctor: Similar to Haodf, physicians must personally activate the additional appointment service to offer online scheduling for extra visits (subject to an additional fee). After submitting medical information and the desired consultation date, and upon completion of payment, the appointment is confirmed by the physician, enabling an in-person additional visit.
4. Juyi160: This also depends on whether the doctor proactively enables the additional appointment service; patients need to submit medical records for the doctor’s review and approval of the additional appointment.
5. XYWY.com: Displays physicians' clinic schedules, allowing patients to directly request additional appointment slots based on availability. Basic visit information must be provided; upon approval, an SMS confirmation serves as authorization for the added appointment.
6. Ping An Good Doctor: Primarily staffed by full-time physicians, with no appointment scheduling function.
7. Renowned Surgeon-Led Procedures: A platform dedicated exclusively to surgical appointment scheduling, offering no other functionalities. Appointments are available only after physicians review the submitted medical records.
8. Some specialized consultation platforms, such as Yijiayi (oncology) and Yiben Huxi (respiratory diseases), also offer appointment-based add-on registration services, which require physicians to activate this feature.

Summary: Overall, with the exception of WeDoctor, which is integrated with hospitals’ appointment registration systems, most other platforms offer appointment and add-on registration services initiated by individual physicians. The majority of these services are free of charge, while a small portion require payment.

Consequently, the outcome of this event will trigger a chain reaction. Contrary to popular belief, this is not bearish news but rather a significant bullish development.

The Era of Mobile Health Has Arrived!

1. Promote the widespread adoption and use of apps primarily focused on appointment scheduling.

Just as in the past, when numerous on-the-ground enforcement measures and even criminal prosecutions failed to eliminate ticket scalpers at railway stations, the problem was only half resolved by making train tickets available for online purchase (enhancing information transparency). The other half was addressed by building high-speed rail lines and introducing bullet trains to increase train speeds (boosting supply). These two approaches have continuously reinforced each other, providing the market with clear expectations.

Therefore, this development represents a major breakthrough for appointment registration portals within the niche of mobile healthcare. It will significantly alter user behavior, making online appointment scheduling a dominant trend, thereby boosting the penetration rate of mobile healthcare. This move is comparable to the landmark efforts made years ago to combat ticket scalping at railway stations. Initially, there were widespread complaints about the poor service of the 12306 ticketing system; yet now, aside from migrant workers and those facing emergencies, who still queues up at railway stations to buy tickets? Consequently, giant online platforms such as Ctrip and Qunar have replaced fragmented offline agencies.

A true leap forward in mobile healthcare has begun, gradually expanding from traffic entry points into the mainstream medical market. This trend is more favorable to platforms such as Guahao.com, Huakang, Jiuyi 160, and Qu Yiyuan, with larger platforms standing to benefit the most.

2. After the ban on additional registrations, some mid-sized companies will face negative impacts.

In particular, many companies claim to increase physicians’ income, but in reality they exploit bottlenecks and price differentials to resell appointment slots, or engage in other under-the-table practices. When this ecosystem operates on a small scale, it has little impact on the broader landscape; it may indeed provide physicians with modest supplemental earnings, boost platform activity, and help bridge the gap between patients and providers.

However, it is important to consider that once a small initial trend proves viable, platforms that have already benefited become addicted, much like opium users, believing they have discovered a replicable “singularity.” They continuously expand their reach, while onlookers rush in en masse, leading to “asymmetric competitive gaming.” When the entire gray industry chain grows sufficiently large, it disrupts normal diagnosis and treatment order, intensifies conflicts, and inevitably triggers a circuit breaker. The only uncertainty is when the “black swan” event will occur and what will trigger it. After all, without a fuse, is the market truly immune to collapse?

Therefore, it was foreseeable from the outset that companies adopting such short-sighted strategies—believing they had addressed physicians’ pain points while undermining public interest through localized profit-sharing schemes—were destined for catastrophic failure. Consequently, once business contraction and declining investment expectations occur, a “double whammy” may arise: funding dries up while operations stagnate, leading these companies to either fail outright or become zombie entities.

3. This is beneficial for large-scale doctor-patient platform companies such as Haodf, WeDoctor, and Chunyu Doctors.

Even from a theoretical business perspective, a significant portion of additional appointment slots stems from legitimate medical needs. When offline channels fail to provide patients with convenient access through supplementary services, a substantial share of this incremental demand will inevitably shift to online platforms.

Both patients with minor ailments and those with severe conditions can derive partial benefits. It is well known that 30% of outpatient visits are entirely unnecessary, while others are merely for verification or psychological reassurance. Even addressing just 10% of that 30% represents a substantial business opportunity. This approach also helps eliminate ineffective demand, balance existing resources, and indirectly release a portion of effective medical resources to patients who truly need them. Notably, this leverages physicians’ spare time and sleep hours, which is reasonable and effectively increases the incremental supply in the market. Wherever there is demand, it will inevitably be stimulated.

Consequently, competition for patient traffic is likely to intensify in the future, leading to the formation of distinct traffic advantages. Currently, Haodf appears to be the biggest beneficiary, as its more than 90,000 registered doctors constitute the primary providers of offline additional appointment slots. This enables Haodf to directly absorb and fulfill pent-up demand through partial conversion. Therefore, I estimate that Haodf’s revenue this year will likely be four to five times that of last year, approaching RMB 100 million. As the Chinese company most comparable to Zocdoc in the United States, Haodf now has significant room for valuation growth.

As the ecosystem extends further downward, the substantial and concentrated demand from patients will drive multi-site practice and future independent practice, thereby inducing ecological evolution. For platforms that have already secured sufficient resources to sustain operations for two decades without survival concerns, this will lead to a downstream squeeze on smaller platforms, marking the onset of brutal market consolidation. This is not merely the prelude where many weak companies are lamenting their plight, nor is it simply the second half of the mobile healthcare game; rather, the decisive battle has begun, with market developments unfolding far more rapidly than we had anticipated.

In fact, the practice of adding extra appointments beyond the scheduled registration does hold certain social value, but it indeed encroaches upon public resources. A physician’s working hours belong to the hospital, regardless of whether one considers the compensation commensurate with their labor value. Without altering the legally defined employer-employee relationship—particularly given that some physicians are state employees—if you feel undervalued, you are free to resign and seek opportunities in the open market. Therefore, while providing complimentary extra appointments may be more acceptable, leveraging third-party platforms as intermediaries to charge substantial fees for personal gain constitutes a form of disguised commercial bribery, which is fundamentally no different from accepting red envelopes.

Admittedly, while the blanket removal of additional provisions is not without its flaws, China’s vast size means that any loophole will inevitably be exploited. Therefore, this approach may not be the most reasonable; however, there is little alternative during extraordinary times. Meanwhile, this measure does not contradict multi-site practice and will, in fact, help standardize it. Multi-site practice refers to physicians openly undertaking work at Hospital B after fulfilling their contracted duties at Hospital A. It does not mean engaging in private side jobs while still under contract with Hospital A, as such behavior would violate professional ethics.

4. Gray-area practices such as "flying knife" surgeries and physician brokers will face short-term headwinds.

Everyone should reflect on the intent and window guidance behind this policy, which is actually designed to standardize clinical practice order and prohibit the abuse of power for personal gain or the use of public resources for private work. Extending beyond the issue of adding extra appointments, the next likely targets are private consultations and “fly-over surgeries.” As many know, while some “fly-over surgeries” fall under multi-site practice regulations, most such procedures are conducted discreetly, as doctors often prefer not to disclose their involvement. Furthermore, these procedures sometimes indeed take place during working hours—or during time when physicians are theoretically expected to be at their hospitals—since travel time to and from the location is also included.

Most of this revenue is paid directly by patients, with the inviting hospital facilitating payment on their behalf. Even when third-party platforms employ transfer payment mechanisms, they face numerous systemic challenges. I anticipate that following stricter controls on appointment registration and additional slots, regulations governing unauthorized consultations at small clinics and "flying knife" procedures will be tightened.

5. This presents an opportunity for pharmaceutical e-commerce platforms, patient communities, and integrated service platforms.

As this platform creates a crowding-out effect, tiered service platforms are poised for significant growth. The post-diagnosis and rehabilitation markets also hold substantial potential, as many patients revisit specialists primarily for follow-up consultations, efficacy monitoring, or treatment plan adjustments. Consequently, home medication delivery and end-to-end care services will present substantial opportunities.

This policy also benefits patient communities. Given the various conflicts and issues arising in real-world medical consultations and treatment, it will further facilitate communication, interaction, and information sharing among patients, enhance platform engagement, and unlock new demands. The entire industry is poised for accelerated growth, which makes platform neutrality even more critical for patient communities. Any patient community operated by pharmaceutical or medical device companies is unlikely to gain widespread support from patients. Even a powerful and well-funded company like Eli Lilly, despite leveraging advanced technologies and substantial resources, found its diabetes-focused “Xin Tiandi” initiative ultimately meaningless. Therefore, large corporations have little chance of success in this area; their very scale precludes them from succeeding. Opportunities belong to third-party players, particularly mid-sized platforms.

6. This is also a significant benefit for physician tools.This means that many doctor-patient-oriented products may be indiscriminately eliminated by blanket regulatory measures. However, physician tools fall outside this scope and are poised for significant growth. As physicians move toward independent practice, there will be a growing need for more convenient mobile solutions for medical record-keeping, clinical archives, consultations, and case discussions, which will also give rise to new forms of professional community engagement. When integrated with pharmaceutical marketing, digital strategies, and three-tier triage systems, the potential for innovation and expansion is substantial.

7. Other factors are slightly bearish for the medical escort and caregiving industry.Because many instances of internal staff securing appointment slots, adding extra appointments, and cutting in line are being restricted, the current focus is on monitoring added appointments. In the near future, inspections will extend to queue-jumping and labor discipline violations; the storm has not yet fully passed.

(Author: Dr.2, WeChat ID: 2823095726; article sourced fromWeChat Official Account: Zhenlipai (Account ID: zhenlipai)