A Plea to 'Aim One Inch Higher': Give Medical Innovation a Chance to Survive

A flurry of events rapidly unfolded at hospitals across Beijing after the Spring Festival, perhaps serving as a wake-up call to hospitals throughout China.

The government could no longer sit idly by after the viral incident of “the woman in white coat angrily confronting scalpers.” How could the nation’s capital fail to curb ticket scalping? Thus, the “Eight Measures for Healthcare in Beijing” were prominently introduced: registration for general outpatient visits at renowned Grade 3A hospitals would be unlimited and open to all; physicians’ manual addition of appointment slots was strictly prohibited; and a comprehensive appointment-based registration system for outpatient services was scheduled for full implementation by the end of the year.

The policy’s intentions were undoubtedly good, and the hospital’s execution was first-rate; indeed, scalpers vanished almost overnight. However, it was the outpatient medical staff who bore the brunt of the burden, forced to grind through overtime as patients poured in like a tide. The consultation time per patient simply shrank from two minutes to one. Whether patients, for whom securing an appointment had suddenly become easy, should celebrate or shake their heads in dismay was a question no one cared to address. As for the doctors and nurses, they no longer even had the energy or courage to complain.

In addition to the stringent measures implemented within hospitals, news media have also conducted overt and covert investigations into the industrial chain of scalpers. Recently, a television documentary focusing on the crackdown on scalpers devoted nearly half of its 18-minute runtime to detailing how scalpers sourced appointment slots from the mobile healthcare app “Yihu Doctor” and then clandestinely resold them to patients at inflated prices. This report immediately garnered significant attention, inadvertently implicating the mobile healthcare sector, which found itself thrust into the spotlight and portrayed as an accomplice to scalping activities.

It must be said that at a time when television audiences have grown weary of the usual news stories on “cracking down on scalpers,” injecting some so-called fresh angles on “Internet innovation” may be a tactic for media outlets to capture attention. However, for the mobile health industry as a whole, such an abrupt and distorted debut in the “primary media” could adversely affect public perception of mobile health overall.

Why Do Appointment Scalpers Persist? Any scarce resource will inevitably attract scalpers, a phenomenon observed worldwide. In China, the absence of a tiered diagnosis and treatment system and general practitioners, coupled with the artificially low nominal prices for specialist appointments at major hospitals, has led to chronic excess demand, naturally drawing in appointment scalpers. This is akin to the scramble for train tickets during the Spring Festival travel rush a decade ago; it is certainly not an issue that can be eradicated through one or two stringent crackdowns.

In fact, the much-hyped “manual appointment additions” mentioned in the news have long existed. Some are for follow-up visits, some for physicians to review test results or prescribe medications, and others are granted out of compassion to patients from other regions who are unable to secure regular appointments. More commonly, additional appointments are offered to patients whose conditions align with the physician’s specialty, particularly those with complex or rare diseases, as physicians are often willing to accommodate such cases for academic purposes. For physicians, adding these appointments simply means voluntarily extending their working hours to see a few more patients, without compromising the hospital’s interests.

News reports have vaguely suggested that there are financial ties between mobile health companies and physicians. In reality, anyone familiar with hospital operations knows that financial gain is not the primary motivation for physicians to add extra appointment slots, as participating in external consultations, performing surgeries, or prescribing medications may offer greater financial returns. Manually adding appointments is a cumbersome process and therefore does not constitute a major source of tickets for scalpers. Mobile health apps that facilitate registration and additional appointments essentially use mobile networks to efficiently match pre-existing demands for pre-consultation inquiries and extra appointments, thereby reducing inconvenience for both patients and physicians and leveraging physicians’ fragmented time to perform tasks beneficial to the majority. Far from being accomplices to ticket scalpers, these platforms serve as tools to standardize the process of adding appointments and enhance convenience for both parties. If such innovative mobile health models are indeed suppressed as a result, it will only lead to a zero-sum game that satisfies no one, with no true beneficiaries.

It now appears that the incident involving the “woman in white coat angrily berating” someone, which alarmed senior management, has even stripped doctors of their rare autonomy to add extra appointments. While medical order seems more streamlined and patient registration appears guaranteed, the lack of an effective triage system (with optimistic estimates suggesting it will take three to five years for a referral framework between primary and tertiary hospitals to take shape) means doctors’ time will be increasingly wasted on mismatched patients. Doctors cannot find the patients they wish to treat, and patients cannot access the specialists best suited to their conditions. This situation will only create more opportunities for scalpers.

For mobile health platforms that subsidize patient triage and additional appointment registrations out of their own pockets, the ban on such extra appointments is naturally bad news. However, in the long run, it will be difficult for hospitals to prohibit physicians from seeing patients outside of regular outpatient hours or even during their spare time. This policy merely creates inconvenience for all parties, forcing platforms—capable of effective management—to evade regulatory oversight, and delaying the realization of innovations that have already emerged.

Similar stories have long unfolded in the ride-hailing and premium car-service app sectors. Certain clear social needs have been repeatedly obstructed under various pretexts, often due to lagging regulations or because they encroach upon the interests of a small minority. The rationale for opposing Didi Chuxing was that the Passenger Transport Management Office deemed it difficult to regulate; opposition to premium car services stemmed from the fact that taxi drivers had paid for operating licenses while premium service providers had not... Despite hundreds of millions of people having improved their travel experience as a result, and despite company executives accompanying top-level representatives as ambassadors of China’s internet industry abroad, the reality on the ground remains one of daily regulatory inspections and enforcement actions. If such misalignment and distortion were to reappear in the healthcare sector, it could only be interpreted as a struggle between entrenched interest groups and emerging forces.

In fact, ready-made objections arise against even the slightest advances in medical innovation: concerns about medical malpractice are cited against online consultations; lack of regulatory support is raised against electronic prescriptions; and safety risks during delivery are invoked against e-commerce platforms for prescription drugs. While these objections are not entirely without merit, they certainly do not justify stifling innovation in its infancy. The underlying motive is simply to avoid disrupting the existing landscape of interests, particularly the traditional system dominated by large hospitals, or to make regulators’ jobs easier and simpler, rather than prioritizing the needs of end users and society.



It is widely recognized that the solution to the problem lies in implementing tiered diagnosis and treatment systems and allowing physicians to practice freely. An adequate supply of medical services will naturally eliminate scalpers. The technological advantages and innovative models of mobile health were originally powerful tools for promoting tiered diagnosis and treatment and independent practice, capable of improving patients’ healthcare experiences, breaking down information barriers between doctors and patients, and facilitating the optimal allocation of medical resources. Most entrepreneurs in the mobile health sector are idealistic and driven individuals who have no intention of profiting from existing services such as appointment registration, additional slot allocations, or triage. In fact, many subsidize these services out of their own pockets to better serve both patients and physicians, and there has never been any report of anyone aiming to develop into an online scalper. Suppressing these startups, which are innovating but not yet strong enough to reshape the landscape, will neither eradicate scalpers nor preserve a valuable instrument for healthcare transformation.

We constantly ponder why China has failed to produce an Apple or a Tesla. The reason is actually quite simple: these companies suffered from “malnutrition” in a harsh environment during their early stages. To the media, hospitals, and those who formulate and enforce regulations: please ease up slightly and allow these medical innovators a path to survival!

Even if the regulatory scrutiny does not ease, I do not believe that vibrant healthcare innovators will collapse. The rationale is simple: the market is the ultimate arbiter. Innovations that truly address patient needs and improve the inefficient allocation of medical resources will ultimately withstand pressure and thrive against the odds. It is reported that after Yihu Doctor was “exposed,” its registered user base surged. I believe these new users are not merely journalists or the curious, but rather patients whose previously suppressed demand for medical care had left them with no other options. I also advise mobile health companies not to lose heart when faced with external misunderstanding. Gaining user support is the most significant form of validation. After all, which great innovative enterprise did not go through a nascent, awkward phase?

(Article source: Unicorn)