Zeng Qiang: Achieving Greater Health Benefits at Minimal Cost — VB Group Interview Highlights

Zeng Qiang Chinese PLA General Hospital

Director Zeng Qiang currently serves as the Director of the Institute of Health Management at the Chinese PLA General Hospital. He holds a Medical Doctorate in Geriatric Cardiology, and is a Professor and Doctoral Supervisor, as well as an expert in geriatrics and health management. Director Zeng has been engaged in health management since 2005 and was the first to propose the “Three Strategic Shifts.” He is among the earliest pioneers of health management in China and a leading advocate and promoter of the Chinese model for the health management industry.

Below is a curated transcript of the key highlights from Director Zeng Qiang’s interview on the VB Group, for your review!

Although there is no strong consensus on the concept of health management in either the East or the West, one point remains consistent: it involves collecting and assessing health information about the individuals under management, then formulating intervention plans. By detecting diseases and health risk factors through physical examinations and implementing lifestyle tracking and management, it aims to achieve maximal health benefits at minimal cost. It is a means of maintaining health.

In particular, I wish to emphasize that the primary goal of health management is to maintain and promote health, while the secondary principle is to achieve this at minimal cost. The rationale for proposing health management is to secure greater health benefits at the lowest possible cost.

Current Status of Health Management in China

Health Checkups Are Not Equivalent to Health Management

Physical examinations are merely one component of our data collection. But in China, when did health checkups start to become popular?

According to my research, China’s first specialized health checkup institution was actually a private facility established in 2003. At that time, in the aftermath of the SARS outbreak, people became acutely aware of life’s fragility and began to prioritize their health. This prompted a search for methods to enable early prevention of severe diseases such as SARS. Consequently, health checkups started to garner widespread attention and recognition.

By 2005, the proliferation of health examination centers in public hospitals had propelled China’s health examination industry into a period of rapid growth. In 2014, there were nearly 10,000 health management institutions centered around health examination centers across China, serving over 300 million person-visits annually and employing hundreds of thousands of personnel.

Therefore, in terms of scale and the number of services provided, China has already ranked first in the world. However, there is still a gap in terms of quality and per capita coverage. It can be said that since the establishment of physical examination centers in 2003 and the founding of various health management societies and associations in 2007, along with increasing attention from both the government and the public toward health check-ups, China’s health management sector has made significant progress, particularly in recent years with growing emphasis on discipline construction and other related areas.

Development Goals and Priorities

Taking Command in a Crisis: Tears and Sweat

I began my career in health management in 2005. At that time, the hospital was establishing a medical examination center, and most staff members did not fully understand what such a center entailed. The hospital director asked me if I would be willing to take on this initiative.

I specialize in geriatric cardiology. During my time in the United States, I observed that the U.S. invests more heavily in disease prevention than we do and places significant emphasis on managing daily lifestyle factors. I personally believe this is a promising field. At the time, many hospital leaders, including my mentor, advised me against pursuing this path. However, once they saw my determination was firm, they said, “Go ahead; if it doesn’t work out, you can always come back.”

At that time, I wondered, “Will I still be able to return?” If you’re going to do it, do it well.

In fact, many scenes from my time running the health examination center still frequently come to mind.

When I first established the health check-up center, I attended a conference for such centers in Lushan. Although I was not originally invited to speak at the main assembly, upon learning that I was from the 301 Hospital, the organizers asked me to share a few remarks. Consequently, I delivered a 30-minute impromptu speech, discussing my reflections at that time.

I said that through our efforts, we should ensure that the director of our Health Examination Center neither sheds tears nor sweats. What does this mean? The work in health examination is arduous; examinations are conducted on weekdays, weekends, and even during holidays, with frequent overtime. This hard work has created substantial value for the hospital—this is the "sweat." However, at that time, health examination lacked recognition as a distinct medical discipline. Without being established as a formal discipline, it was difficult to carry out scientific research, secure research grants, or publish academic papers. Consequently, when it came to professional title evaluations and promotions, one could only shed tears.

Three Shifts: Emphasizing Whole-Process and Personalized Care

Therefore, after working in this field for over a year, I proposed that the health checkup industry should undergo three transformations: shifting from a purely operational model to a discipline-oriented approach, transitioning from simple health screenings to comprehensive health assessments, and evolving from basic physical examinations to holistic health management.

Looking back on our journey, many of us have been exploring and advancing step by step. Today, we are both capable and obligated to provide comprehensive health management services, covering the pre-examination, intra-examination, and post-examination stages, which has become a key focus of our development.

What to Do Before the Examination? Current health education aims to raise health awareness and encourage proactive participation in medical check-ups, which constitutes the pre-examination phase. The examination phase encompasses the entire check-up process. Post-examination services focus on chronic disease management. As the saying goes, “Prevent disease if present; prevent risk factors if absent.” Therefore, health assessment is essential.

At the same time, another key point is the issue of personalization.

Many domestic and international observers have described health checkups in our country as resembling a factory assembly line, where individuals undergo a standardized process with numerous tests conducted in rapid succession. I believe that health management should emphasize personalization, and personalized health screenings represent the direction we should pursue in the future.

With the support of the China Health Promotion Foundation and the Health Management Branch of the Chinese Medical Association, we have launched pilot programs in this area. These initiatives are being implemented at Southwest Hospital, the PLA General Hospital, the Second Affiliated Hospital of Zhejiang University School of Medicine (Zhejiang Er Yuan), and the General Hospital of the Chinese People’s Armed Police Force, among others. Although these efforts are not yet fully mature, they represent a strategic direction. Our goal is to enable individuals to identify the most critical health issues with minimal expenditure. In summary, our current development focus is on post-examination services and personalized healthcare solutions.

Treat Without Prevention, the Busier You Get

Traditional healthcare has always been disease-centric. How can the concept of health-oriented care be introduced to China?

In fact, we have been consistently working on this issue and advocating for a shift from a disease-centered approach to a health-centered one. Why, then, does China still predominantly focus on treating diseases? Strictly speaking, it is because our overall level of medical care remains low.

Let me share a joke. For many years, I have been engaged in research on sub-health, a concept that remains somewhat controversial in academic circles. Nevertheless, during China’s 11th and 12th Five-Year Plan periods, I led national-level research projects on sub-health. At that time, people often remarked with self-satisfaction, “Look, the proportion of the sub-health population in our country is lower than that in foreign countries.” When asked why, the real explanation was not that our medical standards were higher. Rather, it was because the prevalence of diagnosed diseases in our country was high. Since sub-health is not classified as a disease per se, and given that many fundamental healthcare issues remained unresolved, the public did not feel a strong urgency to prioritize health maintenance and preventive care (“treating potential diseases before they manifest”).

In Western countries, particularly the United States, the incidence of metabolic diseases, including obesity and hypertension, had remained persistently high in recent years. In response, a national health initiative was implemented, and last year, the United States witnessed a turning point in the trend of cardiovascular and cerebrovascular diseases.

Through health check-ups, health maintenance, and lifestyle management, the public has already benefited in terms of health, which has promoted people’s acceptance of this concept.

There is a saying: “Focusing solely on treatment without prevention only leads to greater burdens.” It is well known that an increasing number of physicians now emphasize disease prevention. Professor Hu Dayi, widely regarded as the foremost expert in China in coronary stenting and catheterization, began advocating for health education and preventive care more than a decade ago. Why? He stated that no matter how many stents he implanted, he could not save all patients with coronary heart disease; it would be far more effective to prevent people from developing the condition in the first place. This underscores why the medical community increasingly agrees that interventions should target the root causes rather than merely addressing diseases after they have developed.

Our country lacks a sufficient health-centered philosophy, for two reasons: first, the overall level of medical care is low relative to the large population; second, the underlying mindset remains inadequate.

Philosophy Matters, Processes Must Be Standardized

Many people equate health management with a scam. How can this predicament be addressed, and how can individuals effectively manage their own health?

In China, most people lack a clear understanding of the true connotation of health management. As a result, some unscrupulous merchants exploit the banner of health management to defraud the public. For instance, in the early days, vendors would set up booths on the street to measure blood pressure, claim that customers had “viscous blood,” and then sell health supplements on the spot. Nowadays, health management is often used as a catch-all concept, with all sorts of unrelated products and services bundled under its guise. This situation indeed calls for regulation. In fact, the consumption of health supplements or functional foods can, to some extent, be viewed as an application of the concept of “preventive treatment of disease” (Zhi Wei Bing).

However, the key issue lies in how to conduct this process in a standardized manner. We must also acknowledge that within professional health examination centers affiliated with hospitals, we are currently unable to charge for post-examination services. In other words, while fees can be collected for the physical examinations themselves, no charges can be levied for subsequent health management services. Consequently, many such management services have been outsourced to private institutions.

I am not suggesting that private health checkup providers perform poorly; rather, I believe their greatest advantage lies in post-examination management. Unconstrained by the regulatory frameworks and social standards applicable to public hospitals, they can set prices entirely according to their own business needs, as they are tax-paying entities contributing to state revenue.

Nevertheless, it is undeniable that the country’s premier medical resources remain concentrated in public hospitals. In principle, physicians in these institutions should be engaged in post-examination services and health management; however, the inability to charge for such services has rendered their implementation unfeasible.

Escaping the predicament still requires relying on established forces.

In previous years, established medical experts disdained delivering public health lectures or writing popular science articles. As the saying goes, “When the regular army stays away, bandits run rampant.” The case of Zhang Wuben serves as a prime example. When legitimate experts remained silent, unqualified individuals stepped in to spread misinformation, causing harm to many people. Fortunately, many renowned medical authorities are now actively engaging in public health education. Nevertheless, some argue that such efforts are futile: authoring a popular science book may not count toward academic publications in discipline evaluations, nor does it significantly aid in professional promotion. However, a well-written popular science book contributes far more to safeguarding the health of the general public.

How to Navigate Out of Difficulties? I believe we should still rely on formal, professional channels. Just as many leading experts are now engaging in health education, if hospitals can expedite the establishment of standardized pricing for post-examination management services through the National Development and Reform Commission, they will be able to provide regulated post-examination services and conduct professional health management. This would ensure that the public receives proper guidance, thereby sustaining effective health management. So, at this stage, how should individuals properly manage their own health?

First, go to a certified medical examination institution to get checked and clarify your health issues;

Second, after the results are obtained, treat the disease if present, and prevent it if absent;

Third, do not readily believe in street rumors;

Fourth, maintain your health using techniques and methods that are suitable for you.

Health Management & Insurance

The primary goal of health management is still to save money.

Health management in China has not developed satisfactorily, with a major issue being its poor integration with insurance—a challenge I have personally experienced. During my years studying in the United States, insurance companies covered the cost of an annual health check-up for us. Why? Because early detection of health issues allows insurers to reduce costs.

Let me first take you through a review of how health management emerged. Modern health management originated in the early 20th century, after World War I, when the United States experienced rapid industrial growth. Many large enterprises hired substantial numbers of workers and, to reduce medical costs, transferred the responsibility for covering these expenses to insurance companies. So how could these insurers make a profit? They reasoned that if their insured individuals remained healthy, they would generate profits. Consequently, they implemented lifestyle management programs for workers, introducing incentive measures such as encouraging increased physical activity and reduced smoking.

Moreover, healthcare costs in the United States rise significantly once an individual falls ill. For instance, a routine cesarean section that costs RMB 10,000–20,000 in China may amount to approximately USD 30,000–40,000 in the U.S. Therefore, the primary driver behind health management is cost savings. At the time, insurance companies were not motivated by a desire to promote health per se, but rather aimed to achieve substantial health benefits at minimal cost. Consequently, insurance has played a crucial role in health management.

Integration of Health Management and Insurance

So, how can health management be integrated with insurance? In fact, many commercial insurance companies in our country have already ventured into this area. For instance, a large number of individuals coming to our hospital for medical check-ups are covered by commercial insurance policies purchased on their behalf. Additionally, there is potential for insurers to engage in chronic disease insurance products as well.

In the United States, insurance companies cover the costs for patients who use apps to manage their diabetes. Why is this the case? As we all know, poor control of diabetes can lead to complications, causing greater harm to patients and resulting in higher medical expenses. If we can effectively manage diabetes, we can prevent these complications, thereby saving costs for insurance companies. Therefore, among chronic disease management initiatives currently undertaken by U.S. insurers, diabetes management is the most prominent example based on my understanding. I suggest that insurance companies in China should develop two types of insurance products: one covering routine health examinations, and another focused on chronic diseases. Existing critical illness insurance policies typically cover conditions with very low incidence rates, such as one in ten thousand or even one in a hundred thousand, which are low-probability events. In contrast, there should be a market for insurance products covering chronic diseases and their associated complications.

Even health checkup institutions are keen to partner with insurance companies for joint management. Since insurance companies are not hospitals, health screenings can be fully conducted at checkup centers, while post-examination management is handled by insurers under the guidance of physicians. This approach addresses both cost and personnel issues, making it a potentially favorable model before the state assumes responsibility for hospital fee collection.

Health Management & Physicians

Doctors Can Do More in Health Management

In the United States, health management professionals operate under a different conceptual framework, focusing exclusively on tasks that fall outside the scope of physicians’ responsibilities. In China, however, many physicians not only practice clinical medicine but also pursue training as certified health managers. Consequently, compared to their counterparts in the U.S., Chinese physicians play a more significant role in health management.

At our research institute, we place significant emphasis on physician training, aiming to transform our doctors into health management physicians who possess both health management expertise and clinical medical knowledge. In fact, the general practitioner (GP) training program we advocated two years ago was aligned with this direction. However, GPs are not equivalent to health management physicians due to differences in curricula, although GPs do have inherent advantages in transitioning into health management roles. We also hope that the state will incorporate more health management training into medical education, enabling physicians to play a more prominent role in disease prevention.

Health managers are required to have a medical background.

I would also like to address the issue of health managers. In China, health managers have been trained for many years, with programs run by the Ministry of Health and other relevant departments. In my view, a health manager does not necessarily need to be a physician, but should ideally have a medical background rather than being merely a medical enthusiast. While individuals without formal medical training can perform related supportive roles, they are likely to encounter significant difficulties if tasked with managing patients in a hospital setting.

Health Management & Internet

Internet Healthcare Startups Are a Direction

To address this issue, I specifically visited Baidu to deliver a presentation. As I mentioned earlier, the pillars supporting health management are informatization and insurance. With the insurance aspect already covered, why does the internet present an opportunity? It is well known that no clinical department in a hospital generates as much data and information as a health examination center. Particularly when undergoing a premium health check-up, one may generate hundreds, thousands, or even tens of thousands of data points. Without robust informatization support, it would be impossible to effectively analyze and summarize these data.

Why is there an opportunity in the internet sector? Post-examination management relying solely on manual oversight has inherent limitations, especially given China’s large population; without digital tools, effective management becomes unfeasible. Our internet-based solutions—including mobile apps, SMS services, and WeChat—enhance connectivity among those under management and facilitate smoother information flow.

Internet companies essentially operate in two areas. The pioneers started with health checkup software. The next step was enabling online queries. When online queries proved insufficient, the question arose: could online consultations be offered? Later, with the advent of wearable hardware devices, another question emerged: could we transmit device data and information in real time to our backend systems for management? These ideas are all promising, but so far, no company has achieved substantial profitability. Consequently, many firms are burning cash through investment. Why are investors willing to fund these ventures? Because they signal a strategic direction.

The opportunities of the Internet lie in post-examination services and post-discharge services.

"From our perspective, shaped by over a decade of experience in health management, we believe the opportunities offered by the internet lie primarily in post-examination and post-hospitalization services."

For example, as we all know, in the case of joint surgery, the success of the procedure depends not only on the surgery itself, which accounts for only a portion of the outcome, but also significantly on postoperative rehabilitation. However, given the severe shortage of hospital beds, patients cannot be kept until they have fully recovered.

So how can patients receive guidance from doctors without occupying hospital beds? If we could leverage a mobile app to enable online video interactions between doctors and patients, allowing them to receive medical guidance even outside the hospital, I believe there would definitely be a market for this.

This includes the management of many chronic diseases. For instance, patients with conditions such as hypertension and diabetes may seek consultations after hospital visits. This need can be addressed through mobile apps, leveraging internet and Internet of Things (IoT) technologies. Some websites currently offer such services, providing physician consultations for a nominal fee. However, in my opinion, the scope of these services remains quite limited.

As I mentioned earlier, over 300 million people undergo health checkups annually in China, yet fewer than 10 million truly benefit from these services. This indicates substantial market potential, particularly for internet companies and mobile apps. However, hospitals comprise numerous departments beyond just health checkup centers. What further roles can these digital players assume? Superficially, they may optimize hospital workflows and enhance service quality. Yet, hospitals are unlikely to grant easy access to core, deep-level medical services.

Some argue that the prospects for mobile health are challenging, not only due to the strong barriers between departments within a single hospital but also between different hospitals. Despite years of advocating for interoperability, the only progress made so far is that laboratory test results no longer need to be rechecked among top-tier (Grade 3A) hospitals in Beijing. However, if certain imaging scans are unclear, they must be repeated, and some specialized examinations still require duplication.

If we could create a unified cloud-based health information card, doctors at any hospital would be able to access your medical records directly through this card, eliminating the need to review physical imaging films. Whether such an initiative is being undertaken, and whether medical examination data can be shared and utilized across institutions, remains an open question. Of course, many of these issues extend beyond the scope of individual enterprises and should be addressed at the national level. Therefore, my recommendation is that if you wish to benefit from future internet-based healthcare services, a more strategic entry point lies in post-examination and post-hospitalization care.

Hardware IoT is highly valuable

I would also like to address the issues surrounding mobile applications. I believe that software, including hardware and IoT solutions, holds significant value for resource management in China. To be candid—though this may not be pleasant to hear—wearable devices appear to be more important in China than in Europe and the United States. This is because faith is generally lacking among the Chinese population, and the power of belief is relatively weak; thus, material mechanisms are required for effective management. In some Western countries, people have their own religious beliefs and will consciously and voluntarily engage in certain behaviors, such as praying at scheduled times, resulting in better adherence. In China, however, there is a greater reliance on external tools for regulation. We once conducted an experiment using SMS reminders for weight management. Participants received text messages informing them of their daily caloric intake and reminding them to exercise. This simple intervention demonstrated a statistically significant difference in outcomes between those who received the messages and those who did not.

Let me share a joke with you. During the establishment of our national "12th Five-Year Plan" research project on sub-health, one task involved measuring physical activity. We provided "advanced" pedometers to both healthcare workers and patients for actual measurement. However, we encountered an issue: a nurse who drew blood samples sat all morning without taking a single step, yet her pedometer recorded over 3,000 steps. Why did this happen? The continuous extension and retraction of her arm were mistakenly counted as steps. Therefore, the scientific validity of such pedometer tools warrants further investigation.

This is precisely my point: How far are the sensing devices in our health IoT ecosystem from truly meeting medical-grade standards? In my view, these smart devices should only serve as genuine data entry points for health management after they have been validated against medical instruments. We cannot simply implement ideas on a whim merely to reduce burdens. The pedometer I mentioned earlier is a quintessential example: a nurse sitting stationary while drawing blood could still register over 3,000 steps.

Health Management Requires the Power of the Community

Another point I’d like to share is that health management requires the power of community. For those of us developing apps and IoT devices, how should we engage our strategic thinking? The key is to enhance the sense of community, leveraging the strong tendency toward conformity among Chinese users. Take WeChat Sports, for example, which many are familiar with. Why do some people walk more? They’re eager to rank first. In my own circle, there’s someone who consistently logs 20,000 to 30,000 steps per day. While I’ve never quite understood this drive, I believe that, regardless of the motivation, it creates a positive social pressure: when your activity is visible to others, you feel embarrassed if your step count is too low.

Everyone wants to be perceived as health-conscious, which aligns with our management philosophy. Such social circles exist not only in our organization but also in banks and corporations. Therefore, I believe that group orientation and precision are the two key aspects to consider in the design of our app or other products.

In this field, I personally place greater emphasis on academic research. Priorities may vary from person to person: many deliver excellent lectures on macro-level topics, while others excel in implementing specific interventions. My focus on academia is likely influenced by my overall educational background.

I have always believed that two aspects are indispensable to the development of a discipline. The first is the improvement of the overall disciplinary system; however, health management has not yet been included in China’s national first-level medical discipline catalog. The second is support from core technologies. The lack of such core technologies is the primary reason why physicians engaged in health management receive insufficient recognition.

To be honest, everyone knows the adage “eat less and move more.” The advancement of many medical disciplines, particularly internal medicine, has been driven by technology. For instance, in cardiology, procedures such as stent placement and catheterization were originally considered interventional techniques and, to some extent, fell within the realm of surgery. Similarly, in gastroenterology, procedures like gastrointestinal endoscopy are now routine. All these practices rely heavily on advanced technologies, rather than merely using a stethoscope or prescribing a few medications.

Based on these two points, my recent work has focused on the following areas: advocating for reliable approaches supported by advanced technologies, such as genetic testing and functional medicine, as well as promoting nationally approved services that utilize immune cells to enhance immunity, provide adjunctive cancer therapy, and offer anti-aging treatments.

These initiatives provide technical support for our health management services. With such support, physicians engaged in health management can demonstrate greater professional value, thereby ensuring the discipline’s credibility and sustainability.

Six years ago, I undertook a research project commissioned by a professional society and a foundation, focusing on a multi-center weight management initiative across China. With widespread support, the number of participants has reached 140,000. Some may wonder why I, originally specialized in cardiovascular medicine, shifted my focus to weight management. It is well recognized that obesity is a common risk factor for multiple diseases. As body weight decreases, blood glucose, blood pressure, and lipid levels all improve significantly. In some cases, individuals who were previously unable to conceive have successfully achieved pregnancy. We have numerous examples demonstrating these outcomes in our practice.

There are numerous methods for weight loss. We have convened two national conferences on weight management to research and discuss various approaches. For instance, we have invited surgical experts to present bariatric surgery as a method, as well as pharmacological interventions. However, in the field of health management, we advocate for non-pharmacological weight loss through lifestyle management and dietary adjustments, which has proven highly effective. Moreover, demonstrating efficacy alone is insufficient; we have also conducted extensive research into the underlying mechanisms.

For example, I am about to launch a gene-guided weight management program. Since individuals have different genetic profiles, they vary in their propensity to gain weight from specific foods. Some people may gain weight by consuming meat, while others may experience more significant weight gain from carbohydrates. Therefore, personalization is crucial, which is precisely what we aim to deliver.

I believe that in future work, the gut microbiota and metagenomics will hold greater value for clinical diagnosis and intervention than traditional genomics. Therefore, we welcome colleagues interested in genetic or methodological research on obesity, as well as those working in related fields, to contact us. We are eager to collaborate with everyone.

In China, our research group is among the most active in investigating the relationship between body composition and disease incidence, as well as associated risk factors. Effective weight management involves not only monitoring total body weight but also assessing body composition, including fat percentage, muscle mass proportion, and even bone mineral content. We have also conducted research on measurement standards. Our team introduced the concept of the waist-to-height ratio (WHtR), which was published in the British Journal of Nutrition. Furthermore, we were the first to propose sex-specific cutoff values for WHtR in the Chinese population. We believe that WHtR offers superior predictive value for cardiovascular and cerebrovascular diseases compared to waist circumference, waist-to-hip ratio, and body mass index (BMI). These represent key contributions of our work.

Throughout our journey in health management, we have never ceased our scientific research endeavors. With over a decade of experience in this field, I have secured several national-level research grants, including one from the National High-Tech Research and Development Program (863 Program) and another from the 12th Five-Year National Science and Technology Support Program. Most recently, I obtained an international cooperation project funded by the National Natural Science Foundation of China. I remain actively engaged in research, contrary to the misconception that health management merely involves conducting physical examinations. We are committed to advancing research because emerging disciplines require robust academic guidance. Only through evidence-based, academically driven approaches can we continually enhance the quality of our work.

The Institute of Health Management was formed through the merger of the Health Medicine Center and the International Medical Center. With a building area of over 40,000 square meters, it comprises six clinical departments, two health examination centers, and a special-needs outpatient clinic, employing nearly 600 staff members. The Institute currently serves as the unit of the President-Elect of the Health Management Branch of the Chinese Medical Association and as the chairing unit of the Professional Committee on Health Management of the People's Liberation Army. It is among the first batch of flagship units designated as National Health Management Demonstration Bases by the Health Management Branch of the Chinese Medical Association and the China Health Promotion Foundation. Additionally, it ranked first in the “Most Trusted High-End Health Examination Centers” survey conducted by China Health Net. At present, the Institute receives nearly 1,000 patients daily for health examinations and medical consultations from across the hospital, with an annual service volume reaching 200,000 visits. It has engaged in beneficial explorations and practices in delivering an integrated service model encompassing health examinations, health assessments, consultations with renowned experts, inpatient treatment, and healthcare and wellness services.

Regarding the issue of post-examination management services, which is of great concern to all of us, I have adopted some flexible approaches in its implementation. For instance, how to conduct health management and how to resolve fee-related issues. Here, I would like to share some good news. In Sichuan Province, Director Liu Yuping has submitted a report to the Development and Reform Commission, and the provincial government has issued an official document allowing hospitals to set their own prices and charge fees for post-examination services independently. As the “Two Sessions” are approaching, we immediately communicated with the National Committee of the Chinese People’s Political Consultative Conference (CPPCC) after receiving this positive update. They requested that I prepare two proposals: one is to include health management as a first-level discipline in the medical field classification; the other concerns service pricing for post-examination management. Once the issue of service fees is resolved, post-examination services can be effectively implemented.

There are always more solutions than difficulties. At this stage, we indeed lack a formal fee structure. Nevertheless, this has not hindered our work, including the ongoing Chronic Disease Management Week. We conduct comprehensive examinations for patients with chronic diseases. Following the assessments, we provide holistic interventions covering exercise, nutrition, and psychological support. These services are conditional: they are available to inpatients. For outpatients, we prescribe nutritional and exercise regimens to be implemented outside the hospital.

In China, the vast majority of those who engaged in health management in the early years are what we call “martyrs” rather than “pioneers.” Why has there been so much talk and so little action over the years? One unavoidable issue is the business model. For many years, health management has remained at the conceptual level, lacking core technologies and clear revenue streams that can be practically implemented. How could any enterprise succeed under such circumstances? Moreover, from a governmental perspective, health management has not been established as a standard, formal medical service. As I mentioned earlier, there are no standardized pricing guidelines, nor is it included in the official reimbursement catalog, making it extremely difficult to operate.

If we cannot identify effective entry points and revenue models for health management, implementation becomes unfeasible. Consequently, there is much discussion but little action, with many equating health management merely to physical examinations. Moreover, some previously advanced the theory that physical examinations are futile. At the time, I could understand this perspective, which stemmed from two main reasons.

Who Benefits Most from Health Checkups? Individuals Who Pay Out-of-Pocket for Comprehensive Packages Benefit the Most, as They Have the Financial Means, Prioritize Their Health, and Are Highly Attentive to Their Results Due to Personal Expenditure.

Who benefits the least? Those undergoing employer-organized health screenings. Why do they derive minimal benefit? Because many individuals have no genuine desire to be screened; they participate merely because attendance is mandatory while on duty. After completing the tests, they simply discard the results without further attention. Screening without follow-up management is tantamount to no screening at all. Furthermore, the accuracy of the screening itself may be questionable—some individuals are diagnosed with diseases just three months after their check-up because the initial screening failed to detect underlying issues. Therefore, personalized health screenings are often critically important.

Health management interventions can be described as a combination of nutrition, exercise, and psychological support. Regarding exercise, we will prescribe an individualized exercise regimen based on your physical examination results and fitness level to inform you which types of exercise are most effective for you. For instance, while it is commonly believed that aerobic exercise is the key to weight loss, greater efficacy is achieved by performing 20 minutes of anaerobic exercise prior to aerobic activity. Furthermore, even within aerobic exercises, there are differences between brisk walking and jogging. Which is better? In both brisk walking and jogging, variable-intensity exercise burns calories more efficiently than steady-state exercise; in other words, alternating between faster and slower paces yields better results than maintaining a constant speed.

As I mentioned earlier regarding dietary issues, for those aspiring to enter the chronic disease management market, hospitals currently only provide prescriptions. However, where should patients purchase the prescribed items? Therefore, collaborating with professional institutions to offer customized, home-delivered dietary solutions—such as diets for diabetes or hypertension—represents a significant market opportunity. Moreover, these services can be effectively addressed using internet e-commerce strategies. Consequently, although hospitals are currently restricted from partnering with general enterprises, post-examination services are inextricably linked to such collaborations, and this step will inevitably be taken sooner or later.

I believe such guidance should be issued by professional and authoritative institutions, rather than obtained through casual inquiries. As I mentioned earlier, with the support of our foundation, we are developing personalized plans aimed at providing overarching guidance by gaining an understanding of patients’ early-stage conditions, medical history, and lifestyle. However, the final formulation of these plans should still be done in consultation with a physician.

Regarding the selection of health screening items, I believe that not only the public but also examining physicians and consulting specialists must be aware that different tests have distinct characteristics. Recommendations should prioritize clinical utility rather than assuming that the most expensive options are the most effective.

It is entirely feasible. This requires cultivating health managers within communities, preferably with support from higher-level authorities for management purposes. The national strategy of shifting focus upstream and decentralizing resources embodies this very principle. So why has it not gained traction? The core issue lies in the unresolved question of payment. Therefore, there is no problem with implementing this at the community level.

I believe the most viable approach for you at present is to focus on areas that public hospitals currently struggle with, particularly in post-examination services, including patient navigation and related support.

Because private institutions can set their own prices, they can offer post-examination services as long as there is demand, given that they pay taxes to the state. In hospitals, although we recognize that many such services are beneficial, we cannot charge for them and therefore cannot provide them. This represents an advantage for you; however, it remains essential to select reliable technologies for implementation.

Regarding risk assessment, I addressed this issue nearly six or seven years ago. We need not be overly concerned with the precision of such software, as these assessments are probabilistic in nature—meaning the predicted outcomes may or may not occur. In my view, the primary significance of risk assessment lies in raising health awareness among those assessed, encouraging them to place greater emphasis on their own well-being. Whether the calculated risk is 78% or 87% is of relatively minor importance.

Moreover, since risk assessment models used worldwide are largely similar, there is no need to overly concern oneself with their absolute accuracy. In the early stages of our risk assessment development, we relied entirely on data from Western populations. Given the differences in ethnicity, the resulting outcomes varied. As long as the model is fundamentally reliable, built upon a database of the Chinese population, and incorporates machine learning capabilities for self-correction, it is considered adequate.

From the perspective of health checkups, I have long advocated a concept: “Essential items are indispensable, while age, region, and gender serve as references.” What does this mean? It addresses the issue of personalization.

How do I view economic issues in healthcare? If a medical intervention poses no harm to the body and you have sufficient financial resources, you may opt for the most comprehensive approach upfront, which we refer to as “buying time with money.” Alternatively, one can start with the most basic examinations and proceed step by step only if issues are identified. However, in China, we do not advocate for immediate, all-encompassing interventions for the general population. Instead, it is more important to follow established clinical guidelines and select the most appropriate tests that offer the best cost-effectiveness and return on investment.