Medical Weekly No.7: When Will Healthcare Truly Go Mobile?

Topic: When Will Healthcare Become Mobile?

Location: National Primary Healthcare Management and Operations Exchange Group

Exchange: Zhao Yue

Why is it difficult to disrupt the healthcare service industry using existing mobile internet models? Upon reflection, the primary reason is the limited availability of resources that can be aggregated and mobilized. Uber can recruit individuals who know how to drive but are not professional drivers to serve as drivers; Airbnb can enlist people with spare rooms who are not traditional landlords to act as hosts. However, where can one find individuals who are capable of providing medical care but are not licensed physicians? Therefore, the fundamental issue in the healthcare industry is that the supply of high-quality services falls far short of demand, and the internet model cannot fundamentally increase this supply.Secondly, healthcare services demand exceptionally high quality. Poor driving may at most result in detours and wasted time; substandard accommodation may merely cause a few nights of restless sleep. In contrast, medical diagnosis and treatment involve matters of life and death. Internet-based platforms cannot guarantee the quality of such critical services. Furthermore, unlike other service sectors, healthcare requires highly complex skills and resources. Becoming an Uber driver requires only spare time and a personal vehicle; becoming an Airbnb host is even simpler, requiring only cleaning skills and an unused room. However, for a physician to provide diagnostic services, beyond the experiential skills of traditional Chinese medicine’s “inspection, listening and smelling, inquiry, and pulse-taking,” various diagnostic instruments and prescribed medications are required, with severe cases necessitating sophisticated surgical equipment, among other resources. These intricately intertwined and complex resources cannot currently be aggregated onto internet platforms. Of course, when technological advancements eventually enable physicians to easily provide diagnostic and therapeutic services without relying on bulky and complex instrumentation, the healthcare industry will likely become as mobile and dynamic as other industries transformed by the internet.

Topic: The Key to China’s Healthcare Reform Lies in Enhancing and Standardizing Primary Care

Location: Dayi Cloud Valley

Contributor: Shao RuitaiZhang GuohuaDayi Cloud ValleyLin Feng

An objective assessment of China’s healthcare quality and coverage reveals that, while it may not compare favorably with Western nations, it ranks among the better systems in the developing world. Current challenges primarily include the coexistence of uneven distribution and wastefulness of medical resources, low standards and lack of standardization in primary care, and difficulties and high costs associated with accessing medical services. Regarding the high cost of care, three factors are particularly burdensome for the general public: first, the high expenses of seeking medical treatment outside one’s home region, encompassing both direct medical costs and indirect costs such as accommodation and transportation; second, patients traveling extensively based on hearsay, which wastes medical resources and incurs substantial financial burden; and third, the tendency to seek care at large tertiary hospitals for minor ailments, which naturally drives up costs. Addressing these issues and retaining patients within the primary care system require significant improvements in the quality of primary healthcare. Furthermore, enhancing the capabilities of county-level specialized hospitals can provide effective treatment for many patients requiring specialized care. The improvement of primary care networks must go hand in hand with the advancement of specialized care at the county and prefecture levels; such a synergistic approach should resolve the majority of healthcare challenges.

Improving the quality of primary healthcare and standardizing clinical practices are fundamental to addressing the issue. Meanwhile, an undeniable reality is that enhancing the capabilities and standardization of primary healthcare institutions cannot be achieved through simple training alone; instead, appropriate transformation strategies must be identified to enable primary healthcare to deliver its full value.

In WeChat groups for doctors and healthcare professionals, there are numerous medical inquiries and requests for assistance, most of which come from individuals within the industry. When our own family members or friends fall ill, do we trust and choose primary care institutions? Does this not serve as counter-evidence? Trusting the institution rather than the individual practitioner is, in fact, a rational choice; under conditions of information asymmetry, it may well be the optimal strategy.

The low degree of marketization in healthcare is an indisputable fact. The debate over whether the sector should be market-led or government-led has never ceased; both sides have their merits, and it can be said that there is no definitive solution under current conditions. De-administratization should be the future direction, but this does not necessarily mean a market-led approach.

Topic: The Healthcare Payment System Should Be Reformed; Seeing More Patients Is Not the Goal—Reducing Medical Visits Is the Right Path.

Location:Dayi Cloud Valley+

Contributor: Liang Liangliang

Mobilizing physicians’ enthusiasm should not be limited to encouraging them to treat patients; more importantly, it should incentivize their active participation in disease prevention. If empowering physicians is one of the core elements of healthcare reform, then the central focus must shift from treatment-oriented care to prevention-oriented care. As for profitability and how to ensure physicians earn a fair income, these are challenges that still require innovative solutions.

Do doctors prefer to see more patients or fewer? More patients mean higher earnings, albeit with some risk to life and safety. Fewer patients mean no income; in the era of internet-based healthcare, having no patients is futile!

Reforming our healthcare payment system is critical. If global budget prepayment under medical insurance can be implemented in the field of disease prevention, the savings generated could be directly allocated to preventive care institutions as service procurement incentives. This would gradually shift physicians’ mindset toward prioritizing prevention. Although tangible results may not emerge within ten or even twenty years, I am confident that sustained efforts will ultimately lead to an absolute reduction in the total number of patients.

Topic: Sharing Brings Immense Value.

Location: Chinese Non-Government Medical Institutions Association

Contributor: Li Hailin

Excerpt from Kevin Kelly’s Stanford Lecture: Sharing Generates Significant Value! For instance, by sharing your health data with physicians and health managers, you can substantially reduce the likelihood of misdiagnosis. In the internet era, sharing is a crucial mechanism for value creation. Many people today lack awareness of sharing, remaining trapped in self-referential internal loops, which is essentially a waste of their life energy. We are now in an era where everyone transmits their own data. Tools like WeChat enable each individual to operate radio stations and self-media platforms at zero cost, providing excellent opportunities for information sharing.

Topic: Successful healthcare reform requires the cooperation of physicians, not coercion.

Location: China (Grassroots Level)

Participant: Xu Weiming

A successful healthcare reform model should be designed to implement a general practitioner (GP) system, wherein GPs serve as gatekeepers safeguarding residents’ health. Their compensation should be positively correlated with the utilization of medical insurance funds, while patients retain the freedom to choose specialist hospitals and physicians, thereby preventing overtreatment. Additionally, a policy should be enforced whereby physicians are subject to dismissal if the positive rate of their ordered ancillary tests falls below 30%, thus curbing excessive diagnostic testing. GPs should prioritize preventive care and health maintenance, a practice that has proven successful worldwide.

Controlling the drug-to-revenue ratio is like pressing down a gourd only to have another float up; it fails to address the core issue, amounts to formalism, constitutes administrative interference in clinical practice, reflects bureaucrats dictating medical care to clinicians, and forces physicians to order more tests while prescribing fewer medications. Healthcare reform requires the cooperation of physicians, not their coercion.

We often criticize the “Fujian gang” for their egregious fraudulent practices, yet public hospitals may now be even worse. Consider the many elderly patients with hypertension and heart failure who are nearing death, with multi-organ failure already setting in. Palliative care would be the appropriate approach at this stage, but they are instead admitted to intensive care units (ICUs), costing thousands of yuan per day. This raises suspicions that hundreds of thousands of yuan are being extracted from patients just before they die. Worse still, some hospitals refuse to admit patients unless they agree to ICU care. Such overtreatment is no different from murder for financial gain.

Healthcare reform is like squeezing persimmons—picking the soft ones to squeeze, specifically targeting doctors. In reality, it is very difficult to substantiate evidence of red envelopes and kickbacks involving physicians.

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