Two Thought-Provoking Stories on Healthcare from MedCircle Weekly No.6

Topic: Healthy China Should Focus on Preventive Care.Location: Dayi Cloud ValleyContributor: Liang Liangliang

The smog that blanketed North China was dispersed by wind and snow after two days without a red alert. Yet, just yesterday, I was chatting with a friend from Shanghai who works in internet healthcare; he suffered from an upper respiratory infection and persistent coughing due to Beijing’s smog. This incident prompted me to reflect on a critical issue. Currently, the primary objective of internet healthcare is to address the difficulties and high costs associated with accessing medical care. However, this approach merely attempts to solve the problem of treatment access.The state supports the nation’s health needs through medical insurance. In any country, medical insurance funds are primarily contributed by the vast majority of healthy individuals to cover the occasional needs of those who fall ill; thus, the total fund pool is limited. When a country’s disease prevalence continues to rise and the population with chronic diseases expands—especially with the incidence of conditions like cancer—it heavily depletes social medical insurance resources, threatening financial sustainability. Meanwhile, pathogenic factors such as air pollution (exemplified by smog), drinking water contamination, and food safety issues are becoming increasingly prevalent and severe. The growing number of patients directly threatens every one of us present here, regardless of whether you work in internet healthcare, internet finance, or other internet sectors. If this trend continues, the most direct victims will be ourselves and our children. Many of us are parents, and some are even grandparents. Therefore, our efforts should not be limited to solving the difficulties and high costs of seeking medical treatment; we must focus more on how to reduce disease incidence and lower the total number of patients. Although this approach may not be highly profitable, it ensures the healthy growth of ourselves and our children. Hence, I suggest shifting more energy toward pre-disease prevention rather than solely post-disease treatment. If we recognize this, I believe that after ten years of effort, we can truly achieve the fundamental goal of sustainable development. This is the essence of a "Healthy China."Discussion:1. Looking at the current health mindset of the Chinese population, who is willing to invest in preventing illness? Most people only seek medical attention when they are critically ill. They tend to avoid doctors when they are healthy or in a sub-health state, as many perceive preventive medical consultations as doctors trying to swindle their money.2. The "boiling frog" syndrome fails to garner widespread attention. For instance, consider how much the national awareness regarding diet, lifestyle, and environmental protection has improved since the SARS outbreak.3. Currently, many middle-class and affluent individuals are placing greater emphasis on disease prevention and regular check-ups. However, the concept of wellness has been severely misrepresented by so-called "experts." There is an urgent need to popularize modern medical health concepts.4. The lack of trust is a significant obstacle to implementing the "Healthy China" initiative. Consequently, there is a marked difference in the influence exerted on patients by ordinary physicians versus those who serve as trusted, friend-like consultants.5. Education is needed to change the world. Unfortunately, our education system has become excessively profit-driven. Therefore, I hope to transform the populace through internet-based education, such as MOOCs. It takes ten years to influence one generation and twenty years for two generations to profoundly change a nation and its people. Did not the Meiji Restoration take only 30 years? And that was a transformation under centralized rule.6. An increase in the number of patients is inevitable. As society develops, many diseases that were previously untreatable or unaffordable can now be treated. This is a sign of social progress. However, the contradictions have been misled and exaggerated. What is needed now is guidance, not mutual blame, starting with each individual around us.

Topic: Are Doctors Angels?Location: Exploring New Directions in HealthcareParticipant: Michelle

Last Sunday, I went hiking with a group of visiting scholars from China. They asked me about my profession, and I replied that I used to be a physician but now work in scientific research and business. The conversation then turned to physicians in China, culminating in the conclusion: “Physicians used to be ‘angels in white,’ dedicated to saving lives and healing the wounded, but that is no longer the case.”I listened patiently to their critiques for over an hour before finally losing my composure. I raised my voice and exclaimed, “Physicians face occupational hazards every day; they need understanding, love, and protection. They are merely ordinary people, not angels, let alone gods. In fact, they may be even more vulnerable than the average person. Every time they recall a patient who passed away under their care, they experience immense pain. When I was practicing medicine, a patient with end-stage liver cirrhosis held my hand tightly, begging me to save him. My heart was shattered, yet I was powerless. He eventually passed away, leaving me with the lasting sensation of his hand in mine. Do any of you here understand this? Stop judging physicians. All doctors are ordinary people like you; they may commit wrongs, succumb to temptations, and have needs for money, recognition, and, above all, happiness. Stop treating them as angels. It is your good fortune if they can save you; they are neither required nor obligated to guarantee a cure for your illness…”My outburst, so uncharacteristic of my usual gentle demeanor, left them speechless for half an hour. Afterwards, many sent me text messages saying, “It was the first time we had heard such words; it was truly shocking…”Discussion Points:1. The higher the public welfare expectations placed on healthcare, the greater the harm inflicted upon medical professionals. Therefore, to safeguard the lives, health, and safety of our medical colleagues, please refrain from exacerbating these public welfare pressures.2. The severe lack of trust between physicians and patients significantly increases healthcare costs. This has created a vicious cycle. Even if trust were present, the overwhelming influx of patients cannot be matched by the limited number of physicians. Consequently, the quality of care suffers as doctors strive to meet high outpatient volume targets, potentially leading to adverse outcomes. Furthermore, even if we were physicians ourselves, who could guarantee a miraculous recovery when facing critically ill patients?3. The practice of seeking medical care through personal acquaintances remains somewhat appealing, primarily due to its convenience and the stronger sense of trust it fosters.4. Whenever violent incidents against medical staff occur anywhere in China, news spreads rapidly across the internet. This further reinforces a self-protective mindset among healthcare providers, driven by the instinct to seek advantage and avoid harm.

Topic: How Should Tiered Diagnosis and Treatment Be Implemented?Location: Dayi Cloud ValleyParticipant: Liang Liangliang

Highly skilled physicians are concentrated in top-tier hospitals. This resource allocation pattern has naturally fostered a deeply entrenched societal perception that primary care physicians are less competent, creating a vicious cycle. Patients’ growing distrust of community doctors is a major reason why we have failed to establish an effective tiered diagnosis and treatment system. Regarding personnel policies, the public institution status of hospitals restricts physicians’ professional autonomy. Competent doctors who should ideally be deployed to community settings are neither willing nor able to go against prevailing policies.In Western countries, the foundation of primary care—provided by private practitioners or partnership-based teams—is supported by health insurance funds being skewed toward the primary care level. Although private clinics appear to operate independently, their high efficiency results from the strategic direction of insurance funding toward community-based private practices. Consequently, they fulfill, and even exceed, the performance expectations of China’s public primary healthcare institutions. This model effectively serves the goal of maintaining and improving regional population health by reducing disease prevalence and mitigating its impact. In contrast, policies that allow private capital to enter China’s healthcare system under the guise of improving tiered referral systems are largely performative, if not malicious. The profit-driven nature of capital only exacerbates the increasingly severe burdens on the healthcare system, drawing widespread public criticism.Currently, the only policy capable of subtly leveraging healthcare reform is the liberalization of physician practice, specifically by encouraging multi-site practice. Whether this approach succeeds remains to be seen; however, if physicians can fully utilize their expertise and health insurance funds are appropriately adjusted to support independent practitioners or teams, the long-awaited tiered diagnosis and treatment system may finally become a reality.We are now in an era where internet thinking significantly influences, and even reshapes, social operational orders. Mobile health, smart healthcare, internet-based medical services, and e-PCHM (electronic Primary Care Health Management), characterized by strong service stickiness and the ability to deliver consistent, high-quality care, could start by changing public habits in accessing healthcare. This shift could alter the overreliance on tertiary hospitals, completely disrupt the current benefit-sharing structure among primary, secondary, and tertiary healthcare levels, and ensure that national fiscal and policy investments benefit the general public rather than generating improper profits for pharmaceutical and medical device vendors.Nine years into healthcare reform, with four years of substantive changes, we have witnessed significant development in primary care. However, we have also observed the impregnable profit-oriented structure of tertiary hospitals. We cannot simply blame doctors or hospital administrators for greed, as their contributions far exceed what their incomes compensate. Where do the true profits of tertiary hospitals flow, given the conservatism of health insurance policies and the long-standing opaque practices in pharmaceutical procurement and sales? Perhaps anti-corruption efforts will eventually expose this sore spot.

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