Is Internet-Enabled Tiered Healthcare a Mirage or a Remedy?

As national healthcare reforms deepen, discussions around tiered diagnosis and treatment have gained momentum within the medical community, with numerous mobile health companies attempting to leverage the internet to promote triage-based care. While some dismiss these efforts as empty promises, others maintain that the internet is powerful enough to disrupt the complex healthcare system. However, subjective debates do not clarify the actual role played by mobile health. Let us first examine the following true story.

Renqing, an 11-year-old child from Xigaka Village, Jianni Brigade, Niao Township, Diebu County, Gannan Tibetan Autonomous Prefecture, Gansu Province, had been suffering from a blood disorder for six years. As his condition failed to improve and his family could no longer afford the medical expenses, Gansu Television Station conducted consecutive reports on young Renqing on March 25, 2015, and contacted Dr. Zhai Ruirun, Director at Qingdao PLA No. 401 Hospital, who had previously treated two pediatric patients with blood disorders in Gansu. On April 6, Renqing, accompanied by reporters from Gansu Television, boarded a train to Qingdao. Under the meticulous care of Dr. Zhai and his team, Renqing made a significant recovery. However, he caught a cold after returning home due to the 3,000-meter altitude difference between Qingdao and Gansu. As traveling back and forth between Qingdao and Gansu for further treatment was impractical, Dr. Zhai ultimately provided remote treatment to Renqing through a primary care referral point established in Diebu County, Gannan, via the internet hospital platform of a mobile healthcare service.

In fact, there are many similar stories, particularly in the less-developed central and western regions of China where medical resources are scarce. If a mobile diagnosis and treatment mechanism were implemented, diseases could be triaged based on their severity, urgency, and complexity of treatment. Medical institutions at different levels would then assume responsibility for treating conditions commensurate with their capabilities, thereby enabling initial consultations at the primary care level and facilitating two-way referrals. This is precisely why many experts strongly advocate for a tiered diagnosis and treatment system.

For both the healthcare industry and mobile health, these developments are merely the tip of the iceberg. Currently, there are over 3,000 mobile health apps on the market. From internet giants such as BAT (Baidu, Alibaba, and Tencent) to traditional medical device manufacturers, top-tier (Grade A) hospitals, and entrepreneurs who have already completed multiple rounds of financing, all eyes are fixed on the healthcare sector, which is in urgent need of reform. Returning to the question posed at the beginning: Can mobile health leverage its asset-light model to promote the implementation of tiered diagnosis and treatment at the internet level?

Mobile Health Players Set Their Sights on Tiered Diagnosis and Treatment

Regarding tiered diagnosis and treatment, Zhu Hengpeng, a leading policy analyst, has described the administration-led approach as akin to “climbing a tree to catch fish”—a futile endeavor. So, what strategies are mobile health players adopting? Generally, there are two approaches: first, leveraging the “healthcare + insurance” model to enable online consultations and gradually break into the tiered system; second, promoting physicians’ free practice. However, it must be acknowledged that all current efforts remain superficial and fail to address the core issues.

Since the State Council issued its guidelines in September this year to promote the implementation of tiered diagnosis and treatment, many mobile health players have begun to adjust their original strategies. After raising $394 million, Guahao.com was renamed WeDoctor Group and subsequently made a high-profile announcement that it would invest $300 million to build a “National Internet-Based Tiered Diagnosis and Treatment Platform.” This inevitably raises questions about how much of WeDoctor Group’s grand vision is mere hype.

Based on the introduction, WeDoctor Group has divided its tiered diagnosis and treatment plan into three stages: window shift, team-based healthcare, and internet hospital. Let us briefly analyze these stages.

The so-called "window shift" is essentially about optimizing the patient care journey. This represents a highly rational entry point; compared to online consultations and establishing offline clinics, optimizing the care processes within the existing healthcare system appears to have a lower barrier to entry. For instance, various aspects of the patient journey—such as queue management and number calling, access to test reports, one-stop payment settlement, and post-consultation follow-ups—can all be extended to mobile platforms. Currently, two players hold advantages in China’s online appointment registration market: Guahao.com, which operates on a national scale, and JiuYi 160, which is prominent in South China. For WeDoctor Group, entering the market through the "window shift" strategy is indeed a competitive advantage.

As for team-based care, it has long been proposed but remains largely unimplemented. Data show that the United States has 2.42 physicians per 1,000 people, while China, after including 1.4 million village doctors, reaches 3.15 physicians per 1,000 people. However, tertiary hospitals in China employ only about 10% of the country’s physicians yet accounted for 46% of outpatient visits over the past year. In other words, medical resource allocation in China is uneven; many patients prefer tertiary Grade A hospitals and specialist clinics, harboring doubts about the competence of primary-care physicians. Team-based care is undoubtedly the optimal approach to balancing the distribution of medical resources, but it faces numerous challenges, such as how to enhance the professional capabilities of primary-care physicians, how to build public trust in them, and how to achieve precise matching between patients and providers. The road ahead is long and arduous.

As for internet hospitals, nearly all mobile health players have recognized a key issue: internet healthcare will ultimately evolve from merely providing medical services to directly delivering diagnosis, treatment, prescriptions, and insurance coverage through internet hospitals. WeDoctor Group aims to connect healthcare providers, pharmaceuticals, and insurance via the internet hospital model, striving to become China’s version of Kaiser Permanente in the digital era. From the perspective of industry insiders, healthcare providers and insurers in China are still engaged in strategic maneuvering: hospitals calculate against insurers, insurers calculate against hospitals, and both exploit the informational asymmetry that puts patients at a disadvantage.

Internet hospitals have impacted the interests of too many stakeholders. The current healthcare system is fraught with numerous problems and resistance. Nearly all mobile health players are accumulating hospital and physician resources while simultaneously navigating policy-related risks. In short, the lack of policy relaxation has prevented breakthroughs in “electronic prescriptions,” making genuine online diagnosis and treatment unattainable. Furthermore, the failure to standardize details such as drug formularies makes it difficult for mobile health platforms to assume significant responsibility in tiered diagnosis and treatment. There are also challenges related to the development of “medical data” infrastructure.

Reflections on the Challenges Posed by Mobile Internet to Tiered Diagnosis and Treatment

What Exactly Can Mobile Health Change? Previously, many questioned it from the perspectives of service models and strategic layout. Here, the author raises the following questions regarding tiered diagnosis and treatment in mobile health from the viewpoints of physicians and patients.

1. Can it outperform the administration-led tiered diagnosis and treatment system?
One of the key reasons many mobile health companies are pursuing internet-based tiered medical care is their skepticism toward the administrative-led tiered diagnosis and treatment model. The guidelines issued in September have set a 2020 timeline for establishing the basic framework of the tiered diagnosis and treatment system, proposing to construct this order through four pillars: initial consultation at primary care institutions, two-way referrals, separate management of acute and chronic conditions, and coordination between upper- and lower-level medical facilities. In other words, mobile health players are not only competing with their peers but also racing against policy implementation timelines; they must accelerate user cultivation and the accumulation of core resources. For example, WeDoctor Group launched the “WeDoctor Quick Appointment” service based on its Guahao.com platform. While this appears to narrow the entry point of Guahao.com, it is essentially an attempt to provide symptom-oriented treatment, improve the accuracy of initial diagnoses, and enhance referral efficiency, thereby achieving precise matching between patients and physicians. This approach aims to accelerate patient acceptance of mobile healthcare while simultaneously improving physicians’ diagnostic and treatment outcomes.

2. How to Resolve the Distribution of Interests Between Doctors and Hospitals?
Whether it is tiered diagnosis and treatment or team-based medical care, the primary concern for physicians remains financial incentives. Based on current fee structures for online consultations, if independent private practice were to become fully viable, it could, to some extent, raise physicians’ income levels. However, two other issues persist: professional title evaluation and social perception. Regarding the first issue, the author once spoke with a physician who chose to open a private clinic after graduation. Working in public hospitals offers numerous training opportunities and facilitates the assessment for professional titles, whereas independent practice means forfeiting these advantages. As for the second issue, a real-life case illustrates the point: Dr. Lin Hongwei, a Ph.D. in oncology, once announced his permanent withdrawal from Chunyu Doctors due to negative patient reviews. This incident essentially reflects the problem of low doctor-patient compatibility. At present, there are no perfect solutions to these challenges.

3. Can Mobile Internet Improve the Doctor-Patient Relationship?

A friend working at a county-level hospital told the author that doctor-patient disputes occur almost every week. A series of negative media reports have eroded many patients’ trust in physicians, leading them to believe that doctors are merely trying to increase their expenses. Meanwhile, doctors also live in fear of harassment or troublemaking by patients or their families. Mobile healthcare services, which lack face-to-face interaction, will face even more severe trust issues, especially given that consultation fees for specialists on certain online platforms can range from tens to hundreds of yuan. Early on, platforms such as Guahao.com chose to position themselves as bridges between doctors, hospitals, and patients, thereby avoiding direct involvement in doctor-patient disputes. However, as they strive to implement tiered diagnosis and treatment systems and establish internet hospitals, navigating doctor-patient relationships remains an unavoidable challenge.

4. What concerns the general public the most?
The public is most concerned about the difficulties and high costs of accessing medical care. Tiered diagnosis and treatment has significantly helped alleviate the difficulty of accessing care, but it appears ineffective in addressing the issue of high costs, particularly in the absence of an integrated “healthcare + insurance” model. This also represents an unbearable burden for mobile health initiatives. In other words, the current focus of mobile health remains on resource accumulation, although competition may shift toward subsidizing medical expenses in the future.

In any case, leveraging mobile internet to implement tiered diagnosis and treatment has given us hope for healthcare reform. While it may not replace the existing healthcare system, it serves as an exemplary model for promoting tiered diagnosis and treatment.

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Alter, an internet observer, has long been dedicated to observing and researching industries such as smart hardware, O2O, and mobile phones. WeChat Official Account: spnews