Mobile Health Cools Down: Solving the Medical Insurance Payment Bottleneck Is Key

By Chen Suiqi |

After initially addressing the challenges of appointment registration and scheduling, and subsequently expanding into offline clinic development, mobile healthcare progressed to the emergence of mid-stage services such as medical accompaniment and telemedicine. It has now extended to post-consultation health management, with the closed-loop model of mobile healthcare beginning to take shape. Although mobile healthcare is gradually refining its core functionalities, it still struggles with the predicament of having a large user base but low engagement levels.

Why Has Mobile Health Failed to Garner a Large Base of Loyal Users?

First: The “brand awareness” of mobile health is virtually zero.

A survey conducted by a well-known media outlet revealed that among randomly interviewed members of the general public, only 20% had any awareness of mobile health. Of these, merely 13% could accurately articulate the primary functions of mobile health, with most people’s understanding limited to wearable devices. More strikingly, only 5% of respondents had ever experienced mobile health services. Despite mobile health being an emerging field committed to providing high-quality medical services to the public and primarily aimed at helping individuals manage their health, the results are disheartening. It appears that after the rapid development seen in 2014, mobile health has failed to achieve the expected outcomes, which is truly lamentable.

Secondly, users are completely unfamiliar with mobile health features.

The aforementioned phenomenon of low public awareness of mobile health is well recognized by many companies in the sector. Consequently, those with substantial financial resources have resorted to a flawed strategy: burning cash to “buy” users. This trend has been evident in initiatives ranging from Chunyu Doctor’s “Consult Top Specialists for One Yuan” and Ping An Good Doctor’s “Purchase Medications for One Yuan” to Didi Chuxing’s “Genetic Testing Program.” While user numbers have surged, these platforms have simultaneously faced challenges with low user engagement. This issue extends beyond the general public; even physician users appear unable to escape this predicament. Given their higher educational attainment, physicians would be expected to demonstrate greater acceptance of such technologies than the general population, yet reality tells a different story. Many doctors candidly admit that sales representatives frequently prompt them to install various apps. Although often unclear about the apps’ specific functions, physicians proceed with installations solely to receive subsidies, paying little attention to the actual utility of the applications. This highlights the drawbacks behind the cash-burning model in mobile health. Although user bases have expanded, users remain unfamiliar with or even ignorant of the apps, thereby undermining the ability of these products to deliver their intended value.

Furthermore, the use of mobile medical services is costly.

It is undeniable that mobile healthcare is transforming traditional medical consultation models, streamlining the patient journey, and indeed moving in a positive direction. However, the success of a product depends not only on its quality but also on reasonable pricing, which remains a key factor influencing purchasing decisions; this holds true for mobile healthcare as well. Currently, the issue of payment integration in mobile healthcare remains unresolved, deterring many users and earning it the label of “premium healthcare.” Consider the following comparison: If an ordinary employee falls ill and visits a Grade 3A hospital, they can have 20% of outpatient costs reimbursed, up to RMB 50 for examination fees, and up to RMB 200 for prescription medications. For a typical minor ailment, the employee’s out-of-pocket expense might amount to only around RMB 100 after reimbursement. But what if they were to use mobile healthcare services? Since mobile healthcare platforms are not yet fully integrated with national health insurance cards, the same condition would require an out-of-pocket payment of at least RMB 300. For average wage earners, even though they recognize the convenience of mobile healthcare, such costs remain prohibitive. Must mobile healthcare become merely a luxury for the wealthy?

Nevertheless, various indicators suggest that mobile healthcare is moving in a positive direction. Following the National Health and Family Planning Commission’s earlier initiatives to establish electronic health records and implement tiered diagnosis and treatment, the central government recently allocated RMB 11.124 billion in subsidy funds to support public hospital reforms. Furthermore, with Alibaba’s “Future Hospital,” Tencent’s “Smart Healthcare,” and China UnionPay’s “Modern Hospital” successively entering the mobile healthcare sector, payment-related challenges are being gradually resolved. Among these, Alipay is currently the only platform enabling real-time mobile reimbursement for medical insurance; however, this settlement capability remains subject to certain restrictions. Specifically, the hospital must be part of Alibaba’s “Future Hospital” network, and users must have designated their medical insurance coverage at that particular hospital to qualify for real-time settlement.

Although Alipay has begun to address the process disruptions and diminished user experience caused by gaps in the payment workflow, it remains constrained by hospital medical insurance reimbursement regulations and limited manpower. Consequently, medical insurance authorities have long been reluctant to open interfaces to mobile payment platforms, restricting Alipay’s functionality to its own “Future Hospital” initiative. This limitation hinders Alipay’s ability to capture a significant share of the market, given the currently limited number of “Future Hospitals.” Furthermore, the administrative complexities surrounding medical insurance involve substantial inter-agency dynamics between the Human Resources and Social Security Bureau and the National Health and Family Planning Commission, which cannot be easily bypassed or resolved. A qualitative leap in this area requires further liberalization of national policies to enable more social security users to adopt mobile healthcare services with confidence. Additionally, medical insurance payments generally mandate real-name authentication, making the integration of mobile payment systems with medical insurance IC cards particularly challenging. Until advanced biometric technologies such as fingerprint verification or facial recognition become widely accessible, this remains a significant obstacle. Moreover, the security implications of integrating hospital information systems with third-party payment platforms must be given due attention.

However, as insurance companies increasingly venture into the mobile healthcare sector, new models for medical expense reimbursement may emerge in the future. Furthermore, with the government deepening its healthcare reforms, it is inevitable that payment channels for mobile healthcare services will be opened up. At the same time, mobile healthcare enterprises should intensify their promotional efforts in hospitals, communities, businesses, and universities, focusing on cultivating user habits and helping users understand the value of mobile healthcare. Only by genuinely addressing the challenges of “difficulty in accessing medical care” and “high medical costs” can mobile healthcare fulfill its original mission.

This article was contributed to VCBeat by the author, Chen Suiqi. The views expressed herein are solely those of the author and do not represent the position of VCBeat. About the author: Chen Suiqi is a columnist for the WeChat public account “yidongyiliaoquan” (Mobile Healthcare Circle) and a new media editor at Family Doctor Online. He works in the internet industry, has a keen interest in researching mobile internet-related businesses, and offers unique insights into mobile healthcare.