China Medical News: Chinese medical device maker’s US$2 a day heart attack risk warning system faces resistance in the US. Beijing-based Lepu Medical claims that the highly accurate system, backed by the world’s largest patient data set. Can offer data analytics service at just US$2 per patient over a 24-hour heart monitoring period Lepu’s subsidiary Shenzhen Carewell Electronics. Which has developed the analytics system, has incorporated some 47 million pieces of data collected from over half a million patients in 2,500 Chinese hospitals.
There are four pain points in Chinese medical field: insufficient medical resources, a long training period for doctors, high medical costs, and a high doctor misdiagnosis rate. AI may be leveraged to solve some of these problems.
A trial in late 2018 in which 25 drugs were procured for 11 Chinese cities – mostly from local generic drug makers – saved the Asian nation 5.8 billion yuan (US$844.6 million) as prices more than halved on average. The government has since expanded the programme nationwide, pushing prices down by another 25 per cent. In 2020, China’s biggest-ever round of drug price cuts saw global pharmaceutical firms losing most of the nationwide contracts to local rivals, as Beijing aggressively pushes to contain health care costs by an average of 53 per cent decline in latest bulk purchase.
Among 33 commonly used medicines in a bidding exercise on Friday, some moneymakers for global pharmaceutical companies had the deepest cuts, with the biggest one being as high as 93 per cent as shown in a government-funded medical procurement website.
Bayer’s diabetes drug acarbose had its price slashed by 80 per cent, said Zhang Jialin, a health care analyst at ICBC International.
Some other drugs in the group that included therapies for hypertension, dementia and viral infections saw prices drop more than 60 per cent in the bidding, Zhang said.
AI in Medical imaging: Due to the huge gap in the number of professional doctors in medical imaging in China, the rate of misdiagnosis and missed diagnosis is high, and the speed of manual diagnosis is limited. AI in medical imaging can help to process image data in the following aspects: reading mode, time, accuracy, objectivity, memory, modeling conditions, information utilization, repeatability, the difficulty of quantitative analysis, experience transmission, and cost. Patients, physicians, and hospitals will all In 2017, the total amount of financing in this field exceeded 1.7 billion RMB.The following are the primary healthcare AI companies in China:
- AI Medical imaging: Airdoc, YITU依图科技, InferVISION (推想科技)
- The AI in Diagnosis: 云知声，iFLYTEK科大讯飞，iCarbonX碳云智能
- AI in Medicine discovery: 晶云药物，晶泰科技
- An AI in health management: 安翰医疗，妈妈帮
- AI in disease prediction: 万灵盘古，认知关怀
JINGLING YANG. China’s enduring core values.
Posted on 20 December 2019
China. The public health care system is getting better and Australia can help.
The health care system in the People’s Republic of China (PRC) was once a grave social concern and a major reason behind public disapproval of the government, but recent policy change that emphasises fairness, efficiency and strong government involvement has significantly elevated public confidence in the system and support of the government.
Australia’s health care system is a good model in which the Chinese health authority has shown strong interest. China is also a major market for Australian pharmaceutical and health products. Cooperation between Australia and the PRC will benefit both countries and their people.
In the three decades following the launch of economic reforms, the PRC government undertook health reform that featured withdrawal of the State. Public hospitals were given less funding but more freedom to commercialise services and charge mark-ups on drug sales to compensate for the loss of government funding. Hospitals became increasingly profit-driven. Medical staff were encouraged or pressured to carry out fraudulent and corrupt activities that significantly drove up health care costs.
To make things worse, the State also retreated from another front – health insurance.
At the end of the 1970s when the economic reforms had just started, ninety percent of the population in both rural and urban areas were covered by publicly funded health insurance schemes. By the end of the 1980s, less than five percent of the rural population was covered with some form of health insurance. In the urban areas, the collapse came later but was nonetheless phenomenal. In 2003, only 43 percent of urban residents were covered by some type of publicly funded health insurance, a sharp drop from seventy percent in 1993.
By the early 2000s, the corrupt, inefficient and exploitative health care system was one of the policy areas that the public was most dissatisfied with. Complaints over accessibility and affordability of medical services were loud and widespread. The Communist Party’s governing capacity was widely questioned. Its failure to meet its ideological commitment to “serve the people” was fiercely criticised. The outbreak of SARS in 2003 testified the inefficiency of the system and raised alarms for the authorities. In 2005, the health reform was declared a failure.
The year 2009 marked a watershed for health care reform.
The government, after years of vacillation and trials, finally made up its mind to face public anger and place greater emphasis on solving livelihood issues. A new round of health reform was launched which aimed at constructing a system that placed the people’s interest at the centre. Following global consensus on directions for health care systems. The PRC government promised to expand and strengthen its primary care system and to provide efficient, accessible and affordable medical services to all citizens by 2020. New co-funded public health insurance schemes that had been experimented locally were promoted across the country, including the New Rural Cooperative Medicine. The Basic Medical Insurance for Urban Residents and Urban Employee Basic Medical Insurance.
The reform gathered momentum under Xi Jinping’s government. A notable achievement in recent years is the increasing coverage of health insurance and increasingly favourable benefits targeting equality in health care.
A major move in this space is the combination of the Basic Health Insurance for Urban Residents and the New Rural Cooperative Medicine, which aims to remove the dual system covering the urban and the rural sectors and to improve social justice and equality. By the end of 2018, over 95 percent of citizens were covered by a public health insurance scheme.
In line with the targets set in the 13th Five-Year Plan of Medical and Health Reform, this year the government has initiated a new type of “State retreat”. Spelt out in an important policy document jointly endorsed by ten ministries or ministerial agencies is the government’s promise to strictly control the number and size of public hospitals in order to make room for the development of the private health sector. The policy also encourages local governments to purchase health and social services from both public and private providers and promises fairness in the process.
This is a ground-breaking move, indicating that the health reform has truly broken away from unmanaged commercialisation as well as from the residue of the planning economy. Another breakthrough in this round of reform is the unprecedented emphasis. On a healthy lifestyle over curative medicine and its promise of large scale investment of resources and administrative efforts in health promotion and education programs. These policies are being implemented systematically. Their outcomes may not be clear at this stage but they are on the right track.
The PRC health care system still has many problems. The quality of medical services needs to improve, and corruption is still not completely stamped out.
But people, in general, have more confidence in and feel more satisfied with the system. And this confidence and satisfaction have fed into their confidence in the government.
The improved PRC health care system means not only improved equality and life expectations for Chinese people but also a better business environment and more opportunities for Australia. Australia not only offers China an excellent example of a mature national health system. But, can also benefit greatly from bilateral cooperation. In the process of designing rules guiding and regulating government purchase. Australia’s health care system was widely studied by PRC policy advisors as a good model. GP training is another area of potential.
China’s primary health care system will need about 700,000 GPs by 2030. But it now has only about 310,000, many of whom are not adequately trained. Australia could play an important role in this regard due to its established GP system. Nurse education and age care systems are other promising areas. The Australia-China Memorandum of Understanding and Plan of Action on Health Cooperation signed in 2015 also set out other areas of cooperation, such as health systems innovation, communicable disease prevention, tobacco control and medicines policy.
Given China’s increasing participation in global health governance and its huge and increasingly open market, the potential for cooperation between Australia and China in health care and commercial opportunities for Australian health industries are enormous.
Jingqing Yang is Associate Professor in China Studies at UTS. His recent publications include Informal payments and regulations in China’s healthcare system and “State and the sick role”.
‘Good Doctor’, Digital Hospitals: How Mobile Apps Are Alleviating China’s Healthcare Problems
By Manya Koetse December 20, 2019
ay Hi to Doctor WeChat
Although the messaging platform often compares to Facebook, it offers much more than its Western counterpart. But comes with the baggage that the Chinese government has complete oversight over it. Of course, that also means that the central leadership lets it operate. Which you cannot say about all the other, mainly Western messaging platforms. It has censored Facebook Messenger since 2009, blocked the South Korean-owned Line app in 2015, and banned WhatsApp last year.
Thus, WeChat has an ambition and an open door to become a one-stop solution for all kinds of consumer needs in mainland China. Now, it is even poised to take on an even greater role. An initiative is underway to integrate WeChat with China’s electronic ID system. WeChat will issue virtual ID cards which individuals would use instead of physical state-issued ID cards.
Since WeChat requires users to register with their real names per government policy. It’s not a stretch to imagine that one day. WeChat may entirely replace state IDs – or even medical health records?
The Medical Futurist imagines that similarly to Apple. The Chinese WeChat could connect patients’ complete medical health records to patient’s phones.
Tencent has already been steadily building up a network of participating hospitals – over 38,000 medical facilities as of 2017 – where users can book doctor’s appointments through their WeChat Intelligent Healthcare to avoid long lines at medical facilities. Following their health checkup, patients can also conveniently access their medical reports through WeChat and pay for their medical bills. Also, in a push for healthy living, the app’s step count function can be linked to WeSure.
Users who reach over 8,000 steps in a day will receive a hongbao from WeSure that can be deposited in their WeChat wallets. From here, it’s only one step further to give full access to medical health records. And what’s even further down the line? We believe it’s chatbots! As technological innovation allows it, chatbots could take the burden off the shoulders of primary care physicians and support the diagnosis of patients with simpler medical problems. In such a resource-strained country like China that could mean a viable solution.
Digital health in China
One-Minute Clinics and cloud hospitals
Chatbots could only aid and not replace physicians, so they cannot completely solve the problems within Chinese primary care. But what if we couple solutions with telemedicine? Experts believe that the integration between telemedicine, online prescription sales, online scheduling of follow-up diagnostic or speciality physician appointments, and electronic medical records could be a game-changer for China’s healthcare system.
The central leadership also recognized that and has started pushing for a national telemedicine network. Above all, in April 2018, the state council of the People’s Republic of China has communicated the Internet Plus Healthcare initiative, which allows medical institutions to provide online diagnostics for specific diseases and other services.
Moreover, one of China’s major insurers, Ping An Insurance (the name literally meaning safe and well) is already pushing for a national telemedicine network.
They’re offering a simple app to order non-prescription medicine and personal care products online. Users only need to complete a quick, AI-driven questionnaire for the app to determine their health needs, after which the products will be delivered to their home or office within just an hour.
Another example is SUNPA, which has built four Telemedicine centres in China in cooperation with public institutes. The network covers eight provinces and municipalities with a total population of over 200 million. But the Middle Kingdom is not only building networks, but also cloud-based hospitals. The first one has launched four years ago in Ningbo.
The hospital equipped with cutting-edge cloud technology and connects 100 primary care institutions, 226 specialists and care providers. It also installed four cloud-based “Diagnostic Rooms” for hypertension, diabetes, psychological consultation, and primary care, enabling patients to access these services from the comfort of their home.
And as the latest example already combining artificial intelligence and telemedicine, last year, Ping An’s Good Doctor project, a one-stop healthcare ecosystem platform, piloted unstaffed clinics that employ artificial intelligence called “One-minute Clinics” near Shanghai. Which connect patients with a clinician on Ping An Good Doctor’s in-house medical team.
In January, the company announced that it had placed its One-minute Clinics across 8 provinces and cities in China and signed service contracts for nearly 1,000 units, providing healthcare services to more than 3 million users.
China’s healthcare industry is facing some serious challenges. As Chinese society is rapidly digitalizing, mobile apps now provide innovative solutions to alleviate pressing problems in the country’s health services sector.
This is the “WE…WEI…WHAT?” column by Manya Koetse, originally published in German by Goethe Institut China on Goethe.de: “Good-Doctor Apps und Digitale Krankenhäuser.”
Social Credit System, artificial intelligence, surveillance cameras; these are some of the hottest topics making headlines in mainstream Western media when discussing China-related developments recently.
With the rapid digitalization of Chinese society. These topics certainly have come to play a more important role in social media discussions within the People’s Republic of China (PRC). But if there is one issue that seems to concern Chinese social media users the most. It is not facial recognition nor their ‘Sesame score’: it is the topic of healthcare.
In December of 2017, a photo showing a crying mother kneeling down beside a toddler on the sidewalk in front of a Shanghai hospital went viral overnight. The moment was captured on camera by a reporter who was visiting Shanghai’s Children’s Hospital.
The photo of Guo Yinzhen and her son that went viral in China (image via NetEase, source: https://3g.163.com).
The mother, Guo Yinzhen, is a single parent. Who had travelled from a remote village to seek medical help for her 3-old-son. Who was suffering from congenital hydrocephalus or ‘water on the brain.’ Already having travelled to the city multiple times and spending all her money on medical bills. Guo could not afford the additional 100.000 yuan (€ 12.600) for medical procedures needed to save her son’s life.
Guo’s story struck a chord with Chinese netizens, who continue to share the heartbreaking photo on social media to this day. It has become emblematic of China’s healthcare problems.
Crowded Hospitals and ‘Healthcare Disturbance’
The key to an adequate healthcare system, no matter where in the world, is that there is a right balancing in the “iron triangle” of efficiency/cost containment, high quality care, and patient access. China, however, struggles with all three sides of this triangle.
Guo’s case is an extreme example, but many people in China dealing with less serious health issues and needing basic medical services also struggle to afford and access the healthcare they need.
Over 95% of people in China have health insurance, but people from different regions do not enjoy the same benefits and their out-of-pocket expenses can vary greatly. Uncovered medical costs can sometimes be catastrophic and simply unaffordable for patients and their families.
As more money flows are going to healthcare facilities in China’s cities. There is also the issue of varying levels of providers’ medical education and the overall healthcare quality, with the substantial majority of modern hospitals still existing in urban areas.
Easy access to the right kind of healthcare can be especially problematic for China’s rural population, as people often need to travel long distances and have to go through. The lengthy process of registering and waiting for their doctor’s appointment. Which sometimes requires them to stay in the city overnight.
For all of these reasons, China’s bigger public hospitals can get super crowded, sometimes resembling shopping malls on an end-of-season sales day.
On social media, both patients and medical workers often complain about the stress brought about by the huge crowds and the shortage of doctors in hospitals across the country.
Perhaps it is no wonder that China even has a word to describe outbursts of violence between patients and doctors: ‘Yī nào’ (医闹, literally: “healthcare disturbance”)
Weibo user ‘Sunscreen’ complains about the crowds at Huashan Hospital.
One major problem within China’s healthcare conundrum is the lack of local family or primary-care doctors. Which often makes bigger hospitals the first stop to any kind of medical treatment for Chinese patients.
The reasons for this issue are manifold. There is a general lack of trust in private and smaller local healthcare clinics. For example, and patients often choose to go directly to a bigger hospital to avoid making extra costs.
This makes it extra difficult for many community health care centres – that are already struggling. To make enough money and to retain qualified staff. In a society that is rapidly ageing, the challenges facing China’s healthcare industry are only becoming more pressing.
A Doctor Today, Just an App Away
As China’s online environment is thriving, new innovative online apps are popping up on a daily basis. Some of these apps. That have found their ways into China’s most popular app rankings, are offering solutions to some of the country’s most pressing healthcare problems.
One of these apps is Ping’an Good Doctor (平安好医生). Which was developed by health insurance provider Ping’an in 2015 and calls itself China’s “one-stop healthcare ecosystem.”
“Ping’an Good Doctor” promotional image by Ping’an.
Employing some 1000 medical staff in its in-house team, contracting over 5,200 external doctors. And collaborating with 3000 hospitals and thousands of pharmacy outlets across the country. The app is somewhat of an “online hospital.”
Through the app, users can look through an online database of medical professionals, order medicine at nearby pharmacies, get 24/7 online medical consultancy, search for information about both Western and Chinese Traditional Medicine, etc. But they can also use Ping’an Good Doctor as a fitness app to track their own health.
Screenshot of Ping’an app screen, by author.
When looking for a specific doctor for a one-on-one consult. The app first lets users select an area of expertise (e.g. dermatology or gynaecology). And then offers a list of different specialists in various price categories.
Doctors from well-known hospitals, for example. Or those with excellent ratings, have a one-time consultation fee of 100 yuan (€ 12,60). Other doctors can be consulted starting from 30 yuan (€3,70). All costs can be paid efficiently via online payment apps.
Doctors to pick from within the app’s various price categories.
Ping’an Good Doctor uses an AI-driven system to ask patients various questions about their symptoms and to automatically create a user’s medical record to save time. Based on the AI-generated record and the conversation with the patients. Files such as photos can also be upload to the app. The doctors can prescribe medication or refer the patient to a hospital for an offline appointment if needed.
Ping’an recently announced that its number of registered users exceeded 300 million users, with 62 million monthly active users. Because the app keeps building on its AI-driven system. Ping’an Good Doctor can expect to only become a ‘smarter’ smart health app the more popular it gets.
Although Ping’an is now leading within China’s medical app category. There are many other apps providing similar services, such as Chunyu Yisheng (春雨医生). Haodafu Online (好大夫在线), or DingXiang Doctor (丁香医生).
The emergence of these apps is just one of many ways. In which China’s digital developments, online media, and tech giants are impacting the healthcare industry profoundly changing. How patients receive healthcare information and access medical services now and in the future.
List of recommended medical apps in the Tencent app store.
In a way, China’s medical consultation apps fill the void in offline primary care. Patients who would otherwise turn to hospital care as their first stop can now access medical consultations any time. Any day, at a relatively low cost. Those who suffer from relatively harmless conditions could be diagnosed by a medical specialist via the app and get the medicine they need within a matter of minutes. With the growing popularity of these kinds of apps, many patients no longer need to visit a hospital at all.
Are smart health apps such as Ping’an Good Doctor the solution to China’s healthcare problems? No, they’re not. Struggling mums like Guo Yinzhen will not find the help they need there. But they do contribute to a more efficient healthcare environment. Where crowd flows in hospitals can be reduced, and patients do not need to spend a lot of time and money to stand in hour-long queues to get five minutes of their doctor’s time.
Although smart health apps could not help Guo Yinzhen and her son, social media apps could. As soon as their story went viral in late 2017. Shanghai Children’s Welfare Foundation Xiaoxingxin offered to cover medical treatments for the little boy. With a notable pediatric neurosurgeon operating the child. According to the latest updates, the boy’s situation was “looking good.”
Hopefully, the same holds true for the challenging sides of China’s healthcare industry.
By Manya Koetse
 Burns & Liu, 2017: 3-4.
Burns, Lawton Robert, and Gordon G. Liu. 2017. “Introduction.” In China’s Healthcare Industry: A System Perspective, Lawton Robert Burns and Gordon G. Liu (eds), pp-1-116. Cambridge: Cambridge University Press.
Economist, 2017. “China needs many more primary-care doctors.” The Economist, May 11 https://www.economist.com/china/2017/05/11/china-needs-many-more-primary-care-doctors [20.10.19].
Zhou, Viola. 2018. “Does China Have Universal Healthcare? A Long (And Better) Answer.” Inkstone, Oct 10 https://www.inkstonenews.com/health/china-translated-does-china-have-universal-health-care/article/2167579
This text was first published by Goethe-Institut China under a CC-BY-NC-ND-4.0-DE license (Creative Commons). As part of a monthly column in collaboration with What’s On Weibo.
Manya Koetse is the editor-in-chief of www.whatsonweibo.com. She is a writer and consultant (Sinologist, MPhil) on social trends in China. With a focus on social media and digital developments, popular culture, and gender issues. Contact at email@example.com, or follow on Twitter.