Why Should We Learn from the Chinese Digital Healthcare System?

Wim Vanhaverbeke & Guanghui Han

(Part of this article is based on the Masterthesis of Guanghui Han - University of Antwerp)

Introduction

The rapid advancements in technology have revolutionized various sectors, and healthcare is no exception. Digital healthcare, characterized by the integration of technology into healthcare services, is transforming how we diagnose, treat, and manage health conditions. From telemedicine and mobile health apps to AI-driven diagnostics and health data analytics, the possibilities are endless. In this article we explore why the Chinese digital healthcare system stands out and what lessons the West can learn from its innovative approach.

China has made significant strides in digital healthcare, driven by a need to overcome systemic challenges such as unequal access to quality healthcare and an overburdened hospital system. Companies like Tencent's We Doctor and Ping An's Good Doctor have developed comprehensive digital health platforms that improve access, reduce costs, and enhance the quality of healthcare services. By providing an analysis of the Chinese digital healthcare system, and by understanding the factors contributing to its success, we aim to draw actionable insights for Western healthcare systems facing their own unique challenges.

In the following sections we will cover the benefits of digital healthcare development in China, the ecosystem of medical stakeholders around digital healthcare platforms, and an evaluation of whether the West can adopt similar strategies to improve its healthcare landscape.

The Benefits of Digital Healthcare Development in China

China's digital healthcare transformation offers numerous benefits, addressing both systemic inefficiencies and patient needs. The Chinese healthcare system, historically hospital-centric, faced challenges of overcrowded hospitals, uneven distribution of medical resources, and limited access to high-quality healthcare, particularly in rural areas. Digital healthcare platforms have significantly alleviated these issues.

One of the primary benefits is increased accessibility. Digital platforms like We Doctor and Good Doctor provide online consultations, diagnostic services, and health management tools accessible from anywhere in the country. This has been particularly beneficial for patients in remote or underserved regions, who previously had to travel long distances to access quality healthcare.

Moreover, these platforms offer cost-effective solutions. By providing online consultations and reducing unnecessary hospital visits, they help lower healthcare costs for both patients and the healthcare system. Patients can receive timely advice and treatment for minor ailments without the need for expensive hospital visits. Additionally, the use of AI and big data analytics in these platforms enhances diagnostic accuracy and efficiency, further driving down costs.

Another significant benefit is the improvement in healthcare quality. Digital platforms in China leverage advanced technologies like AI to support doctors in diagnosing and treating patients. This not only enhances the accuracy of diagnoses but also enables personalized treatment plans based on comprehensive health data. Furthermore, these platforms facilitate continuous health monitoring and management, leading to better long-term health outcomes.

Digital healthcare platforms also promote preventative care. By enabling continuous monitoring and health management, these platforms help identify potential health issues early and provide timely interventions. This proactive approach reduces the incidence of severe health problems and lowers the overall burden on the healthcare system. The emphasis on preventative care is crucial in a country with a large population and varying healthcare needs, ensuring that resources are utilized efficiently.

In addition, digital healthcare platforms have fostered greater patient engagement and empowerment. Patients have access to their health data, educational resources, and direct communication channels with healthcare providers. This transparency and accessibility empower patients to take a more active role in managing their health, leading to better adherence to treatment plans and improved health outcomes.

Lastly, the integration of digital healthcare platforms with traditional healthcare services has created a more cohesive and efficient healthcare system. These platforms bridge the gap between patients and healthcare providers, ensuring that patients receive comprehensive care. By coordinating with hospitals, clinics, pharmacies, and other healthcare providers, digital platforms streamline the patient journey and reduce redundancies in the system.

The Ecosystem of Medical Stakeholders Around Digital Healthcare Platforms in China

The digital healthcare revolution in China has given rise to several large digital platforms: The two most prominent are Tencent's We Doctor and Ping An's Good Doctor. These platforms exemplify the scale and integration of digital health services that are unparalleled in the West. We Doctor, established in 2010, has become a behemoth in the digital healthcare space. As of the end of 2020, it boasts over 270,000 registered doctors and connects with over 7,800 hospitals, 95% of which are tertiary hospitals. Additionally, We Doctor has established 27 internet hospitals and serves a user base of approximately 222 million registered users, with 25.4 million active monthly users .

Ping An Good Doctor, launched in 2015, mirrors this success with an equally impressive reach. By June 2022, it had more than 440 million registered users and facilitated nearly 1.3 billion cumulative consultations. The platform employs a team of 1,800 full-time in-house doctors and partners with over 3,000 hospitals, approximately 85% of which are tertiary hospitals. Furthermore, it collaborates with 208,000 pharmacies, covering over 35% of the national market, and supports 24/7 drug delivery services in 80 cities . This extensive network allows Good Doctor to offer a wide array of services, from online consultations and diagnostics to prescription services and medication delivery, forming a closed-loop system that enhances patient care and accessibility .?

The scale of these platforms is staggering when compared to their Western counterparts. While the West has seen significant advancements in digital health, such as telemedicine services offered by companies like Teladoc Health and the integration of health services through platforms like MyChart, none match the comprehensive and integrative approach of We Doctor and Good Doctor. For instance, Teladoc Health, one of the largest telemedicine providers in the U.S., serves approximately 50 million members and offers access to around 50,000 doctors. However, it does not encompass the same breadth of services or the extensive network of hospitals and pharmacies that characterize the Chinese platforms.

China's digital healthcare platforms benefit from their unique ecosystem where various stakeholders play pivotal roles in creating a seamless healthcare experience. Tencent's We Doctor for instance benefits significantly from its integration with WeChat, a super app boasting over a billion active users. As a gateway for internet traffic, WeChat has enabled We Doctor to rapidly acquire a vast customer base, leveraging its extensive reach to provide health services to millions of users. Similarly, the existing payments systems in WeChat were easily extended to healthcare servies. This integration facilitates easy access to healthcare services directly through an app that users are already familiar with, streamlining the process of seeking medical advice and services.

Similarly, Ping An Good Doctor benefits from its association with Ping An Group, one of the largest insurance companies in China. This relationship provides Ping An Good Doctor with a substantial user base and financial backing, allowing it to offer a wide range of services, from online consultations to medication delivery. The Ping An Group's extensive network of insurance customers seamlessly integrates with Good Doctor's platform, providing insured patients with easy access to digital health services covered by their policies.

In contrast, the West lacks such super apps and integrated insurance networks, which presents a significant challenge in replicating the Chinese model. The closest comparison in the West might be platforms like MyChart or telemedicine services offered by companies like Teladoc Health. However, these platforms do not have the same level of integration or user base as We Doctor and Ping An Good Doctor, highlighting the need for innovative approaches to build a similar ecosystem in the West.

The expansive reach and integration of We Doctor and Good Doctor highlight a fundamental difference in digital healthcare development between China and the West. In China, these platforms have created a cohesive ecosystem that bridges the gap between various healthcare stakeholders, ensuring that patients receive holistic and continuous care. This level of integration and the scale at which these platforms operate are currently unmatched in the West, where digital healthcare initiatives often remain fragmented and narrowly focused.

Understanding the sheer size and impact of We Doctor and Good Doctor is crucial as we explore what lessons the West can learn from the Chinese digital healthcare system. These platforms not only demonstrate the potential of digital health to improve access, reduce costs, and enhance the quality of care but also provide a blueprint for developing integrated healthcare ecosystems that can address systemic challenges more effectively.The success of digital healthcare in China can be attributed to the collaborative ecosystem of medical stakeholders built around these platforms. Companies like Ping An and Tencent have created super platforms that connect various healthcare actors, including hospitals, clinics, pharmacies, and insurance companies, to provide comprehensive and integrated healthcare services.

Ping An Good Doctor, for instance, has developed an extensive network of healthcare partners, including a full-time in-house team of qualified doctors who provide 24/7 online consultations. This network is complemented by partnerships with offline healthcare providers, ensuring that patients can access necessary medical services seamlessly. The platform's closed-loop system includes online consultations, prescription services, medication delivery, and referrals to offline clinics or hospitals when needed. This integrated approach ensures that patients receive holistic and continuous care.

Tencent's We Doctor follows a similar model, emphasizing collaboration with various healthcare stakeholders to create a robust digital healthcare ecosystem. The platform provides a wide range of services, from telemedicine and online pharmacies to health management and insurance services. By leveraging Tencent's technological expertise and extensive user base, We Doctor has been able to build a comprehensive healthcare platform that addresses the needs of both patients and healthcare providers.

These super platforms not only improve access to healthcare but also enhance the efficiency and effectiveness of healthcare delivery. By integrating various healthcare services into a single platform, they streamline the patient journey, reduce redundancies, and ensure that patients receive timely and appropriate care. Moreover, the use of AI and big data analytics enables these platforms to continuously improve their services and offer personalized care to patients.

The ecosystem approach also fosters collaboration and innovation among healthcare stakeholders. By bringing together diverse actors within the healthcare sector, these platforms create opportunities for knowledge sharing, joint research, and development of new healthcare solutions. This collaborative environment accelerates the adoption of innovative technologies and practices, driving overall improvements in healthcare delivery and patient outcomes.

Furthermore, the integration of insurance services into digital healthcare platforms has significantly enhanced the financial accessibility of healthcare. Insurance companies, by partnering with these platforms, can offer tailored insurance products that cover digital healthcare services. This reduces out-of-pocket expenses for patients and encourages the use of digital healthcare solutions. In turn, insurance companies benefit from lower claims costs due to the emphasis on preventative care and early intervention.

The ecosystem built around digital healthcare platforms also includes pharmacies, which play a crucial role in ensuring the timely delivery of medications. By partnering with digital platforms, pharmacies can offer convenient medication delivery services, improving patient adherence to treatment plans. Additionally, the integration of pharmacies into the digital ecosystem allows for better tracking and management of medication usage, reducing the risk of medication errors and adverse drug interactions.

Hospitals and clinics benefit from their inclusion in the digital healthcare ecosystem by reaching a broader patient base and optimizing their resources. Through digital platforms, healthcare providers can offer teleconsultations, manage appointments more efficiently, and reduce the burden on emergency and outpatient departments. This allows hospitals and clinics to focus on providing high-quality care to patients with more complex medical needs.

The ecosystem of medical stakeholders around digital healthcare platforms in China exemplifies a comprehensive and integrated approach to healthcare delivery. By fostering collaboration among various actors, these platforms enhance access, efficiency, and quality of healthcare services, ultimately leading to better health outcomes for patients.

Can and Should We Emulate the Chinese Digital Healthcare Approach in the West?

While the Chinese digital healthcare model offers valuable lessons, the question remains whether it can be effectively replicated in the West. The healthcare challenges faced by China, such as access to care and an overburdened hospital system, differ from those in the West. However, there are structural problems in Western healthcare systems that digital healthcare could address.

In the West, healthcare systems struggle with fast rising costs and a shortage of medical personnel. Digital healthcare may offer a potential solution to these issues by providing more cost-effective and efficient healthcare delivery. However, current digital healthcare initiatives in the West often focus on narrow problem-solving solutions, such as digital applications for specific medical specialties fosussing on particular healthcare professionals such as? radiologists, cardiologists or oncologists, rather than addressing the broader transformation needed in the healthcare sector.

To emulate the success of Chinese digital healthcare platforms, Western healthcare systems need to adopt a more integrated and holistic approach with a primary focus on patients us final users of the healthare system. This involves creating comprehensive digital platforms that connect various healthcare stakeholders and provide a wide range of services. Additionally, there needs to be a focus on continuous health management and preventive care, rather than solely on acute care. By leveraging advanced technologies and fostering collaboration among healthcare providers, payers, regulators and patients, the West can and should develop digital healthcare platforms that improve access, reduce costs, and enhance the quality of care.

However, there are challenges to implementing such a model in the West. One major obstacle is the regulatory environment, which varies significantly between countries and will impact the deployment of digital healthcare solutions. Additionally, the existing healthcare infrastructure and stakeholder dynamics in the West are different from those in China, requiring tailored approaches to build effective digital healthcare ecosystems.

Another challenge is the cultural acceptance of digital healthcare. In the West, there may be resistance from both patients and healthcare providers to adopt new technologies and shift towards a more digital-centric healthcare model. Addressing these cultural barriers will be crucial to the successful implementation of digital healthcare platforms.

Moreover, the business models of digital healthcare platforms in the West need to be sustainable and aligned with the financial incentives of various stakeholders. This may involve developing new payment and reimbursement models that support digital healthcare services and incentivize preventative care and continuous health management. Implementing these fundamental changes can be challenging.

When considering whether to emulate the Chinese digital healthcare approach in the West, a final critical aspect to address is data privacy and security. In China, the regulatory landscape around data protection is less stringent compared to the European Union and the United States. Companies like We Doctor and Ping An Good Doctor often operate with fewer restrictions concerning data collection and usage, allowing them to innovate rapidly and offer comprehensive services. However, this also raises concerns about data privacy and security, as the protection of personal health information may not be as robust.

In contrast, the EU and US have stringent regulations such as the General Data Protection Regulation (GDPR) and the Health Insurance Portability and Accountability Act (HIPAA), respectively. These regulations ensure that patient data is protected but also create barriers to the rapid deployment and integration of digital healthcare solutions. The need to comply with these regulations can slow down the development of comprehensive digital health platforms similar to those in China. Any attempt to replicate the Chinese model in the West must prioritize robust data privacy and security measures to gain the trust of both regulators and users. Despite these data privacy and security challenges, the potential benefits of adopting a more integrated digital healthcare approach are significant: By ensuring compliance with data protection laws and focusing on secure, user-friendly platforms, the West can and should develop digital healthcare solutions that enhance access, efficiency, and quality of care.

Who Should Lead the Formation of Digital Healthcare Platforms in the West?

One major question is who in the West should spearhead the development of such super platforms. Should it be legacy companies like Philips, Siemens, GE, or IBM? These companies have extensive experience and established relationships within the healthcare industry. However, their traditional business models and bureaucratic structures might hinder rapid innovation and adaptation. Moreover, these companies have historically focused on hardware and services rather than comprehensive digital ecosystems.

Alternatively, should large data companies like Google, Apple, Microsoft, or Amazon take the lead? These tech giants have the technological expertise, financial resources, and experience in creating user-centric platforms. However, they lack deep-rooted connections with healthcare providers and might face resistance from stakeholders wary of their involvement due to concerns over data privacy and security. Their forays into healthcare, though promising, have often been met with skepticism and regulatory hurdles.

Should classical Electronic Health Record (EHR) companies like Epic spearhead the initiative? EHR companies already have significant penetration in the healthcare market and a deep understanding of healthcare workflows. Yet, their systems are often criticized for being cumbersome and not user-friendly. Expanding their services to create integrated digital health platforms would require substantial redesign and innovation, which could be met with resistance from their existing customer base.

Another approach could be to have hospital associations drive the demand for such platforms. This demand-side initiative would ensure that the platforms are designed with the needs of healthcare providers in mind. However, hospital associations might lack the technical expertise and financial clout to develop and sustain such large-scale platforms independently. Collaboration with technology firms would be essential, but aligning the interests of diverse stakeholders could prove challenging.

The role of the government in governing digital healthcare platforms cannot be overlooked. China's centralized government has played a significant role in the development and implementation of digital healthcare initiatives. The government has provided substantial support, including funding, regulatory frameworks, and infrastructure development, which has been crucial in the success of platforms like We Doctor and Ping An Good Doctor.

In contrast, the United States operates under a federal system where each state has relative independence, which can complicate nationwide healthcare initiatives. While the federal government can provide overarching guidelines and support, the implementation often varies significantly from state to state. This decentralized approach may hinder the development of cohesive, large-scale digital healthcare platforms. Nevertheless, the federal government can still play a critical role by incentivizing innovation, providing funding for pilot projects, and creating a regulatory environment that supports digital health initiatives. In Europe, healthcare is still

In Europe, the situation is equally complex due to the presence of multiple independent countries, each with its own healthcare system, regulations, and policies. Despite efforts of the European Union (EU) to harmonize regulations and fostere cooperation among member states, healthcare remains largely the responsibility of individual nations. This fragmentation hinders the development of cohesive, continent-wide digital healthcare platforms. Despite these challenges, the EU can play a pivotal role by setting common standards, funding cross-border healthcare projects, and promoting interoperability among national systems. By leveraging the EU's regulatory and financial instruments, Europe can facilitate the development of integrated digital health solutions that transcend national boundaries, ensuring a more unified approach to healthcare innovation across the continent.

Collaboration with established Chinese platforms could offer a shortcut to developing effective digital healthcare systems in the West. However, such collaborations come with their own set of challenges, including regulatory differences, cultural barriers, and geopolitical tensions. Despite these obstacles, the potential for improved healthcare outcomes makes it essential to explore all possible avenues for advancing digital healthcare.

Lastly, should we consider collaborating with Chinese platforms and duplicating their efforts in the West? This approach would leverage the proven success of platforms like We Doctor and Good Doctor, but there are significant cultural, regulatory, and operational differences between China and Western countries. Additionally, concerns about data security and geopolitical tensions might complicate such collaborations.

Each of the potential solutions we mentioned above comes with its own set of setbacks. Legacy companies may struggle with innovation, large tech firms might face trust issues, EHR companies need substantial system overhauls, hospital associations lack technical prowess, governments don’t have the same position and power as the China central government to steer management of digital platforms, and collaboration with Chinese platforms brings geopolitical and regulatory challenges. However, despite these challenges, the potential benefits of digital healthcare in the West are significant. By learning from China's experience and adopting a more integrated and holistic approach, Western healthcare systems can address their own challenges and improve healthcare outcomes. The journey towards digital healthcare transformation is complex and requires collaboration among various stakeholders. Yet, the necessity for this transformation is undeniable. As healthcare costs continue to rise and the shortage of medical personnel persists, the need for efficient, accessible, and high-quality digital healthcare solutions becomes more pressing.

Conclusion

China's digital healthcare revolution offers valuable insights for the rest of the world. The comprehensive and integrated approach taken by platforms like We Doctor and Ping An Good Doctor has addressed systemic healthcare challenges, improved access to care, and enhanced the quality of healthcare services. While the healthcare landscape in the West differs from that in China, with access to healthcare services being less of an issue, the financial sustainability and labor shortages are rapidly emerging as structural problems. These challenges may only be solved through a fundamental shift towards digital healthcare platforms as part of the solution.

The core principles of digital healthcare—accessibility, cost-effectiveness, and quality improvement—are universally relevant, both in China and in the West. By learning from China's experience and adopting a more integrated and holistic approach to digital healthcare, Western healthcare systems can address their own challenges and improve healthcare outcomes. The journey towards digital healthcare transformation is complex and requires new forms of collaboration among various stakeholders.

This heightened level of collaboration, the use of major digital platforms to integrate services, and the adoption of an ecosystem approach to jointly deliver complex and effective healthcare services across different actors will be essential. In this renewed setting, it is no longer imaginable that each part of the healthcare system—caregivers, hardware and software vendors, hospitals, insurers, regulators, and governments—maximize their own share of the pie without first considering how their joint actions for patients may increase the pie. By reassessing their role and collaboration within the ecosystem, stakeholders can make healthcare more patient-focused, accessible, cost-effective, and capable of coping with labor shortages.?

By fostering collaboration, embracing advanced technologies, and focusing on preventative care, the West can and should develop digital healthcare solutions that enhance access, efficiency, and quality of care for all. The experiences of platforms like We Doctor and Ping An Good Doctor demonstrate that it is possible to create a more integrated, efficient, and patient-centered healthcare system. Western healthcare systems have the opportunity to learn from these examples and implement strategies that not only address their current challenges but also pave the way for a more sustainable and effective healthcare future.