By Daniel Addyson.
The Chinese healthcare system is struggling to provide adequate medical access for its 1.4 billion citizens. But the Chinese may have already have built the foundation for sustainability: their love of mobile technology.
Getting medical care in China
For a westerner visiting a Chinese hospital for the first time, it’s an eye-opening and sometimes mind-boggling experience. During the few trips I have made to China over the last decade, I’ve occasionally had to visit local hospitals. The scene can be at once chaotic and yet oddly more efficient than the US. Typically, visiting the doctor means going a large hospital (as opposed to outpatient settings like the US), which houses multiple specialties ranging from primary care, to maternity wards, to high-end surgery. Much like standing in line at the grocery store, you grab a ticket and wait in line to see the receptionist, who then directs you to the appropriate specialty center. From there another ticket is taken to wait for the specialist. The process continues on to other specialties if needed, such as X-ray or lab draws, until finally you end at the original doctor, who will examine the accumulated results and make a final determination of the condition.
When I first encountered this style of healthcare, I was somewhat enamored. I compared the experience to the US, where I had to book an appointment to a primary care physician or specialist, then a separate appointment on a different day across town for a blood draw, then return to the original doctor on yet another day for my follow-up consultation. A few hours of actual medical intervention were stretched into days or weeks. The system I first experienced in China seemed to compact all of that waiting and scheduling into a much shorter span of time. This is the prevailing paradigm of clinical care in China and other East Asian countries. Although smaller outpatient clinics do exist, most care still takes place in large, multi-specialty hospitals.
The Problem: insufficient capacity
Thankfully, my experiences with healthcare abroad have been relatively minor and infrequent. For the average Chinese citizen, and even expats, the experience can be far worse. Shaun Rein, a US expat and market research expert living in China, writes about his experience with Chinese healthcare in his book, The End of Copycat China: The Rise of Creativity, Innovation, and Individualism in Asia:
I went to 38 doctors. I became used to Chinese hospitals, and they are not pleasant places for everyday people. If you don’t have lots of money to buy VIP time slots or connections to skip queues, you just have to grab a ticket and wait in line to see a doctor. Patient rooms are often filled with dozens of other patients so privacy does not exist. The frazzled, overworked doctors in top-tier hospitals have so many patients to see that they often spend less than a minute per patient.
Rein goes on to describe the causes for the massive inefficiency in Chinese medical care, which in fact are fairly basic: 1) doctors are not paid very well, so it’s not seen as a lucrative or desirable profession to enter; 2) there aren’t enough medical providers to see the number of citizens in China’s rapidly urbanizing cities. Consequently, there are a number of knock-on effects that further exacerbate the problem: social acceptance of bribery (“red envelopes”) for quality care; paying extra to skip waiting queues (“VIP service”); or using personal connections (“guanxi”) to schedule appointments with doctors. The problem even extends to device and pharmaceutical sales, where reps bribe providers to use their products.
Rein’s assessment is that the situation is gradually improving, and he credits President Xi Jinping’s crackdown on fraud for helping stem the abuses in the healthcare system. However, China is still left with its fundamental problem: quality care is still often unaffordable or inaccessible for many poor and middle-class Chinese citizens. Although the government has plans to dramatically increase the number of medical providers throughout the country , the prospect of overwork and little pay doesn’t make the medical field particularly attractive to Chinese college graduates. This means that there is still a very high risk of chronic shortages of qualified staffing in rural areas and for certain specialties.
Why mHealth can help
- Continuity, Quality of Care & Data Access: Using mobile platforms can provide consumers with a pipeline to their medical history: medications prescribed, previous visits to providers, diagnostic results, etc. Rather than trying to navigate a fragmented care environment where a patient might be shuttling between different hospitals and trying to maintain separate sets of medical records, mHealth platforms can consolidate this data and help patients make sense of it. On the same token, data collection from mHealth options allow both patients and providers to better monitor chronic conditions, medication adherence, and other important data points in the care process.
- Freeing up hospital capacity: One of the primary goals of mHealth is to increase the availability of healthcare by reducing costlier and time-consuming face-to-face communication between patients and providers and replacing it with digital communication. In this regard, mHealth has performed well in a few different areas. Two primary examples are below:
- Routine counseling: reaching out to patients for follow-up and routine care via phone or app rather than having them come back to an actual clinic.
- Digital diagnosis: In addition to patients texting or sending photos to their providers for remote diagnosis, there are a number of initiatives to turn smartphones into self-contained diagnostic tools. App developers and data scientists are using machine learning technologies to identify cancerous skin lesions based on image recognition. Even the way we use our smartphones are being used to predict our health status. These kinds of advances are poised to provide much needed decision support to overworked medical staff.
Why China is unique: its love of mobile technology
It’s clear that China’s healthcare system is literally at overflow capacity. The country needs innovative solutions to lighten the service burden on major hospitals. Fortunately, China’s love of mobile technology makes mHealth solutions a perfect fit to get better healthcare access to its citizens.
China’s mobile focus
Healthcare technology companies seeking to make inroads in China face a market that is already primed to adopt mobile solutions. China has embraced mobile technology in a way that’s hard to imagine in the US or other Western nations. According to a Verto Analytics report, “As many as 94% of all Chinese online users use smartphones vs. 70% in the U.S.” In addition to the popularity of smartphone usage, the Chinese market has unique characteristics that make it uniquely open to mHealth uptake:
- The prevalence of mobile commerce: Mobile options for everything from shopping to in-store payments to social media are just as, or more, prevalent in China as the West. An illustrative case in point: mobile pay. There are now effectively two options for making payments in China: cash or mobile pay, with mobile being the far more preferable choice with both small and large vendors. Most B2C transactions in China effectively run through one of the country’s mobile payment giants, such as WeChat or Alipay. The Chinese market is also much more open to using mobile options for their day-to-day needs. For example, Rein cites the relative success of mobile grocery shopping in China compared to the US, where uptake has been minimal. Rein explicates a number of reasons for the popularity of digital lifestyle, ranging from convenience to safety concerns from air pollution. These numerous factors have helped acclimate much of the population to conduct business over their smartphones; healthcare companies who can take advantage of this stand to quickly gain substantial market share.
- Multi-function smartphone apps: An additional feature that sets China apart is not only the prevalence of mobile options, but the integration of multiple functions into a single app, (ie. payments, messaging, social media, and shopping). Unlike Westerners who are accustomed to apps with one or two primary uses, the successful Chinese model is based on a few apps providing diverse and multiple services. WeChat stands as an illustrative case in point: chat features, ride sharing services, and mobile payments among others, are all housed under one platform. Companies seeking to implement mHealth and telehealth programs in China can leverage existing platforms, which already have wide and stable customer bases, to reach their desired patient populations.
With Chinese consumers adopting mobile options much more readily than in the West, companies seeking to implement mHealth technologies already have a primed market and the technology infrastructure to facilitate its adoption.
Challenges to implementation
Although the market appears ripe, effective implementation in the Chinese market also faces unique challenges. It’s no secret that companies often fail :
- China’s rural and offline populations: mHealth and Telehealth platforms are frequently cited as ways for providers to reach rural and other low-access populations. But there’s a converse problem: rural populations also tend to have lower access to infrastructures like wireless data that make mobile technologies work. Although the government has made a huge push to consolidate the Chinese population through urbanization programs, roughly 43% of China’s population still lives in rural areas. Additionally, in spite of the high proportion of smartphone users, only 50% of the total population is even online. Smartphone penetration is expected to reach over half the population by 2019, and with it the infrastructure needed to make smartphone use practical (namely, wireless and cellular data access). Nevertheless, companies need to accurately assess their target population before trying to enter the market.
- Patient perceptions of quality & safety: Rein’s Copycat China dedicates an extensive amount of space to the concerns Chinese have for quality products and services. With the number of scandals regarding food and medical safety, as well as the prevalent air pollution problem, Chinese consumers place very high value on product quality. mHealth technologies, whether telephonic outreach to patients or digital diagnostics, need to clearly demonstrate that they provide high quality medical care. Consumers need to be convinced that they’d be just as good or better off staying home rather than going to a top-tier hospital for routine medical needs.
- Managing providers’ expectations: Providers also need to see the value of putting in the time and effort of new initiatives for medicine. The Brookings Institution report recommends that the government incentivize providers to participate in telemedicine programs, but expectations for mHealth solutions also need to be managed. Digital platforms are typically promoted as a way for more patients to get to doctors. However, doctors who are already overworked need to see how mHealth options can reduce their crushing workload, otherwise they are likely to see little reason to participate.
Conclusion: Focus on delivery strategy and solving targeted needs
In spite of these challenges, mHealth can be a major win for the Chinese healthcare system and for the companies who provide these services. Rather than trying to foment a major revolution in the Chinese healthcare system, companies interested in implementing mHealth solutions will most likely find success in developing focused, strategic partnerships that solve specific needs for patients. By working with hospitals and government health plans to access patient populations, as well as popular mobile apps to effectively run their platforms, mHealth technologies stand to create substantial progress in improving quality care access in the Chinese health system.
Daniel Addyson is a data scientist and healthcare analytics consultant. His work specifically focuses on health technology and analytics implementation for emerging markets, with a specialization in East Asia. Dan's work can be found at www.linkedin.com/in/danieladdyson