An ecosystem to overhaul China’s health care

Like many countries, China has a health care problem. Changing demographics and lifestyles mean demand for health care is outstripping growth in medical resources and its cost is rising faster than the insurance premium.

With 250 million people over the age of 60, the world's most populous country is ageing. Diseases associated with more affluent societies, such as cardiovascular conditions and diabetes, are on the rise. China has 400 million chronic disease patients whose treatment costs 70% of total health care resources. And there is a shortage of medical professionals-China needs an additional 700,000 general practitioners and 10 million nursing staff. In 2019, the country spent 6 trillion RMB ($928 billion) on health care, a figure that's expected to reach 16 trillion RMB in 2030.

But an uneven distribution of resources and their inefficient use mean the cost of providing health care services is unnecessarily high: China's top hospitals are overwhelmed with patients, but many of them have mild conditions and don't need to be in a health care facility at all. Of all hospitalized patients, 23% are in top tier hospitals, which account for only 0.3% of the total number of hospitals. And patient data is fragmented among thousands of local clinics and hospitals, making diagnosis, treatment, and effective public health policy implementation more complicated. This inefficient structure leads to wildly disparate service levels and costs in health care, which makes it difficult for insurers to provide standardized coverage.

The government acknowledges these challenges and the need to reform the health care system. President Xi Jinping has put public health at the core of the country's policy-making programme, emphasizing health in government policy-making agenda. The national goal of Healthy China 2030" focuses on disease prevention and a comprehensive overhaul of the health care system.

The big question, though, is how to connect all the stakeholders in China's sprawling health care system in a way that reduces costs, improves public health outcomes and makes health care more insurable? For Ping An, trying to impact one segment or another is not the answer. The solution must involve a whole ecosystem involving the government, patients, providers, payors, and technology in dynamic interaction which enables all to function to their full potential.

Beyond digitization

It is no surprise that the efficiencies offered by digitalization hold the potential to transform the health care provision in China. But given the scale, complexity, and importance of the challenge, Ping An believes that improving outcomes for all stakeholders has to go further than bringing more health care delivery online or connecting different data sources.

Instead, there needs to be a transformation that achieves horizontal" and vertical" integration. Payors, providers, and patients need to be more connected to improve efficiency, and payors also need to be able to communicate their needs to providers, helping to determine the cost and level of health care services. Only a high level of integration can ensure that a health care ecosystem will be sustainable. That is why Ping An's health care ecosystem strategy-and the role of its 12 distinct entities in the sector-are built on this holistic online and offline approach.

Source: Ping An

Technology is at the heart of this strategy. Building an effective digital infrastructure for better health care in China involves leveraging a high level of professionalism developed working in the Chinese health care market, as well as substantial investment in cloud, artificial intelligence (AI) and data management systems: fields in which Ping An is a recognized leader. Underlining its commitment to innovation, Ping An invests 1% of its annual revenue in research and development for healthtech and fintech technologies.

Making it work

This leadership in technology is the key to Ping An's ecosystem strategy-and to better outcomes for all participants, including the company itself. Reimbursements paid by private commercial health care insurers only account for 6% of China's health care spending at the moment. That means insurers, in this capacity alone, can exert little influence over the cost and service level of the health care provision. As a result, insurers' potential to contribute to China's health care system is limited.

Ping An's technology and services change this equation. The value of Ping An's technology to the government in monitoring and improving public health-not to mention its benefits to medical professionals-allows the company to access public health care institutions. That means Ping An can help institutions to improve operations, manage costs, and deliver better and more affordable service to patients, making health care more insurable.

Built on a vast database of diseases, medical products, treatments, medical resources and patient information, Ping An Smart Healthcare is at the heart of this vertical integration." It provides tools to manage public health care, empower providers, and improve medical resource accessibility and patients' disease outcomes.

For example, Ping An Smart Healthcare's intelligent image analysis system enables doctors to shorten diagnosis times from 15 minutes to 15 seconds. The integrated data analysis package, AskBob, aims to be the Bloomberg for doctors." Already, AskBob is used by as many as 710,000 doctors, covers around 3,000 diseases, and its AI capabilities in diagnosing and treating cardiovascular disease are comparable to that of human doctors. In a competition at the Great Wall International Congress of Cardiology last year, AskBob scored 97.7 points compared to 93.9 points for a team of doctors from top tier hospitals.

In collaboration with China's National Clinical Research Centre for Metabolic Diseases, Ping An Smart Healthcare has developed an advanced type 2 diabetes management tool powered by its underlying AI technology and database resources. The tool has been deployed in the center and more than 600 hospitals nationwide, serving more than 100,000 patients and delivering a 30% improvement in patients' compliance rate.

Across the spectrum

Ping An Good Doctor and Smart Healthcare work together to create a robust product and service cost model, driving synergies by drawing providers and social health insurers into the system. If Ping An Smart Healthcare is the vertical thread connecting government and medical institutions with the delivery of health care to patients, Ping An Good Doctor is crucial to the group's efforts to connect patients, providers and payors through the horizontal" axis of its ecosystem strategy. Ping An Good Doctor provides online consultations with AI-assisted medical teams and integrates seamlessly with offline medical services within the ecosystem. Users can search for basic information for free, with consultations and treatments available at a cost.

The adoption of telemedicine soared during the pandemic. By 30 December 2020, Ping An Good Doctor had 373 million total users, with a monthly average of 72.6 million users, and some 903,000 daily enquiries. Ping An Good Doctor has an in-house medical team of more 2,200 members and a network of more than 20,000 domestic medical experts and 300 renowned doctors across China.

But while these numbers are impressive and should continue to grow, currently only 3% of all medical consultations are conducted online in China-a smaller proportion than in the United States. To be truly transformative, the ecosystem must address the substantial proportion of consultations that still take place offline.

The ecosystem's network of offline health care providers is therefore highly important. Ping An Good Doctor partners with 151,000 pharmacies, 49,000 clinics, more than 3,700 hospitals, and over 2,000 medical examination centers to provide services such as hospital referrals, appointments, and inpatient arrangements. Ping An Good Doctor also works with 1,000 prominent international doctors and the world's top ten hospitals to ensure handy and accurate medical services for users.

Paying the bill

The benefits of this ecosystem strategy to government, patients, and providers are clear. But covering the cost of improved health care in China involves payors-and that's where the opportunity lies for Ping An to commercialize its strategy. Insurance products are integrated throughout the Ping An health care ecosystem. Ping An HealthKonnect provides payors such as social health insurers and companies with anti-fraud and health care resource management models that reduce overtreatment, fraud, and abuse. The group's recent Ping An Doctor Home proposition, which offers private family medical services online, includes up to 1 million RMB of insurance coverage against any injury or loss of time or property caused by the platform.

In total, the Ping An Group already provides health care services to 210 million individual financial services customers and four million corporate clients. However, transformation of China's health care system is a long-term investment into Ping An's own future: a healthier health care system allows the company to acquire new financial services customers as well as to retain and grow spending with the group by existing financial services customers.

The facts reinforce this business case. In recent years, 15% to 20% of Ping An's new financial services customers have come from this growing health care ecosystem. Financial services customers who also have health care services use, on average, three Ping An financial services products, whereas a financial services customer without health care services uses only two of the group's products. The average assets under management (AUM) of customers using both financial and health care services is $10,000, versus $5,600 for those who only use financial services.

Lessons for the world

Confucius said that when it is obvious that the goals cannot be reached, don't adjust the goals; adjust the action steps." Ping An's ecosystem strategy reflects a willingness to think differently about how to solve a longstanding problem, deliver on the Healthy China 2030" goal, and may offer a useful example to other countries.

Some of the unique characteristics of China's system, especially an open approach towards data-sharing and the role of government in health care, unquestionably help to make Ping An's ecosystem strategy viable. However, the health care challenges China faces are not unique. Indeed, data fragmentation, inefficiency, high cost, and a shortage of medical professionals afflict health care systems around the world. Undoubtedly, all governments would want to use technology to better monitor and protect public health, especially since the outbreak of covid-19.

Each country will make its own decisions on how patient data can be gathered, aggregated and shared, and the role of government in health care will of course vary in every country. But it is clear that achieving better outcomes for patients, providers, payors, and governments-as Ping An's health care ecosystem strategy aims to do in China-must in some way harness the power of data and AI to create efficiencies and standardize the cost and level of medical services.

This content was produced by Ping An. It was not written by MIT Technology Review's editorial staff.