Health Professions January 28, 2019
Digital expansion in China and the effect on healthcare

By Dr Harriet Leyland - World Healthcare Journal

As the health needs of the population continue to grow, China must provide additional resource and apply significant innovation and creativity to meet these demands.

China’s health landscape

The healthcare industry in China is growing, estimated to be worth USD $1 trillion a year by 2020. It provides care to a population of 1.4bn people in 27,000 hospital facilities nationally. However, the amount of healthcare workers is strikingly low with only 2.2 doctors and 2.54 nurses for every 1000 people (2016) compared to the OECD average of 3.4 and 9.0 respectively. Concurrent issues of increasing life expectancy, a more urban population with large health disparities between socioeconomic groups, the rising incidence of non-communicable disease (NCD) and health issues caused by a polluted environment are building. An imbalance between the allocation of resources and the utilisation of different segments of the healthcare system causes overcrowding and poor access, with late diagnosis being a frequent occurrence, and the healthcare system is currently being tested to its limits.

Technology and innovation as a strategic priority 

Despite the 2008 financial crisis China’s economy continues to grow, partly due to rapid technological development. Healthcare is a key sector in the current round of digitalisation, where disruptive technologies have the potential to dramatically reshape the country’s healthcare system by disintermediating traditional hospital-based care delivery. Despite the desire, however, the fragmented government-run public health system, which makes up more than 85 per cent of the healthcare provision has, so far, been slow to adopt digital solutions, and the drive to use technology in healthcare has largely come from the private sector.

Multiple factors play into making China’s desire to lead the world in the digitalisation of healthcare a realistic proposition. The population is well-connected by mobiles, accessible to most due to low cost and good networks and the use of smart devices that continuously collect health data is highly prevalent.

Concerns around privacy seem less prevalent than in many regions and, rather than provoking fear about job losses, technology is more often seen as an enabler, for example Chinese doctors appear to be keen to automate their most repetitive work. The two most significant factors in China’s favour are the scale of the data held by China and that the restrictions on the use of this data are currently less stringent than in many judiciaries.

The technology push within China’s healthcare landscape has been driven by large tech companies, and the first wave of these highlights both the potential and the scale. Good Doctor, an online health platform, backed by Ping An Insurance, the world’s largest and most valuable insurer, connects to a nationwide network of healthcare providers including 3100 hospitals and more than 1000 health check centres as well as dentists and pharmacies. This service has gained 190m registered users since being founded in 2014, although those currently accessing these types of services are only a small percentage. The convenience of easily accessible online healthcare compared to the care delivered in crowded hospital outpatient departments will continue to drive the success of these services.

Chinese hospitals are increasingly using technology to bridge the gap between urban centres, suburbs and more remote parts of the country. Both document sharing and live streaming are used to provide support to the local staff and to deliver a more consistent level of medical care. Video consultations for patients in remote regions are becoming more prevalent with many hospitals developing dedicated telemedicine services.

Dr Harriet Leyland, Healthcare Consultant

Artificial intelligence

The Chinese government is thinking big when it comes to AI and aims to become the global leader in this technology by 2030. In 2017 the China Food and Drug Administration incorporated AI diagnostic tools into its list of permitted medical devices and there are currently around 130 companies working on healthcare sector AI applications.

iFlytek, a voice recognition software company, has developed an AI medical assistant that listens to doctor-patient consultations and produces reports, even suggesting prescriptions, to help save doctors time. Their medical robot famously passed China's medical licence examination in 2017, becoming the world's first robot to pass a national medical licence exam, a year earlier than a similar accolade achieved by a Babylon chatbot in the UK.

The future and opportunities

The next ten years will be revolutionary in the healthcare sector in all geographies. Digital technology, including AI, will be being used in healthcare delivery, expanding the range of models from the current face-to-face patient-healthcare worker interaction model. The openness to digitalisation and the light touch regulatory environment, alongside access to massive amounts of data, make China a very interesting space to watch during this development.

Progress is unlikely to evolve in a smooth, well-planned manner, and the disparity in healthcare access between social groups is likely to continue as the best care remains out of reach for many. As the popularity and uptake of online health services increases, the development of new services will continue and it seems the government will be pushed into defining more coherent policy on how healthcare should be delivered in the 21st Century.

The ability of the government to implement change where the will exists means China has the potential to trail blaze digital advances, so anyone with an interest in the delivery of healthcare in the next few decades ought to pay attention.

Contact:  harriet.leyland@doctors.org.uk


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