FlyTitle: Telemedicine in China

The covid-19 epidemic has brought millions of new patients online. They are likely to stay there

新冠疫情促使成百上千万病人上网求诊,这可能成为常态

经济学人双语版-手机医生来问诊 The smartphone will see you now

WHEN SARS, a coronavirus, hit China in 2003 citizens hunkered down at home. This proved a blessing for some businesses. Chinese social media took off. So did e-commerce. Richard Liu, who ran a chain of consumer-electronics shops, shut all his brick-and-mortar stores and set up JD.com. The firm is now valued at $64bn.

当2003年由一种冠状病毒引发的非典疫情席卷中国时,人们宅在家中闭门不出。这对一些企业来说反倒是个福音。中国社交媒体乘势起飞。电子商务也大举兴起。当时经营数码产品连锁店的刘强东关掉了所有实体店铺,创办了京东。如今,该公司的市值已达640亿美元。

A novel coronavirus that has brought China to a halt this year is boosting another fledgling industry: telemedicine. As hospitals turn away patients with other ailments and many Chinese are confined to their homes or steer clear of clinics for fear of infection, millions are seeking treatment and advice on the internet. The government is egging them on.

今年一种新型冠状病毒让中国陷入停顿,这又在推动另一个正在起步的产业:远程医疗。随着医院停止接收其他疾病的患者,以及许多中国人在家自我隔离或担心去医院会感染病毒,成百上千万的人正在互联网上寻求治疗和建议。而政府也在鼓励这种做法。

Xin Lijun, boss of JD Health, says that his platform’s monthly consultations have grown tenfold since the outbreak, to 2m. Some 1.6m tuned in to a talk by a top cardiologist that the JD.com subsidiary live-streamed. Without the outbreak, the shift in consumer behaviour would have taken perhaps five years, reckons Mr Xin. Chen Qiaoshan of Analysys, a consultancy in Beijing, thinks that China’s online health-care market may near 200bn yuan ($29bn) this year, up from her pre-outbreak estimate of 158bn yuan.

京东健康的CEO辛利军表示,自疫情爆发以来,其平台的月问诊量已经增长了10倍,达到200万人次。这家京东子公司邀请一位顶尖心脏病专家做了一场网络直播讲座,吸引了约160万人收看。辛利军估计,若不是此次疫情爆发,这样的消费者行为转变可能还需要五年。北京咨询公司易观的陈乔山认为,今年中国线上医疗的市场规模可能接近2000亿元,疫情爆发前她的预测是1580亿元。

China’s telemedicine market—including consultations and drug sales—had been predicted to grow vigorously even before the latest epidemic. Ping An Good Doctor, a medical-services app run by a big insurer, claimed in September that over 300m had registered on it, equivalent to one in three internet users in China. Tianyancha, a data firm, counts over 1,000 home-grown telemedicine companies.

在这轮疫情爆发之前就已有预测认为中国的远程医疗市场(包括线上问诊和药品销售)将迎来强劲增长。大型保险公司平安运营的医疗服务应用“平安好医生”去年9月宣称注册用户已超三亿人,相当于中国网民总数的三分之一。根据数据公司天眼查的统计,中国本土远程医疗公司已超过1000家。

经济学人双语版-手机医生来问诊 The smartphone will see you now

Until now, however, most of these firms have stuck to delivering drugs or, in Ping An’s case, booking appointments with specialists, whom Chinese patients favour over general practitioners, even if it means queuing for hours at a hospital. Prestigious “AAA” hospitals account for one in ten public institutions but receive half of all outpatients. And the many Chinese who believe in traditional medicine, with its injunction that a reliable diagnosis cannot be made without feeling the pulse, would not dream of accepting health advice by video link.

然而到目前为止,多数远程医疗公司的业务还仅限于送药上门,或者像平安好医生那样提供专科医生挂号。比起全科医生,中国的患者更偏爱专科医生,哪怕要在医院排上几个小时的队。声名显赫的三甲医院数量只占公立医疗机构的十分之一,却接诊了一半门诊病人。而对于很多相信中医的中国人来说,既然中医讲究靠把脉做出可靠诊断,他们不会想要通过视频来问诊。

Authorities, too, have been cautious. In many countries, including America, the world’s biggest telemedicine market, most insurers do not reimburse patients’ online expenses. Nor, in all but a few regions, does China’s national health-insurance scheme. Most Chinese online doctors are permitted only to handle repeat prescriptions and follow-up consultations, not make an initial diagnosis. A draft government policy from 2017 took “a negative tone” on internet hospitals and recommended they be shut down, recalls Li Tiantian, founder of Dingxiang Doctor, which runs a medical myth-busting-and-advice forum.

政府也态度谨慎。在许多国家,包括拥有世界最大远程医疗市场的美国,大部分保险公司都不会赔付患者的线上医疗费用。除了少数几个地区外,中国的社保也不报销网上看病的费用。中国大多数线上医生只被允许处理复诊续方,不得做初诊诊断。丁香医生(运营着一个辟谣和科普医学论坛)的创始人李天天回忆,2017年一份政府政策草案对互联网医院持“负面态度”,并建议关停这些医院。 

Last year the government began to lift some restrictions, such as a ban on the sale of prescription drugs. But covid-19, as the new disease is known, has accelerated the shift. At the peak of the epidemic in early February a health-ministry directive mandated that internet-based medical services be given “full play” to diagnose and treat patients. Another encouraged hospitals to give online consultations. Jiangsu province, China’s industrial powerhouse, authorised reimbursements for online medical care. So have cities including Shanghai and Wuhan, capital of Hubei province, where covid-19 first emerged.

从去年开始,政府陆续取消了一些限制,例如允许在网上销售处方药。但这一次的新冠疫情加速了这种转变。在2月初疫情最严重的时候,国家卫健委出台政策,要求“充分发挥”互联网医疗的作用,为患者提供诊断和治疗服务。另一项政策鼓励医院开展线上问诊服务。工业强省江苏已经批准了线上医疗的医保报销。其他城市也先后将线上医疗纳入医保,包括上海和首先爆发疫情的湖北省会武汉。

Telemedicine firms are trying to win over the government and consumers by behaving like good corporate citizens. Many, including JD Health, are offering patients consultations free of charge while the epidemic lasts. Ali Health, an arm of Alibaba, China’s e-commerce titan, launched a free “online clinic” for residents of Hubei, which has been under lockdown; in five days 100,000 patients got a remote consultation. WeDoctor, an app backed by Tencent, a tech giant, mobilised 20,000 physicians to work online for no pay. Ping An set up an “antivirus command centre” to dispatch free face masks around the country. Dingxiang Doctor got epilepsy medication to 300 children in Hubei amid an acute shortage of suppliers and delivery firms. Its real-time heat map tracking covid-19 infections has been viewed 2.5bn times.

远程医疗公司正努力扮演良好企业公民的角色,以赢得政府和消费者的信任。包括京东健康在内的许多公司均在疫情期间为患者提供免费问诊服务。中国电商龙头阿里巴巴旗下的阿里健康为封城中的湖北居民提供“线上义诊”,五天内有十万名患者接受了远程问诊。科技巨头腾讯投资的微医动员了两万名医生在线上无偿工作。平安成立了“抗击病毒指挥中心”,在全国免费发放口罩。丁香医生在供应和配送公司严重紧缺的情况下,为湖北300名儿童送去了癫痫药物。该网站实时跟踪疫情的热力图已被浏览了25亿次。

All this is costing the companies money. But, says Mr Xin of JD Health, it makes “little sense” to focus on profit at the moment. What matters, he adds, is how covid-19 has made people think twice about rushing to hospital and helped foster trust in general practitioners, who provide the bulk of online advice. It has also broadened the appeal of firms like his, beyond middle-aged patients with chronic conditions to web-savvy youngsters seeking advice for parents and grandparents and healthy types simply seeking reassurance. Of the 10m people who have turned to the internet for health services in the past month, perhaps half were first-time online patients, says Ms Chen. At least a third are likely to keep using such apps, she estimates.

这些公司为此大把花钱。但京东健康的辛利军表示,这个时候考虑盈利“毫无意义”。他说,真正重要的是新冠病毒使得人们不再动辄跑去医院,而有助于培养人们对全科医生的信任,这些医生提供了绝大部分的线上问诊。疫情也让他们这类公司吸引到了更多用户,不再只是中年慢性病患者,还有精通网络、为父母和祖父母寻求建议的年轻人,此外还有仅仅是为消除疑虑的健康人群。陈乔山说,过去一个月里有一千万人通过互联网寻求医疗服务,其中可能有一半是初次上网求医。她估计,至少有三分之一的人可能会继续使用此类应用。

Remote possibilities

远程的潜力

It is not just patients and politicians who are embracing telemedicine. JD Health has lured more pharmacies to its platform (in part by waiving the fee it earns on drug orders in Hubei). China’s underpaid, overworked doctors are also keen. Xiao Xingxing left a AAA hospital in Beijing to consult full-time for JD Health; many old colleagues and classmates are doing the same, she reports. And against the backdrop of a global, virus-induced stockmarket rout, Chinese online health firms offer a tonic to ailing investors. This year the share prices in Ping An Healthcare and Ali Health are up by 33% and 74%, respectively. ■

积极拥抱远程医疗的不止病患和政客。京东健康还吸引了更多药店进驻其平台(部分原因是它免收湖北地区药物订单的平台费用)。工资收入低、工作强度大的中国医生对此也充满了热情和期待。肖幸幸(音译)从北京一家三甲医院辞职后,加入了京东健康担任全职医生。她说自己的许多老同事和同学也做出了同样的选择。在疫情引发全球股市暴跌的背景下,中国的互联网医疗公司为困顿的投资者注入了一针强心剂。今年以来,平安健康医疗科技和阿里健康的股价已经分别上涨了33%和74%。