Whether it is online consultation, appointment for diagnosis and treatment, or health management advice based on physical examination reports, everyone has long fallen in love with Internet medical treatment, and is accustomed to "moving their fingers" before seeing a doctor to find a reliable doctor.
The epidemic has activated online diagnosis and treatment, coupled with the frequent favorable policies, Internet medical care has ushered in a new stage of development. Public hospitals, Internet companies, private medical and medical informatization enterprises have entered the market, and more and more participants have entered the market.
At the end of 2021, when the industry ecology is gradually improving, the health industry and Jingdong Health jointly launched the special topic of "Insight into the Value of Internet Medical Treatment", which aims to start from multiple groups with the deepest influence of Internet medical treatment, gain multi-dimensional insight into the latest trends in the development of Internet medical care, and witness the practical value of Internet medical development at multiple levels.
Since 2020, public hospitals have accelerated their entry, making China's Internet hospitals grow in scale.
According to statistics from the National Health Commission, in the first half of 2021 alone, more than 500 new Internet hospitals were added. In the past two years, what has online business brought to public hospitals?
According to data from Ai Media Data Center, the size of China's mobile health market is expected to reach 63.55 billion yuan in 2021 and 83.96 billion yuan in 2024. In the face of the huge market scale, how to find an operational breakthrough in the online business of public hospitals?
The health community tried to find out through interviews with several public hospitals.
"Amplified my energy"
"When I go to the clinic every day, I basically meet my online patients." Liu Xingpeng told the health community.
In 2011, Liu Xingpeng, who worked in the Department of Cardiology at Beijing Anzhen Hospital affiliated to Capital Medical University, was transferred to Beijing Chaoyang Hospital Affiliated to Capital Medical University as deputy director of the Heart Center. From specialized hospitals to general hospitals, the number of patients with heart diseases inevitably decreased, so Liu Xingpeng decided to contact online treatment.
In the past ten years, Liu Xingpeng has served about 5,000 patients online, most of whom are from Shandong, Inner Mongolia, Shanxi and other places, and his personal homepage has reached 3.654 million. When mentioning these numbers, Liu Xingpeng's volume rose significantly, "It amplifies my energy." ”
Internet medicine magnifies the ability of doctors and at the same time straightens out the order of hospital visits.
Since obtaining the Internet Hospital license on February 28, 2020, the Internet Hospital of Shanghai Children's Hospital has been running for nearly two years, and about 250 doctors in 25 departments of the hospital have provided online services, and the departments with the largest service volume are pediatric endocrinology, dermatology, and health care.
Although the running time is not long, the running effect has begun to appear.
"85% of online users convert to offline." Wang Miao, director of the hospital's medical department, told the health community that the main role played by Internet medical treatment at present is drainage.
Among online patients, 85% do initial consultation, "they will ask which department to hang up and what disease to see"; the remaining 15% are follow-up patients. At present, the average ratio of online and offline patients in the hospital is 1:9, and the endocrinology department even reaches 1:2.
"In these departments with high online conversion rates, the waiting time of offline patients is significantly shortened." Wang Miao's most intuitive feeling lies in the optimization of hospital processes, the time of patients staying in the hospital is significantly shortened, and the use rate of doctors for fragmented time is significantly improved.
Cultivate a sense of "grouping" of doctors
Large hospitals use the Internet for medical drainage, are small hospitals more prolific?
Not.
According to the design route of hierarchical diagnosis and treatment, patients should be treated from the severity of the disease to the order of the first-level hospital, the second-level hospital and the third-level hospital. But how can patients accurately determine the severity of the disease? How do they know which hospital they should go to?
"When we do consultation online, it is equivalent to giving patients an early professional guidance." In Liu Xingpeng's view, this is a measure to comply with the hierarchical diagnosis and treatment system.
According to Wang Miao, the online consultation mode has slowly cultivated the doctor's "grouping" awareness: patients with common diseases are guided to follow up treatment in lower-level hospitals, follow-up treatment of patients, and patients with severe and acute diseases come to the clinic offline. "The whole medical process has become more orderly, which is of great help to doctors to improve their professional ability and promote the development of the discipline."
After the arrival of the epidemic, the number of off-site patients in Shanghai Children's Hospital has decreased significantly. For some chronic disease patients who are inconvenient to go to a large hospital but need long-term treatment, the doctor will guide the local hospital to give further examination and treatment through the Internet hospital. In this way, some patients with chronic diseases are left in grass-roots hospitals, and large hospitals are more focused on overcoming difficult and serious diseases.
The Internet medical model of the Fourth People's Hospital of Langfang (hereinafter referred to as the Fourth People's Hospital of Langfang) has brought another part of the patients to the primary hospital.
In 2019, the four hospitals of Langfang City explored the offline and online integration mode within the medical community, and they used the "desktop cloud" to map the hospital HIS, LIS, ECG and other systems to the township health center and the village clinic, realizing the new model of "platform operation of county hospital resources".
Xing Yuhua, vice president of the Fourth Hospital of Langfang City, told the health community that the platform provides services such as diagnosis and treatment, drug distribution, emergency transport, etc., and shares the resources of the inspection and imaging center online, and the business income is shared proportionally by the two sides. "In this way, primary health centers that were previously unable to do examinations and imaging can provide these services and retain more patients."
However, all online businesses, including consultation, examination, and medicine, have brought benefits to the four hospitals in Langfang City, which are far less than the hospital's investment. The model has been running so far, and its business is still losing money.
But Xing Yuhua compared the profit model of online business to a takeaway platform, and he firmly believes that with the extension of running time and the expansion of scope, when the service volume rises sharply to a certain level, the inflection point of profitability will come.
Online consultation, calling for greater freedom
Whether it can be profitable is always a topic that cannot be bypassed in the development of Internet hospitals.
At present, the online charging standards and scope of public hospital Internet hospitals are lower than the cost of online diagnosis and treatment, resulting in inability to make a profit.
Taking Shanghai Children's Hospital as an example, Wang Miao mentioned that the online service volume of its Internet hospital is about 300 person-times per day, half of which is free services for the grass-roots level, and the other half is in accordance with Shanghai price regulations, the registration fee is 25 yuan / person, the same as the ordinary outpatient registration fee.
Yu Guangjun, president of the hospital, co-authored "What are the charges for public hospitals to carry out "Internet +" medical services?" The construction cost of the information system based on the standard of simultaneous construction of 5 general follow-up clinics and online services for patients with common diseases was estimated, and the annual amortization cost was about 2.102 million yuan, and the cost of online diagnosis and examination of common diseases and chronic diseases was 35.03 yuan / person,030, which was higher than the current general outpatient price of 25 yuan / person.)
"Is online service profitable? According to the current charging standard, there is definitely none. Wang Miao said.
The logic of the Four Hospitals of Langfang city is to hope to expand the volume of services to balance the cost of services. Another option is to expand the range of services.
The Measures for the Administration of Internet Hospitals (Trial Implementation) stipulate that patients have not been treated in physical medical institutions, and physicians can only provide follow-up services for patients with some common diseases and chronic diseases through Internet hospitals.
This has led to the Internet hospital dominated by public hospitals being more inclined to receive patients with chronic diseases and common diseases. For example, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine and Fudan University Affiliated Cancer Hospital only support online follow-up consultation.
Follow-up consultation only is based on medical safety and medical quality considerations, but the drawbacks are also obvious. The function of physical hospitals cannot be fully realized in Internet hospitals, and it is difficult to balance revenue and expenditure. "The narrower the scope of what we can do, the smaller the role of the hospital's Internet business, and if the scope can be expanded, it can serve more people." Wang Miao said.
At present, more and more experts have suggested that the online initial diagnosis of some departments be opened.
Liu Xingpeng also believes that at this stage, the medical industry should create more conditions for doctors to embrace the Internet and use Internet hospitals. "The main body providing medical services is medical personnel, and the dominance of Internet medical care should be placed on the doctor's side, not the administrative organ or the president." What Liu Xingpeng hopes is that in the future, doctors will be able to serve patients anytime, anywhere, and get paid accordingly.
At present, the construction of Internet medical care is still in the stage of controversy among hundreds of schools. In Xing Yuhua's view, the industry's exploration should not stop at the construction of Internet hospitals based solely on the interest model, but should stand at the height of hierarchical diagnosis and treatment to expand the Internet medical business.
Source: Health Community
Author: Yang Ruijing