Internet hospital license "big sale", "gold rush ticket" is not fragrant now?

"No need for 5 million, no need for 4 million, Internet hospital license at a loss."

Internet hospital license with only two years left in the "shelf life", listed for network transfer, with a quotation of 4.1 million;

On the official website of an Internet hospital license, multiple license information is played on a rolling basis, and most of these licenses were approved in 2020, most of which came from Ningxia, Hainan, where the development of Internet hospitals was the hottest that year...

In the past six months, various resale information of Internet hospital licenses has frequently appeared in the Internet medical circle.

A number of Internet medical practitioners said that ninety percent of Internet hospitals in public hospitals spawned by the epidemic are in a "zombie" state, and this situation is even worse now; The Internet hospitals run by third-party institutions have long been operated as "handheld self-service machines"; Some enterprises whose main business is selling drugs have clarified the route of selling drugs after obtaining the Internet hospital license, and quietly cut off the "mutual medicine business".

When the Internet hospital landed from the concept to the reality, everything was not as imagined.

Today, Internet hospital licenses are being sold and peddled everywhere like hot potatoes, all of which began in the past 3 years of frenzy.

Regarding the first year of the Internet Hospital, it dates back to 2015, when the Wuzhen Internet Hospital was launched; Subsequently, in 2016, HaoDafu Online obtained the first Internet hospital license in Ningxia, and as of October 2019, there were 269 Internet hospitals nationwide.

3 years of epidemic, this track suddenly accelerated.

In 2020, the new crown epidemic broke out. Most people stay at home, and completing the diagnosis and treatment process online has become a rigid need for medical treatment. A number of industry insiders recalled that after February 2020, companies went to various places to worship mountains and obtain licenses; All localities directly named tertiary public hospitals, and must go online for consultation with Internet hospitals, and a number of Internet hospitals rushed out.

Internet medical industrial parks have sprung up in many places, and enterprises have flocked to obtain licenses, and some have not hesitated to spend a lot of money to entrust intermediaries to obtain licenses; In order to attract investment, government performance, local taxation and drive industrial development, the government has "even approved more than a dozen licenses for one hospital, all of which are operated by enterprises."

According to incomplete statistics from Eight Points, as of February 2023, more than 180 Internet hospital-related policies have been introduced across the country. As of May this year, there were more than 2,700 Internet hospital licenses nationwide.

In just over three years, the number of Internet hospital licenses nationwide has surged from less than 300 to 2,700, nine times that of the past.

Under the fury, the myth of "making more money and operating widely" in the plan was shattered. In Ningxia and Hainan, many enterprises have "zero operation" after obtaining licenses. At that time, millions of people worked hard to get licenses, because there was no profitable physical business, and gradually became a burden for enterprises.

In the past, the Internet hospital license that you had to worship the mountain and find connections to get has now become a burden that many insiders are eager to change hands and can't turn around.

Fanatic licenses

In the three years of the epidemic, anyone who has done Internet hospitals knows that it was a period of time when "enterprises pushed for licenses, and the government approved a large number of licenses".

According to Bi Jia, co-founder of One-Two-Three Digital Healthcare, the release of Document No. 25 "Internet Hospital Management Measures (Trial)" in 2018, coupled with the sweep of the epidemic in the three years since 2020, is the key reason for the emergence of Internet hospitals and the approval of a large number of Internet hospital licenses.

A number of industry insiders described the scene at that time to Eight Points Jianwen, and after Document No. 25, Internet hospitals in many places were like mushrooms, "because there are laws to follow"; At the beginning of 2020, when the epidemic struck in many places, some provinces and cities began to roll names, drawing the names of tertiary hospitals, requiring that an Internet hospital consultation system must be established; Even in some places, the government directly came forward to set up Internet hospitals, and community health centers were hung up on Internet hospitals in the form of medical alliances", and in the approval process, you can "get on the bus first and make up the ticket later".

With a relaxed environment and encouraging policies, a number of Internet hospitals were quickly approved to go online.

On January 29, 2020, a hospital in Wuhan urgently opened an Internet hospital consultation channel, and the hospital submitted a qualification application on January 31, which was approved on February 3, which took less than 4 days;

On February 5, 2020, an Internet hospital in Tianjin applied to add a respiratory medicine department. After the official acceptance at 16:14 that afternoon, it was completed at 16:25, which took only 11 minutes.

According to arterial network data, in February 2020 alone, there were as many as 65 newly approved Internet hospitals nationwide.

The Internet hospital license of public hospitals was approved quickly, and there was almost no threshold. However, for medical informatization enterprises and private hospitals, even if it is difficult to get a license, it must be squeezed in.

"With a provincial license, you can open up the province's medical resources, including doctors practicing at multiple sites, and can truly do Internet hospitals from the perspective of official compliance." Zhai Xuelian, former senior vice president of Quality HealthCare Technology and founder of Medical Cube Technology, told Eight Points Health.

Medical information companies to get Internet hospital licenses, in addition to following the trend, is also related to the service attributes of such companies.

Generally, enterprises that have served hospital informatization for many years, whether focusing on the connection of hospital systems or Internet services, on the one hand, have the accumulation of some medical resources such as doctors and drugs, on the other hand, they also have the desire to cut into the core business of diagnosis and treatment services, coupled with the natural Internet genes of Internet hospital services.

"When the three collide, it seems natural to get an Internet hospital license." A relevant person in charge of a medical information company said.

In 2019, in order to win the license of the Internet hospital, Zhai Xuelian did not hesitate to hold the project book and carry the PPT to find people from the local authorities again and again. "Although we are a company composed of a team of professional doctors, we do not have the background of offline medical institution operation, and we need repeated explanations to prove our ability and gain trust." After obtaining the permit, Zhai Xuelian quickly rented office space, engaged in decoration, and made necessary personnel and software and hardware preparations for the opening of various offline medical institutions.

At that time, an Internet hospital license, for medical information companies, meant a business that had value in the capital market or could extend the willingness to cooperate. Such companies tend to have lower costs to build internet hospitals and better foundations for in-hospital cooperation.

"The essence of an Internet hospital license is actually a qualification to provide limited medical services online in compliance, as long as it does not involve post-diagnosis prescriptions, pre-hospital extension business does not actually require mutual medical qualifications." Bi Jia said.

But some "believers" even hold several license plates in their hands.

The "license fever" of Internet hospitals has intensified, and even a number of Internet medical parks have been spawned in some places, and modern license "savers" have emerged, and even some places have begun to use Internet hospital licenses to attract investment.

Zhao Xin (pseudonym), an Internet hospital practitioner, recalled that in 2022, the chairman of a medical information company ran to a western province, and the local government wanted to attract investment and develop the traditional Chinese medicine industry. In order to enhance the advantage, the local relevant departments began to approve the Internet hospital license, the form of Internet + traditional Chinese medicine, the government has both political achievements and good storytelling, and a license can attract hundreds of thousands of dollars in income for the local area.

According to people familiar with the matter, at one time, and even some places turned the approval of Internet hospital licenses into a channel for developing the local economy, on the one hand, applying for licenses, bringing many opportunities for local investment attraction; On the other hand, there will be annual reviews, and enterprises need to spend a certain amount of money.

And physical hospitals are simply attached. "A public hospital has approved more than a dozen licenses, but it has nothing to do with the hospital, the enterprise operates, and the hospital is purely taking on a task." Zhao Xin said.

For a time, Internet medical industrial parks blossomed all over the country. Enterprises rush to settle in, and the settled enterprises can be given priority to obtain licenses, as well as policy support, investment and financing docking, and even rent reduction and reduction.

In the face of these supports and offers, buyers are still crazy despite the high intermediary fees for Internet hospital licenses in some places.

No one asked for a license

The hustle and bustle suddenly stopped, in just two years, no one asked for an Internet hospital license, and the cold silence came earlier than expected.

The news of the transfer of the license was broadcast on the official website of a company that handled the license on behalf of the company. Scroll for a long time, no one cares.

A license that took time and effort to obtain in the past has now become a "cost item" for enterprises.

"Only a license, no real money-making business, still can't work." After two years of "market education", many relevant people who competed for licenses in those years woke up.

Li Shuo (pseudonym), who has been engaged in AI medical services for a long time, has recently come into contact with some companies that want to transfer licenses, and these companies, at first, due to preferential policies, have gone to various places to get licenses. Some enterprises often apply for several licenses depending on the business line or different regions.

But in fact, many licensed enterprises, because of the epidemic, rarely go to the license location to carry out Internet hospital business. According to the service volume of social Internet hospitals announced by a province in 2021, as of January 2021, only a few of the 58 Internet hospitals have generated effective operational data; The 20 Internet hospitals have 0 doctors, 47 have 0 consultations, and 51 have 0 prescriptions.

After the company obtains the license, but does not develop locally, this is a headache for the local park and the government.

"Local governments are also aware of this problem, so they are ready to introduce some favorable policies to promote investment this year." Li Shuo said.

The park where Li Shuo Company is located also conducts tax assessment for Internet medical enterprises settled in this year, "In the signed agreement, a certain tax payment amount must be reached within three years, otherwise the enterprise needs to return the original fee reduction." Previously, many companies took licenses and went to other places to do business, and did not leave their revenue in the place where the license was issued. "Just this year, the industrial park where our company is located, they began to have such requirements."

Li Shuo recalled that at the government meetings he participated in many times, the tax payment situation of local Internet medical enterprises would be reported, a number of enterprises with large business volume and high tax payment would be praised, and the list of enterprises with zero tax payment would also be announced.

This situation, when the company first rushed into the game, was completely unexpected, and even more did not expect that after taking the license, the business could not run.

For most companies, it is better to sell the license in various parks.

In addition to revenue and taxation, some places also require enterprises with local licenses to rent local government cloud servers and purchase corresponding network security services, which cost at least 100,000 yuan a year. In addition, there are site fees, system development and operation and maintenance costs, etc., "at least 4.5 million a year."

In some places, enterprises that require approval of Internet hospitals must build two systems, one is a remote consultation center based on the offline physical medical institution system, and the other is an online Internet hospital. In addition to the operating costs of offline entities, there are also the construction and maintenance of online and offline systems, which are naturally high, with a total cost of more than 5 million yuan, and the purchase of equipment and other expenses of more than 2 million.

In addition to third-party Internet hospitals, public hospitals also lack motivation to set up Internet hospitals.

Doctors are a public resource, and deployment is a problem. "Some departments do not have much funding, and once the department requests it, it is difficult to get support for the hospital to allocate nurses, course managers, and technicians, let alone post-hospital full-course management and real follow-up." Bi Jia said.

"Unless it is some Chinese medicine departments, for example, the Chinese medicine formula granules prescribed in the hospital are increased by 15%; The Chinese medicine formula granules prescribed by the Internet hospital are increased by 25%. A business person said.

Zhao Xin, who used to work as an Internet hospital in a hospital, has now come out to start his own business, talking about hospital-type Internet hospitals, he said, "The business of third-party help hospitals to operate on behalf of hospitals is more shallow, and the Internet hospital has become a handheld self-service machine." ”

Zhao Xin further added that the reason why it is shallow is that the expansion of business is relatively limited by policies in hospital-type Internet hospitals; Second, the Internet hospital outlet has slowly passed.

"In the development of Internet hospitals, hospitals have turned the expansion of some businesses into the expansion of convenient services, so they have slowly become a handheld self-service machine."

Some hospitals want to sell their own in-hospital preparations on Internet hospitals, but it doesn't work; Some hospital departments want to put the dental cleaning package on the Internet hospital, and after the patient purchases the service, it is not possible to go to the offline physical hospital for verification.

Ninety percent of Internet hospitals in a "zombie" state, several years have passed, or follow-up and prescription medicine.

In the medical field, the concept of "Internet hospital" is really impossible for insiders to play.

"Besieged" general Internet hospitals

"I think the license transfer is also normal, it's the process of big waves." Bijia said.

In 2014, known in the industry as the first year of China's Internet medical care, now entering the 9th year, the industry reshuffle eliminated ignorant enterprises, which is also in line with business rules.

It's just that the successful templates of the past have attracted some people who have not joined the track and try to ride the wind.

In December 2015, the Wuzhen Internet Hospital, jointly founded by WeDoctor and Tongxiang, Zhejiang Province, obtained its first Internet license; In April 2016, Haodai obtained the Yinchuan Internet Hospital license, and the "Yinchuan Model" once became an industry benchmark. Since then, Internet hospitals in various places have exploded, and Ningxia, Hainan, Chengdu and other countries have become Internet hospital gathering places... These are the origins of "dreams".

However, unexpectedly the high operating costs, I had to stop the loss in time. Most of the people in this "transfer wave" are the private institutions that rushed into the market.

Some ran out of results, others left dismally.

But behind the "transfer tide", like the besieged Internet hospital, there are still people who want to enter the game, but now the people who enter the market are more "pragmatic" than before.

"People who need mutual medicine licenses now generally have suitable business scenarios and need qualifications to meet compliance needs. There will be no layman buying a license, expecting to cash out later. An industry veteran said.

Taking Ningxia as an example, the local "Internet + medical health" demonstration province (region) has been under construction for four years, and passed the national acceptance on May 29 this year. Mature demonstration areas, coupled with preferential tax relief policies, have attracted many enterprises to settle in.

According to Li Shuo's observation, in 2022, there will be a wave of people applying. In 2022 and 2023, these batch of Internet hospitals applying for licenses will develop professionally in subdivided fields, mostly pendant specialized hospitals.

Specialties are a direction that Internet hospitals aim for.

In Zhai Xuelian's view, the choice of specialization is reasonable, which is the focus of Internet hospitals to operate profits. Online consultation for specific diseases accurately targets patient groups, manages patients in the form of private domain traffic, and only serves the patient group of that disease. At present, specialized Internet hospitals are mainly patients with high degree of compliance, such as chronic diseases, gynecology, pediatrics, dermatology, etc., in addition to consultation, follow-up visits, health management, prescriptions and other diagnosis and treatment behaviors, which can support the revenue of private institutions.

In addition to specialty, the development of pharmaceutical e-commerce is another direction.

Internet hospitals have their technical advantages in laying drug sales channels, and obtaining an Internet hospital license is equivalent to finding a legal way to sell prescription drugs for pharmaceutical e-commerce.

However, the subtle thing is that pharmaceutical e-commerce does not want the Internet hospital to develop too well, once the development is too good, the powerful entity behind the Internet hospital will attract patients from online to offline, which is contrary to the original intention of Internet pharmaceutical e-commerce.

For medical institutions, the ultimate goal of developing Internet hospitals is naturally to bring patients offline, after all, examination, surgery, hospitalization and other diagnosis and treatment methods are the core of medical treatment and the main source of revenue. "The role of Internet hospitals is to improve user stickiness and improve the probability of patients visiting offline." Analysis of the above-mentioned senior practitioners in the industry.

If patients come to the hospital, what is the point of online Internet hospitals?

Looking back, the emergence of Internet hospitals has saved public hospitals from fire. For example, Heilongjiang Provincial Hospital, which once had a debt of 2 billion yuan, doubled its outpatient volume after it went online in 2019, and the hospital got out of prison.

Today, there are still public hospitals that continue this "ideal story". Most of them had committed leadership teams that were determined to reinvent the process and are still operating well. Taking West China Second Hospital and Beijing Cancer Hospital as examples, the former opened up the whole process of online medical treatment, and the latter transferred all cancer patients to online diagnosis and treatment when they could not be opened during the epidemic through the "Bei Langyun Medical Record".

Now, the fever of the Internet hospital has passed, and the concept no longer has crazy tension, but the background of imagination still attracts people inside and outside the "siege".

Written by Luo Chunhao and Peng Leyi

Li Lin丨Responsible editor

This article was first published on the WeChat public account "Eight Points Jianwen" and may not be reproduced without authorization