In an congratulatory letter to the World Internet Conference Internet Development Forum held this November, China’s president Xi Jinping hailed the important role the internet served in promoting economic recovery, ensuring social progress in countries across the globe, and promoting international cooperation against Covid-19. Pointing to the role the internet can play in driving economic recovery, he noted that telemedicine was among the many online platforms that were widely used when the outbreak surfaced. Case in point, the supply chain and technology-focused retail giant JD.com saw more than 10 million medical consultations on their platform between January and April, and daily online consultations today remain at 100,000 on average for the subsidiary of Richard Liu’s e-commerce giant JD Health, making it the largest online medical consultation platform in China.
President Xi Jinping’s letter was just another marked instance of the Chinese government’s growing belief that the telemedicine sector has the ability to vastly improve their healthcare system. Industrialization, urbanization, exposure to environmental hazards, are all contributing factors to the health challenges China is currently facing, and lifestyle factors such as unhealthy dietary behavior, smoking, and an aging population have played a role in the rising incidence of non-communicable diseases such as cancer and cardiovascular disease for the country. Significant strides have already been made in coverage for healthcare, with the start of the century seeing less than one-third of China’s population having access to health insurance and today nearly 100 percent have access. However, even though they had given its citizens protection from becoming impoverished by the costs of healthcare, much of their system was still reactive rather than proactive, treating patients who were already sick.
As a result, in October of 2016 the Healthy China 2030 Blueprint was introduced, encompassing 15 goals sought to be achieved between 2020 and 2030 including decreasing the health effects of second-hand smoking, reducing obesity, increasing overall physical activity, and preventing chronic diseases. The plan moved China’s healthcare focus from a model centered on care to one of promoting public health and preventing diseases. However, with the introduction of this plan came several new challenges. First, only a few strong, well-resourced public health capacities across healthcare communities exist in the country to train health professionals to support the implementation of such policies. Second, preventative services are still inadequate to provide preventative care such as smoking and cancer screenings, mental health services, or to support evidence-based health promotion programs and tailored disease prevention interventions within communities, worksites, schools, or residential neighborhoods. Finally, due to a prior focus on care rather than prevention the existing health system delivery infrastructure was primarily dominated by hospitals, making regular access to such programs and services difficult for many, especially those in third and fourth-tier cities and rural areas.
In order for the goals of the Healthy China 2030 Blueprint to be attained, there needed to be a change in the country’s healthcare infrastructure. The creation of physical facilities to implement these changes would have required a massive scale and huge costs – not to mention the difficulties of staffing such locations with well-trained physicians – and placing the burden on hospitals had the potential to cause critical issues in overstretching the staff. For this reason, the plan indicated that efforts will be made to foster new industries, new forms and models of business in the health sector and to develop internet-based health services. The solution to the problem of infrastructure? Telemedicine.
In 2018, the Chinese State Council announced the promotion of an Internet Plus healthcare development model. Issuing a guideline, they encouraged medical institutions to use information technologies such as the internet to expand the space and content of healthcare service. Healthcare institutions were also encouraged to cooperate with internet companies to utilize their technological capabilities such as big data to enhance the integration of regional healthcare information. To help promote the development of online medicine sales and the logistics of medical supplies, they sought to explore the interconnection of prescription information of healthcare institutions and medicine retail formation, and medical insurance information will be more thoroughly integrated for ease of use. Finally, cloud platforms would be developed for the use of healthcare education and training, further increasing the amount of care available to those in need. Through issuing this guideline, China was able to propel their improvements to healthcare modernization management, optimize resource distribution, improve efficiency of services, reduce costs, and meet the increasing demands on healthcare they were facing.
Thanks to these prior preparations, when the coronavirus began sweeping through the world in 2020, China was much better prepared to face it than it would have been prior to the development of telemedicine. In July of this year, the government further relaxed limitations on internet healthcare, with the National Development and Reform Commission issuing a guideline to promote the development of new business models including internet hospitals and all thirteen of China’s ministries and commissions issuing a joint document requesting the improvement of telemedicine services, further relaxing limitations on their inclusion in the national medical insurance scheme. Two months later in September, the State Council issued another guidance to encourage the development of new business models in China that stressed the importance of promoting internet-based healthcare services. Through the developments made over the last two decades, China’s telemedicine industry has seen a complex compound growth rate of over 30 percent and garnered the most advanced digital healthcare system in the world.
Between late 2019 and summer of 2020 alone the number of telemedicine providers in China jumped from less than 150 to almost 600, but by that point Richard Liu’s JD.com had already been in the business of healthcare solutions for seven years. Starting by selling healthcare and pharmaceutical products on their retail website, in 2016 they launched a platform through which third-party pharmaceutical retailers could do business while also starting their own first-party pharmaceutical business. Through utilizing their supply chain connections and forming partnerships with offline pharmacies, they were able to cover 99 percent of the population of China, creating pricing stability and enabling accessibility for lower-tier cities while also enabling the pharmacies in the regions better access to supplies. Today, they are able to guarantee a drug delivery time of 30 minutes or less.
In 2017, the company officially established JD Health, beginning their work on the development of internet hospitals one year before the government would officially voice their support of them. They began cooperating with hospitals to offer telehealth consultations via phone or text to their patients, allowing hospitals to expand their services online without having to invest in costly website infrastructure and manpower for upkeep, understanding early on the needs the Healthy China 2030 Blueprint would create. They also began a medical procurement platform aimed at leveraging their supply chains to traditional channels’ circulation efficiency and increase the transparency of information. The platform has been especially beneficial to drugstores, clinics, and medical institutions located in fourth-tier cities and below, helping the small businesses of more rural areas overcome previous difficulties such as incomplete drug procurement varieties, inability to compare prices, and long procurement cycles. Today, JD Health stands as its own entity separate from JD.com, having recently made its debut on the Hong Kong Stock Market. Utilizing the smart technologies such as AI and big data developed, they have found numerous ways to provide much-needed aid during the coronavirus pandemic as well as transform the healthcare sector.
The advent of Covid-19 had the potential to put a massive strain on the healthcare system of China. Hospitals already faced the burden of being the main source of healthcare in the country, leaving them with the responsibility of educating the public, advising on symptoms, as well as treating those with the disease who required intensive care. To alleviate pressure from hospitals, JD Health worked with urgency to integrate a section of their app to include a free online consultation platform. Through the platform, patients experiencing coronavirus-related symptoms could speak directly with a physician at no charge, and they soon launched a standalone app that expanded the scope of the service to include all diseases, much as an urgent care clinic would work in the United States. Through this aid, hospitals were able to focus their attention on treating those with the most severe symptoms, while citizens could have the peace of mind of a doctor’s consultation without endangering themselves or others by leaving their homes. They also organized several livestreams with some of China’s top medical experts who had experience with the 2003 SARS epidemic on a variety of coronavirus-related topics in an effort to further alleviate public anxiety.
Having become the largest pharmaceutical retailer in China, JD Health worked closely with JD Logistics to ensure that although the coronavirus had taken precedence in the minds of many, the fast and efficient delivery of medicines still occurred for those with chronic diseases and illnesses. They made sure that through their own JD Pharmacy and third parties selling through their platform remained stable in their prices, disallowing drug price hikes that could catastrophically destabilize the industry. Additionally, by delivering drugs directly to the homes of patients, they helped those with chronic illnesses that may be more susceptible due to weakened immune systems to avoid putting themselves at further risk by venturing to infections hotspots like hospitals in order to procure their drugs.
JD Health also utilized their AI technology to provide aid to local governments in disseminating information. The company integrated their universal smart conversion platform into the WeChat account of mayors’ offices across China, where it was able to use its advanced capabilities to provide the latest epidemic information to users. The technology has the ability to understand semantics as well as analyze syntax to get a quick and accurate understanding of the user’s questions, and then uses question prediction, intent recognition, and other methods to provide the latest epidemic information. The government’s openness to the technologies provided by JD Health helped provide citizens with quick access to answers on pertinent epidemic-related questions such as fever clinic inquiry, epidemic self-screening, medical guidance, and even a way to check if a user’s recent mode of transportation such as a flight or train had a coronavirus patient on it. Through embracing technology and telemedicine, China was able to maintain a steady hand on the pandemic.
While the coronavirus pandemic remains an issue that must be managed, Richard Liu ensured that the overall health and preventative care of China wasn’t put on the backburner as a result. As previously discussed, prior to more recent innovations China’s healthcare system focused on care rather than prevention, and as a result most Chinese citizens would search for a specialist whenever they faced a potential illness rather than maintaining a relationship with a general practitioner. To aid in encouraging people to seek timely, consistent, and comprehensive healthcare support, they launched “family doctor” telehealth services. Through the service, up to eight family members can share a service package that includes unlimited 24/7 online medical consultation support with immediate response from a general practitioner, medical consultation with experts within 48 hours, and constant and personalized health management advice. The service allows Chinese people easier access to doctors with strong credentials from some of the country’s highest-level hospitals who they are more likely to trust, therefore hopefully increasing the regular usage of the service and improving the overall health of the country.
One issue that stands to see significant gains from the rise of telemedicine in China is mental health awareness and treatment. The Covid-19 pandemic exacerbated the psychological stress of millions of people, and as a result JD Health launched a free 24-hour telemedicine consultation service for mental health. They soon expanded the program within their app to include a wide variety of mental health and psychological services and providing livestreams to disseminate relevant knowledge. Around 173 million people in China suffer from mental illness, over 90 percent of which have never received professional treatment, and despite modern developments regarding the treatment and management of mental illnesses, many Chinese people still hold a stigma for it that prevents them from seeking help. Through telemedicine via the JD Health app, people can access quality services and seek treatment with complete confidentiality, avoiding the added stressor of visiting a hospital or psychiatric facility. Additionally, the convenience of the telehealth model means that the hindrance of traveling and waiting for in-person appointments can be bypassed entirely, meaning that issues that may have previously been brushed off as “minor” such as insomnia or low-grade anxiety can easily receive the treatment they deserve.
The telemedicine sector in China is one of the fastest growing industries, thanks in part to the government’s openness to innovation and encouragement of the integration into their system and vision of the benefits it can bring to their healthcare overall. Richard Liu has sought to pivot his company’s focus from e-commerce to that of technology and services, seeing those two sectors as the greatest way to bring value to China and the world. Through JD Health’s pivotal use of technologies to advance the telemedicine sector, in a short amount of time they have been able to make significant advancement and bring value to the lives of millions.