2020 Internet hospitals will break the 100 billion mark, but there are three major problems to be solved

The 2020 China Internet Hospital Development Research Report deeply analyzes the current construction progress, existing problems, future construction development trend and typical Internet hospital construction cases of China's Internet hospitals "Internet hospital" refers to a one-stop service platform based on physical hospitals, focusing on follow-up and regular consultation, integrating consultation, prescription, payment and drug distribution The scope of diagnosis and treatment is mainly the re diagnosis of chronic diseases and some common diseases, and the first diagnosis is strictly prohibited According to the measures for the administration of Internet hospitals (for Trial Implementation) issued in July 2018, the existing forms of Internet hospitals are clearly defined: there are two existing forms of Internet hospitals, one is the Internet hospitals of physical medical institutions; the other is the Internet hospitals independently set up by physical medical institutions Either way, we must rely on physical hospitals The demand for internet medical market grows exponentially, and the market scale is expected to exceed 100 billion yuan in 2020 From the perspective of the demand scale of internet medical market, in 2018, the scale of internet medical market in China exceeded 49 billion yuan, and the CAGR of the scale of internet medical market in 2011-2018 was as high as 38.4% According to this growth rate, it is predicted that by 2020, the scale of Internet medical market in China is expected to exceed 100 billion yuan (see Figure 1) Figure 1 scale change of internet medical market in China from 2011 to 2020 Data source: prospective industry research institute, Health Research Institute Secondly, the number of Internet hospital visits has grown by leaps and bounds From the perspective of the number of Internet hospital visits, the number of Internet hospital visits in 2016 was 04 million By 2019, according to the data provided by experts, the current average number of Internet hospital visits is about 2000-3000 per day According to this number, the number of Internet hospital visits in 2019 is about 21-320 million, with an average of 270 million In 2016-2019, the number of Internet hospital visits has doubled Long (see chart 2) Figure 2 change of consultation volume of Internet hospitals in China from 2011 to 2019 (unit: 100 million times) Data source: 2016-2018 data comes from Kaidu consulting, 2019 data is estimated by health research institute according to expert opinion The top-level design of Internet hospital construction is basically complete, and the industry development ushers in a period of policy dividend In recent years, the state has issued a series of Internet plus medical health policies, including comprehensive policies and Implementation Rules for a specific subdivision (including subdivision of medical insurance payment and Internet Pricing, telemedicine, prescription transfer, etc.), which has optimized the Internet hospital landing policy environment In particular, in 2018 and 2019, relevant policies were successively issued, and the development of Internet Medical ushered in a policy dividend period (see Figure 3) Table 3 main policies and regulations for the construction and development of Internet hospitals in China in 2014-2019 Data source: sorting out the public data from the health and health committees at all levels 1 The construction of Internet hospital will be accelerated in 2019 By the end of November 2019, the number of Internet hospitals has reached 294 Only from January to November 2019, the number of Internet hospitals in China has reached 148, which is the total number of Internet hospitals in 2014-2018 The construction of Internet hospitals has entered the accelerated construction period in 2019 Figure 4 number of Internet hospitals built in China by the end of November 2014-2019 Data source: before 2018, the data is from the arterial network, and in 2019, the data is from the Institute of health 2 The construction and development of Internet hospital attract many enterprises to participate actively In the construction of Internet hospitals dominated by enterprises, we found that there are up to 14 types of enterprises sponsored by the construction of Internet hospitals Among them, the largest proportion of internet medical enterprises is 46.5%, and representative enterprises include micro medicine, good doctor, JD medical, Ali Medical, etc (see chart 5) Figure 5 types of Internet hospital construction initiators dominated by enterprises in 2019 (N=101) Source: Institute of health 3 51.8% of the hospitals have obtained Internet hospital license, and nearly half of the Internet hospitals have not yet obtained Internet hospital license According to our survey of 83 Internet hospitals, 51.8% of them have obtained Internet hospital license and 48.2% have not yet obtained Internet hospital license, that is to say, nearly half of them have not yet obtained Internet hospital license This is closely related to the development policies and progress of Internet hospitals in various regions For example, the construction of supervision platform for Internet hospitals in various provinces, the formulation and release of relevant policies, regulations and rules to support the development of Internet hospitals, etc (see chart 6) Figure 6 license acquisition of Internet hospital (N=83) Source: Institute of health At present, the construction of Internet hospitals is accelerating, and more and more enterprises, hospitals and other relevant institutions are participating in the construction of Internet hospitals However, in terms of the operation status and profitability of the Internet hospitals that have been completed and have realized normal operation, the profit model of the Internet hospitals is not mature, most of them are still in the state of occupying the market and continuous exploration 1 The proportion of Internet hospitals achieving revenue is close to 90% According to our statistics on the revenue of 83 Internet hospitals that have been built, 89.6% of them have achieved revenue, but their revenue capacity is relatively weak, and more than 70% of the Internet hospitals whose revenue does not exceed 5 million RMB (see chart 7) Figure 7 operating revenue of Internet hospitals in 2019 (N=83) Source: Institute of health 2 More than 70% of Internet hospitals earn no more than 5 million yuan and have limited profitability For the Internet hospitals that have achieved profitability, the profitability is relatively limited Among them, 32.4% of the Internet hospitals have a profit of less than 1 million RMB, while only 13.5% of the Internet hospitals have a profit of more than 1 million RMB According to the type of institutions, the profitability of Internet hospitals dominated by medical institutions is slightly lower than that of enterprises (see Figure 8) Figure 8 net profit of Internet hospitals in 2019 (N=83) Source: Institute of health According to the survey results of 83 completed Internet hospitals, the top 3 problems and challenges in the construction and operation of Internet hospitals are as follows: 1 How to define the first visit and the second visit is the biggest problem for Internet hospitals According to the spirit of [2018] No 26 document issued by the State Council and [2018] No 25 document issued by the national health and Health Commission, the Internet diagnosis and treatment mainly refers to follow-up How to define the future visit? According to the requirements of the national documents, we need to get the patient's medical records, but how to determine the authenticity, reliability and quality of the patient's medical records by the doctors who provide Internet diagnosis and treatment services (follow-up), and whether there are a series of problems such as fraudulent insurance and replacement of medical records need to be solved 2 The top-level design is not perfect, such as medical insurance payment, medical supervision, etc The integration of Internet diagnosis and treatment services into medical insurance is a necessary condition for Internet hospitals to achieve sustainable development First of all, medical insurance currently covers more than 95% of the population of the country Without the support of medical insurance, the scale, business flow and business income of Internet hospitals will also face some problems Second How to effectively supervise the diagnosis and treatment quality and behavior of Internet hospitals is the biggest bottleneck of the development of Internet hospitals At present, all the quality control behavior management based on Internet hospitals needs the entity hospitals relying on Internet hospitals to standardize themselves At the national level, there is no corresponding regulatory laws and regulations on the quality and behavior of Internet hospitals 3 How to break the business barriers of Internet diagnosis and treatment services and realize the interconnection and information sharing is an urgent problem for Internet hospitals to achieve accelerated development Internet diagnosis and treatment is a systematic behavior, involving a series of problems such as medical treatment, medicine, medical insurance and payment Different links need to be connected Any link that is missing or incomplete will affect the normal operation of medical institutions.. (see Figure 9) Figure 9 problems and challenges in the construction and operation of Internet hospitals - mention rate (N=83) Source: Institute of health Note *: "other" includes the uncertainty and passivity of the Internet hospital cooperation hospital, the current conservative attitude of highly qualified doctors towards entering the Internet hospital platform, etc 1 In the future, in the development of Internet hospital business, online follow-up for common and chronic diseases, online light consultation, family doctor signing service, drug distribution and online payment for Medicare settlement are more promising First of all, the online referral rate of common diseases and chronic diseases is 74.0%, which is the core business of Internet diagnosis and treatment services in the future .. Secondly, the rate of online consultation was 69.0% .. Third, family doctors signed up for services, with a mentioning rate of 67.6% .. Fourth, drug distribution is an important link for Internet hospitals to form a closed-loop business, with a mentioning rate of 64.5% .. Fifthly, the online prescription was issued, with a mentioning rate of 61.9%.. (see Figure 10) Figure 10 future business focus of Internet hospital - mention rate (N=1244) Source: Institute of health Note *: "others" include inter clinic settlement, bedside settlement, home-based rehabilitation, post hospital follow-up, chronic disease management, health guidance, home care, health education, popular science publicity, characteristic medical value-added services, etc 2 It has become one of the development trends of Internet hospitals to combine with medical consortia and medical communities, and to integrate regional coordination 1) The combination of Internet hospital, Medical Association and medical community is getting higher and higher, showing the trend of regional integration Physical hospitals and powerful Internet hospitals combine the "Internet plus" mode in the form of medical consortium and medical community, bringing the result that 1+1 is far greater than 2 .. Typical case: Construction of Internet hospital in Jinping medical community, Guizhou Province Founded in 2017, Guizhou Jinping medical community Internet hospital Under the direct leadership of the county Party committee and the county government, the people's Hospital of Jinping County is taken as the leading body to realize the County Township integrated business coordination, implement the clinical path management, realize the overall planning of medical insurance resources, improve the incentive mechanism of medical personnel while saving medical insurance resources, and the people also have a sense of gain As of May 2019, through the construction of Internet Hospital of medical community, Jinping Internet hospital has connected 18 medical institutions in the county, health data of 230000 residents in Jinping County, and established medical services such as Jinping academician workstation, Internet hospital, remote consultation center, image center, ultrasound center and family doctor signing Comprehensively improve the medical service level in the county, with the medical treatment rate reaching 86%, 8% higher than that in 2018, effectively controlling the outflow of medical insurance funds Data source: Lu Qingjun, director of China Japan Friendship Hospital visited and published data 2) More application of AI technology, 5g, 3D imaging and other advanced technologies is an important feature of the development of Internet hospitals Taking Ping'an good doctor as an example, he has put forward the idea of "building a new ecosystem of Internet hospital with AI medical technology", and has reached strategic cooperation with nearly 50 large hospitals in China, such as aviation general hospital of China Medical University in Beijing, Sichuan Second Hospital of traditional Chinese medicine, the fourth Affiliated Hospital of Nanchang University, etc., to build a new "Internet hospital" by concentrating all the advantageous resources 3) The future construction focus of Internet hospital will be more and more concentrated in county basic medical institutions The development of Internet hospitals benefits the most from the county-level medical institutions, which can connect more expert resources in the Internet hospital platform county