East Tech West

There's a medical app for that: How China turned to telehealth during the coronavirus

ETW Feature 01

There’s a medical app for that

How China turned to telehealth during the coronavirus
Online medical appointments and check-ups via smartphone are only just the beginning for health technology in China, with the industry set to be worth more than $50 billion by 2025.

When tech entrepreneur Alvin Foo first moved to Shanghai 15 years ago, his experience of visiting a doctor usually meant joining a long line at a hospital: “The way that people go to hospital in the past was … if you needed to go and see a doctor, the first thing that you need to do is, you need to get a number. And once you get a number, usually you have to queue,” he told CNBC by phone.

“Some people … started queuing the night before,” Foo added.

Foo, co-founder of cryptocurrency investment firm DAOventures, described a time when his wife arrived at a skin hospital at 4 a.m., but by the time she got to the front of the line, all the allocated appointments were gone. “That’s the kind of pain that a lot of Chinese people, the patients (would) have to actually deal with,” he said.

Those with the means might hire someone to wait in line for them, an illegal practice that Chinese authorities have clamped down on, but the combination of a population of 1.4 billion and a lack of medical staff means demand still outstrips supply.

What changed life for Foo and millions of others in China has been the launch of online appointment booking and consultations from the likes of Tencent-backed WeDoctor, which has reported having around 250,000 doctors registered on its platform, and Ping An Good Doctor, which claims to have more than 340 million registered users. During the coronavirus outbreak, these platforms and other giants such as JD Health offered free online consultations, which has accelerated their uptake.

“People can now freely consult a doctor, unlike in the past where it was a pain even just to get a … number to seek consultation,” Foo told CNBC.

While there are still lines and long waiting times for in-person appointments, these pushes into online medicine by tech giants, as well as moves from the state, are set to help the Chinese telehealth market reach $54.2 billion by 2025, according to a UBS estimate (see chart). The firm’s “Future of Humans” report, published in September, estimated its current value as $8.6 billion, and suggested China’s market would outstrip the U.S. market in 2023.

There is huge potential for digitally-provided health care in China partly because of its aging population, according to Carl Berrisford, a strategist at UBS Global Wealth Management’s chief investment office, based in Hong Kong. “The other (reason) is a very elevated level of broadband and internet penetration and mobile penetration. And … the distinct pieces of the actual medical consulting system … you have to go to a hospital if you want to see a doctor,” he told CNBC by phone.

“It took Covid for the Chinese government to recognize that actually, online consultations could be useful,” Berrisford added.

In July, a group of Chinese departments and ministries announced joint support for the development of online services, and earlier this month China’s National Healthcare Security Administration published guidance on how medical care provided online could be reimbursed by insurers. While state health care is refunded at a provincial level, which will take time to roll out, the central government is keen for local administrations to provide plans for service agreements with insurers by the end of the year. “We regard it as positive news as it shows central government’s clearer acceptance of (the) online health care business,” UBS analyst Yawen Tan stated in a November 2 note.

Along with Foo, other people living in China that CNBC spoke to welcomed the country’s health tech boom. Hayley Stainton, a tourism professor from Britain, has lived in Hangzhou in eastern China since 2019 with her husband and two children and uses Tencent-owned WeChat to organize medical care.

“I have the hospital translator as a WeChat contact ... I am in a WeChat group called Alicare, where we receive information about health care facilities and can speak with medical professionals,” she told CNBC in an email. She also has medication delivered “in minutes” when she orders via Alipay, a platform operated by Alibaba affiliate Ant Financial, which said it had more than 390 million frequent active users of its health channel in the first quarter.

Stainton, who runs a website called Tourism Teacher, also described her experience of using China’s Covid-19 tracking app developed by Alipay. “For around six months, you were required to show your health code everywhere — restaurants, malls, public transport, and even in your compound where you live. If the code was red you would be denied entry. Some places do still ask for this now, but it is much less prevalent since Covid has been controlled.”

Is she concerned about privacy? “It was necessary for the pandemic. A lot of ‘rights’ were sacrificed in China to facilitate the successful eradication of the virus here, unlike many parts of the world who are keeping these rights intact but are now experiencing second or third waves,” Stainton said.

In May, Hangzhou’s government proposed that a similar app would permanently track citizens’ health, based on medical records and other factors such as whether they smoked, but it is not clear whether such plans will be realized.

It took Covid for the Chinese government to recognize that actually, online consultations could be useful.”
Carl Berrisford, Strategist - UBS Global Wealth Management

Hospital operator IHH Healthcare has 80 hospitals in Asia and Europe and in September launched a WeChat program for its Parkway Health locations in Shanghai and Suzhou, 60 miles northwest of Shanghai, allowing patients to book appointments, see lab reports and scans and get preliminary, basic advice from a doctor. Kenneth Chung, CEO of clinic operations for IHH East China said it is also developing a platform to let patients in mainland China book an appointment with a spine professor in Hong Kong, for example, where the group’s Gleneagles Hospital has a specialist center.

But, given the complexity of medical issues, prescribing online has its limits, Chung said. “A new patient who wants (the tranquilizer) benzodiazepine over the phone, it’s probably difficult … But people with diabetes, high blood pressure, that’s probably easier,” he told CNBC by phone.

Looking to the future, Chung said there is the potential to do much more online. “The end point is that we can do everything virtually online ... And then doctors can practice anywhere in the world, the patient can access the doctors anywhere in the world. And then the medicine goes to your door within 30 minutes, 45 minutes, for a fee that is reasonable or that it's linked to an … insurance (policy) that the patient has.”

Of course, legal frameworks and policies would have to be established before much of this is possible. “It all has to be streamlined before this can go big, but I strongly believe that Covid-19 will expedite all the policyholders and all the stakeholders to make sure that this happens,” Chung said.

The pandemic proved to be a boon for insurance company Prudential, whose Pulse health app launched in 2019 and has since been downloaded almost 12 million times. It is available in 11 Asian markets including Hong Kong and Taiwan, and lets users check their symptoms via an AI chatbot, developed in partnership with British company Babylon. Individuals can also have a health assessment based on their lifestyle.

According to Prudential group CEO Mike Wells, the app was developed as a move into preventative health. “The original vision was to increase the relevance of our relationships with our consumers … Insurers traditionally are in the protection space. And health in Asia is more wellness and health, a combination of the two ... So, we wanted to move into prevention, we wanted to move into postponement,” he told CNBC’s East Tech West event last week.

In March, the company offered free Covid-19 insurance for 45 days to those in Hong Kong when they downloaded Pulse, including a “diagnosis benefit” of 10,000 Hong Kong dollars ($1,272) if they contracted the disease, and a payment of 100,000 Hong Kong dollars if they died from it.

As well as providing medical information, the app provides revenue: Leads generated via Pulse reached $60 million in Annual Premium Equivalent (APE) in April, a measure of sales used by insurers, according to a transcript of Prudential’s second-quarter earnings call in August. The Asian market for insurers is set to accelerate, Wells stated on the call. “When income per capita reaches around $10,000 per capita, this is when insurance penetration takes off. So, we have great opportunities in the right markets like China, which are close to or at an inflection point,” he said.

Pulse is adapted to suit each country’s medical and cultural characteristics. In Hong Kong, for example, a rise in non-communicable diseases such as diabetes means there is the potential for platforms that use AI to help people manage their health, according to a spokesperson for Babylon in the Asia-Pacific region.

Health monitoring is also an area of investment for insurer Bupa Hong Kong, which provided consultations via video and delivered medication to people during the pandemic, according to the region’s general manager Andrew Merrilees.

“The digital delivery of health care will be one of the biggest changes our industry will deal with in the next couple of years. We see a huge potential,” he told CNBC by email.

Earlier this month it launched rewards platform Bupa4Life in Hong Kong, with British software company Tictrac, where users earn points when they meet monthly health goals such as eating better or taking on an exercise challenge. Rewards include free flu shots, insurance policy discounts and online fitness classes.

Tictrac also uses behavioral science to motivate people when they need it, for example by having people set themselves a target to do at least 150 minutes of exercise a week (per guidance from the World Health Organization). The platform breaks this down into daily minutes and “nudges” people to encourage them to work out.

"When income reaches around $10,000 per capita, this is when insurance penetration takes off. So, we have great opportunities in China."
Mike Wells, CEO - Prudential

A prescription for the future

While telemedicine and monitoring are two areas that are “becoming widely investable,” according to UBS’s “Future of Humans” report, there are several other potentially transformative health technologies at an early stage, it suggests, such as diagnosis via artificial intelligence, care robots and tech that uses smartphone sensors or cameras to assess conditions. The report calls these “moonshots,” and suggests they are for “investors with a long time-frame and higher risk tolerance.”

For Brendan Tansey, the Shanghai-based managing director of Viking Cruises, having a computer make a diagnosis could be an attractive prospect. “I always want a second opinion. And the idea that some … artificial intelligence, which is being trained and made smarter all the time, can look at your scan, and look at something based on huge data sets … (and say) ‘you look to be heading in this direction, or you look to have this syndrome,’ I think I’d love to have more of that,” he told CNBC by phone.

Tansey’s wish might not be that far away from being granted.

Dan Vahdat is CEO and founder of health care tech company Huma, (which changed its name from Medopad in April), a business valued at a reported $200 million to $300 million, with operations in the U.S., Europe and China. It has developed AI that can predict whether someone is likely to develop a non-communicable disease, based on biomarkers — signs that disease might be present or progressing — Vahdat explained.

“We have built these algorithms … with half a million patients’ data to predict actually, as an individual, what is the likelihood of you having diabetes, cardiac diseases … 10 years from now,” Vahdat told CNBC by phone. “And that is also very interesting from the government's perspective or from insurance perspective or from … care providers’ perspective because then they know Dan has 80% likelihood of having diabetes in 10 years from now, if Dan continues his life as it is (and) maybe we can do something about it.”

Huma also has a partnership with Johns Hopkins University on software that predicts how likely Covid-19 patients are to develop complications, based on 35 data points, which helps medical staff calculate how much ICU capacity they might need. It’s also working with Tencent in around 15 hospitals in China to help diagnose Parkinson’s disease, using artificial intelligence that has been trained to measure how affected someone is by the condition. And it’s possible for someone to have an assessment from their own home. “You do certain movements in front of the phone, the same movement that otherwise you’d have to do in front of your doctor … It’s a very standard test,” Vahdat said.

In each market, Vahdat told CNBC, issues in health care are similar. “The more remotely … you can look after and monitor the patients, the more you can offer, and then you avoid complications, everybody (is) happy, right?” he told CNBC by phone.

For Foo, being able to self-monitor and share data with a doctor will move health care into being more proactive. “Right now it's very reactive, when I'm sick I'll tell you I'm sick … More and more Chinese people are conscious of their health care. I think they want to go from reactive to proactive services.

And the way to do it is to share data, share regular data for doctors to come back to you to tell you what can you do to improve your health,” he told CNBC.

"Right now it's very reactive, when I'm sick I'll tell you I'm sick… More and more Chinese people are conscious of their health care. I think they want to go from reactive to proactive services."
Alvin Foo, Co-founder - DAOventures

Medical moonshots


Writer: Lucy Handley
Editor: Matt Clinch
Design: Bryn Bache
Images: Getty Images
CNBC’s Evelyn Cheng and Arjun Kharpal contributed to this report.