Exploration and Research on the Integrated Development of “Internet Plus Medical Treatment”

Guo Jialin,Wang Shuling

(School of Business Administration, Shenyang Pharmaceutical University, Shenyang 110016, China)

Abstract Objective To analyze the development of “internet plus medical treatment” and to explore advantages.Methods The literature of “internet plus medical treatment” was systematically combed and analyzed.Results and Conclusion After exploring the status quo of “internet plus hospitals”,smart pharmacy and web-assisted health management in China,we find that there are some problems in the medical service at present,such as the imperfect laws and regulations,the hidden dangers of information security and the obstacles of medical insurance payment.Therefore,we propose that the development of web-assisted medical service should be led by the government and relevant policies must be improved.Then,self-regulation should be strengthened,and industry standards should be enhanced.Three suggestions are made to improve medical insurance payment and benefit both hospitals and patients,which can provide reference for promoting the development of “internet plus medical treatment” in China.

Keywords: internet plus;medical treatment;medical service;integrated development

“Internet plus medical treatment” represent the new development direction of the medical industry,which is conducive to resolving the contradiction between the imbalance of China’s medical resources and the increasing demand for health care.This medical mode is actively guided and supported by the Ministry of health.For instance,during the epidemic prevention period in 2020,many hospitals and internet health platforms launched online medical services in China.After years of improvement in “internet plus medical treatment”,the application has been relatively mature in some developed countries.Take the United States as an example,the “internet plus medical treatment” is striving to reach African American,rural,and low-income patients to ensure that they can fairly access the innovation of health care services[1].As China is still exploring the “internet plus medical treatment”,it is still in the stage of continuous breakthroughs and improvement.Some China’s scholars found that the fast development of “internet plus medical treatment” could lay a good foundation for further improving the medical level and the convenience of the public[2].Although many medical organizations in China begin their informatization construction of medical service after realizing the importance of “internet plus medical treatment”,in practice,the role of “internet plus medical treatment” is far from enough.Therefore,this paper studies the development of “internet plus medical treatment”,exploring the role of “internet plus medical treatment”,and finding out their problems.

1 Concept of “internet plus medical treatment”

1.1 Development process and connotation of“internet plus”

Domestic “internet plus” concept first appeared in 2012.Since the internet was used in our life,most people have had an idea that the internet can change everything.In the application stage of military LAN,people never thought that the internet would eventually become the link to almost everything,nor would they think that after the transformation of LAN to WAN,it would quickly spread to the whole world at a geometric speed.It may not be expected that many years later,China has created many new business models with the help of the internet,which in turn accelerate China’s economy greatly.So far,China has four of the top ten internet companies in the world.The Chinese government even creates the concept of “internet plus” and regards it as China’s national development strategy.“Internet plus” is the link between the internet and all traditional industries,which is the practice of internet industry.It promotes the development of economic structure,enhances the vitality of social economy,and builds a platform for social innovation and development.Generally speaking,“internet plus” is the integration of traditional industries through internet technology.However,it is not a simple combination,it is a new social mode.It takes advantage of the internet to transform and upgrade the economic and social life.Therefore,it enables the internet technology to improve the creativity and productivity of the whole society and forms a new economic development mode[3].Through the internet platform,the two will be deeply integrated to create a new development environment for the society.

1.2 Concept of “internet plus medical treatment”

“Internet plus medical treatment” is a new form of medical service,which is formed by the deep integration of internet and traditional medical service.In this process,internet works as carrier and information technology works as the means.“Internet plus medical treatment” is different from the traditional medical mode.It breaks through the original concept and the previous restrictions.Therefore,it can modernize the medical management mode,optimize the allocation of resources,and create a new service mode.It not only improves efficiency but also reduces the cost of production to meet people’s demands for increasing health care.Besides,it has realized the transformation of medical innovation and provided us with a new perspective for medical services[4].

2 Necessity and importance of developing “internet plus medical treatment”

2.1 Necessity of developing “internet plus medical treatment”

The “Outline of the National Health Service System Plan (2015-2020) issued by the General Office of the State Council pointed out that we should actively promote the development of mobile internet and telemedicine services.Meanwhile the government should carry out the cloud service for the health of public in China,actively applying new technologies such as mobile internet,internet of things,cloud computing and wearable devices.In addition,health information services and intelligent medical services benefiting the public should be promoted with the application of big data.In 2016,the General Office of the State Council issued the “Guidance on Promoting and Standardizing the Application of Big Data in Health Care”,which further clarified that medical big data is an important strategic resource of China.It also put forward some normative requirements for the provision and management of “internet plus medical treatment”.“Opinions on Promoting the Development of Internet Plus Medical Treatment” was issued by the General Office of the State Council in 2018,which provides policy guidance for the development of “internet plus medical treatment” in a comprehensive way.This document encourages hospital medical services based on internet,public health services,family doctor contract services,drug supply services,medical education,and science services.Compared with the previous years,the state has attached great importance to “internet plus medical treatment” in recent years.At present,we should not only build the “internet plus medical treatment” system,but also strengthen the support system for it.

2.2 Importance of developing “internet plus medical treatment”

2.2.1 Population aging

At present,the number of elderly people in China is rising quickly.When the population over 65 accounts for more than 7% of the total population in a country,it is called “aging society”.According to the data,the population aged 65 and above in China accounted for about 12.6% of the total population in 2019.Therefore,the rapid rise of the elderly population will become a big problem.China has to face such problems as insufficient supply and low quality of medical services for elderly people.Besides,the medical cost is gradually increasing[5].So,this requires more “internet plus medical treatment” to provide timesaving,convenient and effective services to meet the needs of senior citizens.

2.2.2 Insufficient offline medical resources

In recent years,due to the shortage of medical resources,it is difficult for patients to see a doctor in China.The number of doctors and nurses per 1000 people is low,and the number of beds in tertiary public hospitals is insufficient.All of these reasons require the fast construction of “internet plus medical treatment”.This mode is convenient for people who are busy every day,elderly people with mobility difficulties and patients who seek medical treatment in other cities due to limited medical resources.In the future,hospitals offering online services will become an important part of the medical system.

2.2.3 Normalization of epidemic situation

Many doctors and nurses were sent to care for patients infected with COVID-19 when it broke out in 2010.Meanwhile,many patients who suffered other diseases also gave up going to the hospital because they were afraid of cross infection.They chose to consult online,resulting in a sharp increase in online medical demand during the epidemic[6].At present,since China is entering the stage of normalization of epidemic situation,the demand for “internet plus medical treatment” is also more urgent.

3 Development status of “internet plus medical treatment”

In the early days,“internet plus medical treatment” was at the initial stage.Only a small number of internet companies tried to invest in the medical care.But because of the particularity of the medical industry,these companies failed and they lost a lot of funds.However,with the advantages of the internet in various fields,the government begun to formulate some policies that are conducive to the development of “internet plus medical treatment”.Then,the internet companies started to pour in.The online diagnosis and treatment take shape gradually,and the industry enters a period of the rapid development.The outbreak of COVID-19 led to the shortage of fever clinics,ICU wards,and isolated areas in many hospitals in China.Therefore,the offline medical resources are under great pressure.During the epidemic,a large number of people tried to contact online diagnosis and treatment to reduce the waiting time,which greatly accelerated the process of the “internet plus medical treatment” industry.

3.1 Hospitals offering online services

3.1.1 Mode status

Under the background of multi sector promotion,hospitals offering online services have developed into a normal state (Fig.1).The demand for online medical service of hospitals has increased dramatically.Hospitals with online medical service have become popular under the background of new infrastructure.Since the outbreak of the epidemic,the National Health Commission and the National Medical Insurance Bureau have intensively issued a series of incentive policies,which directly promoted and stimulated the development of public hospitals with online medical services.According to some statistics from the National People’s Health Commission,more than 7 700 hospitals above the second level established an appointment diagnosis and medical care system in 2021,providing online services.By June 2021,China had more than 1 600 hospitals that offer online medical services[7].

Fig.1 Number of hospitals with online medical service in China from 2014 to 2020

Since 2015,the government have begun to recognize medical institutions to carry out service on the internet.By the end of 2020,63.2% of secondary and above public hospitals had carried out telemedicine services[8].According to the prediction of the prospective industry research institute,the scale of the domestic telemedicine market was 14.4 billion yuan in 2018 and is expected to reach 39.2 billion yuan by 2023,with a compound growth rate of about 22.18%[9].

Bettelheim also observes: Since all the treasure and jewels given the princess by her mother are of no help to her, this suggests that what a parent can give his child by way of earthly goods is of little aid if the child does not know how to use it well (Bettelheim 1975, 139).Return to place in story.

At present,graded diagnosis and treatment is an important strategy to promote China’s medical supply side reform.In order to better improve the grading treatment,through the “internet plus medical treatment”,we can effectively increase the movement of high-quality medical resources,improve the diagnosis and treatment level of primary medical institutions,achieving a new pattern of graded diagnosis and treatment (Fig.2).

Fig.2 Graded treatment mode under the “internet plus medical treatment” system

3.1.2 Service status

With the gradual expansion of the “internet plus medical treatment” system,the mode of medical service and patient seeking medical treatment has gradually changed.In some remote areas,patients can rely on a mobile phone to receive consultation form a specialist at home[10].The development of “internet plus medical treatment” has provided a new way for the doctor-patient relationship in China.The use of internet makes communication between medical institutions and patients more convenient.Patients can communicate with doctors at any time through WeChat to reduce the irritability of waiting[11].In addition,internet big data can analyze the causes of medical disputes in the past,so we can also use this advantage to avoid medical disputes from the source.By constantly improving the management of the hospital and providing new diagnosis and treatment modes for patients,we can make them satisfied.

3.2 “Internet plus smart pharmacies”

3.2.1 Mode status

For a long time,China’s hospitals have low efficiency in pharmaceutical services,but drug delivering personnel has high work intensity.In addition,the old equipment and poor information coverage of traditional pharmacies lead to such problems as low work efficiency and long timeconsuming drug delivery.Therefore,patients’satisfaction is declining.Duo to this reason,the intelligent pharmacy has become a major focus of the development of “internet plus medical treatment” with its unique advantages.In 2021,the intelligent medicine vending machine in Jumi Pharmacy was in response to the call of the state.In addition,since 2016,Elong Technology has extended the product application from inside the hospital to outside the hospital,and successively launched urban central pharmacy,small and micro self-service pharmacy,personalized intelligent preparation system of traditional Chinese medicine and so on.Among them,the smart pharmacies have always been the largest source of revenue of Elong Technology,with a revenue contribution of about 60% from 2017 to 2020.In 2018,Kangmei Pharmaceutical announced that it would invest 10.5 billion yuan in the business of “smart pharmacy+smart medicine cabinet” within three years.It built 15 smart pharmacies across the country.As of today,Kangmei Pharmaceutical’s smart pharmaciea have been implemented and applied in many cities and local hospitals,such as Guangzhou,Shenzhen,Beijing,Shanghai,Chengdu,and other places.Moreover,in 2020,Kangmei Pharmaceutical’s smart pharmacies have been launched on the “Suikang” platform,providing important health services to citizens in Guangzhou such as health codes and online traditional Chinese medicine services.

3.2.2 Service status

3.3 Management of “internet plus health care”

3.3.1 Mode status

In 2018,Xining No.1 Medical Group,relying on the tight medical association structure,jointly developed the Nali App with Nali Health,which cracks the phenomenon of isolated island of data information among medical institutions.In addition,Shenzhen Luohu Hospital Group relies on the close medical association structure,integrating resources to build a regional information platform and develop the Healthy Luohu App,which is also to realize data integration and system interconnection among medical institutions.

3.3.2 Service status

The management of “internet plus health care” has created a mobile health record information database,forming a medical big data with personal health as the core,family as the unit,and throughout the life cycle of residents,covering electronic medical record information,public health service information and health management information.This mode can provide basic guarantee for opening residents’electronic health data.China’s medical institutions will gradually realize the transformation from disease treatment as the center to people’s health as the center.Through information technology to achieve resource sharing,an integrated medical service model has been established.Many other enterprises also invest in the community health management system,enabling the whole industry process with science and technology,which provides community residents with life-cycle health management services based on the innovative service model.

4 Problems in the development of “internet plus medical treatment”

4.1 Imperfect laws and regulations

China’s “internet plus medical treatment” industry is still new.At present,there is no uniform standard in this industry.Therefore,many provinces are still exploring this mode without a good standard[13].The internet belongs to a virtual platform,which covers a wide range of contents.It is difficult for the law to supervise all aspects.Many functional departments are responsible for inspecting and controlling the quality of medical services,resulting in the overlap of functions and powers,which increases the cost of law enforcement,causing a serious waste of resources[14].In addition,China’s laws do not specify the responsibilities that doctors offering online service,medical institutions and enterprises should bear.Because of the lack of a sound internet medical dispute handling mechanism,when patients are infringed on their interests in internet medical care,there is no way to deal with them in a timely and effective manner,which also greatly reduces their enthusiasm for “internet plus medical treatment”.It also affects the doctor-patient relationship to a certain extent.Therefore,the government should formulate laws and regulations such as technical standards for “internet plus medical treatment”,and clarify the responsibilities and obligations of various legal subjects in “internet plus medical treatment”.

4.2 Problems in information security

The mode of “internet plus medical treatment” may lead to the leakage of patients’ medical information.In the normal hospitals,the information of patients and the prescriptions made by doctors will go through strict privacy management of hospitals.If someone reveals them in a malicious way,he will be punished according to the system.Doctors carrying online service will issue electronic prescriptions to patients,which also makes the patient’s information and prescriptions easy to be leaked by criminals[15].Moreover,once the electronic prescription is online,it will also be maliciously changed by some people,which will can cause great harm to the patients.Not only the privacy security needs to be guaranteed,but also the exchange of patient information and data information among different hospitals is urgent[16].At present,China’s public hospitals still have the problem of relatively low information and data openness.The electronic medical records and examination reports of patients cannot be shared among these hospitals.If patients want to transfer to another medical institution for treatment after examination in one medical institution,they need another examination,which greatly wastes time and medical resources.

4.3 Obstacles to medical insurance payment

In recent years,there has been a problem of expensive medical treatment in China,partly because of the low level of medical security.For lowincome families,if one person falls ill,especially the family’s labor force falls ill,it is a fatal blow to the family because they not only lose their source of income,but also have the huge medical expenses.Nowadays,the reimbursement of medical insurance has become a major obstacle to the development of “internet plus medical treatment”.Due to the huge population,the overall operation of medical insurance is under considerable pressure.Blindly adding “internet plus medical treatment” to the reimbursement of medical expenses will greatly increase the pressure of medical insurance system[17].In addition,according to the medical insurance policy,when public medical institutions carry out internet follow-up visits,medical personnel at different levels can provide services,which are charged according to the price of general outpatient clinics.This means that doctors and hospitals pay higher costs without obtaining corresponding benefits,which affects their enthusiasm to a certain extent.Therefore,it is still a major challenge for the government to formulate a satisfactory standard for “internet plus medical treatment” reimbursement.

5 Countermeasures and suggestions for the development of “internet plus medical treatment”

5.1 Adhering to the guidance of the government and improving relevant policies

To give full play to “internet plus medical treatment”,we should adhere to the leading position of the government,integrate the “internet plus medical treatment” into the health system,improve relevant planning,ensure investment and management,coordinate government management and enterprise participation,and guide the sustainable development of “internet plus medical treatment”[18].Starting from two aspects of online and offline,the government should clarify the scope of “internet plus medical treatment”,recognize the difference between online service and offline service,formulate different laws and regulations,and increase the supervision.

5.2 Strengthening self-regulation and improving industry standards

China’s medical institutions have set up higher industry standards to control the entry threshold of the “internet plus medical treatment” market.The “internet plus medical treatment” industry should formulate a unified information platform system.Medical institutions should not make use of patient’s diagnostic information for other purposes.There must be a strict and secure information system both online and offline.Besides,a punishment method for information leakage should be formulated.At the same time,medical institutions should optimize the allocation of resources to maximize benefits,accelerating the interconnection of information among medical institutions at all levels,and establishing a good competition mechanism among them[19].Building the online and offline integration of medical institutions enables the information of patients to be retrieved and saved in time and effectively,which brings convenience to both doctors and patients.

5.3 Improving the medical insurance payment to benefit patients

According to the current national medical insurance policy,patients with common and chronic diseases can be reimbursed for their medical insurance expense under the following circumstances: diagnosis and purchase of drugs in hospitals and other medical institutions.Nowadays,patients are using the online diagnosis,which requires to reform the reimbursement of medical insurance.When online revisit and drug purchases can be reviewed and reimbursed,we will promote the development of “internet plus medical treatment”.At present,we can take the lead in testing online payment medical services in some regions,striving to bring more online diagnosis and treatment projects into the medical insurance payment,and guaranteeing mechanisms such as maintaining the settlement regulation,identifying fixed-point qualifications and monitoring the maintenance service process.Once the policy of medical insurance reimbursement for “internet plus medical treatment” is established,the burden of patients can be reduced.In return,“internet plus medical treatment” can also get more patients’ support.The cost calculation and pricing of “internet plus medical treatment” need to be further optimized.In the future,“internet plus medical treatment” can be combined with the outpatient service,which can not only ensure the safe operation of medical insurance fund,but also ensure the balance of hospital income,and fully reflect the value of doctors.

6 Conclusion

At present,China’s “internet plus medical treatment” is in the fast developing stage.Some services have already covered the public.During the COVID-19,a large number of people tried to use online medical service,which greatly pushed forward its development.Besides,the central government also attached great importance to solve the problem of “difficult and expensive medical treatment”,and the targeted policy support issued one after another will give full play to its potential and advantages.In the future,people’s health concept and the mode of medical treatment will change dramatically.“Internet plus medical treatment” is the direction we should focus on.However,challenges and opportunities coexist,which means it has both benefits and risks.There are still some problems and bottlenecks in the development of “internet plus medical treatment” in China.This will require us to adhere to the principles of government leading,timely detecting the problems and actively solving them in related fields.In addition,supervision and regulation of relevant departments should be strengthened.We should improve the system of medical insurance,benefiting both patients and hospitals,and further promote the development of “internet plus medical treatment”.It is hoped that in the near future,the “internet plus medical treatment” system can become mature and complete,which will bring better and more convenient services to the public.