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In 2023, the medical order will be restored, the supply efficiency will be improved, and the supply content will be richer. At the same time, medical services are also facing stricter regulations and slowing investment.
Regardless of the external environment, for industry innovation, overcoming obstacles and perseverance is the eternal theme, and the pace of medical service innovation oriented by integration, continuity and accessibility is still accelerating.
In order to understand the logic of industry change more clearly, this time, combined with the typical innovation measures and results of the industry since 2023, we will interpret from the four dimensions of model innovation, service innovation, management innovation and payment innovation, select the top ten innovation cases, and explain the innovation path and value of some cases in detail, in order to provide reference for the industry.
Talking about 2023 medical services
The overall growth of medical services in the country has increased significantly in 2023, both compared with the same period in 2022 and compared with 2019 and before.
According to data released by the National Health Commission, from January to September 2023, the total number of diagnosis and treatment in China's medical and health institutions reached 51100 million, an increase of 6% year-on-year, and an increase of 124%γIn terms of inpatient services, the number of discharges from medical and health institutions from January to September reached 2200 million, a year-on-year increase of 189%, an increase of 16. compared to the same period in 20197%γ
Changes in the volume of medical services in recent years Data**: National Health Commission, Eggshell Research Institute Compiled and mapped.
On the one hand, the demand for non-urgent and critical care has been released, and the demand for elective surgery has increased, making the overall medical service volume on the rise. On the other hand, healthcare organizations are better able to meet patient needs through supply innovation. In terms of online medical care, online medical resources represented by Internet hospitals are continuing to increase, and there are currently more than 3,000 Internet hospitals across the country providing first-class diagnosis and treatment services.
From the perspective of the type of medical institutions, private hospitals will recover significantly in 2023, which is at the same frequency as the overall growth of hospitals.
According to the data released by the National Health Commission, from January to May 2023, the number of hospital visits nationwide will be 16700 million person-times, a year-on-year increase of 35%, including 2 in private hospitals800 million person-times, a year-on-year increase of 70%γ
Policy data: The high-quality development and refined management of hospitals meet greater challenges
Since 2023, the National Health Commission and the National Health Insurance Administration have issued more than 200 policy documents related to medical services, putting forward higher requirements for the high-quality development and refined management of hospitals in terms of improving service quality, medical anti-corruption, centralized procurement, and DRG DIP payment reform.
In terms of improving the quality of medical services, a number of three-year plans have set phased targets. For example, the "Theme Activity Plan for Improving Medical Experience and Patient Experience (2023-2025)" proposes to strive to use "patient-centered" throughout all aspects of medical services in three years, and improve the comfort, intelligence and digitalization of medical services as a whole.
Source**: Official website of the National Health Commission, compiled and mapped by the Eggshell Research Institute.
In terms of medical anti-corruption, since 2023, a centralized rectification of corruption in the pharmaceutical field has swept the country, and the communication mechanism between doctors, hospitals and pharmaceutical companies is undergoing changes. In addition to centralized rectification, the three-year inspection will further promote the standardized management of hospitals. The "Work Plan for the Inspection of Large Hospitals (2023-2026)" issued by the National Health Commission proposes that the inspection of the new first-class hospital involves the construction of industry style and the operation and management of hospitals.
Yu Jianlin, deputy general manager of Gaotejia, believes that medical anti-corruption has affected the entire medical ecosystem, and has a great impact in the short term; However, in the long run, it will bring benefits, and those drugs and devices that are innovative, can bring clinical benefits, and are cost-effective, can really be used by patients. It's a process of getting back on track after going through labor pains.
The centralized procurement of drugs and consumables organized by the state has continued to be normalized, and from 2023, the centralized procurement policy represented by dental implants and OK mirrors will cover the consumer medical field. This means that the centralized procurement logic presents new characteristics: it not only covers the drug consumables needed for disease diagnosis and treatment, but also covers the consumables needed to improve health conditions, especially the products that have urgent needs and heavy burdens for the two key groups of "one old and one young"; It involves not only physical products, but also the "centralized procurement" of services.
Regulation and control of dental implant medical services in some regions**Data**: The official website of the local medical insurance bureau, compiled and mapped by the Eggshell Research Institute.
In addition, as of September 2023, 282 co-ordinated areas across the country have achieved actual payment, accounting for 71% of the total number of co-ordinated areas; All co-ordination areas under the jurisdiction of 12 provinces (autonomous regions and municipalities directly under the central government) such as Beijing and Hebei have started DRG DIP payment. The overall progress of the country is faster than the phased task target, and some areas have completed the full coverage required by the three-year action plan ahead of schedule.
According to the policy plan, the reform of DRG DIP payment method will be fully completed in 2024. The next year will be a critical period for the reform of payment methods for medical institutions.
Capital data: The overall pace of investment has slowed down, and the medical care track stands out
In 2023, the overall investment and financing activity in the medical service sector will decline, but there will still be more prominent segments, and 8 companies from different tracks will successfully IPO, increasing the confidence of the industry.
By the end of 2023, there were a total of 59 financings in the primary market in the medical service sector, with a total financing amount of about 344.2 billion yuan, compared with the number of 65 incidents in 2022, 73The amount of financing of 4.9 billion yuan has decreased.
In the view of Jiang Xiaodong, managing partner of Changling Capital, companies that have existed for a long time and have multiple rounds of financing before are easier to raise smoothly at present, regardless of whether these companies are profitable or not, as long as their income can reach a certain scale, under the premise of appropriate valuation, investors may invest in order to revitalize existing assets; In addition, companies with new business models and fast growth are also more likely to obtain financing.
Distribution of financing events in the primary market of medical services in the subdivision Data**: Arterial Orange Database, compiled and mapped by the Eggshell Research Institute.
From the perspective of subdivisions, medical care has become the most eye-catching track, with a total of 11 transactions, accounting for the highest proportion.
According to the National Bureau of Statistics, as of the end of 2022, the natural growth rate of China's population was -060, this is the first negative population growth in China in 61 years, and the population structure has a key node. The combination of medical care and elderly care services has attracted more and more attention from the market, and high-quality enterprises have been favored by investment institutions.
Pension services are not a money-making field in the traditional sense. Wang Bin, managing director of Yikai Capital, said frankly, but affected by various market environmental factors, the industry has a strong wait-and-see attitude, and pension has become one of the more certain areas. However, will the increase in the aging population in the future be directly proportional to the increase in demand? How to deal with the problem of growing old before getting rich? These are all challenges that need to be faced by elderly care services.
It is worth mentioning that while guiding state-owned enterprises to increase investment in medical and health care, there are also a number of "national team" institutions investing in medical services.
Payment data: The digitalization process is accelerating, and the information exchange between medical insurance and commercial insurance has started
In 2023, the overall level of medical security will continue to improve.
First of all, the implementation of medical insurance outpatient treatment has achieved remarkable results. The general outpatient medical insurance has been basically established for employees, covering more than 400,000 medical institutions, with more than 2.5 billion people and more than 200 billion yuan of reimbursement during the year. The outpatient medication guarantee mechanism for the "two diseases" of residents' medical insurance continues to be optimized.
In terms of the medical insurance catalog, 126 new drugs have been added to the new version of the catalog, bringing the total number of drugs to 3,088, and the negotiated drugs will benefit the public to purchase more than 2100 million person-times, superimposed on price reductions and medical insurance reimbursement, reducing the burden on patients by more than 200 billion yuan.
In terms of centralized procurement of drug consumption, two batches of national centralized procurement of 80 kinds of drugs were carried out during the year, with an average price reduction of 57%; Carry out centralized procurement of intraocular lens and sports medicine consumables, with an average price reduction of 70%; Carry out special treatment of oral implant medical service charges and consumables, and the overall cost of a single dental implant has increased from an average of 150,000 yuan dropped to about 6,000-7,000 yuan, and a total of 1.5 million seeds were planted.
In recent years, the income and expenditure of medical insurance** data**: the official website of the National Health Insurance Administration, compiled and mapped by the Eggshell Research Institute.
According to the data of the National Health Insurance Administration, from January to November 2023, the total income of medical insurance** was 29,3621.5 billion yuan, with a total expenditure of 249109.4 billion yuan. Combined with the normalized income and expenditure situation, the growth rate of medical insurance expenditure is higher than the income growth rate as a whole, and the aging of the population may aggravate this phenomenon, and the situation of cost control is still grim.
In terms of commercial insurance, the growth rate of health insurance has dropped from a maximum of 67% to 4%, which needs to be broken urgently.
According to the data of the State Administration of Financial Supervision and Administration, in the past decade, the scale of health insurance income has continued to grow, and the proportion of life insurance has also grown steadily.
But on the other hand, health insurance has also shown a slowdown in growth, from 50%-60% at the peak of growth to less than 5% in the past three years. Combined with the needs and trends of the current medical service system, health insurance needs to increase the coverage of non-standard groups through product innovation and strengthen the health management of such groups.
The growth of the original premium of health insurance in the past ten years Data**: The official website of the National Health Insurance Administration, compiled and mapped by the Eggshell Research Institute.
In July 2023, seven departments, including the Shanghai Municipal Health Insurance Bureau, issued the "Several Measures for Further Improving the Diversified Payment Mechanism in Shanghai to Support the Development of Innovative Drugs and Devices", proposing 28 key tasks, of which 16 involve promoting the standardized development of commercial health insurance. For example, qualified commercial insurance companies can use medical and medical insurance big data to carry out calculations and calculations in accordance with the law on the basis of compliance and safety, develop marketable products, achieve scientific and accurate pricing, and effectively reduce risk control costs and products**.
Previously, the National Health Insurance Administration has carried out pilot projects in 12 cities across the country to authorize inquiries and uses of medical insurance personal information. In the pilot cities, insured persons can not only inquire and obtain personal medical insurance information through online and offline channels, but also open relevant personal information to commercial insurance companies after personal authorization, bringing convenience to commercial insurance insurance and claims.
In the past, due to the lack of in-hospital diagnosis and treatment data, commercial insurance had many pain points in underwriting and claims, and insufficient data was one of the factors for few insurance products to be oriented to non-standard people.
At present, the digitalization process of medical insurance is accelerating and the scope of data application is expanding, and from this trend, medical insurance data will play an increasingly important role in promoting commercial insurance innovation in the future. The innovative development of commercial insurance will better complement medical insurance and help improve China's multi-level medical security system.
Interpretation of medical service innovation
Model innovation: expand the supply of resources, promote the expansion and balanced distribution of high-quality resources
In order to further promote the expansion and balanced distribution of high-quality medical resources, the state is vigorously promoting and accelerating the construction of national medical centers and regional medical centers. Up to now, 13 national medical centers have been built, and 125 construction projects in 29 provinces have been approved in five batches.
The essence of the national medical center and the regional medical center is to promote the original high-quality medical resources to further strengthen the ability in the diagnosis and development of difficult and critical diseases, the training of high-level medical talents, and the transformation of high-level basic medical research and clinical research results, on the other hand, to promote the rational allocation of high-quality resources through the flow and co-construction of technology, talents, infrastructure, etc.
For social medical services, it is still possible to promote the expansion and balanced distribution of high-quality medical resources through the construction or circulation of high-quality resources, and complement the public medical system.
For example, Banger Orthopedics was selected as the first batch of alliance units of 5G+ orthopedic robots of the National Orthopedic Medical Center, with the help of 5G technology of orthopedic robots, the surgery is more intelligent and minimally invasive, and the sinking of high-quality resources is promoted.
Service innovation: Strengthen integration, continuity, and accessibility, and improve the quality of medical services
Improving the quality of medical services includes all aspects, including improving the medical quality and safety management system and norms, implementing the code of conduct for medical services, and improving the standardization and normalization of medical services.
At present, the state is promoting the construction of medical quality control centers, including national quality control centers, provincial quality control centers, municipal (prefecture) level quality control centers and county (district) level quality control centers (groups), quality control centers will play an important role in medical institutions to carry out medical quality and safety management and control.
Medical quality assurance needs to take system construction as the bottom line, and value-based medical care can also be pursued as the goal to achieve a higher level of medical quality.
Gulian Medical takes the reform of payment methods as a breakthrough to explore value-based medical care; And focus on the construction of "high-quality" to maximize the quality and effect of medical care, and comprehensively implement value-based medical care.
Improving the level of drug protection and pharmacy services is also part of improving the quality of medical care.
Shanghai Pharma Cloud Health has launched the comprehensive flagship of Yiyao, integrating specialized pharmacies for innovative drugs and Internet + cloud pharmacies to improve the accessibility of new specialty drugs and general slow medicines, and continuously innovate pharmaceutical services.
Currently,The medical service system is promoting the transformation from "treatment-centered" to "health-centered", and it is necessary to speed up the construction of a combination of prevention and treatment mode and establish a sound prevention and treatment systemIncluding disease control institutions at all levels, medical institutions, grassroots health institutions, etc., strengthen coordination and cooperation between different institutions, form a joint force, and improve the effectiveness of prevention and control. In particular, it is necessary to strengthen the management of key populations and diseases, such as targeted health promotion and preventive health care services for pregnant women, infants and young children, students, occupational groups and the elderly.
Under the trend of population aging, cancer prevention and control should not be underestimated. At present, it has become the focus of prevention and treatment work to strengthen cancer prevention, screening, early diagnosis and treatment, and scientific research, and to concentrate superior forces to make key breakthroughs in key links such as pathogenesis, prevention and treatment technology, resource allocation, and policy support.
Following the first proposal of "ecological cancer prevention" in 2022, in 2023, Ying Kang Life will continue to promote the transformation of cancer medical services from disease diagnosis and treatment to "pre-diagnosis and treatment" life cycle management, and accelerate the transformation of cancer prevention and treatment mode.
Referring to the number of employees participating in medical insurance across the country, the scale of the occupational population is huge, and workplace health has become an increasingly hot social topic.
Ping An Health has upgraded its "Easy Enterprise Health" product system to provide enterprises with systematic and full-process employee health management services with more flexible and efficient customized products, helping enterprises improve human resource efficiency.
In the traditional medical service system, there is a division between different types of services such as prevention, diagnosis and treatment, and health care, and there is a lack of effective connection. When medical institutions at different levels provide services, there are problems such as incoherent services and unsmooth information. When patients visit different institutions, the transmission of medical information is not continuous, which makes it difficult to form a complete record and evaluation of medical services, and these factors may affect the quality of medical services.
In recent years, with the help of digitalization, continuous medical services have emerged throughout online and offline, inside and outside the hospital, and in all service linksIn particular, the continuous service of connecting various resources with specialized or special diseases as the dimension has played an important role in helping to improve the quality of medical care.
For example, JD Health has launched 27 specialty centers, and in 2023, it will focus on **, psychiatric psychology, and traditional Chinese medicine, refine the content of specialty and disease services, and build a closed loop of services.
In addition, in terms of improving the convenience and accessibility of services,Taking into account the different needs of users, Xiaocheng Group solves the contradiction between high product unit price and use demand through the form of assistive device leasing, and empowers the assistive device leasing format with the whole process digitalization.
Management innovation: Innovate the management model from the dimensions of manpower and standardization to create sustainable power
The management innovation of medical institutions needs to start from many aspects, including operation system, human resources, brand building, etc. At the same time, medical institutions in different specialties and at different levels also need to build appropriate management models.
Taking human resource management as an example, the same consumer medical institutions, ophthalmology has a high degree of dependence on equipment, and the oral cavity has a high degree of dependence on doctors' operations, which determines that dental institutions need to focus on human resource management.
In 2023, the newly upgraded "Star Plan" of Meadville Dental has been fully implemented in its institutions to build sustainable human resource advantages; In the future, we will continue to iterate the partnership model to help solve the problem of dental talents.
The chain management of medical institutions also involves the key issue of standardization. Standardization makes management more standardized and simplified, reduces operating costs and improves management efficiency; It also makes it easier for companies to replicate quickly, capture more markets, and accelerate the pace of expansion. Standardization is particularly important in some asset-heavy, low-margin, and talent-scarce segments.
For example, Jinxin Fuxing Health Care takes the combination of medical care and elderly care as the core, and establishes a nurse rank and promotion system in 2023, improves the standardized management of elderly care institutions, and lays the foundation for expanding chain operations.
Payment innovation: Accurately reduce the payment burden of the target group and promote the diversification of health insurance products
Under the trend of population aging, the incidence of chronic diseases with long course and high cost increases; At the same time, with the decline of organ function of the elderly, partial or total loss of self-care ability, and even cognitive dysfunction, the demand for nursing services increases, and the nursing burden is heavier. In addition, in recent years, under the influence of factors such as life pressure and lifestyle habits, the population represented by breast abnormalities, pulmonary nodules, thyroid nodules, and prediabetes has increased.
However, for a long time, most mainstream health insurance products only covered healthy people, but these products have become increasingly homogeneous, more competitive, and the penetration rate among healthy people has reached a high level.
On the one hand, it is difficult for a large number of non-standard and sick people to obtain health insurance protection that matches their needs, and on the other hand, the growth of the health insurance market is sluggish.
The Healthy China Initiative - Cancer Prevention and Control Action Implementation Plan (2023-2030) proposes to encourage qualified commercial insurance institutions to develop commercial health insurance products related to cancer prevention and control. Previously, the "Guiding Opinions on Further Enriching the Supply of Life Insurance Products" issued by the General Office of the former China Banking and Insurance Regulatory Commission also mentioned that the upper age limit for insurance should be further increased to accelerate the meeting of the insurance protection needs of the elderly aged 70 and above. Appropriately relax the insurance conditions, and provide reasonable protection to the elderly with pre-existing conditions and chronic diseases.
It can be seen that health insurance products for non-standard and sick people are expected to become a breakthrough to solve the contradiction.
In 2023, Yuanmeng Healthcare, together with industry partners, will launch the "Care for Brain Health" Alzheimer's disease insurance product, and will focus on exploring the integration and innovation of "health insurance + health services" for chronic diseases and the elderly.
Under the ecology with the goal of innovation in non-standard and sick health insurance, medical, pharmaceutical, insurance and third-party service platforms can give full play to their respective advantages, form complementary advantages, and achieve their own development while serving more people.