When Dai Yufan began developing a fever and painful cyst, her first thought was to see a doctor. But due to the COVID-19 pandemic, visiting her local hospital seemed scarier than her symptoms.
“So I tried an online health service,” says Dai, 27, an office worker in the southern Chinese city of Shenzhen. “I asked about my condition via an app and [a doctor online] suggested some medicine and other treatments.”
While the coronavirus has stretched medical services around the world to breaking point, the virus has also fostered a boom in online medical services, known as telehealth. The industry is predicted to be worth almost $30 billion this year in China alone and has the potential to transform Chinese healthcare by reducing strain on urban hospitals and providing a stop-gap solution for rural dwellers.
China already has over 1,000 telehealth companies, according to data firm Tianyancha, including some run by tech giants JD.com, Baidu, Tencent and Alibaba. Dai used the Good Doctor subsidiary of Ping An Insurance, which claimed in September to have 300 million registered users. All are seeing a boom in consultations due to lockdown measures.
Before the pandemic, JD Health took 10,000 online consultations per day. But as hospitals and clinics became swamped with suspected coronavirus patients, that has rocketed to 150,000, with JD Health’s own pharmacy delivering medicines directly to patients’ homes. Xin Lijun, CEO of the $7 billion-valued company, says the convenience of telehealth will remain attractive after the crisis abates.
“People have developed the habit of getting diagnosis and treatment online,” Xin tells TIME. “This greatly reduces the pressure on traditional hospitals.”
China’s healthcare system has made vast strides over the past few decades. Public sector spending on health care increased almost 14-fold between the SARS outbreak in 2003 and the end of 2018, according a March 2019 report by the WHO and World Bank. Nearly every Chinese citizen has some level of health insurance, with patients contributing an average of 32% of their treatment costs compared with 60% a decade ago.
But problems persist, especially as a severely aging population increases demand for treating chronic conditions such as arthritis, cancer and heart disease. China has only 1.8 doctors for every 1,000 people, compared with 2.4 in the U.S. and 2.8 in the U.K. Compounding matters, China’s doctors are unevenly weighted towards specialties to the detriment of primary care.
While the U.S. has a dozen family doctors for every 10,000 citizens, China has just 2.2, meaning specialists at Chinese hospitals are overburdened with general duties. Chinese patients typically queue up for many hours at highly ranked hospitals even for minor aliments but remain suspicious of underutilized local clinics. According to the WHO and World Bank report, China’s healthcare is too “hospital-centric, fragmented, and volume driven.” The system is also becoming too expensive to sustain, with healthcare costs growing 5-10% faster than GDP.
Online consultancies can help solve many of these issues, explaining why so many companies are aggressively exploring the space. Baidu Health boasts over 100,000 doctors from across China who offer online consultations 24 hours a day. The platform was made free to those with pneumonia symptoms during the pandemic and had handled over 54.5 million enquiries by Apr. 26, including 400,000 from outside China.
It’s also a boon for China’s overworked and underpaid doctors, who are able to supplement their income via online services. Dr. Qiao Guibin, director of Thoracic Surgery at Guangdong Provincial People’s Hospital, works for Baidu Health part-time. By encouraging patients to stay at home during the pandemic, online healthcare also reduces the chances of cross-infection of both patients and doctors.
“Online medical treatment may have saved a lot of lives during the pandemic,” says Qiao.
And not just in China. Qiao even treated a patient in Canada who had contracted COVID-19. “He was very anxious at first,” say Qiao. “But I reassured him that as a young man he shouldn’t worry too much, because 80% of people do not need medicine and COVID-19 [as a viral disease] is self-healing.”
Qiao checked in with the patient daily during his quarantine and heard a few days ago that he had completely recovered. “He is very grateful.”
There are also mental health benefits for patients isolated from friends and family due to lockdown measures. When Cai Anqi, 23, a public health student in London, developed a fever she naturally worried it might be COVID-19. However, the U.K. government’s guidelines were simply to self-quarantine unless her symptoms severely worsened. Wracked with worry, she instead turned to China’s telehealth provider WeDoctor.
“I described my condition: fever, dizziness, and runny nose, but without a cough. The doctor’s advice was to rest more, eat nutritious food, drink more water. She said as long as I don’t cough, it should be fine, as a cough is the main symptom of COVID-19. After her professional advice, I didn’t panic so much. After a few days following the doctor’s advice, the fever was gone.”
The U.S. is also trying to boost the sector in response to the pandemic. In March, President Trump advocated waiving certain federal rules to allow doctors to provide care remotely using video chats and other services. “What they’ve done with telehealth is incredible,” Trump said.
Across the U.S., telehealth provider Amwell has seen an increase in patient volumes of around 150-300% generally and up 700% during the early days of the outbreak in Washington State. Some individual hospitals have increased demand for Amwell’s services 20-fold in an effort to shield front line medical workers. Amwell CEO Roy Schoenberg says telehealth has proved particularly valuable in “geographic care deserts” and for elderly patients with mobility issues.
“We see this application of the technology as critical for democratizing healthcare and ensuring that all in need of care can access it, during COVID-19 and in the future,” he tells TIME.
Telehealth also allows patients to choose doctors based on their experience and patient reviews. Dr. Liu Yafeng has 18 years’ experience working as a gastroenterologist in China’s Hebei province, where he also ran the local hospital’s oncology and ICU departments. But while he might handle 30 consultations a day at a bricks and mortar hospital, he can manage about 200 online. It cost just 10 renminbi ($1.40) for an online consultations via JD Health or 15 renminbi ($2.10) for a 15 minute voice consultation. Liu has made 15,154 online diagnoses since joining the firm, with a 99% patient satisfaction rate.
“I get a greater sense of accomplishment because of all the positive feedback I receive from patients,” he says.
Still, significant challenges remain: “The biggest challenge of telehealth comes from diagnosis, which often requires specialist equipment,” says Liu. “It is an emerging industry and may take a long time to solve this problem.”
The concerns are echoed by the patient, Dai.
“I will still use the online health service after the pandemic, but I don’t think I trust online doctors’ diagnosis quite as much as a proper consultation,” she says. “I still feel distant from the online doctor. After all, he doesn’t know all my problems.”
—With reporting by Zhang Chi/Beijing