The promising platform is called Guahao (挂号网) and it claims to be China’s largest online appointment registration system. With a national network of nearly 4,000 hospitals, 600 being Level-3 hospitals, and over 300,000 specialists, it is hard to dispute it’s size.* Guahao began development in Shanghai 2010 in collaboration with the Chinese Health Education Network, Fudan Hospital and Healthcare Management Co., and the Chinese Hospital Association, and later expanded nationally. Guahao attempts to alleviate the bitterness patients endure during a typical hospital visit.
*It should be known that there are actually several online appointment registration systems in China; However, most are small, regionally splintered and have questionable legitimacy. Guahao is by far the largest and most well supported system in China.
China historically has not had a call-ahead appointment scheduling system. Patients throughout China have long lamented the country’s hospital queuing system, or the lack thereof. Patients arrive at the hospital, literally take a number, and wait for their turn – sometimes for over 24 hours. It is not uncommon to see throngs of patients and their family members outside of the hospital, camping out in makeshift beds to see a physician. A lack of appointment system puts pressure on the hospital’s health workers. Patient scheduling provides predictability of patient flow and allows for more efficient allocation of healthcare resources. Not to mention it makes for a much more patient-centered approach to healthcare delivery.
Although still relatively unknown, even to China’s young urban professionals, Guahao claims 12 million users and currently supports services in 18 provinces. With a slick, easy-to-use online platform, Guahao lets patients assess their personal calendars, local hospitals, and physicians to make an appointment one day to two weeks in advance. Patients can currently choose from hospitals in one of 18 supported provinces. Intrigued by the platform, I decided to give it a run through. Being in Shanghai, I selected that as my city for care. Patients may then choose to filter by hospital, or service; they are given options for Tier-3A, Tier-3, Tier-2, and Tier-1 hospitals.
There are also options to toggle for Chinese/Western medicine and specialty hospitals. In China, like many people in my urgent (imaginary) health situation, I opted to go for a top-flight hospital in the city. China has a poorly developed referral system, with many patients bypassing primary and secondary care options, in favor of specialists in well-known hospitals. Once I chose Fudan University’s famed Huashan Hospital, I was given a list of all the hospital’s departments and their corresponding specialties. It is not uncommon in China to triage yourself – I think my ear has a problem, so I am seeing one of Huashan’s five ENT doctors. All physicians have aggregated ratings and comments provided by past patients. While this may have little to do with the actual quality of care each doctor provides and mostly to do with patient satisfaction, it is an interesting feature nonetheless.
I chose an appointment slot tomorrow afternoon with Dr. Lin. After inputting my contact information and a brief description of my otological ailment, I received a verification text message for my appointment time. The whole process took less than five minutes and the total cost for the reservation was 17 RMB – approximately $3.00, to be paid online or upon arrival at hospital. That was fun!
Guahao has recently formed a partnership with Taobao, China’s e-commerce giant. Taobao connects its users to the Guahao.com site through Taobao’s Lifestyle section of their website. While it may seem like a win-win for everyone, the partnership has found itself in the center of media storm this week. On May 22nd, the Beijing Municipal Health Bureau ordered a termination of the Taobao-Guahao cooperation for registering doctor appointments in Beijing public hospitals. The Bureau’s official statement (in Chinese) cited that third parties were not permitted to commercially integrate with local, public hospitals. A WSJ China Realtime Report article covered this story briefly, but did not delve into the additional reasons given in the official statement. The health bureau cited an apprehension over personal information leakage by such a large business entity as Taobao. While China lacks HIPAA-type laws and has not shown a general concern for patient privacy, this may become a legitimate concern as China’s health information systems become increasingly advanced.
The Beijing Municipal Health Bureau also stated that city has its own free appointment system, the Beijing Unified Registered Appointment Platform, which began trials in 2011. According to the official statement, it has 142 hospitals and 3.9 million people registered in its network. Although Guahao merely referred secured patient appointments through to the municipal Beijing platform, acting as a feeder of sorts, the health bureau did not approve of the Taobao partnership. Guahao has since closed its transfer link for patient appointments in Beijing.
In official response, Guahao has stipulated that they supply a free service and have not made a profit in their three years of operation. The fee charged for a hospital appointment goes directly to the hospital. Guahao expressed Taobao can provide promotion and publicity services. Access to Taobao’s large and devoted user base would be tremendous in shifting the paradigm from in-person to online reservations. On the surface, Taobao has two interests in a Guahao partnership. Appointment queuing at Chinese hospitals is notorious for “Yellow Cattle” – or ticket scalpers. Using the Guahao service as a registered Taobao user will help Taobao block scalpers and identify unscrupulous businessmen. Second, by adding another product line, Taobao may be able to increase user traffic in their system.
The Guahao platform is large and increasing, but still relatively unknown to the average Chinese patient. Online reservation services give patients a convenient common good that can dramatically improve the beginning of the “hospital experience.” Beijing seemed to identify the need for this service, even investing in their own system; However, has shutdown a complementary service in Guahao. Whether it is paranoia, embarrassment, or a general public concern over the Guahao-Taobao partnership, one has to wonder if this program was terminated too soon? In the context of limited medical resources, expanding a service like Guahao can help improve healthcare resource utilization. This marketization of registering appointments is something actually benefiting the hospitals and benefitting the public. The government merely needs to improve its regulatory capabilities and facilitate reforms, not hamper them.
Bradley Hoath is a writer for the Asia Healthcare Blog. He is currently a dual-degree MHSA/MA student, studying Health Management & Policy and Chinese Studies, at the University of Michigan. He has spent two years living in China, and has worked with a Project HOPE-Shanghai Children’s Medical Center collaborative initiative.
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Long lines are symptomatic of short supply. Supply shortages can only be resolved by increasing supply or reducing demand. You can implement an electronic queuing system, but no matter how fancy your queuing system, people will still queue up, just somewhere besides the hospital. If patients queue up in front of hospitals instead of primary care physicians, it is likely that there are not enough primary care physicians not because of some kind of information asymmetry.
It is an empirical fact that where there is no supply shortage, appointments will actually decrease the volume able to be seen. This is why nearly all restaurants and all grocery stores don’t take reservations. The most successful businesses, by volume, serve their customers whenever they happen to walk in. In the USA, primary care doctors could serve more patients per day if they would allow them to come in, at will, instead of being blocked into an appointment .