The Rise of the Home-Based Healthcare Revolution in China

With a population of 1.4 billion, the People’s Republic of China is facing a pressing challenge in providing effective medical services throughout the country, particularly given the age profile of this vast population. 

Its Healthy China 2030 policy aims to enhance healthcare accessibility and equity. In recent years there has been a significant shift toward health care in the home, sometimes being bought privately by individuals and families, preferring to receive care there rather than within busy hospitals. The charge can be double that of hospital care but the demand continues to boom, despite that. Yet surprisingly for a country that is so digitally advanced, there is perhaps less tech-enabled home care than one would expect, although this is starting to change, with some strong examples emerging of innovative services blending tech and in the home care. 

I was invited by the Hospital Authority of Hong Kong to join their annual conference to describe our journey on virtual wards in England over the past five years and it was great to share and learn from their experiences. Hong Kong is the fourth most densely populated region in the world and their health care is highly tech-enabled achieving the exceptionally high ranking of digital maturity at HIMSS level 7 across all 43 of its public hospitals, last year. 

The special administrative regions of Hong Kong and Macau maintain their own separate universal healthcare systems that are distinct to those on mainland China. 

The importance of home 

For the Chinese, “home” holds great significance both emotionally and culturally. While the approach to senior health care in China is becoming more diverse as society changes, ageing at home and maintaining cherished family connections firmly remains the mainstream choice for most elderly individuals and their families. 

9037

A survey undertaken by the National Health Commission, found that the vast majority - approximately 90% of senior adults in China prefer aging at home, while 7% rely on community support and 3% stay in institutional care facilities. This distribution is commonly referred to as “9037.”

Health care approaches in China 

Over the past two decades, China has increased health insurance coverage to over 95% of the population. The country has also succeeded in lifting an incredible 600 million of its people out of poverty in a generation, and as a result of economic growth and higher personal incomes.

Rising disposable incomes are also fuelling healthcare spend, thanks to a burgeoning middle class across the region. Healthy China 2030 describes what's next and focuses on building out primary and community care as well as harnessing innovation and technology.

Telemedicine

There has been widescale adoption of telemedicine, helpful for providing equity of access to specialists, which is key when - 

42.65% of China's population lives in rural areas, about 80% of China's medical resources are concentrated in the cities, two-thirds of which are in megacities

However, this, to date, has mainly focused on providing teleconsultations as opposed to tech enabled, hospital equivalent home care. 

In China, telemedicine began very early, in the 1980s, and began as a way to provide care to those working for a large shipping company -

“In 1986, Guangzhou Ocean Shipping Company's hospital provided emergency transoceanic consultations for its ships' crews via radiotelegraphy, which was believed to be the first telemedicine practice in China”

These interesting articles outline how telemedicine for Chronic diseases fits with the Healthy China 2030 policy - 

“The Healthy China 2030 policy aims to enhance healthcare accessibility and equity, with a strong emphasis on integrating telemedicine into rural chronic disease management. With China’s rapidly aging population and a high prevalence of chronic diseases such as hypertension, diabetes, and cardiovascular conditions, rural healthcare systems face significant challenges due to limited medical infrastructure, specialist shortages, and financial barriers. Telemedicine has emerged as a critical solution, enabling remote consultations, AI-assisted diagnostics, and digital health monitoring to improve patient outcomes in underserved regions.”

And that it serves as a way to distribute healthcare resources more evenly - 

Aging population

China’s elderly population surpassed 210 million in 2023 and is expected to exceed 300 million by 2035. It has a far larger aging population compared to, for example Japan’s 37.44 million and Singapore’s 0.95 million in 2023. Estimates are that the over 65 cohort is currently increasing by 10 million people annually. 

Size of the nation’s health care

The Healthy China 2030 initiative aims to expand the size of the nation’s health service industry to around US$2.4tn by 2030, which would mean doubling it in the space of a decade. The country’s latest Five-Year Plan for the healthcare and pharmaceutical industries, launched in 2021, lays particular emphasis on innovation. 

According to Sam Radwan of ENHANCE International, China's projected healthcare spending in 2050 may exceed Germany's entire 2020 gross domestic product.

Others describe it thus -

“It is hard to overestimate the size and potential of the Asia-Pacific healthcare market. The APAC region accounts for nearly two thirds of the planet’s population – and its people’s healthcare needs are changing, particularly in China, where the senior citizen cohort is currently increasing by 10mn annually. Rising disposable incomes are also fuelling healthcare spend, thanks to a burgeoning middle class across the region. Their numbers are forecast to reach 3.49bn by 2030, compared with 1.38bn in 2015. The Covid-19 pandemic has also pushed healthcare higher up the consumer agenda. A survey by Bain & Company found that almost half of the region’s adults are now willing to spend more to receive better health outcomes and experiences. Government policies are fuelling the boom, too. The Healthy China 2030 initiative aims to expand the size of the nation’s health service industry to around US$2.4tn5 by 2030, essentially doubling it in the space of a decade.”

References and more on this at the link below -

Major growth anticipated in remote monitoring in China

There is also anticipated to be major growth in hospital at home and remote monitoring in China.

“The China Remote Patient Monitoring Market Industry is expected to grow from 2.1(USD Billion) in 2024 to 16.08 (USD Billion) by 2035.”

A home based approach 

China has encouraged its community institutions to coordinate and offer more home care services to the elderly. This market however, faces multiple challenges, including insufficient service supply, inconsistent quality, workforce shortages, unequal resource distribution between urban and remote areas, complexity of coordination and high pricing.

According to the Chinese Journal of Health Policy, a survey conducted among 34 community institutions in 12 cities showed a shortfall in sufficient offerings; roughly one-third offer home medical services, while less than 15% provide home hospital beds, rehabilitation services and home nursing. However, there are a number of examples that buck this trend. 

Combining tech and in person care 

In Hong Kong they have been using predictive analytics to target patients most at risk of emergency readmission. These patients receive regular calls in the home to check they are taking their medication correctly, and that they are recovering well post-discharge.

It was explained to me that the service, which began as a pilot, showed such strong results that it has now been made a routine part of care, and is one of the ways in which their home grown EPR system that is shared across all hospital providers, is so valuable. Many thanks to Ngai Tseung Cheung Head of IT at the Hospital Authority, for taking me through this, and he has devoted the past 30 years of his career to building this technical excellence.

A different example of marked growth in this area is Ping An’s home-based senior care programme, launched in 2021, now supporting over 120,000 people and operating across 75 cities in China, partnering with around 150 health care providers and 233,000 pharmacies. Their home care model includes remote monitoring, as well as an AI smart system, an online concierge and access to a family doctor.   

They describe it thus - 

“The AI-powered smart system can detect 13 behavioural risks - including accidental falls, poor sleep quality and intense exercise - as well as nine major real-time environmental risks at the user’s home, such as air quality, gas leaks and excessive smoke concentration. The life concierge is an online personal assistant who swiftly responds to the needs of the elderly around the clock, seven days a week. Managing a wide range of the care services that matter most to the elderly, the assistant coordinates medical care, health management, nutrition, transportation, finance and entertainment. Medical services are provided via a team of 50,000 doctors in the Group’s Ping An Health unit, who are available to provide 24-hour remote medical diagnosis and treatment for customers” 

For more see -

It has to be said that it is a very interesting model indeed, to see an insurer provide this level of care in the home, combined with tech enablement including smart home devices and interesting new coordination or concierge roles.

They clearly see real value in keeping people well for longer with this support, such that they spend less time in costly as well as over clinical, hospital settings, hence making such a major investment and commitment to the model.

Ending at the Convention

The attendees at the Hong Kong Hospital Authority convention were so interested in the Virtual Ward experience in the UK that we couldn’t get through all the questions.

We referenced that to have a similar level of virtual ward beds per 100,000 population as in the UK, where we are now at 20 virtual ward beds per 100k, that would be 1,500 beds for Hong Kong and an astonishing 280,000 people receiving hospital level care at home, through tech enablement, across all of China.

Our session was chaired by Chun Bon Alexander Law to the left of the photo, next to him is Catherine Jones from Australia then CT Lui and next to me is our host Jeffrey LAI.

Many thanks indeed, particularly to Jeffrey for the invitation to speak, and the whole team for hosting such an excellent event where it was terrific to learn from inspirational colleagues from around the world, and return home with new connections and insights.

It was a real privilege to be able to take some time to explore mainland China ahead of the conference and I enjoyed some solo travel to the beautiful mountainous rural regions of Guilin, Yangshuo and Longji, before returning to the bright lights of Hong Kong.