Discussion keeps the world turning.
This is Roundtable.
Home health care is in high demand, whether it's IVF, Botox, or elderly care.
Could online nurse booking be the next big thing?
In true 21st century style, where there is a demand, there is an app for it.
Let's explore the future of Ubering a nurse on demand.
And stick around for our special segment, Heart to Heart.
Your questions, our answers, business, tech, culture, or whatever stirs your soul, we're ready to dive in.
Keep sending them to RoundtablePodcast at qq .com.
Coming to you live from Beijing, this is Roundtable.
I'm He Young. For today's program, I'm joined by Steve Hatherly and Yuxian in the studio.
First on today's show, the Uberization of healthcare promises unparalleled convenience.
Imagine scheduling a nurse to visit your home with just a tap on your smartphone, similar to hailing a ride on Uber or DD if you live in China.
No waiting rooms, no long drives to the hospital, and no need to take extra time off work.
Medical care delivered right to your doorstep.
Though only around nine online platforms or applications currently provide this Uber style nurse booking service, we must ask, is this true convenience or are we opening the door to bigger challenges around safety, quality, cost, and trust?
So quote unquote, Ubering a nurse to your home essentially refers to an online booking service.
So what does this service actually involve?
Yes, so like you mentioned, this whole online nurse booking model kind of allows patients to actually arrange a home visit by professional nurses via online channels, such as apps like who should doubt that nurses at home or simple who should go the nurse and also via lifestyle platforms like JD dot
com towel bell made one and even social media platforms like shell home shoe or the red the domestic Instagram as well.
I find that interesting.
Sorry to interrupt just right there.
Because these are not applications that are developed by hospitals per se, right?
Correct. Yeah, these are just I mean, when we talk about JD and Taobao and made to on these are ones where you do shopping for everything from carrots to light bulbs to appliances to but now you can also on these same platforms, you can also make an appointment with a nurse to visit your home.
I find that quite interesting.
Yeah, it's like previously, I only heard about delivering some self checking medical boxes to you.
But nowadays, apparently the service has extended to from delivery merely to indoor services as well.
And the concept of this whole online nurse booking actually began around 2018 when the National Health Commission and other related departments began promoting this internet plus healthcare services.
So I actually registered and an account on this golden nurse app.
And something very interesting to me as at the very beginning is that after I put in my phone number, they also require your ID number, which lead to a full name card of showing my name, my age and everything right after registration, which led me to believe that this whole system is closely connected
to the medical insurance system with a medical the whole medical system for a Chinese citizen.
So it's like all linked together, which made me to believe like this is actually a national mechanism that's officially allowed for people to have such access to indoor professional medical services.
But also, I'm sorry to jump in, but also, I think that might be too early to assume, because at the moment, you still cannot pay from using your medical insurance, you still pay right out of your pocket.
Yeah. So therefore, at this current stage, people could also argue, why are you taking so much of my information?
Do I feel safe with all your private information on that platform?
That's going to be my next point too, because at first I felt kind of astonished seeing all my information already enlisted to that system while I book it.
But then the next step for me was to try to find out what they have, what services they offer.
So apparently they can just based on your requirements, based on the appointments you booked, obviously the nurses can come to your home and provide all different kinds of services, including merely an injection, which take about 200 yuan or less than 30 US dollars, but also quite complicated services
as well, such as dialysis, treatment, which is something you can just imagine it as a robotic kidney for people who has kidney issues, that machine can, that's already like a indoor machine that you kind of need to have at your home.
So this nurse, upon home visiting, she or him can help you to use that machine professionally to help you with your condition.
And then there's other easier treatments, such as bandage exchanging, where take out the stitches after, what's that called again, Botox or other kind of beauty surgeries.
Aesthetic procedures.
Yeah, aesthetic procedures.
And that's kind of not that expensive.
For bandage exchanging, it only costs 159 yuan, which is around 20 dollars.
And for taking out stitches, it costs 400.
So between 50 to 60 dollars.
And then there are also basic ones like dental care or nasal feeding.
And then there's this tracheal tube management, which is something you kind of need to do in a hospital, but you can also DIY at home, but require a professionality in doing so.
So I guess what you're saying then there is that the available services, when you book an appointment with a nurse who visits your home, it can be something as simple as changing bandages for those who don't have the ability to do it themselves or as something as complicated as tracheal tube management.
So that implies to me, and you went over some of the costs, that some of them might be quite cheap, some of them might be more expensive, but even still 20 dollars, you know, 100 and something yuan for a bandage exchange.
That's still expensive, isn't it?
You know, none of this, as we stated perhaps already, is covered by medical health insurance right now.
Everything is out of pocket for the patients, correct?
Yeah. And well, although whether something is expensive or cheap, that's subjective.
But for most average people living in China spending 200 yuan for an injection on demand at your home, or in the office, if you can find the private space to do so, that's still a lot of money.
Somebody, well just think about this.
If you need three injections, is it for Botox or whatever else, then 200 times three, that's 600 yuan.
That's more than most people's daily wage.
So yeah, I mean, of course with services, you know, demand versus supply, there is an equilibrium that can be reached, but it's still, it's certainly not cheap.
It's true. And again, you know, it's not just for aesthetic medical procedures, it's for more serious things as well.
And the demand here in China is there.
According to data from the Ministry of Civil Affairs, by the end of 2023, the elderly population here in the country exceeded 29 million, with many, over 75 % suffering from chronic conditions that require regular medical attention.
And this creates a pretty significant demand for at -home healthcare services.
So yeah, you do have things like your Botox injections, but you also have things like in vitro fertilization injections, which as far as I know, can be done by yourself or with your partner, but some people prefer, I guess, to have it done by a professional.
So the demand is there, and that's why this exists at all.
Well, it's really interesting.
It certainly surprised me in many ways when we look at, you know, the factors that are driving this kind of service, especially the specific kind of medical services that people need at home or sometimes in their office.
It's just as baffling for me to see that some of the personal anecdotes were office workers talking about, quote -unquote, ordering, well, pretty much booking a nurse to come to your office during lunch break to give you an injection or some kind of assisted medical service.
Yeah, could you go to some of the other factors that are driving this kind of service in China?
I think like Steve mentioned earlier, the aging population is definitely one of the major drives for this whole market to grow, because as I was just going through the list of services that's provided on the app, I realized that the majority of it is to cater to the needs of the elderly group or rather
the immobile bedridden group of people who probably just stay at home with like a nanny role in their home without their kids around them 24 seven.
So in this case, the children's role or the person that's trying to book such a service for their bedridden parents, this is kind of dedicated for their benefits, I think.
I can just make sure that someone professional is going to help with the indoor treatment of my parents or of the elderly in my family simply through booking such a service online.
Yeah, it's incredibly convenient to be able to do this, that this is even an option.
And you're right, for the people who, I mean, think about that.
For the elderly, a lot of people would have trouble getting to the hospital in the first place.
Yeah. And they might not need to go for something that would take days and days.
It might be something that takes 15 or 20 minutes.
Maybe they just need to get a shot.
So this is much more convenient.
And for office workers too, right, a trip to the hospital can take a few hours.
So having to leave your office, go down, get in your car, get to the hospital, or however you get there, it takes time.
So to be able to have someone come to your office as odd as it might sound, it's incredibly convenient that this service is available.
And also for busy office workers in China, taking that extra time off, you have to apply to take half a day off.
I mean, that's going to cost you.
Usually you can get, well, not always, but sometimes it'll get money deducted from your monthly pay.
Or you might have to use your annual leave, perhaps.
Yes, and that all will show up in the bill, well, in the monthly pay.
So in theory, this sounds great.
At first glance, it sounds super convenient.
But the more you consider it, actually, the more the complications come to light.
And this is still relatively new.
We've heard in China a few years ago, you can book an appointment for people to come to your apartment to do your nails for you, to clean your home for you, to make a meal for you.
And you can do all of that online on an online platform, make and pay through that platform, etc.
Now medical services, what are the challenges that immediately we can see that arises from this business model?
I mean, this is after all a medical treatment scenario that requires proficiency in doing so, but also there is a huge risk buried behind such service, providing and receiving procedures.
So this issue of a nurse coming inside your home makes this very service provider, in this case, the nurse himself or herself, in the very isolated case where there's potential medical liability issues, you know, bearing underneath this, especially when treating vulnerable populations, such as how we
mentioned earlier, the elderly individuals with chronic conditions.
So there's a lot of nuances to this and a lot of possibilities that this might go wrong or to other directions that's more than just an injection.
So for the nurses, there's this safety concerns.
And apart from that, there's also reported to be cases of harassment because nurse, the job, this role itself is dominated majority by women, by females, I think.
So in that case, there's a lot of, not a lot of, but some reported harassment cases as well.
Yeah, safety concerns, obviously.
Yeah. If the nurse is a man or a woman, I think there are still safety concerns there.
The issue, as you mentioned, of medical liability when treating vulnerable patients such as the elderly who have chronic conditions already, you know, in a hospital, there's a team of medical professionals that are there to support nurses.
But when at home, when working at home or someone else's home, I should say, oftentimes they're working alone and they don't have anyone there to back them up.
And that's just opening the door for a list of potential problems.
And also when we talk about nurses, I'm wondering who these men or women are.
In China, we've talked about for many years, a shortage of doctors, as well as a shortage of nurses.
And for those professionals, medical professionals who go through the education and can become a certified nurse in a proper hospital in China, that takes at least five years of education after getting your basic qualifications, et cetera.
And to get a post in a country with everything going on around you, and you've probably got patients lined up to see to help, who's got time for a part -time job to become a contractor for an online platform?
Yeah. Well, I mean, there's only a small percentage of nurses that are actually even eligible to do this online service work.
This is from the National Health Commission.
And they talked about that, the qualifications necessary.
These nurses, if they want to qualify to do this online service work, they have to have at least five years of experience and a higher level of professional certification.
And you talk about the number of nurses and the shortage around the country.
By the end of 2023, there were approximately 5 ,600 ,000 nurses, a little over that.
That's from the Bureau of Statistics.
But a rough estimation says that there's a 4 million person shortage of nurses nationwide.
And as a result, platforms themselves, the platforms that are providing these services, well, they're having difficulty in recruiting these qualified nurses to meet the demand that exists already.
Yeah. And also for the nurses that, for the cases that I've read from the paper .com, a domestic news platform, tick Beijing as an example.
So the average income for, say, online nurses here tends to be around the same as working in a hospital full -time.
So most of these nurses that's interviewed by the paper .com are either experienced nurses who's qualified for doing part -time jobs or previous nurses who used to work in the hospital but got out of the system and choose to do this more flexible part -time jobs.
And also there are new moms who used to be nurses but want to earn some extra part -time earnings during their maternal leave.
So these are the groups, the picture of the groups of nurses that's participating in such services for now.
So by the sound of it, now it's not very stable, obviously, because you're waiting for the orders to come in.
And apparently, at the moment, having three, four orders of bookings to come in is pretty good.
But that's hardly for someone to sustain a living on that.
So this is basically a side gig for a certified nurse if that person is willing to do that.
Yeah, essentially, because remember, these are from platforms.
So these platforms, it's just like if you go to a platform and order a plumber to your home, that's the same thing.
So these platforms are serving as agents in a sense.
And in that way, there are limitations.
The platforms are sometimes slow to dispatch the orders or there are additional commissions or service fees that reduce the earnings for the nurses as well.
There's also the issue for the nurses and the customers.
So if we think of the platform as the middleman, you can skip the middleman once there's an established relationship between the nurse and the patient.
So in that way, the nurse could maybe make some more money and be contacted directly and you don't have to go through the platform.
So there's challenges for the nurses, but there's also challenges for the platforms as well.
Yeah, and the platforms in a lot of cases, like you mentioned, Steve, as the middle person, quote unquote, they actually have a lot of responsibility to play as well, because given the intimate and the often personal nature of serving you, providing service that's medical treatment related, there is a strong
need for trust between the nurses and the clients, in this case, the patients.
So a lot of times it should be the platforms who is coordinating everything.
But it's also reported that in some cases they fail to do that.
They're just the platform for information, but not quite there yet to provide such coordination that maintains the balance between these three parties.
And from the patient's point of view, you probably want to go with the same nurse who's.
