“The primary care infrastructure in Wuhan was comparatively not up to standard, [and] awareness among residents of public health care was relatively low,” Donald Li Kwok-tung, the organisation’s Hong Kong-based president, said in an interview. “The surge of patients rushing to hospitals quickly overwhelmed the entire system in Wuhan and in surrounding cities, and infected patients seeking treatment helped to spread the virus more quickly in the process.”

And as the pandemic tapers off in Wuhan and mainland China, a blueprint has in fact emerged, which is being followed by governments across the globe: entire cities have been locked down, travel restrictions have been put in place and the production of medical items ranging from ventilators to hand sanitisers has assumed paramount importance.

And eyes will once again be on Wuhan and China, as they pick up the pieces and carry out reforms with the aim of avoiding another such outbreak.

In the last round of reforms Beijing carried out about a decade ago, it targeted universal health insurance coverage and the provision of affordable health care services for all by this year. The coronavirus pandemic drew in online medical service providers to fill some of the gaps left behind by the last round of reforms – and it is these services and providers that China is expected to call upon as it strengthens its health care infrastructure over the coming decade.

Fifth-generation internet technology, which is expected to diversify the ways people access medical resources and services, use of artificial intelligence in medical diagnoses, increased insurance coverage and telemedicine are expected to help resolve some long-standing problems – the underdevelopment of primary health care services, over reliance on China’s big public hospitals and a shortage of doctors.

This also gives China’s private sector an enormous opportunity to shape a market that is projected to be worth 16 trillion yuan (US$2.3 trillion) by 2030.

“If you look at health care systems globally, there are three major types. One is a national health care system, such as that in the United Kingdom and Canada. Another one is made up of smaller, private entities, such as that in the United States. In Hong Kong and Singapore, we have more flexible approaches, with parallel private and public systems,” said Dr Dennis Lam Shun-chiu, the popular ophthalmologist who founded C-Mer Eye Care Holdings.

The US system is costly, with health expenditure accounting for 17 per cent of the country’s gross domestic product. In the absence of a centralised system, state and local governments across the US are vying to purchase the same medical equipment as Covid-19 spreads across the country. A competitive market for these materials has driven up prices, according to Andrew Cuomo, the governor of New York State.

Health expenditure accounts for about 10 per cent of GDP in the UK and Canada, and about 5 per cent to 6 per cent in Singapore and in Hong Kong. In China it accounts for 5 per cent and is rising. Even before Covid-19, its annual health care spending was expected to outpace revenue by 2.9 percentage points between 2030 and 2035, according to a World Health Organisation-World Bank joint report released last year.

That is why Beijing says it wants a “more balanced” system, with the private sector providing high-quality services and sharing the public sector’s burden.

On March 5, China issued “Opinions on Deepening the Reform of the Medical Security System”, with the aim of having a relatively mature health care system in place by 2030. This system will be built on a more developed medical insurance sector, market-led pricing mechanisms for medicines, more use of big data, as well as new internet and medical services. The document provides a clear road map of reforms, said Tracy Wut, mergers and acquisitions partner at Baker McKenzie in Hong Kong. “In particular, (it) emphasises that the government will encourage the development of commercial health insurance as a supplement to statutory or basic medical insurance,” Wut said.

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Digitalisation has a key role to play, as it will drive the implementation of family medicine, allowing general practitioners to play a gate keeping role.

“If there were family doctors whom patients trusted, then when the doctor told them that they were not sick and there was no need to go to hospital, patients would believe them and feel confident enough to not go. This will save resources and alleviate the unnecessary pressure on public hospitals,” said Li, the president of World Organisation of Family Doctors. He also advises online medical platform Ping An Good Doctor on general practice services as a senior adviser.

“Family doctors can participate in online medical care services and provide consultation via phone and internet, providing continuity of services whilst maintaining their trusted relationships with patients. Meanwhile, others suffering from minor ailments can also consult online doctors, especially when they cannot go for a face-to-face consultation for various reasons, such as accessibility or isolation requirements during an epidemic,” he said.

The Covid-19 outbreak has accelerated the growth of online medical platforms in China. Private digital medical services providers such as Ping An Good Doctor, Ding Xiang Yuan and Chunyu Doctor provide such services as self diagnosis, science popularisation and assessment of suspected cases, according to Baker McKenzie.

Big players such as Chinese conglomerate Fosun International have also been drawn to the sector. “We will speed up online medical platforms and online health insurance to meet demand,” said Chen Qiyu, Fosun International’s co-chief executive. “Our advantage is that we have private hospitals to support online medical consultation platforms,” he said.

But such platforms cannot solve China’s health care problems on their own, said Dr Nick Guldemond, a senior researcher at Leiden University Medical Centre. He is a digital health expert who led a pilot project by the World Organisation of Family Doctors to accredit the online services of Ping An Good Doctor. Dr Guldemond suggested China needed to develop an integrated health care ecosystem that could provide medical services underpinned by a solid policy and regulatory framework and a sound financing system. It should aim for balance between private and public services, he said.

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China has a three-tier health care system, where primary health care facilities are expected to provide affordable first contact care, while secondary and tertiary care facilities provide specialist referral services. However, patients can freely choose their provider. As a result, large and better resourced hospitals get a disproportionate share – with 8 per cent of the system caring for more than half of the entire country’s patients.

This overreliance on big hospitals is itself a symptom of a wider problem. “The real challenge is that the number of doctors is not enough compared to its 1.4 billion population for early disease intervention,” said Chen Kuan, founder and chief executive of Infervision, a Beijing-based medical AI software developer. “It is a paradox that we talk about adopting early screening to reduce health care workers’ workloads, yet we do not have enough human resources to do the screenings.

“This is an area where technology can play a huge role, especially AI, which can alleviate such shortages. It will become ubiquitous in the next five to 10 years, and play a key role in strengthening the capabilities of primary health care facilities.”

AI-assisted diagnoses will become more common because of rising demand for health care services and the fact that doctors can make errors, especially after working long hours, said David Siu Chung-wah, cardiology specialist and a professor at the University of Hong Kong. “I expect AI will take over a large portion of work currently done by doctors in medical imaging and electrocardiogram screenings, in five to 10 years,” he said.

“For example, AI could be used to siphon out a large portion of negative cases that can be excluded with high confidence for certain diseases, leaving a smaller number for doctors to scrutinise and make confirmed diagnoses,” Siu said. “Whether the AI supplier will bear liabilities in cases of misdiagnoses will also be a factor [determining] adoption.”

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But the shortage of doctors will remain and needs addressing. To this end, the Vanke Founding Shareholders’ Equity Management Centre, which manages 200 million China Vanke shares owned by the property developer’s employees, this month decided to donate all of the stock to one of Tsinghua University’s education funds to finance the establishment of a public health research institute. The fund will initially support research projects related to Covid-19 and other infectious diseases. It will also support public health management and talent training. Margaret Chan Fung fu-chun, former director general of the World Hospital Organisation, has been invited to be the research institute’s president.

The World Organisation of Family Doctors has worked with the Chinese Medical Doctors’ Association to establish an Academy of Medicine responsible for postgraduate training and standards. It also plans to assist China with the establishment of a statutory regulatory organisation like Hong Kong’s Medical Council, which will handle the registration of qualified eligible medical practitioners and issue the code of professional conduct and guidelines to ensure quality and safety of medical services.

The most difficult reforms will involve the perception of China’s public hospitals. “The country does not lack private hospitals or clinics. But private hospitals lack the accumulation of reputation, which explains why patients rush to famous public hospitals,” said Nisa Leung, managing partner of Qiming Venture Partners, which has invested in 107 health care companies ranging from diagnostics and vaccines and drugs to services since 2006.

Reputation is a key issue. “China’s public hospitals are too big to compete with,” said Ge Feng, chief executive of Jiahui International Hospital, a two-year-old private hospital in Shanghai run with Singaporean sovereign wealth fund Temasek as a strategic investor. The hospital is targeted at middle income groups looking for better health care services.

There were 20,977 private hospitals, against 12,032 public hospitals, in China in 2018, according to the latest data available. Of these, 1,442 big public hospitals enjoy a pre-eminent place among Chinese consumers and patients.

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“Building a name needs at least 10 years,” Qiming Venture Partners’ Leung said. The expectations around what China can achieve by 2030 just got bigger.

Additional reporting by Eric Ng