Can China's Internet medical platform turn to be an HMO? Is this model more suitable for China? The fundamental problem here is still old: whether to control costs first.

HMO (health maintenance organization) is a form of managed care in foreign countries. If it is understood by popular people, it can be said to be a kind of "closed loop". In this HMO network, the payer and the service party have certain agreed discounts, which provide more affordable and quality control medical services for members. Members are usually asked to choose a primary care physician as a gatekeeper if they need to be referred by a gatekeeper to a specialist in the HMO network. The price of medical treatment in the HMO network is relatively low, and the user's own expenses are also very low. If this network is out, members may need to spend a large part of their own expenses.

A typical HMO example closed loop is Caesar Medical in California. Kaiser Permanente, a combination of insurance and hospitals, has 9.5 million members and has 38 hospitals, mainly in California. The annual revenue in 2013 was $53.1 billion. Caesar's model is to integrate medical services and products to form a closed loop. It provides both medical insurance products and hospitals for members to see if they can centrally control costs and medical risks.

The core and foundation of HMO is: to control costs as the starting point. This is a lack of the entire medical environment in China.

HMO's service model and mobile medical care have a corresponding point of convergence . For example, the relationship with the user is relatively close, because the user sees the same first-time doctor or several specialists all the year round, the user can form a complete and continuous health file, which is not only beneficial to treatment, but also can be used for chronic disease management and postoperative Member interaction measures such as management. At the same time, this closed-loop mode makes it easier to obtain valid data. Most of the current Internet medical data is noise, or invalid data, which is meaningless for clinical diagnosis. But if it is a closed loop, users can get both online and offline services, so that online data can make sense.

Although there are these similar places, if China's Internet medical care wants to turn to be an HMO, there are two roadblocks, one is a doctor, and the other is that the fee has not become the root of the medical model.

Foreign HMOs such as Caesar's medical core are controlled by doctors. The ownership of the hospital is conducive to the management of doctors' behavior. The assessment of doctors is the quality and value of medical services. The operation of hospitals is to reduce costs and increase profits through cost control. Therefore, the core consideration of doctors is to make patients less ill. HMO managers can provide doctors with the motivation to provide health services through doctor training and performance setting. Such so-called chronic disease management, postoperative management, follow-up and other means are possible.

China's Internet medical care itself has no doctor resources, but only a network of resources. The collection of such resources is extremely loose, and the influence on doctors is minimal. The items that doctors can make money are medical treatments. In the final analysis, they are prescriptions and examinations. They have no incentive to perform services that do not benefit.

Another core is that China's medical environment is not aimed at controlling fees, but is aimed at maximizing revenue. This is contrary to the essence of Internet medical care. After all, the digitalization of medical care has the added benefit of increasing efficiency, narrowing the distance between patients and doctors, helping patients to be optimistic about minor illnesses, not being seriously ill, and paying attention to managing their own health after getting sick. These starting points are to control long-term medical expenses. But this is not the consideration of China's medical system. Under this premise, talking about Internet medical care for HMO can only be a cloud.

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