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An ecosystem to overhaul China’s health care

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Like many countries, China has a health care problem. Changing demographics and lifestyles mean demand for health care is outstripping growth in medical resources and its cost is rising faster than the insurance premium.

With 250 million people over the age of 60, the world’s most populous country is ageing. Diseases associated with more affluent societies, such as cardiovascular conditions and diabetes, are on the rise. China has 400 million chronic disease patients whose treatment costs 70% of total health care resources. And there is a shortage of medical professionals—China needs an additional 700,000 general practitioners and 10 million nursing staff. In 2019, the country spent 6 trillion RMB ($928 billion) on health care, a figure that’s expected to reach 16 trillion RMB in 2030

But an uneven distribution of resources and their inefficient use mean the cost of providing health care services is unnecessarily high: China’s top hospitals are overwhelmed with patients, but many of them have mild conditions and don’t need to be in a health care facility at all. Of all hospitalized patients, 23% are in top tier hospitals, which account for only 0.3% of the total number of hospitals. And patient data is fragmented among thousands of local clinics and hospitals, making diagnosis, treatment, and effective public health policy implementation more complicated. This inefficient structure leads to wildly disparate service levels and costs in health care, which makes it difficult for insurers to provide standardized coverage.

The government acknowledges these challenges and the need to reform the health care system. President Xi Jinping has put public health at the core of the country’s policy-making programme, emphasizing health in government policy-making agenda. The national goal of “Healthy China 2030” focuses on disease prevention and a comprehensive overhaul of the health care system.

The big question, though, is how to connect all the stakeholders in China’s sprawling health care system in a way that reduces costs, improves public health outcomes and makes health care more insurable? For Ping An, trying to impact one segment or another is not the answer. The solution must involve a whole ecosystem involving the government, patients, providers, payors, and technology in dynamic interaction which enables all to function to their full potential.  

Beyond digitization

It is no surprise that the efficiencies offered by digitalization hold the potential to transform the health care provision in China. But given the scale, complexity, and importance of the challenge, Ping An believes that improving outcomes for all stakeholders has to go further than bringing more health care delivery online or connecting different data sources.

Instead, there needs to be a transformation that achieves “horizontal” and “vertical” integration. Payors, providers, and patients need to be more connected to improve efficiency, and payors also need to be able to communicate their needs to providers, helping to determine the cost and level of health care services. Only a high level of integration can ensure that a health care ecosystem will be sustainable. That is why Ping An’s health care ecosystem strategy—and the role of its 12 distinct entities in the sector—are built on this holistic online and offline approach.

Source: Ping An

Technology is at the heart of this strategy. Building an effective digital infrastructure for better health care in China involves leveraging a high level of professionalism developed working in the Chinese health care market, as well as substantial investment in cloud, artificial intelligence (AI) and data management systems: fields in which Ping An is a recognized leader. Underlining its commitment to innovation, Ping An invests 1% of its annual revenue in research and development for healthtech and fintech technologies.

Making it work

This leadership in technology is the key to Ping An’s ecosystem strategy—and to better outcomes for all participants, including the company itself. Reimbursements paid by private commercial health care insurers only account for 6% of China’s health care spending at the moment. That means insurers, in this capacity alone, can exert little influence over the cost and service level of the health care provision. As a result, insurers’ potential to contribute to China’s health care system is limited.

Ping An’s technology and services change this equation. The value of Ping An’s technology to the government in monitoring and improving public health—not to mention its benefits to medical professionals—allows the company to access public health care institutions. That means Ping An can help institutions to improve operations, manage costs, and deliver better and more affordable service to patients, making health care more insurable.

Built on a vast database of diseases, medical products, treatments, medical resources and patient information, Ping An Smart Healthcare is at the heart of this “vertical integration.” It provides tools to manage public health care, empower providers, and improve medical resource accessibility and patients’ disease outcomes.

For example, Ping An Smart Healthcare’s intelligent image analysis system enables doctors to shorten diagnosis times from 15 minutes to 15 seconds. The integrated data analysis package, AskBob, aims to be the “Bloomberg for doctors.” Already, AskBob is used by as many as 710,000 doctors, covers around 3,000 diseases, and its AI capabilities in diagnosing and treating cardiovascular disease are comparable to that of human doctors.  In a competition at the Great Wall International Congress of Cardiology last year, AskBob scored 97.7 points compared to 93.9 points for a team of doctors from top tier hospitals.

In collaboration with China’s National Clinical Research Centre for Metabolic Diseases, Ping An Smart Healthcare has developed an advanced type 2 diabetes management tool powered by its underlying AI technology and database resources. The tool has been deployed in the center and more than 600 hospitals nationwide, serving more than 100,000 patients and delivering a 30% improvement in patients’ compliance rate.

Across the spectrum

Ping An Good Doctor and Smart Healthcare work together to create a robust product and service cost model, driving synergies by drawing providers and social health insurers into the system. If Ping An Smart Healthcare is the vertical thread connecting government and medical institutions with the delivery of health care to patients, Ping An Good Doctor is crucial to the group’s efforts to connect patients, providers and payors through the “horizontal” axis of its ecosystem strategy. Ping An Good Doctor provides online consultations with AI-assisted medical teams and integrates seamlessly with offline medical services within the ecosystem. Users can search for basic information for free, with consultations and treatments available at a cost. 

The adoption of telemedicine soared during the pandemic. By 30 December 2020, Ping An Good Doctor had 373 million total users, with a monthly average of 72.6 million users, and some 903,000 daily enquiries. Ping An Good Doctor has an in-house medical team of more 2,200 members and a network of more than 20,000 domestic medical experts and 300 renowned doctors across China.

But while these numbers are impressive and should continue to grow, currently only 3% of all medical consultations are conducted online in China—a smaller proportion than in the United States. To be truly transformative, the ecosystem must address the substantial proportion of consultations that still take place offline.

The ecosystem’s network of offline health care providers is therefore highly important. Ping An Good Doctor partners with 151,000 pharmacies, 49,000 clinics, more than 3,700 hospitals, and over 2,000 medical examination centers to provide services such as hospital referrals, appointments, and inpatient arrangements. Ping An Good Doctor also works with 1,000 prominent international doctors and the world’s top ten hospitals to ensure handy and accurate medical services for users.

Paying the bill

The benefits of this ecosystem strategy to government, patients, and providers are clear. But covering the cost of improved health care in China involves payors—and that’s where the opportunity lies for Ping An to commercialize its strategy. Insurance products are integrated throughout the Ping An health care ecosystem. Ping An HealthKonnect provides payors such as social health insurers and companies with anti-fraud and health care resource management models that reduce overtreatment, fraud, and abuse. The group’s recent Ping An Doctor Home proposition, which offers private family medical services online, includes up to 1 million RMB of insurance coverage against any injury or loss of time or property caused by the platform.

In total, the Ping An Group already provides health care services to 210 million individual financial services customers and four million corporate clients. However, transformation of China’s health care system is a long-term investment into Ping An’s own future: a healthier health care system allows the company to acquire new financial services customers as well as to retain and grow spending with the group by existing financial services customers.

The facts reinforce this business case. In recent years, 15% to 20% of Ping An’s new financial services customers have come from this growing health care ecosystem. Financial services customers who also have health care services use, on average, three Ping An financial services products, whereas a financial services customer without health care services uses only two of the group’s products. The average assets under management (AUM) of customers using both financial and health care services is $10,000, versus $5,600 for those who only use financial services.

Lessons for the world

Confucius said that “when it is obvious that the goals cannot be reached, don’t adjust the goals; adjust the action steps.” Ping An’s ecosystem strategy reflects a willingness to think differently about how to solve a longstanding problem, deliver on the “Healthy China 2030” goal, and may offer a useful example to other countries.

Some of the unique characteristics of China’s system, especially an open approach towards data-sharing and the role of government in health care, unquestionably help to make Ping An’s ecosystem strategy viable. However, the health care challenges China faces are not unique. Indeed, data fragmentation, inefficiency, high cost, and a shortage of medical professionals afflict health care systems around the world. Undoubtedly, all governments would want to use technology to better monitor and protect public health, especially since the outbreak of covid-19.

Each country will make its own decisions on how patient data can be gathered, aggregated and shared, and the role of government in health care will of course vary in every country. But it is clear that achieving better outcomes for patients, providers, payors, and governments—as Ping An’s health care ecosystem strategy aims to do in China—must in some way harness the power of data and AI to create efficiencies and standardize the cost and level of medical services.

This content was produced by Ping An. It was not written by MIT Technology Review’s editorial staff.

Lyron Foster is a Hawaii based African American Musician, Author, Actor, Blogger, Filmmaker, Philanthropist and Multinational Serial Tech Entrepreneur.

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Collective, a back-office for the self-employed, raises $20M from Ashton Kutcher’s VC

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With so much focus on the ‘creator economy’, and countries hit by the effects of the pandemic, the self-employed market is ‘booming’, for good or for ill. So it’s not too much of a surprise that
Collective,a subscription-based back-office for the self-employed has raised a $20 million Series A funding after launching only late last year.

The round was led by General Catalyst and joined by Sound Ventures (the venture capital fund founded by Ashton Kutcher and Guy Oseary). Collective has now raised a total of $28.65 million. Other notable investors include: Steve Chen (Founder YouTube), Hamish McKenzie (Founder Substack), Aaron Levie (founder Box), Kevin Lin (founder Twitch), Sam Yam (founder Patreon), Li Jin (Atelier Ventures), Shadiah Sigala (founder HoneyBook), Adrian Aoun (founder Forward), Holly Liu (founder Kabam), Andrew Dudum (founder Hims) and Edward Hartman (founder LegalZoom).

Ashton Kutcher said in a statement: “We’re proud to be supporting a company that’s making it easier for creators to focus on what they do best by taking care of the back office work that creates so much friction for so many early entrepreneurs. I would have loved something like this when I was getting started.”

Launched in September 2020 by CEO Hooman Radfar, CPO Ugur Kaner and CTO Bugra Akcay, Collective offers “tailored” financial services, access to advisors that oversee accounting, tax, bookkeeping, and business formation needs. There are currently 59 million self-employed workers in the U.S. (36% of US workforce) who mostly do all their own admin. So Collective hopes to be their online back office platform.

Speaking to me over email, Radfar said that the start-up fintech market tends to serve companies like them – other start-ups and growing SMBs: “Companies like Pilot have done an amazing job at building a back-office platform that handles taxes, bookkeeping and finances for start-ups. We want to offer that same great value to the underserved business-of-one community, since they are the largest group of founders in the country.”

He added: “Before Collective, consultants, freelancers, and other solo founders had to string together their back-office solution using DIY platforms like Quickbooks, Gusto, and LegalZoom. If they were lucky, they had the help of a part-time accountant to advise them. Collective makes handling finances easy with the first all-in-one platform that not only bundles these tools into one platform, but also provides the technology and team to optimize their tax savings like the pros.”

According to some estimates, the number of lone freelancers in the US is projected to make up 86.5 million, 50% of the US workforce by 2027, with the freelancer space projected to grow three times faster than the traditional workforce.

Niko Bonatsos, Managing Director of General Catalyst said: “Collective is serving the $1.2 trillion business-of-one industry by building the first back-office platform that saves individuals significant time and money, while providing them with the appropriate tools and resources they need to help them succeed,” said “We’re excited to support Collective as they expand their team and build an exceptional service for the business-of-one community.”

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UK publishes draft Online Safety Bill

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The UK government has published its long-trailed (child) ‘safety-focused’ plan to regulate online content and speech.

The Online Safety Bill has been in the works for years — during which time a prior plan to require age verification for accessing online porn in the UK, also with the goal of protecting kids from being exposed to inappropriate content online but which was widely criticized as unworkable, got quietly dropped.

At the time the government said it would focus on introducing comprehensive legislation to regulate a range of online harms. It can now say it’s done that.

The 145-page Online Safety Bill can be found here on the gov.uk website — along with 123 pages of explanatory notes and an 146-page impact assessment.

The draft legislation imposes a duty of care on digital service providers to moderate user generated content in a way that prevents users from being exposed to illegal and/or harmful stuff online.

The government dubs the plan globally “groundbreaking” and claims it will usher in “a new age of accountability for tech and bring fairness and accountability to the online world”.

Critics warn the proposals will harm freedom of expression by encouraging platforms to over-censor, while also creating major legal and operational headaches for digital businesses that will discourage tech innovation.

The debate starts now in earnest.

The bill will be scrutinised by a joint committee of MPs — before a final version is formally introduced to Parliament for debate later this year.

How long it might take to hit the statute books isn’t clear but the government has a large majority in parliament so, failing major public uproar and/or mass opposition within its own ranks, the Online Safety Bill has a clear road to becoming law.

Commenting in a statement, digital secretary Oliver Dowden said: “Today the UK shows global leadership with our groundbreaking laws to usher in a new age of accountability for tech and bring fairness and accountability to the online world.

“We will protect children on the internet, crack down on racist abuse on social media and through new measures to safeguard our liberties, create a truly democratic digital age.”

The length of time it’s taken for the government to draft the Online Safety Bill underscores the legislative challenge involved in trying to ‘regulate the Internet’.

In a bit of a Freudian slip, the DCMS’ own PR talks about “the government’s fight to make the internet safe”. And there are certainly question-marks over who the future winners and losers of the UK’s Online Safety laws will be.

Safety and democracy?

In a press release about the plan, the Department for Digital, Media, Culture and Sport (DCMS) claimed the “landmark laws” will “keep children safe, stop racial hate and protect democracy online”.

But as that grab-bag of headline goals implies there’s an awful lot going on here — and huge potential for things to go wrong if the end result is an incoherent mess of contradictory rules that make it harder for digital businesses to operate and for Internet users to access the content they need.

The laws are set to apply widely — not just to tech giants or social media sites but to a broad swathe of websites, apps and services that host user-generated content or just allow people to talk to others online.

In scope services will face a legal requirement to remove and/or limit the spread of illegal and (in the case of larger services) harmful content, with the risk of major penalties for failing in this new duty of care toward users. There will also be requirements for reporting child sexual exploitation content to law enforcement.

Ofcom, the UK’s comms regulator — which is responsible for regulating the broadcast media and telecoms sectors — is set to become the UK Internet’s content watchdog too, under the plan.

It will have powers to sanction companies that fail in the new duty of care toward users by hitting them with fines of up to £18M or ten per cent of annual global turnover (whichever is higher).

The regulator will also get the power to block access to sites — so the potential for censoring entire platforms is baked in.

Some campaigners backing tough new Internet rules have been pressing the government to include the threat of criminal sanctions for CEOs to concentrate C-suite minds on anti-harms compliance. And while ministers haven’t gone that far, DCMS says a new criminal offence for senior managers has been included as a deferred power — adding: “This could be introduced at a later date if tech firms don’t step up their efforts to improve safety.”

Despite there being widespread public support in the UK for tougher rules for Internet platforms, the devil is the detail of how exactly you propose to do that.

Civil rights campaigners and tech policy experts have warned from the get-go that the government’s plan risks having a chilling effect on online expression by forcing private companies to be speech police.

Legal experts are also warning over how workable the framework will be, given hard to define concepts like “harms” — and, in a new addition, content that’s defined as “democratically important” (which the government wants certain platforms to have a special duty to protect).

The clear risk is massive legal uncertainty wrapping digital businesses — with knock-on impacts on startup innovation and availability of services in the UK.

The bill’s earlier incarnation — a 2019 White Paper — had the word “harms” in the title. That’s been swapped for a more anodyne reference to “safety” but the legal uncertainty hasn’t been swapped out.

The emphasis remains on trying to rein in an amorphous conglomerate of ‘harms’ — some illegal, others just unpleasant — that have been variously linked to or associated with online activity. (Often off the back of high profile media reporting, such as into children’s exposure to suicide content on platforms like Instagram.)

This can range from bullying and abuse (online trolling), to the spread of illegal content (child sexual exploitation), to content that’s merely inappropriate for children to see (legal pornography).

Certain types of online scams (romance fraud) are another harm the government wants the legislation to address, per latest additions.

The umbrella ‘harms’ framing makes the UK approach distinct to the European Union’s Digital Service Act — a parallel legislative proposal to update the EU’s digital rules that’s more tightly focused on things that are illegal, with the bloc setting out rules to standardize reporting procedures for illegal content; and combating the risk of dangerous products being sold on ecommerce marketplaces with ‘know your customer’ requirements.

In a response to criticism of the UK Bill’s potential impact on online expression, the government has added measures which it said today are aimed at strengthen people’s rights to express themselves freely online.

It also says it’s added in safeguards for journalism and to protect democratic political debate in the UK.

However its approach is already raising questions — including over what look like some pretty contradictory stipulations.

For example, the DCMS’ discussion of how the bill will handle journalistic content confirms that content on news publishers’ own websites won’t be in scope of the law (reader comments on those sites are also not in scope) and that articles by “recognised news publishers” shared on in-scope services (such as social media sites) will be exempted from legal requirements that may otherwise apply to non journalistic content.

Indeed, platforms will have a legal requirement to safeguard access to journalism content. (“This means [digital platforms] will have to consider the importance of journalism when undertaking content moderation, have a fast-track appeals process for journalists’ removed content, and will be held to account by Ofcom for the arbitrary removal of journalistic content,” DCMS notes.)

However the government also specifies that “citizen journalists’ content will have the same protections as professional journalists’ content” — so exactly where (or how) the line gets drawn between “recognized” news publishers (out of scope), citizen journalists (also out of scope), and just any old person blogging or posting stuff on the Internet (in scope… maybe?) is going to make for compelling viewing.

Carve outs to protect political speech also complicate the content moderation picture for digital services — given, for example, how extremist groups that hold racist opinions can seek to launder their hate speech and abuse as ‘political opinion’. (Some notoriously racist activists also like to claim to be ‘journalists’…)

DCMS writes that companies will be “forbidden from discriminating against particular political viewpoints and will need to apply protections equally to a range of political opinions, no matter their affiliation”.

“Policies to protect such content will need to be set out in clear and accessible terms and conditions and firms will need to stick to them or face enforcement action from Ofcom,” it goes on, adding: “When moderating content, companies will need to take into account the political context around why the content is being shared and give it a high level of protection if it is democratically important.”

Platforms will face responsibility for balancing all these conflicting requirements — drawing on Codes of Practice on content moderation that respects freedom of expression which will be set out by Ofcom — but also under threat of major penalties being slapped on them by Ofcom if they get it wrong.

Interestingly, the government appears to be looking favorably on the Facebook-devised ‘Oversight Board’ model, where a panel of humans sit in judgement on ‘complex’ content moderation cases — and also discouraging too much use of AI filters which it warns risk missing speech nuance and over-removing content. (Especially interesting given the UK government’s prior pressure on platforms to adopt AI tools to speed up terrorism content takedowns.)

“The Bill will ensure people in the UK can express themselves freely online and participate in pluralistic and robust debate,” writes DCMS. “All in-scope companies will need to consider and put in place safeguards for freedom of expression when fulfilling their duties. These safeguards will be set out by Ofcom in codes of practice but, for example, might include having human moderators take decisions in complex cases where context is important.”

“People using their services will need to have access to effective routes of appeal for content removed without good reason and companies must reinstate that content if it has been removed unfairly. Users will also be able to appeal to Ofcom and these complaints will form an essential part of Ofcom’s horizon-scanning, research and enforcement activity,” it goes on.

“Category 1 services [the largest, most popular services] will have additional duties. They will need to conduct and publish up-to-date assessments of their impact on freedom of expression and demonstrate they have taken steps to mitigate any adverse effects. These measures remove the risk that online companies adopt restrictive measures or over-remove content in their efforts to meet their new online safety duties. An example of this could be AI moderation technologies falsely flagging innocuous content as harmful, such as satire.”

Another confusing-looking component of the plan is that while the bill includes measures to tackle what it calls “user-generated fraud” — such as posts on social media for fake investment opportunities or romance scams on dating apps — fraud that’s conducted online via advertising, emails or cloned websites will not be in scope, per DCMS, as it says “the Bill focuses on harm committed through user-generated content”.

Yet since Internet users can easily and cheaply create and run online ads — as platforms like Facebook essentially offer their ad targeting tools to anyone who’s willing to pay — then why carve out fraud by ads as exempt?

It seems a meaningless place to draw the line. Fraud where someone paid a few dollars to amplify their scam doesn’t seem a less harmful class of fraud than a free Facebook post linking to the self-same crypto investment scam.

In short, there’s a risk of arbitrary/ill-thought through distinctions creating incoherent and confusing rules that are prone to loopholes. Which doesn’t sound good for anyone’s online safety.

In parallel, meanwhile, the government is devising an ambitious pro-competition ex ante regime to regulate tech giants specifically. Ensuring coherence and avoiding conflicting or overlapping requirements between that framework for platform giants and these wider digital harms rules is a further challenge.

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Amazon updates Echo Show line with a pan and zoom camera and a kids model

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Amazon this morning announced a handful of updates across its Echo Show line of smart screens. The top-level most interesting bit here is the addition of a pan and zoom camera to the mid-tier Echo Show. The feature is similar to ones found on Facebook’s various Portal devices and Google’s high-end Nest Hub Max.

Essentially, it’s designed to keep the subject in frame – Apple also recently introduced the similar Center Stage features for the latest iPad Pro. It comes after Amazon introduced a far less subtle version in the Echo Show 10, which actually follows the subject around by swiveling the display around the base. I know I’m not alone in being a little creeped out, seeing it in action.

The new feature arrives on the Show 8’s 13-megapixel camera, which is coupled with a built-in physical shutter – a mainstay as Amazon is look to stay ahead of the privacy conversations. The eight-inch HD display is powered by an upgrade octa-core processors and coupled with stereo speakers. The new Show 8 runs $130.

The other biggest news here is the arrival of the Echo Show 5 Kids – the one really new product in the bunch. At $95, the kid-focused version of the screen features a customizable home screen, colorful design, a two-year warranty in case of creaks and a one-year subscription to Amazon Kids+.

There’s a new version of the regular Show 5, too, featuring an upgraded HD camera, new colors and additional software features. That runs $85. The new devices go up for preorder today and start shipping later this month.

 

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