3月25日，在亚洲青年领袖论坛健康与医疗主题论坛上，大湾区医疗集团联席行政总裁、香港联合医务集团执行董事李家聪发表了主旨演讲。

全文如下：

大家下午好！在此非常感谢南沙区政府和亚洲青年领袖论坛邀请我们分享管理式医疗的湾区模式。简单介绍一下，我们跟南沙区政府合作非常深了，但是我的背景以及我们企业的背景其实不仅仅是做医疗服务，更多是一个集合投资以及从金融、保险的维度来思考中国的医疗健康产业市场的发展。所以我本身不是一名医生，但是我都是非常喜欢投入到健康产业的背景中的管理者。

今天分享主题围绕着“健康险”，前面有很多专家已经分享了很多关于药物研发以及中国医疗服务制度。这里有一些数据给大家分享一下：中国人口14亿里面，很快将面临的很重大的问题就是慢病人群在未来5～10年里面会超过4亿，这是全世界都没有面临过的一个问题。很多的时候分析全球国家，就拿美国作为例子。美国总的人口都没有4个亿，但是中国的慢病人群已经很快到4个亿了，死于慢病的百分比是86%。刚才，我们看到中国很多因为肿瘤各种各样原因每一年都有一定的死亡率，但是死于慢病的百分比也是非常高的。

在2025年，中国就会面临非常重大的问题。我们总的医疗费用支出，全国可能会去到11万亿，到那个时候，医疗支出占比GDP是7.6%。和其他地区相比，英国大概是9%多，美国是17%多，发达国家平均是10%多。从投资以及很多产业来说，大家会说这么大的GDP占比对于产业的发展是很好的一件事，但是我们的看法是恰恰相反。如果一个国家要花很多的钱在医疗费用上，就等于这个钱没花在其他产业发展上。

自费比例44%，这个数字有点旧，是2018年的。现在中国医疗的自费占比是28%左右，相当于100元有28元要自己掏腰包负责。这个数字跟其他国家比还是比较大一个区别。如果看全球以及亚洲，就是从支付方，不光是从医保、商保以及个人支付，其实健康险公司还是处于比较轻的合作状态。说实话，我们的公立医院体系也很难跟商保有深入的合作。简单健康管理，包括数字化医疗、第三方服务提供商，还是处于非常浅的合作。医药和药械公司的话，在美国就是很好的例子。它们都是处于“我创造一个新的药出来，希望卖得最贵”，但是从健康险的体系以及医保的体系未必是一样的想法。

真正的价值医疗生态圈是挺难做，要协调五个方：支付方、服务方、供应方、技术服务方和政府，这五方是否有同一个初心去为我们的居民提供健康以及医疗的服务。怎么做呢？今天的论坛是亚洲的论坛，南沙定位是观看全世界，我们看一下全世界怎么做。现在，中国有很多地方在这个图上面还是在右手边医疗报销的状态，医保、商保，大家还是有费用进行理赔。有一些地方，像香港，已经进入到医疗服务的模式。开始有一部分的医疗机构，像我们的集团，会跟医保、商保共同承担一部分的风险。再往前走一点，就是治疗决策，怎么样让医生和病人以及保险公司共同去承担医疗费用的责任。预防疾病，“健康中国”也说怎么开始从维护健康作为我们的目标，并不只是治疗疾病的状态去分析未来的健康产业的发展方向。

如果看一下全球，也是我们集团未来希望在南沙作为一个起点推动的新型模式，如何把商业保险以及公立医院体系做一个结合。这里面，全球有很多不同的例子，从联合健康到凯撒等等。由于时间的关系，不一一分享，有机会可以再分享一下我们的服务模式。

到底怎么做，其实多年以来，我们在香港有非常丰富的经验。要重新打造一个买了商业健康险整个服务的链条，怎么可以从预防疾病作为一个中心。怎么做，我们在香港有比较丰富的经验，在香港做了30多年，一直以来都是深度和保险公司合作。他们会给我们一笔钱，帮助他们共同管控将近100多万会员，让他们少生病，做更多的预防，省下来的钱就是我们的盈利。

在大湾区，其实我们已经有第一步发展。在这里，我们携手政府已经搭建了超过100多家社康中心。在社康中心里，第一步会协助政府和我们一起培养全科医生，共同协助政府推动基层医疗的服务空间改革。打造了100多家工作室，把基层医生重新改造。过去是跑到医院看病，我们希望未来更加多的病人愿意到基层看病，帮基层医生做好基石保障，希望他们有对167种常见病的处理能力，涵盖16个模块。在这个基础上，怎么用好香港在这方面的资源以及经验协助两地推动管理式医疗的发展。

除了社康中心，我们也开始携手合作我们所身处的南沙。我们跟广州市第一人民医院南沙医院打造了港澳居民服务中心，让大家未来买了商业保险之后，可以在全科和专科服务里创造更好的就诊体验。

On 25 March, Felix Lee, Co-CEO of The Greater Bay Area Healthcare Group and executive director of UMP Healthcare Holdings Limited, delivered a keynote speech at the Health and Medical Care Forum of the Asia Youth Leaders Forum. Following is the full text of the speech.

Good afternoon, everyone. I’d like to thank the Nansha District Government and the Asia Youth Leaders Forum for inviting us to share our managed care model in the Greater Bay Area. Let me make a brief introduction. We’ve been cooperating with the Nansha District Government for a long time, but our company and I are not engaged in medical services alone. Rather, we try to see from the perspectives of investment and financial insurance into the development of China’s healthcare market. I am not a doctor myself, but a manager who is passionate about and dedicated to the healthcare industry.

Today I’d like to talk about health insurance. Many experts before me have shared a lot about drug R&D and medical service system in China. Here are some data I’d like to share with you. China’s population of 1.4 billion will soon face a significant problem. The population with chronic diseases, in the next 5 to 10 years, will exceed 400 million. This is a problem previously unheard of in the world. Oftentimes, when analyzing countries all over the world, we tend to choose the US as an example. The total population of the US is less than 400 million, but the population with chronic disease in China will soon reach 400 million, with of 86% deaths from chronic diseases. Just now, we have seen that various causes such as tumors have led to a certain annual mortality rate in China, but the percentage of deaths from chronic diseases is also extraordinarily high.

In 2025, China will face a major issue. Our medical expenses may total 11 trillion yuan nationwide, and by then, the proportion of medical expenses to GDP will be 7.6%. How is it compared with others? It is over 9% in the UK, over 17% in the US, and over 10% in developed countries on average. From the perspective of investment and many industries, it can be said that such a large proportion of GDP is beneficial to the industry, but our view is exactly the opposite. If a country spends a lot of money on medical expenses, it means this portion of GDP is not spent on other industries. 

The figure 44% is a bit outdated. It was from 2018. Currently, the proportion of out-of-pocket medical expenses in China is 28% or so. It means for every 100 yuan, 28 yuan comes from our own wallet. In comparison with other countries, there is still a long distance. Where’s the problem? In Asia and the world, if we take a look at the payer, whether it’s government health care, commercial health insurance, or individuals, commercial health insurance companies actually are not very involved. Frankly, it is hard for our public hospital system to maintain in-depth cooperation with commercial insurance. Simple health management, including digital health care and third-party service providers, is not really in the picture. As for pharmaceutical and medical equipment companies, the US model is a good example. The companies will think, “I create a new drug. I will sell it at the highest price.” But the commercial health insurance system and the public health insurance system may not share the same idea.

A truly value-based healthcare ecosystem is hard to build. It depends on the coordination of five parties, namely, the payer, service provider, supplier, technical service provider, and government, as well as whether they all have the same aspiration to provide healthcare services for our residents. Then how do we do it? Today’s forum focuses on Asia, and Nansha is poised to open up to the world. Let’s see how the world does it. There are many places in China now, to pinpoint them on the far right of this graph, still at the stage of medical reimbursement. People have public and commercial healthcare plans and make claims when costs are incurred. Some places like Hong Kong have adopted the model of medical services. Some medical institutions like our group have begun to work with public and commercial health insurance and share some of the risks. Further ahead is treatment decision: how to make doctors, patients, and insurance companies jointly responsible for medical expenses. Then to the far left of the graph, preventive care. The Healthy China Initiative also starts from health maintenance as our goal instead of mere disease treatment to analyze the future direction of the healthcare industry.

Looking at the global picture, this is what we hope to do, using Nansha as a springboard to promote a new model, namely, how to integrate commercial insurance with the public hospital system. There are many examples worldwide, from UnitedHealth Group to Caissa Group. Due to time constraints, I won’t share them one by one. When I have the opportunity, I will share our service model.

As for how to do it, in fact, over the years we have had a lot of experience in Hong Kong. We need to recreate the patient journey for those who have commercial healthcare plans and consider how to shift the focus onto disease prevention. In this regard, we have extensive experience in Hong Kong, as we have been working there for over 30 years. We have always been deeply collaborating with insurance companies. They will give us a sum of money, and we will help them manage nearly 1 million members together to achieve less illness with more preventive care. What’s left of the money is our profit.

In the Greater Bay Area, we have taken the first step. Here, we have partnered with the government to establish over 100 community health centers. In these centers, our first step is to assist the government in training general practitioners so as to help the government advance the reform of healthcare service space at the grassroots. We have created over 100 studios and re-skilled grassroots doctors. Patients used to go see a doctor in the hospitals. We hope that more patients will be willing to seek medical treatment at the grassroots level. To this end, we provide basic support for grassroots doctors and make sure they can handle 167 common diseases covering 16 modules. On this basis, we can consider how to make good use of Hong Kong’s resources and experience in this area to assist in developing managed care in both regions.

In addition to the community health centers, we have also started working together with partners in Nansha, where we stand now. We have worked with Guangzhou First People’s Hospital (Nansha Branch) to build a Hong Kong and Macao Residents’ Service Center, allowing policyholders to seek general and specialized care services with a better experience.