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Disclosures we expect 15% of these drugs can be moved online By studying a hypothetical drug bill for a diabetic patient, we become more confident that the 15% target is achievable China is trying to reduce over prescription in hospitals and instead motive them to focus on medical service quality21 Equities Healthcare Providers (2) setting drug sales as a fixed percentage of total hospital revenue ( 药占比): by 2017, pilot hospitals were required to reduce drug sales to no more than 30% of overall revenue. The Notice on promoting the Comprehensive Medical Reform to All Public Hospitals ( 关于全面推开公 立医院综合改革工作的通知) in 2017 expanded the zero mark-up policy to cover all public hospitals and a longer list of public hospitals were also required to restrict drug sales as a percentage of total revenue under the new reform. With more explicit measures and policies in place, prescription outflow from the hospital started to happen more systematically. Stage III: Further implementation 2018 onwards Policies then shifted focus towards building a framework and infrastructure to further accelerate the implementation of prescription outflow. In 2018, the Ministry of Commerce issued a draft of the Guidance on Classified Administration of Retail Pharmacies ( 全国零售药店分类分级管理指导意见), which suggested classifying and regulating retail pharmacies based on the kinds of drugs they can sell and operational capabilities such as whether their shops are staffed with pharmacists, can provide 24- hour service, and are supported by good drug tracking and digitalized management systems. Another focus centers around building the digital infrastructure for prescription outflow. For example, in the Opinions of the General Office of the State Council on Promoting the Development of “Internet plus Health Care” ( 国务院办公厅关于促进“互 联网+ 医疗健康”发展的意见) issued by the GOSC in 2018, the document promotes real-time sharing of prescription details and retail drug consumption information, which allows drug e-commerce platforms and logistic networks to better develop and expand to serve Chinese patients. In 2020, the NHSA issued the Guidance on Further Promoting Basic Medical Insurance Reimbursement for Internet plus Medical Services ( 关于积极推进“互联网+ ”医疗服务医保支付工作的指导意见), which highlighted that prescription information has to be shared between healthcare institutions and BMIEquities Healthcare Providers forbid hospitals from stopping patients taking prescription to retail pharmacies to purchase drugs. Sep. 2014 MofCom The Notice on Implementing the Main Tasks of Health Care System Reform in 2014 to Improve Service and Efficiency of Drug Circulation ( 关于落 实 2014 年度医改 重点 任务 提 升药品 流 通服务水 平和效 率工 作的通知) To explore a new model for patients to purchase drugs in retail pharmacies. May. 2015 GOSC The Guidance on Urban Public Hospital Comprehensive Pilot Reform ( 关于 城市 公立 医院综合 改革试 点的指导 意见) Announced two specific measures, including the zero mark-up policy and drug sales as a percentage of total hospital revenue, marking the start of another stage for prescription outflow. Apr. 2016 GOSC The Main Tasks of Healthcare System Reform in 2016 ( 关于印 发 深化医药 卫生体 制改 革 2016 年重点工 作任务的 通知) Banned hospitals from restricting prescription outflow, and stated that patients can purchase prescription drugs in or out of hospitals. Apr. 2017 NHC The Notice on promoting the Comprehensive Medical Reform to All Public Hospitals ( 关于 全面推开 公立医 院综合改 革工作 的通 知) Expanded the zero mark-up policy to all public hospitals and drug sales as a percentage of total hospital revenue cap to a wider range of public hospitals. Apr. 2018 GOSC The Opinions on Promoting the Development of Internet plus Health Care ( 关 于促进“ 互 联网+ 医疗 健康” 发展的意 见) Called for the integration of information systems, and encouraged real-time sharing of prescription information between healthcare institutions and retail pharmacies. Nov. 2018 MofCom The Guidance on Classified Administration of Retail Pharmacies ( 全国零售 药店分 类分 级管理指 导意见 征求意见) Suggested classifying retail pharmacies based on the type of drugs they can sell and their level of operational capabilities. Nov. 2020 NHSA The Guidance on Further Promoting Basic Medical Insurance Reimbursement for Internet plus Medical Services ( 关于积 极推进“ 互联 网+” 医疗 服务医 保支付工 作的指 导意见) Encouraged digital prescriptions issued by internet hospitals to be routed to offline pharmacies, and connect up the information systems of health institutions with retail pharmacies. Source: NHSA, NHC, GOSC, MofCom, HSBC The road so far More specific rules and guidelines have been rolled out since 2015, however, prescription drug sales outflow has only yielded some modest results so far. Based on the data we have gathered, the market share of hospital prescription drug sales was only down to 87.7% in 2018 versus 89.9% in 2014 before the policies came into effect. However, we expect COVID-19 to have accelerated the prescription outflow process especially in 1H20 when hospitals were overcrowded dealing with patients from the pandemic as some chronic disease patients may have turned to alternative channels to get prescription drugs. Still, many challenges and roadblocks remain.23 Equities Healthcare Providers (3) there is a cap for total reimbursed special outpatient expenses per month or per year; and (4) type A medicines on the NDRL are 100% reimbursable, Type B medicines are 95% reimbursable (or 90% depending on the region), and then by multiplying the reimbursable cost of medicines by the reimbursement rate you derive the final reimbursed amount. Exhibit 40. UEBMI reimbursement policy for special disease outpatients in some cities Deductible Annual cap _Reimbursement rate_ (RMB) Community healthcare centres Hospitals and others Guangzhou 0 2,400 85% 65% Nanjing 0-1000 2,000-4,000 70-100% 60-95% Chengdu 160-800 na 95% 85-92% Xian 700 5,000 70% Chongqing 200-880 547,000* 80% Wuhan 0 7,000 80-85% Suqian 0 2000 90% Kunmin 300 2000 80% Shuangyashan 0 2500 70% Note: *Chongqings reimbursement cap is combined with inpatient treatment cost. Source: HSBC Estimating the annual medicine expenditure of patient X Back to patient X, depending on the kind of medicine that is chosen by the doctor for treatment, the annual outpatient drug fees can range somewhere between RMB1,011 and RMB4,405 based on our estimates. The 2019 diabetic medicine market was worth RMB70bn based on Menets data, given there were c100m diabetic patients in China in 2019, and the estimated medicine cost for patient X is tracking higher than the national average of RMB700. We assume patient Xs medicine expense came in higher because he/she lives in Guangzhou, a tier 1 city, or his/her financial condition allows him/her to choose more expensive medicine especially those that are listed under Type B. However, we acknowledge that older people may take fewer medications due to cost concerns, so the actual drug expense could be lower. A research paper published in the Journal of Diabetes Investigation on 17 August 2018 titled “Direct medical cost of diabetes in rural China using electronic insurance claims data and diabetes management data” created and analysed detailed data from merging the datasets of the local diabetes management system and the social security system in Tongxiang. Based on the 16,675 patients studied, the median cost per patient was estimated to be RMB1,067 and RMB969 for outpatient costs. The outpatient expense in 2018 came in close to the low end of our estimated range despite the study focusing on rural patient costs. Given an annual cap of RMB2,400 for BMI in Guangzhou, the patients out-of-pocket expense will vary between RMB152 and RMB2,005 but not all can be moved online (Exhibit 41). For example, if patient X chooses to take the relatively inexpensive Pioglitazone, a Type A medicineEquities Healthcare Providers and (3) e-commerce players use recycled packaging material and are improving their packaging design to reduce waste. For example, Cainiao, a subsidiary of Alibaba Group, uses recycled boxes and plastic tape-free packaging for delivery. It also uses Alibabas artificial intelligence technology to come up with optimised packaging methods. ESG factors and risks Key ESG issues are the packaging waste from the delivery of medicines and the potential misuse of personal data Making medical services more accessible and affordable, as well as raising health awareness, are positives for the industry while regulatory risks, provincial governments, and user adoption are among some the factors that could slow down growth37 Equities Healthcare Providers (3) We-Insurance (insurance business); and (4) We-Cloud (technology infrastructure). 1) We-Health WeDoctor aims to provide a closed loop service that spans from online-to-offline covering both general and specialised consultations. By the end of October 2020, WeDoctor has accumulated more than 214m registered users and more than 27m monthly active users (MAUs). Online healthcare services Jerry Liao, founder and CEO of WeDoctor, believes that in the future, 50% of health-related issues can be solved at home, 35% will need help from community clinics, and only the remaining 15% would need to be addressed by professional help in specialised hospitals. Its online healthcare services can be further divided into two segments: - Digital medical services As of October 2020, WeDoctor has over 250,000 in-house and external doctors, of which 10% are in-house doctors and over 80% are attending doctors. Leveraging its doctor team, WeDoctor provides online medical services including pay as you go consultation services, primary care, digital prescriptions, and online drug purchases through the 30 internet hospitals it operates. It also connects over 20,000 pharmacies with its doctor team, providing remote diagnosis and prescriptions to customers who are buying drugs in physical shops. Since launch, this Drug + Consultation Store ( 药诊 店) model has handled over four million consultations as of June 2020, with daily consultations exceeding 36,000. - Health management services Health management services includes chronic disease management and other membership-based services. In Taian, WeDoctor has signed a BMI-designated internet hospital agreement with Taian NHC, again the first third-party platform to obtain this. WeDoctor Taian Internet Hospital targets chronic disease patients in the city, providing online visits, prescription drug refills, and delivery services. Patients can pay with their BMI account online directly.43 Equities Healthcare Providers when it is between 5% below and 5% above the current share price, the stock will be classified as a Hold; when it is between 5% and 20% below the current share price, the stock may be classified as a Hold or a Reduce; and when it is more than 20% below the current share price, the stock will be classified as a Reduce. Our ratings are re-calibrated against these bands at the time of any material change (initiation or resumption of coverage, change in target price or estimates). Upside/Downside is the percentage difference between the target price and the share price. For each stock we set a required rate of return calculated from the cost of equity for that stocks domestic or, as appropriate, regional market established by our strategy team. The target price for a stock represented the value the analyst expected the stock to reach over our performance horizon. The performance horizon was 12 months. For a stock to be classified as Overweight, the potential return, which equals the percentage difference between the current share price and the target price, including the forecast dividend yield when indicated, had to exceed the required return by at least 5 percentage points over the succeeding 12 months (or 10 percentage points for a stock classified as Volatile*). For a stock to be classified as Underweight, the stock was expected to underperform its required return by at least 5 percentage points over the succeeding 12 months (or 10 percentage points for a stock classified as Volatile*). Stocks between these bands were classified as Neutral. *A stock was classified as volatile if its historical volatility had exceeded 40%, if the stock had been listed for less than 12 months (unless it was in an industry or sector where volatility is low) or if the analyst expected significant volatility. However, stocks which we did not consider volatile may in fact also have behaved in such a way. Historical volatility was defined as the past months average of the daily 365-day moving average volatilities. In order to avoid misleadingly frequent changes in rating, however, volatility had to move 2.5 percentage points past the 40% benchmark in either direction for a stocks status to change.Equities Healthcare Providers under our current model Buy = Buy, Hold = Hold and Reduce = Sell. For rating definitions under both models, please see “Stock ratings and basis for financial analysis” above. 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