Podcast: How China is rewriting the rules of AI healthcare with Dr. Ruby Wang
Ruby Wang is a UK-trained physician, founder of China Health Pulse, and author of the upcoming book China Cure, which explores the global impact of China’s biotech and AI healthcare advances.
China’s biotech and healthcare sectors are evolving at extraordinary speed — from AI-powered “doctor avatars” and digital health super apps to a wave of Chinese drug innovation reshaping the global pharmaceutical industry.
In this episode, I speak with physician and healthcare strategist Dr. Ruby Wang about the latest trends in China’s AI + healthcare innovation.
Ruby Wang is a UK-trained physician, founder of China Health Pulse, and author of the upcoming book China Cure, which explores the global impact of China’s biotech and AI healthcare advances.
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Transcript
Kyle Chan (00:00)
Welcome to the High Capacity Podcast. I’m your host, Kyle Chan, a fellow at Brookings. I’m thrilled to be joined today by my guest, Dr. Ruby Wang, a UK-trained physician and founder of LINTRIS Health, a strategy consultancy. She runs the amazing China Health Pulse newsletter and podcast on healthcare and technology in China, which I highly recommend. She also has a book coming out in October titled China Cure, which describes the global impact of China’s biotech and AI health advances. Welcome, Ruby, and thanks for coming on the show.
Ruby Wang (00:34)
Thanks so much for having me, Kyle. It’s such an honor. I’m a huge fan of High Capacity. We’ve been Substack friends for a while, so it’s great to come on here. I’m excited to chat.
Kyle Chan (00:42)
That’s right.
I’m really happy to have you on. You just came back from a more than month-long trip in China, where you were looking at a number of things in the health and tech landscape. To start off, what did you see? What did you hear? What are the big trends people are talking about, and what’s changed since you were last there, I think over a year ago?
Ruby Wang (01:10)
Yes, this trip was very exciting. I always try to do one longer trip every year where I spend a good bit of time on the ground, rather than just going in and out briefly for a work event or to see family. I did a long trip last year around April for over a month, and this year as well, for pretty much the whole of April.
I was in China. I went across six-plus provinces. Two new ones, actually. I went to Guilin for the first time and to Chengdu for the first time, so that was very exciting. Everywhere I went, I was trying to enjoy myself and eat a lot of nice food, but the priority was to talk to people on the ground, whether that’s government, the public sector, multilaterals, think tanks, foundations, people on the China side, foreigners on the ground, or industry leaders, and see what’s really happening.
It was so fun. I had a great time and absorbed and learned so much. I’m blown away every time by the pace of progress in China, including in healthcare. How to describe what I saw? I’m trying to reflect on this properly so I can write about it too, and hopefully this conversation is helpful for me.
Overall, I had the sense that what I was writing about a year ago, and what I saw a year ago, was that biotech was still up and coming and gaining credibility abroad through media, conversations, and investor sentiment. Now, it’s pretty accepted and recognized as excellent. Chinese-origin drug assets are understood to be as good as, if not better than, Western assets in many scenarios. Not across every modality or disease area, but increasingly, the reputation is far from the “Made in China” copycat, cheap generic idea that we had even a year ago.
I was trying to overcome that in my work as a consultant to clients, but now it’s pretty much recognized as good quality. That’s a huge shift within 12 months, to the point that it’s flipping the other way around. I talked to people on the ground who are furiously, frantically going to Chinese factories and labs, trying to get enough drugs to appease the high appetite of their Western clients. There’s this frenzy of urgently trying to find enough Chinese drugs to out-license. We see in the news big Western multinational companies signing these billion-dollar deals, including most recently Bristol Myers Squibb with Hengrui, and also in March, when Keir Starmer, the British Prime Minister, was in China, a big AstraZeneca deal as well.
On the biotech front, I think there’s been a massive landscape shift, combined with increasing confidence on the China side. But that also means a lot of expectation.
On the digital health front, I was already seeing last year how, in China, the digital rails of everyday life are incredibly mature compared to many other countries. You cover this so much, Kyle, that you’re the expert on tech in China. All of daily life, what you need to do to function and to make life convenient, a lot of that exists in China on your phone, day to day. It’s so easy.
Health has always been one of the last sectors and frontiers for technology to integrate in most parts of the world because of the ethics, safety, and necessary regulation, because potentially lives are at risk. But even so, in China, I see it being incredibly mature. I’ve written before about how my take is that China’s digital health ecosystem is one of the most mature in the world, partly because of the digital rails that allow health to be added on to, so it doesn’t have to build its own infrastructure.
Ruby Wang (05:18)
But also partly because of cultural and societal attitudes toward what technology can bring, which more often than not is a positive angle rather than fear, risk, and hesitancy.
Ruby Wang (05:47)
That means that now, what you see in China—and we’ll talk about this later—is an incredibly sophisticated pathway where a patient can access health services
Ruby Wang (06:11)
with many levels of sophistication, whether they need a clinician or not, whether they need to go to a hospital or not. That end-to-end, online-to-offline and back-online transition is a lot more integrated than it is in the West.
A friend I was talking to about this—talking about technology in China in general, not just healthcare—said that a lot of the time, even in the West, even if you have a very sophisticated digital tool, it’s like attaching a super engine onto a tractor. The baseline is not sturdy or sophisticated enough to take on something that’s really great technologically. But in China, you’re not dealing with a tractor. You’re already dealing with a very high-functioning frontier machine. Adding something sophisticated on top of that, whether that’s frontier technologies, LLMs or AI, or a more traditional digital tool like an electronic medical record, imaging, or a wearable, is going to be so much easier to integrate.
Kyle Chan (06:44)
Right.
Ruby Wang (07:09)
I saw that last year already, every day, but this year even more so, to the point where it’s mind-blowing.
Kyle Chan (07:28)
Yeah.
Ruby Wang (07:35)
I visited Ant Afu. I went to their HQ and talked to a doctor who is an AI doctor on the platform. We can go into that a bit more later. Across all of these insights, it always crossed my mind how what seems ordinary now in China is just unfeasible or dystopian in the West. I’m sure you see this all the time in non-health sectors too.
Kyle Chan (07:48)
Yeah, totally. It’s interesting because in the U.S., for so long, healthcare has been that final frontier for the tech industry, where they’ve been trying to announce and launch Google Health, and now a bunch of the AI companies like OpenAI and Anthropic seem to be getting into medicine. But it just seems to be something that is much harder to take off in the U.S. I’ve always been puzzled about why that’s the case. There are a lot of reasons you can point to.
But in China, you’re pointing out that you already have that infrastructure layer down. Could you comment more about that? Who and what are the rails that all this is being built on—the digital rails?
Ruby Wang (08:46)
That’s a great question. Overall, the reason China has been able to do this, from a building point of view, is that the responsible actors are government and industry together. We don’t really see that level of collaboration or alignment between public and private, state and industry, in any other country.
In the West, to generalize, we have industry leaders fronting the force, and then government trying to run behind, regulate, make sure standards are set, and struggling perhaps in some cases. But in China, a lot of the time, it’s the government side leading, setting ambitious agendas, and being quite careful about regulations, actually. It’s always the wrong assumption that China is doing things wildly. They’re obviously very careful about AI, including in healthcare. They’ve set up multiple strategies over the years, including detailed documents from last year or the year before that laid out over 80 specific health AI implementation scenarios.
It’s that level of integration and alignment, which is necessary from government but also from industry. Obviously, there will be huge challenges and misalignments along the way, but having that drive matters. Once you have governance there in China, that’s also pressure for industry. Alongside pressure, there’s also support: subsidies, financial support, structural support, and bringing together talent and capital. All of these parts come together.
I also think that in China, culturally, the attitude of the average person means that demand and supply balance each other and drive each other forward. Certainly in China, one of the reasons government is so eager to drive technological progress, especially in healthcare, is that the demand and urgency are just too great. The population is huge, it’s aging so rapidly, and the disease burdens are massive. There is no other choice. They have to turn toward the most efficient angles, and for that, innovation and technological progress are among the best tools for cost efficiency, speed efficiency, scale, and reach, especially across remote settings.
That unique urgency has driven the recognition and understanding that technology is a tool to use and embrace, rather than something to view as strategically risky.
Ruby Wang (12:04)
Chinese people are not sheep following what is given to them; they are savvy decision-makers. They stir up an environment of fierce competition, so whatever industry, small or big, is creating medical products—whether digital health, wearables, or even drug development, which is a bit more removed from the patient-consumer side—consumers can still have the power to determine who succeeds and who dies. It’s an active environment, much like tea brands in China or Meituan and Ele.me, the food delivery apps.
Kyle Chan (12:29)
Right.
Ruby Wang (12:32)
Consumer-side demand and pressure to win are also important drivers of innovative change and progress on the industry side.
Kyle Chan (13:11)
That’s so interesting. I used to work a little bit on the healthcare side in the U.S. in my consulting days. I remember things like electronic health records were seen from the clinician’s point of view as an encumbrance. It’s interrupting your workflow, you have to adapt, you have to change everything, and then it doesn’t even quite work. From the patient side, you might not see the upside. Versus what you’re describing in China, from supply and demand, there is a lot of need and a lot of interest in trying to leverage these tools to scale up and make this whole process more efficient.
Ruby Wang (13:19)
Yes. There’s one really interesting piece in digital health. It’s so mature in China: the rails, the infrastructure, and the products within that ecosystem, as we’ve talked about. But one key problem, and I think the main problem—what you were saying about the U.S. landscape, and also the U.K. and European context—is that for a digital health company to succeed, we also have to think about the business side of it. At the end of the day, who’s going to pay for it? What is that business model? It’s not just endless capital and fundraising.
This is something I’m querying about the Chinese ecosystem. If we’re talking about platforms with massive numbers, hundreds of millions of consultations, hundreds of millions of users, how are they making money, or how are they becoming sustainable? That’s a question mark for me so far. When I was speaking in China to government officials and company leaders, they were vague about that part.
There’s a sense that in China, you just have to do what you have to do, believe in the dream, and hopefully, because of the scale, even if per unit you’re earning 0.1 kuai somewhere along the chain, when that adds up, the returns are still incredible and worth it. But we can’t rely on that volume in the West. Perhaps that’s why sometimes in the U.S., with its capitalist healthcare ecosystem, or in the U.K., with its very socialist, government-funded ecosystem, you can’t use that methodology, trust it, or take such a big risk. That piece I’m waiting to see.
Kyle Chan (15:18)
That’s super interesting. You mentioned Ant Afu. Could you call out a few interesting apps, services, or platforms like that one or others that give folks who are not familiar a sense of what Chinese consumers and patients are interacting with on a regular basis?
Ruby Wang (15:46)
With digital health apps in China, there are so many options. As in any other sector, you can choose one of hundreds. But there are some bigger names, and usually they’re affiliated with the big tech companies. In the same way that in the West we have Amazon and its health endeavors, Google and health, Apple and health, each big tech company wants a slice of the health pie. They will lean into the health sector through their own strengths.
For example, Apple, with the watch, will do wearables and monitoring as its main entry point, and then build on that. Amazon might be doing interesting things based on its access to the massive consumer market, and Google might do more tracking, data generation, and data collection through its search engines, functionalities, and things.
Similarly in China, the big tech companies—Alibaba, Baidu, JD—originally built their health branches based on their own strengths. Alibaba started as an e-pharmacy, and they had a company spinoff called Ali Health, which I actually worked at for less than a year in 2019, back when they were starting out.
JD Health is a delivery platform, like Amazon. They were doing deliveries as well, along with various other pieces. What’s interesting is that digital health apps have existed for a while, but because those digital rails were maturing slowly, they took time to build up in popularity. Also, as China’s population got increasingly used to becoming digital for everything, that helped.
I became quite interested in Ant Afu in particular late last year, and I wrote a bit about it earlier this year. This time in China, I got to visit their HQ, interview some of their marketing and strategy team, and talk to one of the doctors using their platform. The reason they’ve done so well and accelerated so much, even in a competitive environment, is that they were built off Ant Group, which is a fintech company.
We’ve just talked about health and finances. Anything in healthcare, a root cause of success, implementation, and uptake is whether it’s linked closely enough to the payment side. Otherwise, even the best product—you don’t know how long it’s going to last. Because Ant Group owns Alipay, one of the largest payment platforms in China alongside WeChat Pay, it has a huge existing consumer base, which was already linked with China’s public and private health insurance on the app. The company had great access and could link across and move across existing consumers much more easily than other digital health companies, including Ping An Good Doctor, which had hundreds of millions of users anyway.
That was one reason. Another reason is that the user interface is great. It’s very intuitive. Many of them are, but this one combines a lot of new functions that I hadn’t seen before. For example, you can have a family tab where you link across all of your family’s records and data.
Ruby Wang (19:32)
You do have to manually upload. It’s not end-to-end. But combine that with the insurance piece. Imagine you’re in your 30s or 40s, your parents are aging, and maybe you need to start taking care of them. You can link across to their records and even monitor all of their health journey. That is huge.
Ruby Wang (20:00)
Those functionalities are really important, but they were only possible because Ant Afu had the Ant infrastructure to do it. The further exciting thing is this AI doctor piece. So far it’s branding, but it’s moving toward functionality. I think Ant Afu is the only platform so far to have invested in
Ruby Wang (20:28)
over a thousand, and a growing number of, senior clinicians across China, across the best hospitals, who have uploaded their own anonymized patient records, their own career best practices, and the ways they practice onto an LLM. The LLM acts on their behalf as an avatar, so a patient can interact with the digital version of them directly through the app and pay for it, or whatever.
To me, that was truly incredible because we can’t imagine that in the West. In the U.K., I think last year, former Prime Minister Tony Blair suggested something about AI doctors and AI nurses in an interview and got blasted across many news media and by the general public, with people saying,
Ruby Wang (21:22)
“This is insane. How could we trust an AI doctor? This is too far, too dystopian.” Similarly in the West, that’s always seen as going too far technologically. What about the Hippocratic oath? What about safety and ethics and do no harm?
But in China, it’s really happening. It already exists and people love it. The patients love it. The doctors, the best of the best in China,
Ruby Wang (21:51)
are on the platform. When I interviewed a couple of them, I was so curious. I have a medical license myself, and I was thinking: would I be willing to put that register on the line with something that is a black box at the end of the day and that I can no longer control?
They said, yes, we do trust it enough, and it won’t replace me. I’m not worried about that because it’s only a gateway. There are
Ruby Wang (22:18)
regulations in place. For example, the patient can’t get a prescription or a true diagnosis; they still have to go face to face. But they also recognize that what’s happening in China’s health landscape and tech landscape is inevitable. They’d better jump on the wave, ride along, and go forth into the future of healthcare together, rather than be left behind and lose out.
Ruby Wang (22:46)
That’s such a fresh angle from the clinicians themselves compared to many places in the West. In the U.K., I’m part of a digital health council at the Royal Society of Medicine, where we do a lot of events, training, discussions, and analysis about where technology and health can intersect conceptually and theoretically. Too often the conversation is around
Ruby Wang (23:14)
privacy and ethics, and not enough is about what technology can bring when your system is already struggling. It’s very pragmatic of these Chinese doctors. But then again, Chinese people are very pragmatic as a whole in the way they view the world, so it perhaps makes sense like that.
Kyle Chan (23:29)
If it works and it’s convenient. I have a question about data flows. How does that all work? That’s such a pain point for the U.S. system, where everything is so fragmented. You have health insurers, providers, a hospital system, maybe a separate set of medical groups, and they have to pass data to each other—much less getting it to the patient and then into an app or platform. How does that work in China? How is that different?
Ruby Wang (23:38)
It’s still not linked up, and I think it will be a long time before all of the hospitals in one province, for example, link up so that, as the patient, you just go. A lot of the time it’s about convenience at different touch points, which are increasingly connecting, but not as smoothly as you might think.
For example, even on Ant Afu, where you can do a lot from AI chatbot to booking a doctor to going there, the doctor whose avatar you might have talked to won’t know that you’ve talked to them. So as the patient, you might have to show them your phone screen. With medical records, those aren’t necessarily linked or downloadable on every platform; you might have to physically scan and upload them.
Kyle Chan (24:44)
I have a question about the provider side. How are clinicians using AI? Hospitals, doctors, medical service providers—are there certain apps they are relying on or certain kinds of platforms they’re using?
Ruby Wang (25:19)
This really depends on that hospital’s relationships with local government or with big tech. For example, DeepSeek has come out and made such big waves. I’ve seen them announce partnerships with various hospital chains, including public hospitals and private hospitals, really keen to showcase technical implementation outcomes for their tools.
It depends on who the partnerships are with. There’s no whole-of-country or whole-of-province situation. One thing I’ve noticed is that sometimes the logistical and operational tools by those companies are not really integrated with the consumer- or patient-facing side. Because they’re completely different products with different functions, the client and the opportunity are quite different and siloed.
But when I visited Ant Afu, I was really excited to see that they’ve got a whole clinician-facing side, partly because they’ve had to have it, onboarding the level of AI doctors and having all of that data.
Ruby Wang (26:32)
They built up both sides of the ecosystem in a way that is a lot more rare than I’ve seen in other contexts. That’s a very smart thing to do because both sides can synergize to make the health pathway—which is all joined and only siloed when we cut it up into pieces—more joined up. That will hopefully help in the long term with building the ecosystem.
On the doctor-facing side, there are so many pieces to it. If we categorize it, we can think of clinician diagnostic support, AI tools—it might be big companies or small companies. It can be logistics. It can be transcribing. All of these pieces might be lots of different companies, or it might be one company providing various services. It’s a diverse, competitive ecosystem, as it is here in the West as well.
Kyle Chan (27:34)
Do you see a lot of startups jumping into this space? You’ve talked so far about a lot of the big tech companies with their platforms and huge user bases that they can leverage. They can add the health component onto a whole bunch of other services. You’ve also mentioned DeepSeek and some of the AI companies themselves entering this space. Are there specialized
Kyle Chan (28:03)
health AI or medical AI startups trying to offer something different?
Ruby Wang (28:08)
There will be many; there are always many in China. There’s always someone trying to do something new. But success is tough, because to do digital health, you need access to as much data as you can get to build up a digital health tool. To do that, you need relationships, guanxi. If you’re small, it’s more likely than not that you won’t have the same level of access as a larger company, so immediately you’re put in a weaker position.
Not to say it’s impossible. As happens everywhere, if it’s a good small company, it can easily be acquired by a larger one. For example, when I was working in Ali Health in 2019, they were trying to do e-pharmacy, but they were also generally strategizing: what can we do to stand out? One part of it was almost like a VC arm, acquiring and assessing the best of what the wild west landscape had to offer, trying to pick through the terrible stuff from the potentially good stuff.
Kyle Chan (29:08)
At this point, there are probably so many players in the space that it’s hard to differentiate who really has something unique to offer versus who doesn’t have the data access, for example, that would be so important. I was wondering if you could talk about internet hospitals, which you’ve written about before. What are they, and how are they different from what folks in the U.S. or elsewhere might think of as telehealth or telemedicine?
Ruby Wang (29:38)
It’s so interesting, because since I wrote about internet hospitals, and since this trip in China, I feel like that term is almost out of date now. The official hulianwang yiyuan term for an internet hospital in China was coined around 2018.
Kyle Chan (29:46)
I see.
Ruby Wang (30:07)
The definition is that it’s a legal license for either a software company supporting a hospital, or a hospital building its own software team—whichever way that collaboration forms from clinical to technical or technical to clinical.
The end product is some kind of platform, whether on an app or a computer, that can bridge specific points in the healthcare pathway. For example, booking or online consultation. But the consultation could be via phone call, which even in the West we’ve had with GPs and family doctors for decades now. It’s not anything technically advanced. Then you can move to e-pharmacy prescriptions and later even reimbursement of that consultation or drug. Having two or three points in the pathway transition from offline to online was enough.
The definition of this licensed internet hospital meant that it was allowed to carry these processes on, with rules in place that still exist today. For example, first diagnosis can never be made online, even if a consultation can be made online. As we’ve just said, that might actually be pretty clunky. A patient can talk to a clinician online, go all the way to diagnosis, and both sides are pretty sure of what’s going on. Then they have to start all over again when they go back and see that doctor in person to get that final diagnosis checked against their name and get medication properly for it.
Since 2018, COVID happened. Around the world, and in China, digital health services accelerated so much.
Ruby Wang (31:56) When we talked about urgency and pressures earlier, I forgot to mention COVID, but that was a huge one for all health systems. In China especially, because the quarantine, lockdowns, and distancing were to such an extent. Within China, in some scenarios, even though daily life was seemingly normal in many ways, tracking and tracing, scanning, and the QR code for COVID-negative status made the digital health ecosystem progress really quickly.
I wrote about how, when I was working on this in 2018 and 2019, you could count the number of internet hospitals. It had increased to maybe 400 or 500 internet hospitals in 2019. By 2023, the latest count was maybe over 3,000. But nowadays, what’s the point of calling something hulianwang yiyuan versus not? There are so many kinds and varieties of what counts as a digital health platform.
Ruby Wang (32:50)
This time when I was back in China, with Ant Afu existing and with visits to hospitals or clinics to check them out, the level of services they had, and the fact that each of them would be registered on WeChat, on Ant Afu, or many others to maximize patient access, made the definition of an internet hospital less relevant today. We can describe it as a diverse and rich digital health ecosystem where, depending on where you access it, more and more of the pathway can be completed online.
Kyle Chan (33:21)
That makes sense. These digital services have proliferated so much that maybe that category has exploded into all these different touch points and connections.
You had some really great pieces in your Substack about the regulators and health agencies that play an important role not only in maintaining standards and regulating some of the space, but also in accelerating innovation and promoting the industry’s development, whether the healthcare industry or biotech industry. Could you talk about some of those agencies? Who are they, which ones should people pay attention to, and how have they turned into key players in accelerating innovation?
Ruby Wang (34:27)
This is a great question because, as you know very well, everything in China relates to governance, policy, and ministries to a much higher extent than in many other countries. The ministries that look after healthcare from all angles are essential to understand if you want to work in, operate in, and understand China and its healthcare landscape.
I wrote about this in my Substack in various consecutive posts, and in my book I go into this in detail in chapter five. I call them institutions of power, alongside industry and academic institutions in the whole healthcare landscape.
There are three main health ministries, maybe a fourth, which is the Ministry of Science and Technology, or MOST, which dips into health, science, drug development, and medical innovation on the side when it overlaps. There are also others, like the Ministry of Finance or Ministry of Education, when it comes to doctor training, education, or health financing—not reimbursement and things like that.
The main three are the National Health Commission, which is the main Ministry of Health. That’s the overseer of health policy, system reform, and holistic oversight. Then we have the National Healthcare Security Administration, or NHSA, which is the youngest agency, founded in 2018. That really looks after health insurance, which sounds like a small remit, but actually isn’t, because we talked earlier about how health financing is one of the most important things. I think they’re probably the most powerful health ministry, because they look after health insurance, and they also determine the pricing of drugs and medical products. That’s the one the health industry, biopharma industry, and medtech industry really care about.
Then the National Medical Products Administration, or NMPA, which is China’s version of the Food and Drug Administration, looks after regulations and standards. That’s also an important barrier before we even think about pricing of health products. We have to think about whether they can even be allowed. Are they deemed safe and good enough?
In terms of China’s regulatory standards, the NMPA has worked really hard on bringing the review and regulatory process up to what the world considers the right standards. China’s NMPA joined the international committees, I think back in 2017, and has been steadily working with the U.S. FDA, the UK MHRA, and European regulators to build up capacity and expertise. That’s one of the key reasons that today’s biotech ecosystem is as strong as it is now. If Chinese drugs were only deemed by Chinese regulators to be good enough, then when they came abroad and were trialing for the U.S. Food and Drug Administration, if there were a big discrepancy, as there used to be, that’s where the barriers would lie.
Ruby Wang (38:01)
Increasingly, we are seeing through clinical trial evidence and foreign MNC recognition that the quality of China’s biotech innovation landscape, thanks to the help of China’s NMPA and its increasing standards and excellence in regulation, is enabling a stronger health innovation environment.
Not just in drugs, but also in medical devices. Hardware is an area I’m really excited about in China. One of the things I was most excited about on this trip to China was robotics, arms, humanoids,
Ruby Wang (38:58)
robot dogs, all of which are increasingly prevalent in social media and in what we perceive China to be doing. When I was walking around, there were robot arms serving coffee. When I was in Shenzhen visiting factories, drones were flying ahead, delivering bubble tea. All of that is happening. That background means that health technologies and medical devices, whether sophisticated or more toward care, wearables, and human use, are being created.
Ruby Wang (39:26)
Because China is creating such a high volume of hardware and devices, including in healthcare, that means China’s regulators, the NMPA, are simply receiving a high volume of content. That experience and iteration is teaching them a lot, perhaps equal to or more than a regulator in the West, which sees a lower volume of devices and has less iterative potential or experience learning to define what standards should be and how to accelerate pathways to get to final approval. That part is also very interesting for the NMPA.
MOST, the Ministry of Science and Technology, with the support of the State Council, the higher-up overall structure, has a very strong recognition of health as a priority. We’ve seen in the most recent Five-Year Plan, Made in China 2025, and Healthy China 2030—all of these longer-term plans, which are such a signature way that China creates, delivers, and sees through policy because of its political structure allowing long-term planning—that there is such drive and recognition for the importance of health and innovation. That creates funding, collaboration, and integration, driving technology and healthcare forward in a really unique way from the governance side, then met and taken on by industry, and by local government and industry on the ground.
Ruby Wang (41:16)
Again, going back to what we were saying about this synergistic melting pot, we should still be very aware that there are a lot of mistakes and waste happening.
Ruby Wang (41:45)
But when there’s enough volume, the overall direction is forward.
Kyle Chan (41:49)
It’s very interesting to see the expansion of bureaucratic capacity within these institutions. If you’re getting a huge wave of new drug applications or medical device applications, and you still have the same institutional structure and size, then you’re going to be a major bottleneck. It seems like what China’s done is tried to make that not a bottleneck and add capacity where it might facilitate greater commercial development.
Ruby Wang (42:19)
I definitely agree. On this trip, I visited the 12345 helpline center in Beijing. I don’t know if you know them well, but they handle all kinds of problems for citizens. It’s a kind of civil society mechanism. It was very interesting.
Ruby Wang (42:40)
They were showing me that people can call in to complain about anything, whether that’s Meituan—instead of calling Meituan to complain, they call 12345—or it might be a doctor who didn’t treat you properly. Previously, with the doctor-violence phenomenon yi nao, now this is a potential mechanism to promote stability, which you can imagine is a strong priority for China’s government.
Ruby Wang (43:09)
Even that center: we spent 20 or 30 minutes walking around and learning about the various functions, but then the rest of the day was really looking at their big data infrastructure and showing off that level of integration and tracking. From a government point of view, when I think about the U.K. and how analog lots of things are, if your government is integrating technology and all of your officials and workers are becoming savvy and expecting it, that drives, at a working level and holistic level, a really important traction for technology, how you view it, and how you use it as a whole.
Kyle Chan (43:52)
Going forward, what do you see as the big future trends, either in AI health apps or in medical hardware? What do you think Chinese startups, companies, and hospitals are most excited about when it comes especially to AI in healthcare and medicine?
Ruby Wang (44:20)
We’ve seen it already with the biotech wave and its global rise. I think we’ll definitely see that too with hardware and medical devices. It just takes longer because it’s even more complicated in many ways: how to regulate it, how to deliver it. But I’m seeing that as an inevitable trend. That’s already happening.
In medical devices, in past years, it’s mostly been China selling cheap, convenient products to Southeast Asia and developing countries. But now it’s increasingly frontier, high-quality medical devices for Western markets. One barrier to that is the ability of Western regulators to approve those products. As we’ve just said, the world’s regulators are struggling to regulate devices. It’s a brand-new global challenge. We’ve never done this before. With drugs, regulators have been checking standards for decades. We’ll see what happens there.
Digital health is harder to cross borders. That’s always been the case. In my book, when I was writing about what China’s doing in digital health, I didn’t see a Chinese digital health company succeeding abroad. There are just too many barriers in place: data, implementation, fit, and feasibility. Software is really hard. Nevertheless, it’s important to be aware of what’s possible, because part of understanding China’s landscape is learning without necessarily partnering directly.
Overall, what’s hard across all of this is the business model piece, which is unfortunately the key when it comes to sustaining innovation and making sure industry is supported.
Ruby Wang (46:41)
For example, one worry that many Chinese biotech companies have, and one reason they’re going outward overseas to the U.S. market in particular, is that they are not making returns in their home market. Their prices are being cut by the National Healthcare Security Administration because China’s policy priority is to make drugs affordable. They’re forced to sell drugs at very cheap prices within China. A reason to commercialize in the U.S. market is that the U.S. is known for funding the world’s medicines because drugs cost the most in the U.S.
Ruby Wang (47:09)
That’s one way they’re trying to make the most of the global opportunity. Perhaps medical device companies will do that too. From a moral or public health point of view, we may say that’s not great. Why are we charging American patients more for potentially the same thing? But we already are. A drug in the U.S. may cost 10 times as much as it costs in China because the system allows it to.
Ruby Wang (47:36)
Seeing what happens on the financing side will be interesting, and whether that reaches a point where it limits innovation, alongside all the other pieces we haven’t really talked about today, including cross-border geopolitics. That’s another practical issue, as well as whether U.S. patients and doctors will be happy using Chinese-origin products.
Ruby Wang (48:06)
Personally, I feel there would be less of a problem, because if I’m thinking about it from a doctor’s perspective or from the perspective of caring for a family member, if you have a good product, why should we care where it’s from, as long as it’s helping people and saving lives?
Kyle Chan (48:35)
From a patient or consumer standpoint, Americans are very used to buying stuff that’s made in China or developed in China, and are used to a more affordable price point as well. It’s ironic that the two systems are complementary in some ways, with the U.S. paying so much more than most other countries for drugs and healthcare. Maybe in a way that subsidizes innovation across the world, but at a cost to the American healthcare system.
Kyle Chan (49:02)
To the extent those complementarities continue to hold, and it seems like they’re only growing stronger between the U.S. and China for the pharmaceutical space, and the number of outbound licensing deals seems to be skyrocketing. I wonder whether this will continue barring any major geopolitical intervention or policy intervention from the U.S. side.
Ruby Wang (49:30)
If you’re a multinational pharma company, this has always been your model: making sure your pipelines are sustainable when patents and IP end, and making sure you can find the best assets that exist in the world, wherever they might be. Increasingly, they’re from China, so the numbers are going to link up that way. If another country comes out with a great asset, they won’t be choosy. They’ll go for that one.
Inevitably, China is taking up a greater proportion of the world’s best drug assets. Industry is going where the science is, where the quality is, and where the opportunity is. It doesn’t mean that all of those billions of dollars we’ve seen are going to result in successes. Biopharma is notoriously difficult. The percentage of success, the billions invested, and the decades put in—we can’t tell for sure. But that volume means things are inevitably going in a certain direction.
Ruby Wang (50:08)
In a few short years, Chinese drugs are going to be offered to Western patients, whether directly through that Chinese company commercializing, or with the help of an out-licensing deal by a Western pharma company. Maybe patients won’t even realize the drug originally came from China, because now it’s under the branding of a Western pharma company.
Another interesting pattern is that Chinese companies are going to become multinationals. There aren’t many Chinese multinationals, especially in healthcare. But we have at least one now that we can confidently say is one: BeOne Medicines. They relocated to Switzerland. They changed their name from BeiGene, because they originated in Beijing, to BeOne Medicines. They’re operating as a multinational company. Many might not realize they originated in China, just like some people might not know AstraZeneca is British or Pfizer is American. They probably do, but they might not. To be honest, does it matter at the end of the day when you have global offices and global pipelines? It’s just where the best science is.
Ruby Wang (52:17)
In devices, Chinese companies like Mindray are already doing very well with imaging machines in European and Western markets. Depending on their business strategy, they may take up a greater share of the market, or not, depending on what happens. But more and more Chinese companies in healthcare are becoming global, which was not a thing before. Like with EVs and everything else, this is inevitable. Healthcare has always been slower, but it’s happening finally. For me, working on it is very exciting to be in the mix.
Kyle Chan (52:34)
This is incredible. It’s fascinating to see some of these trends in other sectors and technologies happening here: moving up the ladder, going global, maybe even having some global brands. You also have pressures in the domestic market where you don’t get the margins you might get abroad, so you get a lot of Chinese companies searching for new markets. Whether it’s electric vehicles, robotics, healthcare, or biotech, this is happening.
In some ways, each industry has its own quirks and idiosyncrasies, and healthcare and biotech in particular because it’s so heavily regulated and the stakes are so high. It’s not going to be the same as food delivery. But to see some of these patterns show up is really interesting.
Ruby Wang (53:22)
I always have to caveat that today we’ve mostly described the frontiers, the urban cities, and the best of what Chinese healthcare can be. But inequalities remain, huge ones. Even though China is exporting increasingly sophisticated products abroad, it doesn’t mean it has solved any or all of its own domestic challenges. Those remain, and they’re huge.
But that trend of urgency driving change, and some of that spilling outward, will only increase with time. Every time I’m in China, I’m also trying to learn about what’s still struggling on the ground in terms of healthcare, because there are still challenges. I always want to make sure that when we’re having these conversations about the frontier, the best, and the shiny, we remember that in healthcare, across all health systems, there are still a lot of inequalities that maybe technology can’t solve. It’s more about clinicians, the patient-doctor relationship, the system, and the various actors in it that still have to manually improve in ways that technology can’t solve.
Kyle Chan (54:52)
Just getting the basics right can go a long way. Absolutely.
Kyle Chan (55:22)
Well, thank you so much, Ruby. This was such a fantastic conversation. I strongly encourage everyone to check out your China Health Pulse newsletter and your podcast. It has been an amazing resource for me to understand the space. I also encourage everyone to keep an eye out for your new book, China Cure. I’ll include links in the show notes. Is there anywhere else people can find you, or anything else you want to call out?
Ruby Wang (55:29)
That’s pretty much it. Thank you so much, Kyle. What a pleasure. Thanks for a great conversation.
Kyle Chan (55:30)
Such a pleasure. Thanks for a fantastic conversation.
To wrap up, if you like this episode, please rate and subscribe on YouTube, Spotify, or Apple Podcasts. You can find episode transcripts and more information on the High Capacity newsletter at highcapacity.org. I’m your host, Kyle Chan. Thanks for joining, and see you next time.