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HIMSS 2007 NEW ORLEANS, USA FEBRUARY 26, 2007 OVERVIEW OF CHINESE HEALTHCARE SYSTEM AND HIMSS 2007 NEW ORLEANS, USA FEBRUARY 26, 2007 OVERVIEW OF CHINESE HEALTHCARE SYSTEM AND ITS USE OF I. T. GRACE YU THE DORENFEST CHINA HEALTHCARE GROUP

AGENDA l l OVERVIEW OF CHINESE HEALTHCARE SYSTEM l OVERVIEW OF H. I. T. AGENDA l l OVERVIEW OF CHINESE HEALTHCARE SYSTEM l OVERVIEW OF H. I. T. STATUS IN CHINA l GRACE YU BRIEF SUMMARY OF THE DORENFEST CHINA HEALTHCARE GROUP DISCUSSION 2 THE DORENFEST CHINA HEALTHCARE GROUP

BRIEF SUMMARY OF THE DORENFEST CHINA HEALTHCARE GROUP AND GRACE l THE DORENFEST GROUP BRIEF SUMMARY OF THE DORENFEST CHINA HEALTHCARE GROUP AND GRACE l THE DORENFEST GROUP IS A WORLDWIDE HEALTHCARE INVESTMENT AND CONSULTING FIRM. THE DORENFEST CHINA HEALTHCARE GROUP, A DIVISION OF THE DORENFEST GROUP, IS A HEALTHCARE CONSULTING AND INVESTMENT COMPANY BASED IN SHANGHAI. l PROVIDE SERVICES IN THE FOLLOWING AREAS: – – HOSPITAL CONTRACT MANAGEMENT – GRACE YU CONSULTING FOR COMPANIES SERVING THE HEALTHCARE INDUSTRY – l HOSPITAL CONSULTING HOSPITAL OWNERSHIP AND IMPROVEMENT GRACE IS THE DIRECTOR OF HOSPITAL CONSULTING AND SERVICES FOR THE DORENFEST CHINA HEALTHCARE GROUP. SHE GRADUATED FROM FUDAN UNIVERSITY IN SHANGHAI AND IS A PHD CANDIDATE AT THE UNIVERSITY OF CHICAGO. 3 THE DORENFEST CHINA HEALTHCARE GROUP

DORENFEST INVESTIGATION OF HEALTHCARE IN CHINA 1. 2. VISITED WITH HUNDREDS OF LEADERS IN DORENFEST INVESTIGATION OF HEALTHCARE IN CHINA 1. 2. VISITED WITH HUNDREDS OF LEADERS IN THE HEALTHCARE INDUSTRY IN CHINA TO LEARN ABOUT HEALTHCARE REFORM IN CHINA – ITS PROGRESS, ITS PROBLEMS, AND ITS NEXT STEPS 3. VISITED WITH OVER 100 HOSPITALS TO GAIN AN UNDERSTANDING OF HOSPITAL OPERATIONS IN CHINA, THEIR CURRENT STATUS, AND OPPORTUNITIES FOR IMPROVEMENTS 4. VISITED WITH SEVERAL PROVINCIAL AND CITY HEALTH BUREAUS TO LEARN WHAT THEIR GOALS ARE FOR THEIR PROVINCIAL AND CITY HOSPITALS 5. VISITED SOME PRIVATE HOSPITALS TO OBSERVE THE RESULTS OF HEALTHCARE REFORM PRIVATIZATION EFFORTS IN CHINA 6. VISITED WITH COMPANIES SELLING PRODUCTS AND SERVICES TO THE HEALTHCARE INDUSTRY IN CHINA AND WHAT THEY BELIEVE ARE APPROPRIATE NEXT STEPS FOR REFORMING THE CHINESE HEALTHCARE SYSTEM 7. EVALUATED A GROUP OF HOSPITAL MANAGEMENT AND OWNERSHIP OPPORTUNITIES THAT WERE PRESENTED TO THE DORENFEST GROUP TO BECOME MORE FAMILIAR WITH THE ALTERNATIVE WAYS TO PROCEED IN BUILDING A “MODEL HOSPITAL” IN CHINA 8. GRACE YU VISITED 17 CITIES IN CHINA DEVELOPED A STRATEGY FOR BRINGING DORENFEST SKILL AND EXPERIENCE TO CHINA 4 THE DORENFEST CHINA HEALTHCARE GROUP

THE DORENFEST GROUP VISION FOR CREATING A MODEL HOSPITAL IN CHINA l l OPERATES THE DORENFEST GROUP VISION FOR CREATING A MODEL HOSPITAL IN CHINA l l OPERATES AT A HIGHLY EFFICIENT LEVEL THROUGH EFFECTIVE USE OF MANAGEMENT SYSTEMS AND BETTER WORK PROCESSES l OFFERS ITS SERVICES TO PATIENTS AT AN AFFORDABLE COST l CREATES A HIGHLY SATISFIED PATIENT POPULATION WITH THE PATIENTS OBSERVING A NOTICEABLE IMPROVEMENT IN THE SERVICES AND TREATMENTS PROVIDED BY THE HOSPITAL l GRACE YU PROVIDES IMPROVED QUALITY OF CARE TO ITS PATIENTS UTILIZES APPROPRIATE DIGITAL TECHNOLOGY TO CREATE A STATE OF THE ART “DIGITAL HOSPITAL” 5 THE DORENFEST CHINA HEALTHCARE GROUP

THE DORENFEST GROUP CHINA BUSINESS OPERATIONS l RECENTLY COMPLETED PHASE I PROJECT TO HELP THE DORENFEST GROUP CHINA BUSINESS OPERATIONS l RECENTLY COMPLETED PHASE I PROJECT TO HELP SHENZHEN HEALTH BUREAU PLAN ITS REGIONAL HEALTH NETWORK AND DIGITAL HOSPITAL PROJECTS l RECENTLY TAUGHT A COURSE FOR HOSPITAL PRESIDENTS AT CEIBS (CHINA EUROPEAN INTERNATIONAL BUSINESS SCHOOL) ON HOSPTIAL WORK PROCESSES MANAGEMENT AND I. T. MANAGEMENT l CURRENT ACTIVITIES INCLUDE: – – CREATING OTHER PROJECT ACTIVITIES – REVIEWING CANDIDATES TO IMPLEMENT MODEL HOSPITAL VISION – DEVELOPING PARTNERING RELATIONSHIPS TO DELIVER SERVICES – GRACE YU BUILDING A MANAGEMENT TEAM REVIEWING SOFTWARE SYSTEMS IN CHINA AND OTHER COUNTRIES TO DEFINE THE BEST SOFTWARE AVAILABLE TO PARTNER ON I. T. PROJECTS FOR CHINA HOSPITAL CLIENTS 6 THE DORENFEST CHINA HEALTHCARE GROUP

HIMSS 2007 OVERVIEW OF CHINESE HEALTHCARE SYSTEM GRACE YU 7 THE DORENFEST CHINA HEALTHCARE HIMSS 2007 OVERVIEW OF CHINESE HEALTHCARE SYSTEM GRACE YU 7 THE DORENFEST CHINA HEALTHCARE GROUP

HEALTHCARE COST AS A PERCENT OF GDP ($ AND RMB IN BILLIONS) 5. 55% HEALTHCARE COST AS A PERCENT OF GDP ($ AND RMB IN BILLIONS) 5. 55% $97. 0 (759 RMB) Government Social Insurance Out-of-pocket 5. 62% $84. 9 (658 RMB) 5. 51% $74. 7(579 RMB) 5. 13% $59. 1(458 RMB) 3. 69% $27. 8(215 RMB) 4. 03% $9. 6(74 RMB) 3. 17% $1. 8(14 RMB) GRACE YU 8 THE DORENFEST CHINA HEALTHCARE GROUP

HEALTHCARE COST AS A PERCENT OF GDP ($ AND RMB IN BILLIONS) 9. 00% HEALTHCARE COST AS A PERCENT OF GDP ($ AND RMB IN BILLIONS) 9. 00% $356. 0 (2759 RMB) Government Social Insurance Out-of-pocket 7. 00% $276. 9 (2146 RMB) 5. 7% $154. 1 (1193 RMB) 5. 13% 3. 17% $1. 8 (14 RMB) 4. 03% $9. 6 (74 RMB) 3. 69% $27. 8 (215 RMB) $59. 1 (458 RMB) 5. 51% $74. 7 (579 RMB) 5. 55% 5. 62% $84. 9 (658 RMB) $97. 0 (759 RMB) Forecast GRACE YU 9 Forecast at 7% of GDP Forecast at 9% of GDP THE DORENFEST CHINA HEALTHCARE GROUP

MAJOR CHARACTERISTICS OF THE CHINESE HEALTHCARE SYSTEM l l PATIENTS PAY A LARGE PERCENTAGE MAJOR CHARACTERISTICS OF THE CHINESE HEALTHCARE SYSTEM l l PATIENTS PAY A LARGE PERCENTAGE OF THE HEALTHCARE BILL THAN ANY OTHER COUNTRIES. l CHINA HEALTHCARE SYSTEM HAS THE LOWEST GOVERNMENT SPENDING THAN ANY OTHER COUNTRIES. l PAYMENTS ARE MADE BEFORE SERVICE IS DELIVERED. l PRICE FOR MEDICAL SERVICES FROM DOCTORS AND NURSES ARE VERY LOW. l HIGH DRUG COST AND DIAGNOSTIC TESTS ARE MAJOR CONTRIBUTORS TO THE INCREASING HEALTHCARE EXPENSES l LESS THAN 30% OF THE POPULATION HAS HEALTH INSURANCE. l GRACE YU THE CHINESE HEALTHCARE SYSTEM IS A LOW COST SYSTEM AND IS A EFFICIENT SYSTEM. CHINESE HOSPITALS HAVE PATIENT SERVICE AND QUALITY PROBLEMS 10 THE DORENFEST CHINA HEALTHCARE GROUP

AVERAGE MEDICAL EXPENSE PER OUTPATIENT IN HOSPITALS ($) Medical Services Exam/Test Drug $16 (126 AVERAGE MEDICAL EXPENSE PER OUTPATIENT IN HOSPITALS ($) Medical Services Exam/Test Drug $16 (126 RMB) $15 (118 RMB) $11(85 RMB) $5 (39 RMB) GRACE YU 11 THE DORENFEST CHINA HEALTHCARE GROUP

AVERAGE MEDICAL EXPENSE PER INPATIENT IN HOSPITALS ($) $601 (4661 RMB) Medical Services Exam/Test AVERAGE MEDICAL EXPENSE PER INPATIENT IN HOSPITALS ($) $601 (4661 RMB) Medical Services Exam/Test Drug $552(4284 RMB) $397(3083 RMB) $215(1667 RMB) GRACE YU 12 THE DORENFEST CHINA HEALTHCARE GROUP

HIGH DRUG COST AND DIAGNOSTIC TESTS ARE MAJOR CONTRIBUTORS TO THE INCREASING HEALTHCARE EXPENSES HIGH DRUG COST AND DIAGNOSTIC TESTS ARE MAJOR CONTRIBUTORS TO THE INCREASING HEALTHCARE EXPENSES l l DURING THE 1980 S AND 1990 S, GOVERNMENT SUBSIDIES TO HOSPITALS FELL FROM 50% TO 10%. l HOSPITALS WERE MADE RESPONSIBLE FOR THEIR PROFITS AND LOSSES. l HOWEVER, THE GOVERNMENT CONTINUES TO SET FEES FOR MEDICAL SERVICES, AND FEES FOR MEDICAL SERVICES OF DOCTORS AND NURSES REMAIN WELL BELOW COST. FOR INSTANCE, A NORMAL PHYSICIAN CONSULTATION FEE IS $1 -2$ (7 RMB – 14 RMB). l GOVERNMENT ALLOWS HOSPITALS TO MARK UP THE PRICE OF PRESCRIPTION DRUGS BY ABOUT 15%. PROFIT OF DRUGS OFFSET THE LOSS OF SERVICES. IT ALSO MOTIVATES OVERPRESCRIBING DRUGS. l FEES FOR HIGH TECH DIAGNOSTIC TESTS ARE SET WELL ABOVE COST. l GRACE YU REVENUE FROM THE SALE OF DRUGS CONSTITUTES 50% OF HOSPITAL’S REVENUE. THEREFORE, HOSPITALS RELY ON OVER-PRESCRIBING DRUGS AND DIAGNOSTIC TESTS FOR MAKING PROFIT. 13 THE DORENFEST CHINA HEALTHCARE GROUP

HEALTH INSURANCE l l NATIONAL SOCIAL INSURANCE PROGRAM FOR URBAN EMPLOYEES WAS ESTABLISHED IN HEALTH INSURANCE l l NATIONAL SOCIAL INSURANCE PROGRAM FOR URBAN EMPLOYEES WAS ESTABLISHED IN 1998. BY 2005, IT COVERS 130 MILLION URBAN EMPLOYEES. IN ADDITION, 50 MILLION PEOPLE HAVE GOVERNMENT INSURANCE. l IN RURAL AREAS, ONLY SOME AFFLUENT VILLAGES CAN AFFORD TO PARTICIPATE IN THE NEW COLLECTIVE HEALTH INSURANCE. IT NOW COVERS 170 MILLION RURAL RESIDENTS. BUT THE BENEFIT LEVEL IS VERY LOW. l GRACE YU LESS THAN 30% OF THE POPULATION HAS HEALTH INSURANCE. MORE THAN 1 BILLION PEOPLE ARE NOT INSURED -- 40% OF URBAN AND 87% OF RURAL INDIVIDUALS. PRIVATE HEALTH INSURANCE IS VERY LIMITED. 14 THE DORENFEST CHINA HEALTHCARE GROUP

CHALLENGES OF THE CHINESE HEALTHCARE SYSTEM l l DIFFICULT ACCESS TO HEALTHCARE l LACK CHALLENGES OF THE CHINESE HEALTHCARE SYSTEM l l DIFFICULT ACCESS TO HEALTHCARE l LACK OF HEALTH INSURANCE l CONSUMER DISSATISFACTION l DETERIORATING DOCTOR-PATIENT RELATIONSHIP l DOCTORS TAKE BRIBES OR “RED ENVELOPES” FROM DRUG COMPANIES l OVER-PRESCRIBING OF DRUGS AND TESTS l PUBLIC HOSPITALS HAVE STRONG TENDENCIES TO MAKE PROFIT FROM PATIENTS l GRACE YU RISING COST OF HEALTHCARE LACK OF A PRIMARY CARE SYSTEM 15 THE DORENFEST CHINA HEALTHCARE GROUP

A NEW DIRECTION OF HEALTHCARE REFORM STRATEGY WILL BE FINALIZED IN 2007 l COMMUNITY A NEW DIRECTION OF HEALTHCARE REFORM STRATEGY WILL BE FINALIZED IN 2007 l COMMUNITY HEALTH SERVICES l RURAL COOPERATIVE HEALTHCARE WITH BASIC HEALTH SERVICES FOR ALL RURAL POPULATION l CONTINUE TO IMPROVE PUBLIC HOSPITAL MANAGEMENT l BUILD INTEGRATED HEALTHCARE DELIVERY SYSTEM l l GRACE YU HEALTH INSURANCE PRODUCTS REFORM THE PHARMACEUTICAL INDUSTRY 16 THE DORENFEST CHINA HEALTHCARE GROUP

HIMSS 2007 OVERVIEW OF H. I. T. STATUS IN CHINA GRACE YU 17 THE HIMSS 2007 OVERVIEW OF H. I. T. STATUS IN CHINA GRACE YU 17 THE DORENFEST CHINA HEALTHCARE GROUP

CURRENT STATUS OF THE USE OF I. T. IN HEALTHCARE l l CHINA CURRENTLY CURRENT STATUS OF THE USE OF I. T. IN HEALTHCARE l l CHINA CURRENTLY SPEND A LITTLE OVER 0. 5% OF ITS NATIONAL HEALTH EXPENSES ON H. I. T. ($700 MILLION). l 70% OF H. I. T. SPENDING IS FOR HARDWARE, 20% FOR SOFTWARE, AND 10% FOR SERVICES. l MOST HOSPITALS IN CHINA USE I. T. SOFTWARE FOR FINANCIAL SYSTEMS l I. T. USE IN CLINICAL SYSTEMS HAS EMERGED ON A DEPARTMENTAL BASIS l CHINA HOSPITAL WORK PROCESSES ARE REDUNDANT AND ERROR PRONE WITH GREAT OPPORTUNITIES FOR IMPROVEMENT THROUGH APPROPRIATE USE OF I. T. l GRACE YU CHINA HEALTHCARE AND I. T. USE HAS SIMILARITIES TO THE U. S. IN THE 1970 S POOR INTEGRATION OF DIVERSE SOFTWARE SYSTEMS CREATES PROBLEMS AS I. T. USE EXPANDS 18 THE DORENFEST CHINA HEALTHCARE GROUP

CHINESE HOSPITALS TAKE A BIG LEAP FORWARD IN DIGITIZING ITS HOSPITALS. l l WHEN CHINESE HOSPITALS TAKE A BIG LEAP FORWARD IN DIGITIZING ITS HOSPITALS. l l WHEN WE FIRSTED STARTED OUR WORK IN CHINA, VERY FEW HOSPITALS CONSIDER OF UPGRADING THEIR I. T. SYSTEM. NOW MANY HOSPITALS ARE CONSIDERING MAJOR UPGRADES OF I. T. SYSTEMS l BIG BUDGETS ARE STARTING TO BECOME AVAILABLE TO MOVE TOWARD DIGITAL HOSPITALS WITH ELECTRONIC MEDICAL RECORDS, PACS AND OTHER SYSTEMS l GRACE YU THE MINISTRY OF HEALTH’S GUIDELINES FOR HEALTH I. T. DEVELOPMENT (2003 -2010) CALLS FOR ELECTRONIC MEDICAL RECORDS AND REGIONAL HEALTH NETWORKS TO BE IMPLEMENTED PROVIDING MUCH MOMENTUM FOR HOSPITALS AND HEALTH BUREAUS TO INVEST MORE IN I. T. NOW BUT WEAK APPLICATION SOFTWARE AND IMPLEMENTATION SKILLS ARE DELAYING PROGRESS 19 THE DORENFEST CHINA HEALTHCARE GROUP

CHINESE SOFTWARE IS IN ITS INFANCY l l SOFTWARE VENDORS ARE NOT AS EXPERIENCED CHINESE SOFTWARE IS IN ITS INFANCY l l SOFTWARE VENDORS ARE NOT AS EXPERIENCED IN HEALTHCARE SOFTWARE AS VENDORS IN THE REST OF THE WORLD. PROVEN PRODUCTS FOR EHR DO NOT YET EXIST. l SOME HOSPITALS HAVE ACCOMPLISHED MORE ADVANCED SYSTEMS WITH MUCH CLINICAL FUNCTION AUTOMATED USUALLY THROUGH USE OF SELF-DEVELOPED SOFTWARE l THERE IS A STRONG NEED FOR GOOD HOSPITAL SOFTWARE IN CHINA. l CHINA WILL BE A LARGE MARKET FOR SOFTWARE IN HEALTHCARE. l GRACE YU THE HARDWARE AND NETWORKING CAPABILITY AVAILABLE TO HOSPITALS IN 2005 IS MUCH BETTER THAN IT WAS IN 1970 S IN THE U. S. BUT SOFTWARE AVAILABLE FOR CHINESE HOSPITALS TO AUTOMATE CLINICAL PROCESSES IS IN ITS INFANCY THERE IS ALSO CONCERN AMONG HOSPITAL PRESIDENTS IN CHINA ABOUT THE IMPLEMENTATION SKILL AND EXPERIENCE AVAILABLE IN CHINA TO TAKE THIS BIG LEAP FORWARD THAT IS NOW UNDERWAY 20 THE DORENFEST CHINA HEALTHCARE GROUP

OPPORTUNITIES FOR H. I. T. DEVELOPMENT IN CHINA l l MORE USE OF I. OPPORTUNITIES FOR H. I. T. DEVELOPMENT IN CHINA l l MORE USE OF I. T. IN HOSPITAL MANAGEMENT l DIGITAL HOSPITALS WITH ELECTRONIC HEALTH RECORDS l REGIONAL HEALTH NETWORKS l SYSTEM INTEGRATION l MORE USE OF CONSULTANTS IN I. T. PLANNING AND IMPLEMENTATION l GRACE YU MORE USE OF I. T. IN CLINICAL SERVICES MORE STANDARDS TO SUPPORT I. T. PROGRESS 21 THE DORENFEST CHINA HEALTHCARE GROUP

THANK YOU. FOR MORE INFORMATION CONTACT: GRACE YU THE DORENFEST CHINA HEALTHCARE GROUP JINGHAI THANK YOU. FOR MORE INFORMATION CONTACT: GRACE YU THE DORENFEST CHINA HEALTHCARE GROUP JINGHAI ROAD NO. 3288, BUILDING 4, SUITE 3302 PUDONG, SHANGHAI PHONE: 021 -62791336 WEB SITE ADDRESS: www. dorenfest. com E-MAIL ADDRESS: [email protected] com GRACE YU 22 THE DORENFEST CHINA HEALTHCARE GROUP