中美科技巨头的较量，在医保领域开拓疆土

Amazon and two other American titans are trying to shake up health care by experimenting with their own employees’ coverage. By Chinese standards, they’re behind the curve.

亚马逊(Amazon)和另外两家美国巨头正在试图通过试验自己员工的医保范围来改变医保现状。按照中国的标准，它们落后了。

Technology companies like Alibaba and Tencent have made health care a priority for years, and are using China as their laboratory. After testing online medical advice and drug tracking systems, they are now focused on a more advanced tool: artificial intelligence.

阿里巴巴和腾讯等科技公司多年来一直把医保放在优先地位，把中国当成自己的实验室。在试验了在线医疗咨询和药物追踪系统后，它们现在专注于一个更先进的工具：人工智能。

Their aggressive push underscores the differences between the health care systems in China and the United States.

他们的积极努力突显出中美两国医保制度的不同。

Chinese hospitals are overburdened, with just 1.5 doctors for every 1,000 people - barely half the figure in the United States. Along with a rapidly aging population, China also has the largest number of obese children in the world, as well as more diabetes patients than anywhere else.

中国的医院负担过重，医患比例为1.5比1000，几乎是美国的一半。除了人口迅速老龄化，中国还拥有全世界人数最多的肥胖儿童和糖尿病患者。

The companies’ technological push is encouraged by the government. Beijing has said it wants to be a leader in A.I. by 2030 and pledged to take on the United States in the field. While officials have emphasized the use of artificial intelligence in areas like defense and self-driving cars, they have also aggressively promoted its use in health care.

这些公司的技术推进得到了政府的鼓励。北京已表示，它想在2030年前成为人工智能领域的领军者，并誓言要与美国在这一领域展开较量。尽管官员们强调在国防和无人驾驶汽车等领域使用人工智能，他们也积极推动它在医保领域的应用。

Alibaba and Tencent, which already dominate China’s e-commerce and mobile payments sectors, are at the forefront. Among their goals: building diagnostic tools that will make doctors more efficient.

阿里巴巴和腾讯已经成为中国电子商务和移动支付领域的领头羊，同时也站在人工智能领域的前沿。它们的目标包括：创造能够提高医生效率的诊断工具。

Amazon and its partners, JPMorgan Chase and Berkshire Hathaway, see technology as a way to provide simplified, affordable medical services. Although the alliance is still in the early stages, it could create online services for medical advice or use its overall heft to negotiate for lower drug prices.

亚马逊及其合作伙伴摩根大通(JPMorgan Chase)和伯克希尔-哈撒韦公司(Berkshire Hathaway)将技术视为提供简化的、负担得起的医疗服务的一种方式。尽管该联盟尚处于起步阶段，但它可以创建在线医疗咨询服务，或者利用其整体影响力来协商降低药品价格。

“It’s fair to say that across the board, the Chinese tech companies have all embraced being involved in and being active in the health care space, unlike the U.S., where some of them have and some have not,” said Laura Nelson Carney, an Asia-Pacific health care analyst at Bernstein Research.

“公平地说，总体来讲，中国的科技公司都积极参与医疗保健领域，不像美国，有些公司积极，有些不积极，”伯恩斯坦研究公司(Bernstein Research)的亚太医保分析师劳拉.尼尔森.卡尼(Laura Nelson Carney)表示。

“Few of them have made moves as big as in China,” Ms. Carney said, referring to Alibaba and Tencent’s American rivals.

“它们中很少有谁采取中国公司这么大的动作，”卡尼说。她指的是阿里巴巴和腾讯的美国竞争对手。

Those big moves have had varying degrees of success.

这些重大举措取得了不同程度的成功。

In 2014, Alibaba announced a “future hospital” plan intended to make treatment more efficient by allowing patients to consult with doctors online and order drugs via the internet. But two years later, Chinese regulators stopped the sale of over-the-counter drugs on Tmall, Alibaba’s e-commerce website. They also suspended a drug-monitoring system that the company had created. And last year, the search engine company Baidu scrapped its internet health care service, which allowed patients to book doctors appointments through an app, in a bid to focus solely on A.I.

2014年，阿里巴巴宣布了“未来医院”计划，患者可以在线咨询医生，并通过互联网订购药品，从而提高医疗效率。但两年后，中国的监管机构禁止阿里巴巴的电子商务网站天猫销售非处方药。他们还暂停了该公司创建的药物监控系统。去年，搜索引擎公司百度为了把精力集中在人工智能上，取消了自己的互联网医疗服务，该服务帮助患者通过一款应用程序预约医生。

But some of the more recent initiatives have made inroads. Last year, Alibaba’s health unit introduced A.I. software that can help interpret CT scans and an A.I. medical lab to help doctors make diagnoses. About a month later, Tencent unveiled Miying, a medical imaging program that helps doctors detect early signs of cancer, in the southwestern region of Guangxi. It is now used in nearly 100 hospitals across China.

不过，最近的一些举措已经取得了进展。去年，阿里巴巴的健康部门推出了一个可以帮助解释CT扫描结果的人工智能软件，以及一个可以协助医生进行诊断的人工智能医疗实验室。大约一个月后，腾讯公布了自己的医疗成像计划“觅影”，它帮助广西西南部地区的医生发现癌症的早期迹象。目前，中国有近百家医院在使用它。

Tencent has also invested in WeDoctor Group, which has opened its own take on Alibaba’s “future hospital” in northwestern China. The service allows patients to video chat with doctors and fill their prescriptions online.

腾讯还投资了微医集团，该集团在中国西北部地区开设了自己的“未来医院”。患者可通过该服务与医生进行视频，并在线购买处方上的药。

Advances in artificial intelligence have already been transformative for China’s overworked doctors.

对于中国劳累过度的医生来说，人工智能的进步是变革性的。

Dr. Yu Weihong, an ophthalmologist at Peking Union Medical College Hospital, said she used to take up to two days to analyze a patient’s eyes by scrutinizing grainy images before discussing her findings with colleagues and writing up a report. Artificial intelligence software currently being tested by the hospital helps her do all that dramatically faster.

北京协和医院的眼科医生于伟泓博士表示，过去，她常常要花两天时间分析病人的眼睛，仔细查看模糊的图像，与同事讨论她的发现，然后写报告。该医院目前正在试用的人工智能软件能极大加快她完成这些工作的速度。

“Now, you don’t even need a minute,” she said.

“现在，一分钟应该都不用，”她说。

The software has been developed by VoxelCloud, a start-up has raised about $28.5 million from companies including Tencent and the Silicon Valley venture capital firm Sequoia Capital. It specializes in automated medical image analysis, helping eye doctors like Dr. Yu screen patients for diabetic retinopathy, the leading cause of blindness among China’s working-age population.

该软件由体素科技开发，该公司从腾讯和硅谷风险投资公司红杉资本(Sequoia capital)等处筹集了约2850万美元。它专门从事医学图像自动分析，帮助于伟泓这样的眼科医生筛查糖尿病视网膜病变，这是中国劳动适龄人口失明的主要原因。

There are just 20 eye doctors for every million people here, a third of the proportion in the United States. In April, Beijing announced an ambitious plan for the country’s 110 million diabetics to undergo eye tests.

在这里，每100万人只有20名眼科医生，是美国的三分之一。4月，北京宣布了一个宏伟的计划，要让中国1.1亿糖尿病患者接受眼科检查。

“It’s impossible for one person to read that many images,” said Dr. Yu.

“那不可能有人去读这么多的片子，”于博士说。

Ding Xiaowei, whose grandparents were doctors, founded VoxelCloud in 2016, three months after completing his doctorate in computer science at U.C.L.A. The company, which has offices in Los Angeles and the Chinese cities of Shanghai and Suzhou, is awaiting the green light from China’s version of the F.D.A. for five diagnostic tools for CT scans and retina disease.

2016年，爷爷奶奶都是医生的丁晓伟在完成加州大学洛杉矶分校(UCLA)计算机科学博士学位三个月后创办了VoxelCloud。该公司在洛杉矶和中国的上海与苏州设有办事处，目前正在等待中国的药品监管机构批准五个CT扫描和视网膜疾病的诊断工具。

The sheer size of China’s population - nearly 1.4 billion people who could provide a vast number of images to feed into their systems - provides a potential advantage for the development of artificial intelligence. Also helping: China has fewer concerns about privacy, allowing for easier collection of data that could result in smarter and more efficient A.I. systems. Regulation here isn’t as strict as in the United States, either.

中国人口接近14亿，可为这些系统提供足够的影像。庞大的人口规模为人工智能的发展提供了一个潜在的优势。有利的条件还包括：中国不太关心隐私，这降低了收集数据的难度，从而使人工智能系统更加智能和高效。此外，中国的监管也不像美国那么严格。

In all, more than 130 companies are applying A.I. in ways that could increase the efficiency of China’s health care system, according to Yiou Intelligence, an industry consultancy based in Beijing. They range from behemoths like Alibaba and Tencent to domestic champions iFlyTek, which invented a robot that passed a Chinese medical licensing exam, and an array of smaller start-ups.

据设在北京的行业咨询机构亿欧智库称，目前总共有130多家企业在利用人工智能提高中国医疗保健系统的效率。其中既有阿里巴巴和腾讯这样的巨头，也有在国内领先的iFlyTek和大量小创业公司。iFlyTek发明的机器人通过了中国的医疗从业资格考试。

Money is flowing in. As of last August, venture capitalists such as Sequoia and Matrix Partners had invested at least $2.7 billion in such businesses, according to Yiou. Analysts at Bernstein estimated that spending in China’s health tech industry will reach $150 billion by 2020.

资金正在流入这个领域。据亿欧称，截至8月，红杉资本(Sequoia)和经纬创投(Matrix Partners)等风投机构已经在这类企业中投资了至少27亿美元。伯恩斯坦的分析师估计，到2020年，中国医疗科技行业的支出将达到1500亿美元。

Behind this push is a realization that the country’s health care system is in crisis. With no functioning primary care system, patients flock to hospitals in major cities, sometimes camping out overnight just to get treatment for a fever. Doctors are overworked, and reports of stabbings and assaults by frustrated patients and their relatives are not uncommon.

在这波浪潮的背后，是对中国的医疗保健系统正处于危机的认识。因为缺乏有效的初级护理系统，患者涌向大城市的医院，有时候露宿一晚只是为了治疗发烧。医生劳累过度，感到不满的病人和病人家属袭击医生的报道屡见不鲜。

Yunfeng, the personal investment fund of the Alibaba founder Jack Ma, has invested in one company, Yitu, that hopes to address the shortfall of resources. Yitu is working with Zhejiang Provincial People’s Hospital, the best medical facility in eastern Zhejiang province, to develop software that automates the identification of early stages of lung cancer.

阿里巴巴创始人马云个人的投资基金云峰投资了名为依图的公司。该公司希望解决资源短缺的问题，它正在与东部省份浙江最好的医疗机构浙江省人民医院合作，开发自动识别早期肺癌的软件。

While it initially focused on facial recognition, Yitu has branched out into more complex image-recognition challenges, like cancer scans. Lin Chenxi, who left Alibaba to establish the company in 2012, said he hoped to use the technology to ensure equal access to medical treatment across China.

尽管最初关注的是人脸识别，但依图已进入更复杂的影像识别领域，如癌症扫描。2012年离开阿里巴巴创立该公司的林晨曦说，他希望利用这项技术确保中国各地实现平等的医疗服务。

“In China, medical resources are very scarce and unequally distributed so that the top resources are concentrated in provincial capitals,” he said. “With this system, if it can be used at hospitals in rural cities, then it will make the medical experience much better.”

“在中国，医疗资源非常稀缺，而且分布不均，最好的资源集中在省会城市，”他说。“有了这个系统，如果能在乡镇医院使用，会大大改善就医体验。”

Trying to identify cancer nodes - shifting black-and-white splotches that look something like a Rorschach test - is grueling work, and China’s doctors have far less time and resources than their counterparts in the United States and elsewhere. Gong Xiangyang, the head of the hospital’s radiology department, likened the process to a factory, where burnout and mistakes from overwork can happen.

努力发现癌结节--四处移动的黑白斑点，看起来有点像罗夏测验--是一项艰苦的工作，而中国医生的时间和资源远少于美国和其他地方的同行。浙江省人民医院放射科主任龚向阳把这个过程比作工厂，过度劳累可能会造成体力不支和出错。

“We have to deal with a vast amount of medical images everyday,” he said. “So we welcome technology if it can relieve the pressure while boosting efficiency and accuracy.”

“我们每天要看大量影像，”他说。“所以我们欢迎技术，如果它能减轻压力，同时提高效率的话。”