By Qiu Hui

A rapidly aging population raises demand for professional assistance

Most of Liu Shanshan’s days begin with wake-up calls from strangers. At 6:30 one morning, she woke to an anxious call from the mother of an 18-monthold with a fever. The mother asked Liu about the possibility of hospital services because of Liu’s history of helping patients secure outpatient assistance.

Liu has received an average of 40 to 50 similar calls from strangers every day over the last two months. Callers typically ask her a variety of questions related to hospital services including appointments, registration, insurance, reimbursement, and family doctors. After noticing business opportunities in sophisticated procedures mandated by various hospitals, Liu started her own “outpatient assistance” business.

New Profession

Liu Shanshan fell into the outpatient assistance profession accidentally.

Previously, she was a business manager in a hotel in Beijing. The COVID-19 pandemic devastated the hotel industry so much in 2020 that recovery seemed far away. Her husband’s overseas sales numbers also started shrinking. The couple made the difficult decision to quit their jobs and return to their hometown of Shenyang, capital of Liaoning Province in northeastern China.

In northeastern China, population aging is a pressing issue. Senior care has emerged as a booming and profitable industry. However, getting involved still required a substantial investment. Liu set aside her ambitions to get involved in senior care.

Liu never intended to become an outpatient assistant either. It came about due to experience acquired by visiting a hospitalized relative in Shenyang. The relative was from a neighboring city. His daughter couldn’t leave her job and travel all the way to Shenyang to stay with him. She asked Liu and her husband for assistance.

The grueling week-long experience in hospital with her relative helped Liu realize that seniors had major problems visiting hospitals without help.

She began to observe hospital procedures. She saw how difficult it was for elderly patients to keep up with the latest technology applications used in hospitals. They were often confused with how to download a hospital app, how to register online, and how to print medical records.

Liu started wondering about the possibility of professional assistance to solve such problems. She began to brainstorm the idea heavily.

China is home to 190 million elderly people, many of whom suffer from chronic diseases, according to China’s National Health Commission. They tend to visit hospitals regularly to receive medical advice, treatment, or surgery. A survey showed that more than 70 percent of the elderly living apart from their children had to visit hospitals on their own.

Liu started believing that outpatient assistance would be a promising business. In April 2021, she registered her company as “An’an Outpatient Escort Services.”

She simply sought to improve senior mobility. After conducting market research, Liu set the price for her service at 198 yuan (US$30) for four hours and 298 yuan (US$45) for eight hours. During this time, she would help patients see doctors and receive check-ups in maze-like hospitals.

After conducting market research, Liu set the price for her service at 198 yuan (US$30) for four hours and 298 yuan (US$45) for eight hours.

“Many people don’t understand what we do,” said Liu. She starts the service clock the moment she receives a case. Most clients are seniors with a single child who lives in another city. She is often first contacted by the son or daughter living far away. She reminds clients to prepare for upcoming hospital visits and ensures they bring ID and health insurance cards. Before leaving home, she becomes oriented with the hospital by studying the layout. During visits, she stays with clients as they see doctors to ensure the advice and prescriptions are received and feedback can be relayed to the children.

Unusual ‘Business’

As she did more and more visits, Liu began to detect the changes in her clients’ attitudes. She once got a call about a lady with kidney stones. The patient was in her 50s and childless, and her nephew made the call to Liu from his work desk in another city.

During the first hospital visit when the woman discovered Liu’s role, she went quiet. “She felt all alone and thought I was just another nameless face,” recalled Liu. Tears welled in the woman’s eyes. She explained her duty to the patient in detail and tried to calm her down. After some time, the woman got in a better mood. After getting dropped off, she asked Liu to accompany her on future visits.

Patients in a queue at the cashier’s desk of a hospital in Beijing, August 11, 2021. (VCG)

Liu Shanshan at work.

Outpatient assistance is no easy job. Alongside keeping clients company during hospital visits, Liu also provides patients with psychological support. Running the business for half a year gave Liu considerable experience. She now brings an emergency medical kit in her backpack. She has all the information and features of Shenyang’s hospitals memorized as well as procedures for medical check-ups such as Type B ultrasonics, gastroscopes, and blood tests.

Liu divided her entrepreneurial process into two stages:soft opening and fully active. During the soft opening, she received one or two orders per day, hardly enough to be sustainable.

Later, a media interview of her encouraged many more potential customers to learn about the new business form. Liu’s business entered the active stage as her phone started ringing early each morning. About 80 percent of calls were inquiries about what services they could offer. However, about one out of 10 placed orders for service, which was not bad for a start-up.

Liu rented an office near two major Shenyang hospitals. She was confident that the monthly rent of 2,000 yuan (US$310) would be a “profitable investment” because a dedicated office would make her business look more legitimate.

Growing Industry

Actually, outpatient assistance is far from a brand new thing. Early in 2003, some domestic service companies in Harbin started providing services for the empty nest elderly, helping outpatient assistance emerge in China.

In 2015, the new profession received a development boost when several O2O outpatient assistance companies received financial support. However, development went stagnant due to policy and market constraints.

The threshold to engage in the industry is not high. Institutions and individuals share equal opportunity to secure a piece of the niche market. On some consumption platforms, searching “outpatient assistance” will result in too many choices.

Since launching her outpatient escort service platform in April 2021, Liu Shanshan’s team has grown to three full-time and seven part-time employees. Today, Liu has become more focused on communication and training. Without unified norms and standards, practitioners depend heavily on acquiring experience through practice. Liu requires her employees to have detailed information on the destination hospital and make specific plans for each task. To ensure hospital visits are more comfortable and effective, assistants are expected to prioritize the sequence of events.

China’s 2021 government work report called for efforts to “advance comprehensive reform of public hospitals, expand trials on setting up national medical centers and regional medical centers, strengthen the ranks of general practitioners and rural doctors, and improve the capacity of medical services at the county level.” The document indicated that the tiered diagnosis and treatment system would develop at a faster pace.

During the 14th Five-Year Plan period (2021-2025), China will enter a stage of rapid population aging with more than 300 million people aged 60 or above. Recent construction and improvement of the urban and rural medical service networks has made it easier for seniors to see doctors, but room for improvement remains.

Although the industry threshold doesn’t seem high, practitioners take the profession quite seriously. “You have to be curious and patient,” said Liu. “Elderly clients usually need more emotional comfort while younger clients just want company.”

Liu has ambitions to regularize the industry. She hopes her wealth of experience helps contribute to the establishment of professional standards. She is fully aware that the sector is still nascent. “I want to help more people understand what we’re doing,” she said.