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Exploring modes for digital medical services in rural areas

SHI JIE | 2022-04-28 | Hits:
Chinese Social Sciences Today

FILE PHOTO: Medical digitization developes rapidly in China while it also faces challenges.

Before the advent of the information era, data within the traditional medical system was delivered and transmitted in a slow, incomplete way without a uniform standard. Large “information silos” have been formed as a result, which requires intervention from medical professionals in the decision making process to make up for the data system’s deficiencies. This creates unnecessarily simple and redundant work for doctors. Since the early 1980s, digitization of the medical service system, as part of the welfare system, has been on the fast track for development. Over the last over 30 years, the digitization of medical systems, internationally, can be divided into three stages.
Three stages of medical digitization 
The first stage focused on digitization of medical agencies in a fundamental way. In America, a cooperative mode was adopted, with joint efforts by the governments and transnational corporations. The US selected four leading global information technology manufacturers to be the system integrators and studied the collaboration mode between different medical systems, including electronic health records. The UK, Canada, Australia, and other countries, also invested heavily in medical digitization both on national and local levels. 
The second stage put great emphasis on internal efficiency within the medical system. The third stage is the post-COVID-19 pandemic era, and digitization efforts are attempting to integrate the medical system with public management. The medical concept has transformed and early warnings, treatment, and medical research and development are being incorporated into the system. 
Opportunities and challenges 
Compared with digital medical services in rural areas of developed countries, China has faced both opportunities and challenges.
With the rapid progress of urbanization in China, the continuous reduction of rural populations and structural changes that come with it will greatly impact the rural public medical service system. It is difficult to pursue full medical digitization coverage across rural areas and to hope for balance and comprehensiveness. Given the limited current medical service resources, expanding the scale of single medical facilities would mean reduced amounts of the overall facilities and would constrict possible service area coverage by these limited facilities. This challenge has become one of the major difficulties in improving rural medical services in China.
China’s rural population structure continues to change in the long run. Since the elderly population is still expanding, and many young and middle-aged people have chosen to migrate to cities, the issue of combining medical care and elderly care services should be put at the top of the agenda soon. At present, the concept of preventive treatment of diseases, as a precautionary measure, has not been effectively reflected in rural China, and the problem that health data has not been effectively used for the elderly remains to be solved. 
The overall scale and scope of the digital medical system in rural areas still needs to be expanded. Conditions to promote digitization in large hospitals within big cities already exist. For example, digital medical services and treatment have played a crucial role in the fight against COVID-19 and valuable experiences have been accumulated in this aspect. In the prevention and control of the virus, digitization has improved doctors’ diagnosis efficiency and optimized the treatment process for patients. In this way, remote sharing of medical resources and real-time information communication has been realized, and double results have been achieved with half the effort—which effectively blocked the spread of virus while alleviating shortages of medical resources and personnel.
Past and present of medical reform
Since 1978, China’s medical and health reform has gone through stages of exploration, reform, and deepening. It has transitioned and adjusted since SARS, and a new phase of medical digitization has been instigated by the fight against COVID-19. 
Especially after 2009, when equalized public health services started to be implemented, the fragmented mode of medical services, which had been formed since the reform and opening up, have been reversed. Many places across China have started to reform the health service system by creating medical consortiums (a combination of hospitals, community-based health service centers, and public health institutions with connectivity between them). 
Since 2015, policies such as the tiered diagnosis and treatment model has been implemented, and local hospitals were encouraged to pilot such models for treating hypertension and diabetes. Each stage of exploration has its distinctive features, and in general, changes have focused on big cities and big hospitals. In addition, past medical and health services were subordinate to our overall strategy of economic and social development, but in the future, the guiding principle of medical and health reform should be to promote the integration of urban and rural areas and a national public service system—without distinction.
Shi Jie is a research fellow from the Institute of Industrial Economics at the Chinese Academy of Social Sciences. 



Edited by BAI LE