China’s "Internet Hospitals": How the World’s Largest Health System Went Digital
The groundbreaking nationwide model that made digital health part of everyday life in China, and what the rest of the world should be learning from it.
🩺 This is a Vital Signs post: series of essential explainers from China Health Pulse, where provide essential explainers on key contexts and trends shaping health in China today.
Over the past month, I’ve moved between a flurry of summits and conferences across London’s digital health circuit. At Apple HQ, engineers demoed new health-tracking sensors; at Google, researchers spoke about plans to integrate AI into community care. At Imperial College and the Francis Crick Institute, panellists debated digital twins, AI-driven drug discovery, augmented-reality surgery and next-generation biomarkers.
These places are arguably the shining pinnacles of Western innovation, where the frontier of medicine meets the optimism of technology. And onstage, the buzz was certainly palpable. Ministers from the Department of Health and NHS England innovation leads mingled with healthtech founders, policy advisers, venture capitalists and clinicians. Conversations spilled over from panels into corridors and drinks, each promising some breakthrough in interoperability, automation or patient engagement.
The same faces kept appearing across events: a small ecosystem of believers convinced that the right algorithm, partnership or pilot could fix what politics cannot. Topics repeated in different accents, and from different angles: how to integrate large language models safely, how to fund data infrastructure, how to avoid clinician burnout. The vision is very much real, but frustration and fatigue persists behind the enthusiasm.
Because looking closer, most of these conversations still circled frustratingly around pilots: controlled environments, small-scale projects, “future” trials. Theword “implementation” is often followed by knowing looks, or else a sigh, and the gap between what’s being imagined and what’s actually happening remains vast. Procurement cycles crawl, and promising pilots struggle to survive contact with real patients, real data and real budgets. One policy analyst joked that Western digital health suffers from a chronic condition called “pilot-itis” – it’s an uncomfortably accurate diagnosis.
The everyday reality of our health systems tells a different story, and everyone in those conference rooms admits it. Anyone who has tried to book an appointment or chase a blood test result in the UK’s National Health Service, knows how far “digital transformation” still feels from daily life.
Despite billions invested, the NHS remains low on digital maturity. Waiting lists now exceed 7.6 million, and booking a GP appointment takes weeks. Even where e-portals exist, they often involve endless form-filling that leads back to a phone call rather than faster care. Over 80% of NHS trusts now have electronic records, but fewer than one in five are considered digitally advanced.
The UK’s gap between ambition and delivery is staggering, and across much of Europe and North America, the pattern repeats. Progress is real but patchy, with portals, apps and pilots layered awkwardly on top of old infrastructure.
There are bright spots. The US’s market-driven, albeit eye-wateringly expensive model, allows health chains like Kaiser Permanente to conduct more than half of outpatient consults virtually. And few European nations have achieved digital health integration: Finland’s geography and dispersed population made telemedicine a necessity, while Estonia rebuilt its post-Soviet institutions as a digital state by design. But nowhere else has governance been operationalised at such scale or speed.
The barrier has not been a lack of innovation at all. Instead, it’s the tangle of privacy debates, regulatory drag, siloed procurement and bureaucracy. Evolution is happening, but far too slowly, and digital layers grafted onto analogue foundations rather than a redesign of the system itself. The result is a structure that leaks efficiency, costing the system billions and patients precious time.
Now imagine something different: a patient scans a QR code on a mobile app, describes their symptoms, books a consult, receives an e-prescription and has medicines delivered within hours. Insurance claims, follow-up care and even preventive monitoring flow through the same online system.
It sounds futuristic - dystopian, even. And in the systems we know, it certainly feels miraculously unattainable. But for readers of this newsletter, it might sound a little familiar: because in China, it already exists.
China’s system is not pilot or prototype, but a whole-system digital revolution that is redefining what healthcare can look like when technology and policy move in the same direction, embedded across national infrastructure, and touching daily life at scale.
I recently launched the ChinaHealthPulse Podcast (subscribe on Spotify or Apple), and in the first episode, I spoke with Professor Tien-Yin Wong, who is working to build China’s first AI hospital - a potentially groundbreaking project that pushes the frontier of digital medicine.
But in today’s post, I want to step back and look at digital ecosystem that made such an idea possible in the first place. At the heart of it all, is the internet hospital.
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What is an “Internet Hospital”?
We all know that tele-health is not new. For decades, countries around the world have experimented with virtual consultations, from phone triage lines in the UK to remote clinics in the US and Nordic e-health platforms linking prescriptions and records nationwide. Yet these models have only changed access at the margins, digitise encounters and not systems.
China’s internet hospitals are something else entirely. Since the 2018 Internet + Healthcare regulation, they have been licensed digital counterparts of physical hospitals, integrated with offline infrastructure and authorised to deliver care online as official medical institutions. This legal shift unlocked thousands of hospital-run platforms, gave technology firms a legitimate market, and laid the foundation for digitally enabled triage and care delivery nationwide.
In 2019, when I was conducting market-entry analysis for an APAC health-tech start-up, I saw this transformation up close. Internet hospitals had only just been licensed the year prior, and I was researching their nascent role in China’s healthcare landscape, assessing whether they were worth taking seriously, and whether genuine partnership opportunities could be found. To outsiders, they looked like curiosities of China’s “wild-west” innovation culture, throwing everything at the wall to
But my interviews told a different story. What sounded like a speculative policy experiment was already becoming systemic redesign. Provincial officials were integrating online consultations into their workflows, and clinicians were trialling reimbursement codes for virtual prescriptions.
Fewer than 300 official internet hospitals existed nationwide in 2019. By 2023, turbo-charged by the COVID-19 pandemic, the number had multiplied tenfold to more than 3,000. Today, virtually every brick-and-mortar hospital in China operates alongside an online twin.
Patients can move fluidly between digital and in-person services: there’s no separate login, no new platform to download. Booking a doctor feels as simple as ordering food delivery or paying a bill. Access runs through the apps already used for daily life, from social-media platforms such as Tencent’s WeChat to the payment ecosystem of Alibaba’s Alipay.
Behind that simplicity sits a deeply coordinated loop. Electronic medical records, insurance claims, logistics and pharmacy data flow through the same digital spine, linking hospitals, technology firms and public insurers. This architecture drives China’s digital momentum, converting interoperability from a technical challenge into a strategic advantage across the entire health sector. For a comprehensive breakdown of the digital health landscape, see my post on AI & Health in China, which details the multi-layered impact of technological integration for patients, clinicians, hospitals, communities and governance.
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How China Built So Quickly
Multiple forces made the speed and scale of Chinas internet hospitals possible: clear regulation, structural demand and cultural alignment.
1. Demand made it necessary
China’s ageing population, chronic-disease burden and vast geographic disparities created a pressure that technology could uniquely relieve. Internet hospitals offered a way to stretch limited specialist capacity across provinces without building new infrastructure. Immediacy for patients, for efficiency for hospitals, and continuous access for government, without unsustainable capital spending.1. Governance made it possible
China state has a unique ability to coordinate across ministries, insurers, hospitals and technology firms toward a single strategic goal. I’ve written before about how this administrative machinery drives industrial policy and infrastructure planning now manages digital health as a matter of national capability.This coherence is rare even among advanced economies, and enables China to move from pilot projects to national infrastructure with remarkable pace. It also raised difficult questions about data sovereignty, consent and accountability: who ultimately owns and safeguards the health information of 1.4 billion people, and how it is used? Nevertheless, whether admired or contested, China’s approach shows what can happen when digital transformation is treated not as a project but as a governing principle.
3. Regulation made it certain
The 2018 Internet + Healthcare policy reclassified online services as healthcare. Hospitals could apply for internet-hospital licences, and reimbursement was soon tied to the same insurance funds that cover physical visits. During COVID-19, the National Health Commission went further, mandating that hospitals maintain online channels to ensure continuity of care. What would have required years of lobbying and pilot evaluation elsewhere, was able to became a national standard at astonishing pace.4. Culture made it acceptable
This is where the contrast with the West runs deepest. UK, US and other health systems prize individual privacy and institutional autonomy, as guardrails against state or corporate overreach, but these values intrinsically fracture data flows and slow integration. Health data sits behind legal firewalls, scattered across institutions that rarely talk to each other. Hospitals, insurers and regulators each run their own systems, and the law is written to keep them that way. Integration feels risky even when everyone agrees it would make care safer and faster.But China’s social contract has evolved differently. The idea of health as a shared responsibility runs deep from Confucian family ethics to Mao-era communist collectivism, and now into the digital state. Data is viewed less as private property and more as a resource that gains value through coordination. Citizens are accustomed to shared platforms and to trading visibility for convenience. As I explained in my Q&A for The Wire China, the same trust that Chinese people place in WeChat and Alipay to manage their finances extends easily to managing their health. When they scan their face or link their health ID to an app, it’s rarely read as surrendering privacy; it’s proof of belonging to a system that delivers.
Taken together, these layers explain the astonishing pace and scale of China’s internet hospital expansion, and the wider digital health system alongside it. Where Western systems pilot and debate, China builds and iterates. Its internet hospitals are proof of alignment between policy and infrastructure, necessity and design, people and the state.
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Why it matters
China’s internet hospitals mark a profound shift in what it means to build a modern health system. The country has long struggled with uneven access, overstretched tertiary hospitals and a weak primary-care base. Digital integration hasn’t erased these gaps, but it has begun to rewire how the system allocates care, money and attention. Specialists can now reach patients in remote provinces, chronic care can be monitored continuously, and the state can manage data, logistics and insurance through a coordinated network.
By turning digital access into a policy instrument, China has moved faster than almost any other major economy from experiments to infrastructure. The internet hospital has become the default entry point for millions of citizens: an efficient and effective mechanism for triage, reimbursement and data collection all at once. Provinces such as Guangdong and Zhejiang have gone furthest, integrating online consultations into regional insurance and referral systems. Their success has encouraged others to replicate similar models, reinforcing internet hospitals as a permanent feature rather than a passing reform.
China’s approach suggests that when regulation is decisive and citizens are digitally fluent, system-level change can move at engineering speed, where policy, funding and public behaviour move together. It challenges common assumptions ofWestern systems, that digital transformation must proceed through caution, pilots and incrementalism.
This understanding is critical, and it’s why I’ve been delivering analysis on China’s internet hospitals across both policy and industry work for a while now: advising think tanks and government partners on system reform, supporting multinational pharma companies as they navigate China’s new digital access channels, and working with digital health firms to stay competitive within China while adapting its lessons abroad. There is so much opportunity in what China has built: not only in its market potential, but in the practical lessons it offers on how digital infrastructure, policy and patient behaviour can align to create real, scalable change.
For policymakers: it offers a proof of concept: large-scale digital health becomes possible when regulation, incentives and public behaviour are aligned. And for hospitals and clinicians, it transforms workflow and status. Online clinics can count toward performance metrics, follow-up visits are reimbursed on par with in-person care, and rotation between digital and physical wards can blend flexibility with accountability.
For industry and investors: it opens an entirely new commercial logic. Biopharma and medtech firms now have direct digital channels for patient education, recruitment and real-world evidence generation. The anonymised, population-scale data flowing through internet hospitals is already fuelling AI model training and clinical research, and platforms like Ping An and AliHealth have become gatekeepers for richly detailed clinical information flows.
For global health observers: this remote-first, cloud-enabled and platform-integrated internet-hospital architecture appeals because it can leapfrog to deliver immediate capacity. In developing countries, where budgets are thin and geography vast, the logic of remote-first care makes perfect sense. Chinese partnerships are already linking district hospitals to national referral centres through cloud-based triage and deploying mobile apps that handle prescriptions and insurance verification in real time.
Of course, this progress is not without edges and risks. Elderly, rural and migrant populations risk being left behind, as inequalities in access and literacy persist. System outages or underfunded backend infrastructure can expose new fragilities, and enforcement and interoperability remain uneven, as such scale and ambition take time to deliver across vast landscapes. And crucially, China’s treatment of health data as a sovereign asset, while powerful for national resilience, complicates international collaboration and trust. When Chinese platforms host cloud infrastructure or manage health-data flows, sovereignty on paper can become dependency in practice. What begins as digital empowerment can hardwire new forms of reliance.
In the end, China’s internet hospitals show what happens when technology, governance and public behaviour move in sync, even if imperfectly. Demographics created pressure. Governance opened possibility. Regulation gave permission. Culture provided acceptance. China’s rapid scale-up highlights what policy coherence and public alignment can achieve. It exposes how Western systems’ pluralism and caution, while protecting rights, also limit reach. The challenge now is to learn from China’s speed without replicating its control: to build digital health ecosystems that are integrated yet transparent, efficient yet accountable.
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The Context Is Crucial
This idea, that technology succeeds only within the culture and politics that shape it, has been firmly front of mind for me this past week, as I travelled to Budapest for a regional dialogue on governance and innovation.
We met with government and industry leaders, including the heads of Gedeon Richter, Hungary’s largest pharmaceutical company, the national research network HUN-REN and its Artificial Intelligence Coalition, as well as the Minister of Culture and Innovation. Conversations ahead of next April’s national election - including with Balázs Orbán, Political Director and right-hand to Prime Minister Viktor Orbán, as well as senior figures from the opposition - revealed a country sitting intriguingly between East and West, particularly in how it approaches digital transformation.
Hungary makes for a fascinating test case. Even as it upholds European norms on privacy, autonomy and competition, its legacy of communism, central planning and compact population systems has enabled the creation of a health-data infrastructure that is remarkably connected: linking hospitals, pharmacies and research institutions through a national ecosystem. This is a mindset that feels closer to East Asia’s pragmatism than to the privacy-first caution of Northwestern Europe.
The leaders I spoke with described a general public that is comparatively more willing to accept digitisation when it is framed as a collective good. This balance is precisely what defines the global conversation on health technology today. As countries around the world grapple with how to digitise care responsibly, we should note that historical path-dependence matters as much as innovation itself: each system carries its own imprint of politics, culture and people.
These contrasts, and what they reveal about the future of health, are exactly what I explore in my forthcoming book on China’s health innovation and the global impact of its fast-rising biotech and digital-health evolution - stay tuned!
🩺 This is a Vital Signs post: series of essential explainers from China Health Pulse, where I lay out the key structures and systems shaping health in China.
Thank you so much for this awesome detailed overview of digital healthcare in China!
2 years ago, after getting certified in data analysis, I decided to launch a digital health consulting activity in France, where I'm based. I quickly gave up on the project as I realized how data immature France is, and how much reluctance there is from a cultural perspective.
Hence why the idea of "health as a collective good" is fascinating to me. It can also make sense if one honestly thinks about it. Unfortunately, from what I gather, Western peoples distrust their governments way too much lately to expect any significant advance in digital health -and I don't blame them :)
However, I think that this approach to healthcare could find grounds in African countries. Over there, many traditions ground society on a collective unit (the village, the tribe) as opposed to the Western "nuclear family" base unit. Furthermore, Africans are way more digital and mobile-enclined that their European counterparts. Necessity can be an amazing fuel for early adoption :-D
I do have a question though. Could someone explain the following passage? I don't understand what it means:
"When Chinese platforms host cloud infrastructure or manage health-data flows, sovereignty on paper can become dependency in practice. What begins as digital empowerment can hardwire new forms of reliance."
Thanks in advance! I'll definitely keep following this substack and I'll also look up the podcast on Spotify!
Good read