Internet healthcare in Chinese public hospitals: Towards high-quality development (1986-present)

Dan Du; Guodong Sun; Lili Yuan; Yiyun Yao; Tong Yang; Junliang Gao; Lei Zhang; Dan Du; Guodong Sun; Lili Yuan; Yiyun Yao; Tong Yang; Junliang Gao; Lei Zhang

doi:10.3934/publichealth.2026032

AIMS Public Health

2026, Volume 13, Issue 2: 598-621. doi: 10.3934/publichealth.2026032

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Internet healthcare in Chinese public hospitals: Towards high-quality development (1986-present)

1.
Department of Medical Affairs, Lanzhou University First Hospital, Lanzhou 730000, China
2.
General Surgery Department, Lanzhou University First Hospital, Lanzhou 730000, China
These two authors contributed equally.

Received: 10 November 2025 Revised: 03 May 2026 Accepted: 11 May 2026 Published: 19 May 2026

Background
Internet healthcare has become a key part of China's hospital-centered health system. Driven by “Internet Plus Healthcare”, Healthy China 2030, and public-hospital high-quality development policies, it has evolved from remote consultation experiments into regulated online-offline care pathways. This review traces its development from the first documented remote medical practice in 1986 to the present, focusing on policy, institutional models, clinical evidence, governance challenges, and reform.
Methods
We conducted a structured narrative review of English- and Chinese-language sources on internet healthcare in Chinese public hospitals. PubMed/MEDLINE, Web of Science Core Collection, China National Knowledge Infrastructure (CNKI), and official policy sources were searched. Eligible sources addressed internet hospitals, telemedicine, online follow-ups, remote monitoring, e-prescriptions, insurance payments, digital governance, clinical outcomes, patient safety, equity, or implementation barriers in mainland China.
Results
Internet healthcare progressed through early telemedicine, institutional network expansion, internet-hospital development, and pandemic-driven normalization. The 2018 regulatory framework positioned internet hospitals as extensions of licensed physical medical institutions, thereby permitting online follow-ups for common and chronic diseases while preserving offline accountability. During COVID-19, online consultation, e-prescriptions, drug delivery, and insurance payments rapidly expanded. Evidence suggests benefits for chronic disease management, medication adherence, cardiovascular secondary prevention, and reduced travel burden. However, evidence remains limited for diagnostic accuracy, adverse events, emergency escalation, and long-term outcomes. Persistent barriers include quality variation, workload, cybersecurity, data fragmentation, artificial intelligence (AI) accountability, reimbursement design, regional inequity, and digital exclusion among older adults.
Conclusion
China's model may be understood as a hospital-centered extension of public-hospital functions rather than a stand-alone virtual-care system. Future development should prioritize outcome-based evaluations, safety governance, equitable access, data interoperability, and accountability for internet-based and AI-assisted care.
- China,
- internet healthcare,
- public hospitals,
- telemedicine,
- digital health,
- health policy,
- equity
Citation: Dan Du, Guodong Sun, Lili Yuan, Yiyun Yao, Tong Yang, Junliang Gao, Lei Zhang. Internet healthcare in Chinese public hospitals: Towards high-quality development (1986-present)[J]. AIMS Public Health, 2026, 13(2): 598-621. doi: 10.3934/publichealth.2026032

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Abstract

Background

Internet healthcare has become a key part of China's hospital-centered health system. Driven by “Internet Plus Healthcare”, Healthy China 2030, and public-hospital high-quality development policies, it has evolved from remote consultation experiments into regulated online-offline care pathways. This review traces its development from the first documented remote medical practice in 1986 to the present, focusing on policy, institutional models, clinical evidence, governance challenges, and reform.

Methods

We conducted a structured narrative review of English- and Chinese-language sources on internet healthcare in Chinese public hospitals. PubMed/MEDLINE, Web of Science Core Collection, China National Knowledge Infrastructure (CNKI), and official policy sources were searched. Eligible sources addressed internet hospitals, telemedicine, online follow-ups, remote monitoring, e-prescriptions, insurance payments, digital governance, clinical outcomes, patient safety, equity, or implementation barriers in mainland China.

Results

Internet healthcare progressed through early telemedicine, institutional network expansion, internet-hospital development, and pandemic-driven normalization. The 2018 regulatory framework positioned internet hospitals as extensions of licensed physical medical institutions, thereby permitting online follow-ups for common and chronic diseases while preserving offline accountability. During COVID-19, online consultation, e-prescriptions, drug delivery, and insurance payments rapidly expanded. Evidence suggests benefits for chronic disease management, medication adherence, cardiovascular secondary prevention, and reduced travel burden. However, evidence remains limited for diagnostic accuracy, adverse events, emergency escalation, and long-term outcomes. Persistent barriers include quality variation, workload, cybersecurity, data fragmentation, artificial intelligence (AI) accountability, reimbursement design, regional inequity, and digital exclusion among older adults.

Conclusion

China's model may be understood as a hospital-centered extension of public-hospital functions rather than a stand-alone virtual-care system. Future development should prioritize outcome-based evaluations, safety governance, equitable access, data interoperability, and accountability for internet-based and AI-assisted care.

Authors' contributions

Lei Zhang supervised the entire study, guided the study design, and approved the final version for publication. Dan Du and Guodong Sun contributed equally to this work. Both were responsible for the conceptualization, manuscript drafting, and critical revision for important intellectual content. Lili Yuan and Yiyun Yao assisted in data collection and participated in literature review and coordination of the writing process. Tong Yang and Junliang Gao assisted in document organization, reference formatting, and figure preparation. All authors read and approved the final manuscript.

Funding

This work was supported by the Soft Science Special Project of the Gansu Provincial Science and Technology Program (Grant No.25JRZA199), the Natural Science Foundation of Gansu Province (Grant No. 22JR5RA916), and the In-House Research Fund of Lanzhou University First Hospital (Grant No. ldyyyn2020-46).

Conflict of interest

The authors declare no conflicts of interest.

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