As a trained ethnographer working in consulting and involved in government sponsored projects in China, I grapple with rapidly evolving changes in society as well as technological innovations. From my involvement in this dynamic of change through different ad hoc projects and long-term field work, I believe we are currently at a pivotal moment. The combination of a thriving market, better cultural and social amenities, and more discerning individuals seeking better health could give rise to a more patient-centered and community-based health system and related economy. However, there are gaps between the top-down logic of organizations and siloed medical resources. At the same time, consumers with no training in how to navigate digital infrastructures have been given access to digital channels without any instruction. It can seem as if the technology has been created in vain. This simple fact also discourages investor commitment and diminishes their faith in digital technology’s role in changing China’s health ecology. This can have the effect of making the future of digital healthcare uncertain and limiting the promise of these technologies.

COVID-19 produced a clamor for remote health-care services by patients afraid to visit hospitals and investors keen to tap into the expanding health-care sector. New streams of capital are flooding into markets, stimulating the establishment of digital infrastructure to enable remote consultation and hospital services. For instance, Alibaba has been trying to break into the pharmaceutical market because they specialize in distribution and fulfillment, which essentially parallels the role of a pharmacy. In addition, JD Health is working with local communities in China to offer online access to highly trained doctors who are frequently unavailable at small clinics. Meanwhile, according to estimates by Citi, online drug sales could reach RMB516 billion (US$78.9 billion), or 15 percent of China’s total GDP by 2025, up from 6 percent in 2018. However, most tech companies—and even government stakeholders—still have a top-down vision for the large-scale development and application of technology. The government looks at population-level statistics instead of considering individuals and their experiences of everyday usage; companies or investors look at its input-output ratio (ROI) rather than the process of how a technology takes shape as people adopt it and adapt their lives to it. Since the institutionalization of medical systems has been scaled up, the Chinese medical system has followed a medical paradigm shaped by industrial culture, while also constantly changing with the introduction of new technical conditions and scientific epistemologies. The sites and practices of diagnosis and treatment are no longer bound to the individual who is embedded within a specific social, cultural, and geographic setting. Instead, it becomes necessary to consider the standardized collection of data, which can vary drastically under the monitoring of clinical medical equipment. In these circumstances, institutions and expert panels monopolize professional knowledge and medical resources, rather than being owned by community members.

Recently, our research took an ethnographic approach to look into in situ practices. We didn’t find a large scale transformation of the ways that people seek medical care. Digital alternatives in the field of health care are not replacing conventional practices, regardless of any claim that they could fill long-standing gaps in China’s healthcare coverage, in which the best doctors and equipment are concentrated in top-tier hospitals in big cities.

Interviews with consumers with digital literacy show the promise of digital systems to empower individuals and communities. We learned that they are able to effectively search for information using a professional database. These individuals can connect with and obtain medical resources through online information networks, even reaching out to foreign hospitals. As an example, one research group found that a rural woman, through her network of acquaintances and social media, overcame geographical restrictions and was able to move to a much larger city to locate medical resources. In seeking value-based healthcare services, her ideas of what constitutes good and bad medical solutions were modified by interacting with patient peer groups in urban areas. With online patient communities growing exponentially and becoming rich sources of crowd-sourced data, doctors who are more highly rated by the community and lauded through word of mouth are able to obtain a greater proportion of patient traffic. Today, academic and bureaucratic ranks conferred by institutions are no longer the only path through which doctors seek upward mobility on career ladders. The professional referral system previously defined and controlled by bureaucratic authorities is being replaced by online word-of-mouth referrals. Most importantly, individuals can now own their healthcare data, allowing them to make more informed decisions about their health. The silos of hospitals and community care have been dismantled by the design of more care pathways around the patient, with doctors and nurses in hospitals running clinics and delivering care within the community, while primary care staff provide services that are in reach of the community and specialist hospitals.

With a changing political climate, the expansion of infrastructure, and multimodal communication facilitated by technology, the future landscape of health is being reshaped by new wealth and capital and new openness to community-based resources and human agencies. Simultaneously, institutional and bureaucratic administrations will remain indispensable, particularly with regard to the regulation of new forms of healthcare solutions. By viewing health practices and technological innovation from the bottom up we can orient more resources and technologies in the right direction to drive investments in systems that meet the needs of people and communities.