Li was a 61-year-old patient I met while volunteering in a major urban hospital in Nanchang, China. Over a day, Li and his wife waited 4 hours between two 5-minute examinations. They had also started their day from the rural area where they live at 5 am to make the 3-hour trip to the city. To me, Li described how he had suffered for years from debilitating migraines, finally diagnosed in Nanchang as induced from hypertension.
Like many rural practitioners, Li’s regular doctor was versed in folk medicine but ill-equipped to detect or treat this common condition. Hence, this elderly couple expressed nothing but immense gratitude for the minimal but life-changing care they received in the city.
They never complained about the trip, the wait, or the impersonal care at the hospital. At the end of their long day, my heart sank as I watched them rummage through their bags to pull out ticket after ticket for all the buses and trains they needed to get home.
This is not a rare case. There are millions of rural patients like Li who face significant obstacles in accessing health care.
Rural vs Cities
The health system in China is failing to provide equitable care to its rural residents, their voices and concerns remaining unheard. Even as the public and private sectors spend billions of dollars every year to advance healthcare in China, rural residents are rarely direct beneficiaries.
As part of China’s healthcare reform, care improvement in more impoverished rural areas was separated from those efforts in its wealthier cities. This strategy has turned out to be shortsighted in terms of health disparity.
This disparity’s ripple effect can already be seen, with an overburdened and almost factory-like delivery of healthcare in major urban hospitals, which are now serving as nearly the only option for both demographics.
One of the impediments of spreading medical care to these remote areas is a severe lack of professionals and training. Part of this is a natural result of the migration of younger rural residents seeking opportunities to urban areas, beginning in the late ’70s as China started its modern development.
The majority who continue to choose to leave their hometowns are people early to mid-adulthood, leaving children and the elderly in the rural areas. This drain has significantly decreased productivity in affected rural communities, including, most germane to this issue, a shortage of trained physicians.
Unqualified providers are recruited to fill this gap, with 85% of rural medical providers from the folk sector and without a college degree. Forty years later, China still lacks an adequate solution to fully solve this problem.
Where Telehealth Comes in…
The current pandemic has given us some insight on where to start. When COVID-19 hit China, lockdowns were required in both rural and urban areas.
Urban residents now faced a problem similar to their rural counterparts when seeking medical care. Seeing one’s medical providers in person became complicated and difficult, if not impossible.
The rise of telehealth as an alternative was sudden, and it was quickly developed as a viable and effective solution.
While there are limitations and can’t always substitute for traditional hands-on care, telehealth has proven to be a crucial stand-in and a useful tool to screen patients in need of more complex intervention. It could save him years of delayed care and hundreds of miles of travel for routine check-ups for rural patients like Li.
While it is reasonable to question the limitations–after all, Mr. Li’s blood pressure could not be measured over the phone– establishing a framework with telehealth as a starting point can direct the way forward.
Telehealth can support remote training and consultation of the rural providers to expand the services and interventions they can offer. This could also help address some of the financial difficulties rural patients have when they seek care. This way, local practitioners and the existing infrastructure of care in rural areas can thus be recruited as partners with more advanced professionals elsewhere via telehealth.
China’s population is nearly 1.5 billion, with one-third, half a billion people, living in rural areas. With so many challenges facing rural communities, it is impossible to build up a comprehensive healthcare system overnight. But there is one swift and significant change– the explosion of telehealth services– that is already underway. It is imperative to use this opportunity to ensure that its growth is equally beneficial to every corner it can reach.
This is only the beginning, but the potential to connect rural practitioners to more highly trained providers in China’s cities is an opportunity that needs to be fostered. As this system grows, other medical care components can be added, such as remote pathology labs in rural areas. When consulting and testing can both be easily accessed by rural patients, all will improve the health outcomes.