Digital Health Consortium Highlights 'Strengthening Primary Care' Value Proposition Amid National Two Sessions Focus on Grassroots Healthcare System

Improving the quality and quantity of primary healthcare services has always been the primary objective of China’s deepening healthcare reform. Following the report to the 20th National Congress of the Communist Party of China, which proposed“Following the initiative to expand high-quality medical resources and promote their balanced regional distribution,” this year’s Government Work Report delivered at the Two Sessions once again listed “ensuring basic public welfare, developing social undertakings, and promoting the expansion and downward decentralization of high-quality medical resources along with their balanced regional distribution” as a key priority, thereby continuing China’s overarching theme of “strengthening primary healthcare” in its medical and health services.

Against this backdrop, how to further strengthen the construction of primary healthcare service systems and better meet the growing healthcare needs of grassroots populations has become a focal issue for delegates and members attending the Two Sessions. Meanwhile, measures taken across various regions to expand the supply of high-quality medical resources, facilitate their decentralization, and promote balanced regional distribution have garnered significant attention. Practical cases driving digital transformation and governance reform in primary healthcare, such as Tianjin’s Primary Digital Health Consortium, have sparked extensive discussion across all sectors of society.

Multiple data sources indicate that China’s primary healthcare service capacity and quality have made significant progress in recent years. According to the Statistical Communiqué on China’s 2022 National Economic and Social Development issued by the National Bureau of Statistics, there were 1.033 million medical and health institutions across China by the end of 2022, including 980,000 primary healthcare institutions. Furthermore, as reported in the Statistical Bulletin on the Development of China’s Health Undertakings in 2021 released by the National Health Commission, primary healthcare institutions accounted for 50.2% of the total number of patient visits in 2021, meaning that more than half of all patients in China were treated at primary healthcare facilities.

On this basis, a key objective in building the primary healthcare service system is to allocate medical resources more rationally and efficiently, enabling primary hospitals to play a greater role in delivering healthcare services and retain more patients.

Regarding the development of primary healthcare systems, Zhang Wenhong, a member of the National Committee of the Chinese People’s Political Consultative Conference (CPPCC), Director of the National Center for Infectious Diseases, and Director of the Department of Infectious Diseases at Huashan Hospital Affiliated to Fudan University, stated during the Two Sessions that medical personnel in primary healthcare institutions are the key force enabling China to emerge from the pandemic. Therefore, Dr. Zhang called for continued strengthening of the primary healthcare system, even though China has now entered a phase of eased epidemic conditions. He expressed hope that tertiary hospitals will both empower primary healthcare institutions and establish a structured relationship involving tiered diagnosis, layered management, and patient分流 (diversion), thereby creating a healthcare system characterized by vertical integration, seamless transition between routine and emergency operations, flexibility, and resilience.

Also focusing on the development of primary healthcare systems, Cheng Jing, a deputy to the National People's Congress, academician of the Chinese Academy of Engineering, and chair professor at Tsinghua University School of Medicine, proposed during the Two Sessions that attention should be focused on addressing weaknesses in rural medical and health services. Cheng suggested intensifying efforts to improve the level of basic medical and health security in rural areas. By leveraging modern technological tools such as big data and artificial intelligence, and building upon village, township, and community-level foundations, conditions for rural medical facilities should be improved and service capabilities enhanced. Guided by the goal of comprehensively addressing the health needs of the vast rural population, a primary care diagnosis and treatment system, along with a prevention and control system for chronic and infectious diseases, tailored to China’s national conditions, should be established.

In the proposal titled “Suggestions on Strengthening the Construction of Rural and Community Healthcare Systems,” Si Fuchun, a deputy to the National People’s Congress and Director of the Henan Provincial Key Laboratory and Provincial International Joint Laboratory at Henan University of Chinese Medicine, put forward specific measures. These include accelerating the informatization of primary healthcare, actively developing telemedicine in rural and community settings; fully leveraging big data platforms to establish an integrated urban-rural medical information service platform; steadily advancing the construction of urban-rural healthcare consortia to improve the allocation efficiency of regional medical resources; and establishing and perfecting a tiered diagnosis and treatment system that ensures appropriate care, orderly patient flow, and efficient referrals. Furthermore, by utilizing internet technologies to diversify access to medical care and adopting an online-offline integrated approach, we can promote the homogenization of urban and rural healthcare services and enhance the quality of healthcare delivery in rural areas.

Furthermore, regarding the development of specialized disease prevention and control as well as health management capabilities at the primary care level, Wu Hao, a member of the National Committee of the Chinese People’s Political Consultative Conference (CPPCC) and Dean of the School of General Practice and Continuing Education at Capital Medical University, believes that diabetes and respiratory diseases are currently the most common conditions encountered in primary care settings. Enhancing primary care institutions’ capacities in disease prevention, control, and health management will not only enable residents to access better medical care closer to home but also better leverage the advantages of general practitioners in prevention, diagnosis, and treatment. Therefore, in his proposal for the “Two Sessions,” Wu Hao recommends strengthening the capacity of primary care institutions to manage specific diseases. This entails not only establishing standardized and regulated consultation rooms but also improving the availability of essential medical equipment and pharmaceuticals at the primary care level.

A comprehensive review of the proposals and suggestions related to primary healthcare submitted during this year’s Two Sessions reveals that leveraging digital technologies and digital health platforms to promote tiered diagnosis and treatment and the development of medical consortia, as well as strengthening the prevention and control of specific diseases and chronic disease management at the primary level, has become a consensus among deputies and committee members on improving the primary healthcare service system. This also demonstrates that digital technologies and digital health platforms have become indispensable foundational elements in “strengthening primary care.”

In recent years, governments at all levels have attached great importance to the empowering role of digital technologies and digital healthcare platforms in primary healthcare service systems. The necessity of leveraging the advantages of digital technologies and applying digital healthcare platforms to support the development of China’s primary healthcare system has become fully evident. Particularly in promoting tiered diagnosis and treatment and the construction of medical consortia, as well as strengthening the capacity for prevention and control of specific diseases and chronic disease management at the primary care level, innovative practices such as Digital Health Communities have emerged. Among these, exemplary models have developed replicable and scalable experience patterns, which garnered significant attention from deputies and committee members across various sectors during this year’s Two Sessions.

Complementing the proposals submitted by deputies and committee members to the Two Sessions, a new think tank report on social governance titled *Digital Transformation and Governance Reform*, compiled by the Institute of Chinese Social Management at Beijing Normal University and the Digital Governance Branch of the China Society for Social Governance Research, was released on the eve of this year’s National Two Sessions. Using Tianjin’s grassroots health digital governance practices as a case study, the report summarizes the key approaches, outcomes, and experiences of the Digital Health Community in leveraging digital platforms to improve the “three-medical linkage” mechanism and empower grassroots medical and health services and governance. It provides practical insights for regions across China to strengthen the construction of grassroots medical and health service systems, promote the expansion and decentralization of high-quality medical resources, and achieve balanced regional distribution.

According to the report “Digital Transformation and Governance Reform,” the Tianjin Primary Care Digital Health Community is a tightly integrated internet-based medical consortium led by Tianjin Weiyi Internet Hospital, in collaboration with 266 primary healthcare institutions across the city. It was established in accordance with documents such as the “Guidelines for the Construction of Digital Health Communities in Primary Healthcare Institutions in Tianjin,” issued by the Tianjin Municipal Health Commission and the Municipal Healthcare Security Administration. Leveraging digital technologies and digital health platforms as its infrastructure, it has innovatively established a primary healthcare service system characterized by unified management, standardized services, shared benefits, and joint accountability.

Practical measures for implementing the grassroots digital health consortium include: establishing a digital and centralized service system by deploying unified “Four Clouds” platforms—cloud management, cloud services, cloud pharmacy, and cloud diagnostics—at primary care hospitals to enhance the efficiency of grassroots medical management and services; building a standardized and integrated service system by co-establishing offline standardized chronic disease management centers with primary care hospitals, promoting standardized and homogeneous diagnosis and treatment services on a disease-specific basis to improve the capacity of grassroots medical management and services; and implementing a performance-based payment health accountability system that uses health service behaviors and outcomes as the primary metrics for assessment and incentives, thereby driving the transition of medical services toward a health-centered model and boosting the motivation for grassroots medical management and service delivery.

From the perspective of construction outcomes, the grassroots digital health consortium has ultimately established a win-win situation through multi-party cooperation. First, empowered by cloud platforms, the capacity of grassroots medical services has been effectively enhanced. For instance, while grassroots medical and health institutions previously stocked an average of fewer than 400 drug varieties, they now leverage the “Cloud Pharmacy” platform to select and supplement drugs based on resident demand. In Tianjin, this has enabled effective alignment between the drug formularies of grassroots institutions and those of secondary and tertiary medical institutions, expanding the supply to cover 1,560 drug varieties with 2,785 specifications. Furthermore, the “Cloud Pharmacy” has strengthened prescription review and evaluation processes, effectively meeting the demand for long-term prescription services and providing residents with convenient pharmaceutical care such as home delivery and online guidance.

Meanwhile, patient healthcare experiences and health management outcomes have been significantly improved. As of December 2022, Tianjin’s Primary Care Digital Health Consortium had signed chronic disease management cooperation agreements with 204 primary care institutions and seven secondary hospitals, and was progressively establishing joint chronic disease management centers. Among them, over 1.68 million patients have been enrolled in health records for management, and more than 110,000 diabetic patients have been contracted into the program and placed under the specialized outpatient health stewardship responsibility system for diabetes. The standardized management rate for diabetic patients in pilot primary care institutions reached 81.5%, and the blood glucose control rate improved by over 12.1%.

Furthermore, grassroots digital health communities have integrated medical care and health insurance responsibilities, yielding significant results from the “three-medical linkage” reform. According to the report Digital Transformation and Governance Reform, in practice, grassroots digital health communities participated as a whole in Tianjin’s health insurance payment method reform, implementing unified health insurance settlement and capitation-based payment for diabetes management. They established a performance incentive mechanism centered on health management, allowing retained savings generated through price reductions from joint procurement of pharmaceuticals and medical devices and reforms in health insurance payment methods. This has effectively enhanced healthcare professionals’ enthusiasm for standardized diagnosis and treatment and for delivering health management services.

Building on a systematic summary of the experiences of Tianjin’s grassroots digital health communities, the report *Digital Transformation and Governance Reform* points out that, objectively, these communities represent both a new form of close-knit medical consortiums with distinct Tianjin characteristics and a new model for reshaping primary healthcare service systems through digitalization. They provide digital governance approaches and experiential references to effectively address challenges in primary health governance, such as imperfect multi-stakeholder cooperation and win-win mechanisms, insufficient efficient coordination among medical care, health insurance, and pharmaceutical services (“three-medical” linkage), inadequate primary care service capacity, and flawed physician incentive mechanisms. As such, they have become a benchmark for other regions in developing grassroots digital health communities and accelerating the digital transformation and governance reform of primary healthcare.