Assessment of Internet Hospitals in China During the COVID-19 Pandemic: National Cross-Sectional Data Analysis Study

Abstract

Background: Internet hospitals in China are being rapidly developed as an innovative approach to providing health services. The ongoing COVID-19 pandemic has triggered the development of internet hospitals that promote outpatient service delivery to the public via internet technologies. To date, no studies have assessed China's internet hospitals during the COVID-19 pandemic.

Objective: This study aimed to elucidate the characteristics of China's internet hospitals and assess the health service capacity of these hospitals.

Methods: Data on 711 internet hospitals were collected from official websites, the WeChat (Tencent Inc) platform, smartphone apps, and the Baidu search engine until July 16, 2020.

Results: As of July 16, 2020, 711 internet hospitals were developed in mainland China. More than half of these internet hospitals (421/711, 59.2%) were established during 2019 (206/711, 29%) and 2020 (215/711, 30.2%). Furthermore, about one-third (215/711, 30.2%) of internet hospitals were established at the beginning of 2020 as an emergency response to the COVID-19 epidemic. The 711 internet hospitals consisted of the following 3 types of hospitals: government-oriented (42/711, 5.91%), hospital-oriented (143/711, 20.11%), and enterprise-oriented internet hospitals (526/711, 73.98%). The vast majority of internet hospitals were traditional hospitals (526/711, 74%). Nearly 46.1% (221/711) of internet hospitals requested doctors to provide health services at a specific web clinic. Most patients (224/639, 35.1%) accessed outpatient services via WeChat. Internet hospitals' consulting methods included SMS text messaging consultations involving the use of graphics (552/570, 96.8%), video consultations (248/570, 43.5%), and telephone consultations (238/570, 41.8%). The median number of available web-based doctors was 43, and the median consultation fees of fever clinics and other outpatient clinics were ¥0 (US $0) per consultation and ¥6 (US $0.93) per consultation, respectively. Internet hospitals have provided various services during the COVID-19 pandemic, including medical prescription, drug delivery, and medical insurance services.

Conclusions: The dramatic increase of internet hospitals in China has played an important role in the prevention and control of COVID-19. Internet hospitals provide different and convenient medical services for people in need.

Keywords: COVID-19; China; accessibility; control; cross-sectional; digital health; health care; internet hospital; prevention.

Figure 1

Spatial distributions of internet hospitals in China. The different shades of blue denote the total number of internet hospitals in each province. The color (ie, the different shades of yellow) and size of the circles indicate the number of internet hospitals in each city.

Figure 2

The construction dates of internet hospitals in China. (A) The construction dates of internet hospitals in China by month. (B) The construction dates of internet hospital in China by year. The following important policies were issued during the COVID-19 epidemic in China: (1) Notice on internet diagnosis and treatment consultation services for COVID-19 prevention and control (February 6, 2020), (2) Notice on strengthening internet diagnosis and treatment consulting services for COVID-19 prevention and control (February 8, 2020), (3) Notice on the national telemedicine and internet medical center for the national remote consultation of critically ill patients with COVID-19 (February 21, 2020), (4) Notice on further promoting the development and standardized management of internet medical services (April 18, 2020), and (5) Notice on the technical specifications and financial management of the "Internet+ medical service" project of public medical institutions (May 8, 2020).

Figure 3

Methods for accessing internet hospitals. (A) Patients’ access methods. (B) Patients’ access methods when the funder was a traditional hospital. (C) Patients’ access methods when the funder was an internet company. (D) Patients’ access methods when the funder was another type of company.

Figure 4

Characteristics of internet hospitals. (A) A mosaic plot with areas that show the proportion of doctors’ web-based methods for accessing internet hospitals in China, stratified by the classification of Chinese hospitals and the structure of the main investment. The investors of internet hospitals include THs, ICs, PCs, and GOs. The classification of Chinese hospitals were as follows: Grade III, Grade II, and Grade I and unrated hospitals. Doctors provided medical services through a specific web clinic or app. (B) The investors of internet hospitals. (C) Classification of Chinese hospitals. (D) Doctors’ access methods. GO: government and other organization; IC: internet company; PC: pharmaceutical company; TH: traditional hospital.

Figure 5

Medical service characteristics of China’s internet hospitals. (A) The roles that internet hospitals played in fighting COVID-19. (B) Internet hospitals’ consulting methods.

Figure 6

Human medical resources in China’s internet hospitals. (A) Violin plots that show the number of doctors in China’s internet hospitals. The numbers on the y-axis are logarithms to the base 2. (B, C) Violin plots displaying the consultation fees for a person who visited an internet hospital to find medical help (ie, consultation fees for fever clinics and other clinics). (D, E) Bar plots that show the distribution of doctors’ service times and doctor sources with regard to internet hospitals, respectively.

Figure 7

A bar plot that depicts the number of available departments in internet hospitals.

Figure 8

(A-J) Bar plots that depict the roles of internet hospitals during the COVID-19 epidemic. AI: artificial intelligence.