Can Digital and Intelligent Transformation Improve the Equitable Provision of Basic Public Health Services in China?—Empirical Evidence from Smart Cities and National Big Data Comprehensive Pilot Zones

In many parts of the world, getting a basic health checkup or a vaccination can depend heavily on where you live. A person in a bustling city might have easy access to clinics and digital records, while someone in a remote village faces long journeys and paper files that are hard to share. This gap is known as inequality in public health services. Governments often try to fix this by building more clinics or sending more doctors, but a new approach is emerging: using digital technology to make services fairer. The idea is that if health information can flow instantly across a country, a doctor in a small town could access the same resources and data as one in a major metropolis. This concept relies on two main pillars: smart cities, which use technology to manage urban life, and big data zones, which treat information as a valuable resource to be shared. The question researchers are asking is whether simply turning on these digital switches actually makes health care more equal for everyone, or if the benefits only go to those who are already well-off.

A team of researchers in China decided to test this idea on a massive scale. They looked at data from 284 cities across the country, spanning from 2009 to 2023. During this time, the Chinese government launched two major initiatives: a program to turn selected cities into "smart cities" and another to create "national big data comprehensive pilot zones." These were not just small experiments; they were large-scale policy shifts that changed how cities managed information and resources. The researchers treated the cities that adopted both programs as a test group and compared them to cities that did not. By looking at the years before and after these policies were introduced, they could see if the digital changes actually led to a more equal distribution of basic health services, such as vaccinations, health records for children, and chronic disease management.

The study found that the answer is a clear yes, but with a significant condition. The combined use of smart city technology and big data management significantly improved the fairness of health services. In the cities that implemented both policies, the gap in health service quality between different groups and areas shrank. The researchers calculated that this dual approach increased the level of equity in health services by about 2.47 percent on average. This improvement was not a fluke; it held up even when the researchers checked their work in many different ways, ruling out random chance or other unrelated factors. The technology worked by breaking down walls that used to keep information trapped in one place. Instead of a patient's health record sitting in a single local clinic, the digital systems allowed that data to be shared and used by health officials across the region, helping them see who needed help and where resources were missing.

However, the story is not the same for every city. The researchers discovered that the digital tools worked best in places that were already ready for them. In the eastern and central parts of the country, and in large, populous cities, the policies made a big difference. These areas had the necessary infrastructure, like fast internet and reliable power, and the local governments had the transparency and focus to use the data effectively. In these places, the digital transformation acted like a powerful amplifier, making health services reach more people more efficiently. But in the western region and in smaller, medium-sized cities, the same policies did not show a significant improvement. It was not that the technology failed, but that these areas lacked the supporting conditions. Without strong local leadership, sufficient funding, or a high level of urban development, the digital tools could not take root to fix the inequalities.

The study also revealed that doing just one thing was not enough. A city that only built a smart city network without focusing on big data, or vice versa, did not see the same benefits. It was the combination of the two that created the magic. One policy built the hardware—the roads and networks for information to travel—while the other focused on the software, ensuring that the data itself was useful and shared. When both were in place, they worked together to create a system where health resources could be allocated precisely where they were needed. The researchers also found that the effect was stronger in cities where the government was very open about its spending and where there was a high concentration of people. These factors acted as a foundation, allowing the digital tools to function properly.

Ultimately, this research shows that digital transformation is a powerful tool for making health care fairer, but it is not a magic wand that works everywhere instantly. It requires a supportive environment to be effective. For the technology to bridge the gap between the rich and the poor, or the city and the countryside, it needs to be paired with good governance, transparent funding, and strong local infrastructure. The findings suggest that while China's digital push has successfully improved health equity in many places, the next step is to ensure that smaller cities and less developed regions get the support they need to catch up. Without that extra help, the digital divide could widen the gap in health care rather than close it, leaving the most vulnerable populations behind even as the rest of the country moves forward.