Digital Health Information Systems and Rural Health Equity: A Framework and Evidence from China's Experience

Abstract

Background: Rural-urban health disparities persist globally despite decades of interventions. Digital health information systems offer promise for addressing these inequities, yet implementation remains uneven and evidence fragmented.
Methods: We develop a four-dimensional conceptual framework examining health information education, sharing, application, and governance. We synthesize evidence from China's large-scale rural digital health implementation alongside international comparisons, drawing on published literature and case studies.
Results: Digital health systems improve rural health equity through multiple mechanisms: education interventions enhance health literacy and promote behavior change; information sharing reduces asymmetries and enables care coordination; technology applications extend specialist expertise to underserved areas; and governance frameworks ensure quality, privacy, and participation. China's experience demonstrates substantial impacts including increased primary care utilization, improved chronic disease management, reduced medical expenditures, and enhanced insurance portability. However, effects exhibit heterogeneity across populations, with differential benefits for younger, better-educated individuals raising equity concerns.
Conclusions: Digital health information systems can meaningfully advance rural health equity when implemented comprehensively with attention to infrastructure, governance, and equity. Success requires integrated approaches spanning education, sharing, application, and governance rather than fragmented single-purpose initiatives. China's experience offers transferable lessons regarding scale, integration, and implementation, though adaptation to local contexts remains essential. Future priorities include rigorous impact evaluation, cost-effectiveness analysis, equity monitoring, and governance framework development.