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.
Aim: To develop a comprehensive conceptual framework for understanding how digital health information systems promote rural health equity and to synthesize evidence from China's large-scale implementation experience alongside international comparisons.
Methods: We conducted a systematic literature synthesis and policy analysis to develop a four-dimensional conceptual framework examining health information education, sharing, application, and governance. We analyzed China's digital health policies and implementation outcomes alongside international case studies and comparative evidence from peer-reviewed literature and policy documents.
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.