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The role of IT and digitization in closing the urban-rural divide in healthcare, education and social care

China’s social security system has changed profoundly during the last 40 years of unprecedented economic development. In October, MERICS published a paper that explores the potential roles of IT and digitization in social provision.

The paper, “Serve the People. Innovation and IT in China’s social development agenda,” sets out the findings of a study by ten researchers. Four of the key authors recently presented their conclusions at a lunchtime discussion in Berlin.

The panel consisted of Jane Duckett of the University of Glasgow; Karen Fisher of the University of New South Wales in Sydney; Klaus Rohland, MERICS Senior Policy Fellow and a former World Bank country-director for China, Korea and Mongolia; and Matthias Stepan, Head of Program for Public Policy at MERICS.

MERICS Lunch Talk on MPOC 6

The last mile is going to be the most difficult one

Their main message was that the last mile on China’s road to becoming a high-middle-income-country with a comprehensive social security system is going to be the most difficult. “The low hanging fruit has been gathered,” said Duckett, an expert on China’s health care system, during the discussion chaired by Claudia Wessling, Head of Publications at MERICS. 

Public service delivery has undergone profound changes during 40 years of economic reforms, altering from a “cradle-to-grave” social system providing for the basic needs of almost everyone, to a more market-driven system, especially in the last decade. Despite major achievements, multiple challenges persist – or have emerged – for instance in the health care and housing sectors. The report looks at the actual and potential uses of IT and digitization in health, education, housing security, poverty eradication and disability employment solutions in e-commerce.

CCP General Secretary and national president Xi Jinping has put the creation of a “moderately well-off society” for all at the core of his political agenda, thereby making social welfare provision a key element of government’s quest to preserve stability.

However, as Duckett explained, the increasing gap between urban and rural populations in their access to advanced public services is the major challenge facing the government’s efforts on social security.

IT-solutions vary across different social service sectors

In health care delivery, the medical system struggles to cope with patients from the countryside flooding into specialized hospitals in bigger cities in search of efficient medical care. China’s government is currently trying to extend the network of general practitioners in the countryside, taking a step away from centralized, hospital-based health care.

IT solutions like telemedicine and guidance systems for patients are crucial to improve health care provision for patients in remote areas.

However, the lack of trained staff or incentives for medical personnel to take a job in remote, often backward areas, are major obstacles to improving rural healthcare. The panel stressed that central government will need to channel additional funding into rural healthcare to counter these problems.  

In education provision, IT solutions offer possibilities to improve access to up-to-date curriculum content for rural pupils. However, qualified and trained stuff capable of integrating modern IT equipment into classroom study are vital for efficient implementation. As Matthias Stepan pointed out, IT-based learning still lacks acceptance in China’s educational system, which is predominantly a hierarchical teacher-student relationship characterized by rote learning. Teachers and parents often perceive IT gadgets purely as entertainment devices, so their educational potential is frequently overlooked.

Karen Fisher, who conducts field research with local partners on the situation of disabled people in China, outlined the potential for e-commerce to integrate this group, which often suffers discrimination, into economic life. The physically disabled, in particular, could benefit from new opportunities through online sales platforms, she said.

Fisher gave the example of a young woman in a remote area who had set up her own e-commerce store and developed a sizable business selling produce online. Such grassroots approaches could serve as models to improve the situation of disabled people across China, Fisher said.

The internet also serves as a platform for disabled people to voice their needs and strengthen social ties using online platforms.

However, Fisher said there is so far no statistical evidence of IT solutions becoming a panacea to achieve full-scale inclusion in the job market. She cautioned that some disabilities do not allow for working with online tools, adding that the state could not shed its responsibility to take care of the severely handicapped. Moreover, she argued that a “cultural change” in attitudes towards disabled people in China was urgently needed.

The panelists also discussed whether China’s social policies could serve as a model for other countries. Former World Bank Director Klaus Rohland, who lived in Beijing for many years, emphasized that China’s policies could not simply be replicated by other countries.

However, Rohland highlighted one advantage of China’s policy making: long-term approaches and careful planning before implementation. When it comes to implementing IT solutions, China’s ambition and taste for experimentation could even see it moving ahead of other countries.

Alongside the growing importance of IT solutions, the panelists also forecast increased diversification in China’s public service delivery in the coming years. They predicted state organizations would increasingly work alongside NGOs and private companies. Such diversification will be needed as relying on state institutions alone will not suffice, given the huge task of securing the well-being of 1.4 billion people.