China and other emerging markets take the global lead in mHealth (mobile health) use, despite apparent disadvantages.
The digital revolution has transformed society and many industries along with it, but healthcare, despite its importance, lags behind many other sectors in the adoption of game-changing technology. The introduction of mHealth—that is, the use of the mobile phone to facilitate and/or conduct healthcare services—has been undoubtedly boosted by efforts to meet the challenges imposed by the COVID-19 pandemic, but usage remains low in exactly the place where you would expect it to be highest—the US.
Why is mHealth so important?
The use of mobile apps in healthcare offers many unique advantages, both for the patient and provider, that simple telehealth or mobile-accessible websites cannot hope to match. In the US, where over 85% of the population uses a smartphone¹ (95% among the under-50s), mHealth should be a focal point of patient engagement, yet it lags behind smaller economies.
The fact that the most economically and technologically developed world power is missing out on the efficiency savings and positive health outcomes offered by mobile should be cause for concern, especially when the current global leaders in mHealth adoption are achieving more despite seeming disadvantages.¹
The global picture
Global surveys of health apps show intriguing differences in mHealth adoption around the world. One study by the World Economic Forum² (WEF) showed that health app usage among the population is overall more prominent in China (65%), India (63%), and Indonesia (57%). These countries are also most likely to pay for mobile app services. The US is slightly ahead of Europe in healthcare app usage, but free services dominate. Japan has only 12% of its population engaging with mobile health apps. Interestingly, Chinese users are noted as being cost-sensitive in the WEF report, yet 45% of the population uses some form of paid mHealth service—a positive sign as far as the profit incentive for mHealth is concerned.
How did China overtake the US in mHealth usage?
Chinese and Indian citizens are not only more likely to use mHealth apps, but also to pay for them, overcoming a significant barrier to entry in less wealthy countries. Studies that look into the use of health apps in different Asian regions³ highlight that this wider mHealth adoption in both countries isn’t necessarily for the same reasons, but China, which has undergone a period of rapid development (including in the digital sector) over the last two decades to emerge as a global power, may be the most useful point of comparison for the US.
- China mHealth apps are user-centered and Integrated with popular platforms
An analysis of the adoption and usage of mHealth apps³ among the younger generation in China found that the most significant factors in adoption were effort expectancy (how difficult it is to use?) and social influence (the app is recommended by friends, family, colleagues, etc.), highlighting how Chinese culture’s emphasis on the collective makes social influence particularly important, which is corroborated by other studies thatcompare healthcare attitudes in China to the US⁴ and the role of social capital in mHealth access in China⁵. A logical conclusion would be that successful mHealth apps in China are both easy to use (low effort expectancy) with high levels of user satisfaction to warrant recommendations to others (high social influence).
One factor that might make mHealth adoption more frictionless in China is the app landscape there. It’s no surprise that WeChat, the ubiquitous ‘’everything app’’⁶ for social media, video calls, work email, shopping, transport, etc., is also integrated with healthcare services. WeChat supports the development of healthcare apps inside the WeChat app which makes app development and distribution easier, resulting in a significant vehicle for mHealth interventions⁷.
A 2021 report⁸ identified the most popular medical app in China as Ping An Good Doctor, with almost 11.5 million monthly active users and over 12 thousand healthcare service providers available on it. The mobile app offers real-time medical consultations, appointment booking, and a discussion forum for patients. A survey of the Chinese mHealth market as a whole confirms that the top mHeath apps in the country are similarly focused on appointment booking and telehealth⁹, answering user demand for access to medical care when hospital registration and in-person access to doctors can be difficult, especially the further you are from urban centers.
User stories¹⁰ confirm that appointment booking, cutting down wait times, and better communication with doctors about symptoms, medications, etc., tend to be what people value about these apps. In short, these apps are patient-centered and focused on the users’ needs.
- America has the most developed mHealth tech sector, gut a fragmented healthcare industry
Despite the lack of adoption compared to other countries, the US remains the most attractive market for developers in the mHealth sector, including entrepreneurs from other countries. It’s not as if we lack the technical proficiency to develop apps as good as Ping An Good Doctor or Spring Rain Palm Doctor in China. Nor is the healthcare sector lacking funds: Per capita spending for health costs is 15 times higher in the US than in China¹¹ (with only a slightly longer life expectancy). But this technical knowledge and high spending are wasted if it does not lead to improved medical technology and patient outcomes.
China has a near-universal healthcare system, which makes it easier to develop an app that can be adopted by a wide number of providers and users across the country. In contrast, the US healthcare system is severely fragmented. Despite their proven role in improving patient engagement and access, mHealth apps face several barriers to adoption in the US¹², including funding, reimbursement, and integration with patient health data and other electronic systems. It is difficult to connect the incredible variety of healthcare providers, each with its own silo of patient data in different EHR databases, via a mHealth app that focuses on the user’s needs.
Furthermore, despite value-based care initiatives from the federal government, private companies are still largely set up to prioritize reimbursement under a fee-for-service model. Government incentives to modernize, share information, and promote mHealth services¹³ are not yet sufficient. Historically, mHealth investment in the US has been directed toward B2B services to get providers paid faster¹⁴, whereas in China, B2C patient access to health services dominates, with significant government investment.
Lessons we can learn from China for greater mHealth adoption
Federal and state action is certainly required to streamline the national healthcare system and incentivize providers to support mHealth apps with interoperability across hospitals and clinics. Progress could be boosted by providers and tech vendors lobbying the government for the support they need to scale up their mHealth operations.
But the most important lesson from China’s success with mHealth is how much adoption is driven by users recommending mobile healthcare through their social networks. First and foremost, this can only start by offering high-quality healthcare apps that people actually want to use, a patient-centered platform with tangible benefits for the user. Even though two-thirds of the largest US hospitals already offer mobile health apps, patient engagement is poor due to bad user experience and functionality¹⁵.
If quality and user experience come first, then adoption should flow naturally from one satisfied patient to another. The fact that the US still has such outsized healthcare spending for such little benefit in outcomes over China suggests that the frameworks and digital tools that drive value are just not being taken advantage of, with the potential of mHealth being overlooked in particular.
- Maryville Online. (2021). Mobile Technology in Healthcare: Trends and Benefits. [online] Maryville Online. Available at: https://online.maryville.edu/blog/mobile-technology-in-healthcare/
- Buchholz K. (2020). Which countries use health apps the most?. [online] World Economic Forum. Available at: https://www.weforum.org/agenda/2020/10/where-health-app-usage-is-most-common/
- Alam, M.Z., Hu, W., Hoque, M.R. and Kaium, M.A. (2020). Adoption intention and usage behavior of mHealth services in Bangladesh and China: A cross-country analysis. [online] International Journal of Pharmaceutical and Healthcare Marketing. Available at: https://doi.org/10.1108/IJPHM-03-2019-0023
- Hong, W., Liu, R.-D., Ding, Y., Hwang, J., Wang, J. and Yang, Y. (2021). Cross-Country Differences in Stay-at-Home Behaviors during Peaks in the COVID-19 Pandemic in China and the United States: The Roles of Health Beliefs and Behavioral Intention. [online] International Journal of Environmental Research and Public Health. Available at: https://doi.org/10.3390/ijerph18042104
- Wang, T., Guo, X. and Wu, T. (2021). Social Capital and Digital Divide: Implications for Mobile Health Policy in Developing Countries. [online] Journal of Healthcare Engineering. Available at: https://www.hindawi.com/journals/jhe/2021/6651786/
- Graham, J. and Today, U. (2020). In China, WeChat is everything: Text messaging, video chat and mobile payments. [online] techxplore.com. Available at: https://techxplore.com/news/2020-09-china-wechat-text-messaging-video.html
- Yang, X. and Kovarik, C.L. (2019). A systematic review of mobile health interventions in China: Identifying gaps in care. [online] Journal of Telemedicine and Telecare. Available at: https://journals.sagepub.com/doi/full/10.1177/1357633X19856746
- Statista. (2022). China: leading medical health apps by monthly active users 2020. [online] Statista. Available at: https://www.statista.com/statistics/1043739/china-leading-healthcare-apps-monthly-active-users/
- Hsu, J., Liu, D., Yu, Y.M., Zhao, H.T., Chen, Z.R., Li, J. and Chen, W. (2016). The Top Chinese Mobile Health Apps: A Systematic Investigation. [online] Journal of Medical Internet Research. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020314/
- Basil Strategies. (2016). Leading Mobile Health Apps in China. [online] Basil Strategies. Available at: https://www.basilstrategies.com/leading-mobile-health-apps-in-china-doctors20/
- US-China Institute. (2020). Health Care in the U.S. and China | US-China Institute. [online] Available at: https://china.usc.edu/health-care-us-and-china
- Broderick, A. & Haque, F. (2015). Mobile Health and Patient Engagement in the Safety Net: A Survey of Community Health Centers and Clinics. [online] Available at: https://www.commonwealthfund.org/publications/issue-briefs/2015/may/mobile-health-and-patient-engagement-safety-net-survey-community
- Healthcare IT Today. (2022). Three Barriers to Mobile Use in Health Care | Healthcare IT Today. [online] Available at: https://www.healthcareittoday.com/2022/03/30/three-barriers-to-mobile-use-in-health-care/
- Baum, S. (2016). How do health IT investment trends in China and U.S. differ? [online] MedCity News. Available at: https://medcitynews.com/2016/08/china-and-u-s-health-it-investment-trends/
- Accenture. (2016). U.S. Hospitals Engaging Only 2 Percent of Patients via Mobile Apps, Putting as Much as $100 Million in Annual Revenue [Per Hospital] at Risk, Accenture Finds. [online] Available at: shorturl.at/ikCFQ