Deborah Fallows, a Senior Research Fellow at the Pew Internet & American Life Project, recently completed a study of internet use in China. There’s an estimated 137 million internet users in China compared to over 165 in the U.S.. China is expected to overtake the U.S. in the total number of users over the next few years.

Nothing really surprising here, but I was curious about the role of an expanding internet in addressing one of China’s major health care reform challenges: bringing adequate health care services to the rural areas where most of China’s 1.3 billion people live. In Fallow’s study, she estimates that compared to 20 percent of internet penetration in the urban areas, rural areas account for only 3 percent, with peasants or farmers making up only about 0.4% of the online population. Lack of access to the technology seems to be the primary in the rural areas, with 70 percent of “rural-non-users” saying “they will definitely NOT be online within 6 months.”

Compared to the explosion in use of mobile phones (new rural subscribers representing half of China Mobile’s 53 million new mobile phone subscribers in 2006) internet expansion is going “very slowly”. This is despite the fact that the expanding access has been a government goal since 2001. This lack of progress is quite unfortunate.

Now it appears that most of the priority for bringing the internet to the rural areas lies in promoting economic development and improving education. And Fallows cites some educational efforts still struggling to find a useful foothold in getting the value from the investment.

But given the government’s priority in health care reform especially when it comes to rural health care, the internet offers an abundance of health care system delivery options not now on the table. With suitable training and a web-enabled laptop provided to each one of China’s rural doctors (see previous post) the opportunities for improving the quality of care as well as more effectively managing the distribution and efficiency of health care delivery are enormous. The investment would not be insubstantial but the payoff would be well worth it on many fronts.

Since many rural area residents already possess a cell phone, creative health management strategies combining these technologies could make a critical difference. Even basic remote health monitoring programs could be built without overburdening costs.

The point being made here is instead of seeing the web as a nice-to-have enhancement to making progress in a crisis-ridden health care development environment, it should be seen as an essential component of any health care delivery strategy — an especially where distance and a lack of skilled talent and resources are a big part of the problem.