The Construction and Operational Models of Internet Hospitals in China: A Hospital-Based Survey Study

Abstract Background China empowered and continues to empower internet hospitals, which saw an increase in their development due to the pandemic, to fight against COVID-19. The construction and operational models of internet hospitals can be categorized as self-constructed and self-managed models, self-constructed and enterprise-run models, hospital and enterprise joint-owned models, and as being hosted by a third-party platform. Despite the increasing importance of internet hospitals, there have been few systematic summaries of its construction and operational models. Objective The study’s primary purpose was to understand the construction and operational models of internet hospitals in China. Methods Data were collected from September 2020 from the internet hospital survey and hospital staff survey based on 39 medical institutions and 356 medical staff. T-tests were used to compare the continuous variables’ values. Chi-square tests were used to compare the proportions of the categorical variables. The self-perception of the internet hospitals’ services was assessed on 17 aspects using a 5-point Likert scale. A root cause analysis was used to identify the root causes and influencing factors of the current deficiencies faced by internet hospitals. Results Among the 39 internet hospitals, 22 (56.4%) were self-constructed and self-managed. Self-constructed and self-managed hospitals had lower percentages of professionals providing online services (P=0.006), numbers of doctors outside of the entity (P=0.006), numbers of online nurses (P=0.004), and ratio of online nurses to offline doctors as compared to other models of internet hospitals (P < 0.001). Among the 17 evaluation aspects of the medical staff’s self-perception of the internet hospitals’ services, fee transparency, fee rationality, travel cost capital, patience and responsibility, and consultation behaviors had the highest scores. The root causes included five aspects: human, channels, prices, services, and time. Conclusions There were differences between self-constructed and self-managed models and other models of internet hospitals. This study enriches the literature on the construction and operational models of internet hospitals and provides additional policy implications for tele-medicine management.