Crowdfunding Can’t Cure China’s Health Care Gap
One of the realities of Chinese healthcare is that, despite the existence of a public health insurance scheme, individuals and families in lower income brackets who develop serious or rare diseases are often unable to pay for treatment. In 2017, 40% of people suffering from poverty in rural China became poor because of a medical condition.
Since 2014, crowdfunding platforms dedicated to helping patients cover their medical expenses have become an increasingly important channel for charitable assistance in China. Similar to GoFundMe in the United States, platforms like Shuidichou allow almost anyone to sign up and launch donation campaigns that can be shared widely online.
Despite the occasional scandal, these platforms have provided prompt financial relief to many patients of low socioeconomic status. According to their own statistics, China’s two largest medical crowdfunding platforms, Shuidichou and Qingsongchou, had raised more than 60 billion yuan ($8.34 billion) in donations by 2020.
But while this appears to be another example of science and technology contributing to social progress, it’s worth interrogating online crowdfunding further. Who is really benefitting from crowdfunding — and can these campaigns truly promote social equality?
One of the tenets of classical sociology is that the distribution of social resources is uneven: The higher an individual’s status, the greater their power to acquire resources. Intrigued by whether online crowdfunding is also subject to such an effect, my team and I gathered and analyzed 1,930 cases from a major medical crowdfunding platform. Our study suggests that, while crowdfunding may help patients in need, these platforms not only fail to reduce inequality among those in need of assistance, but also reinforce it.
The success of individual fundraisers on online platforms varies greatly depending on their socioeconomic status. The total amount raised, the percentage of their goal they hit, the number of individual donations made, and the number of times a fundraising campaign is shared all favor individuals of higher socioeconomic status. Those whose socioeconomic status rank among the top 10% of the study sample achieved on average 40% of their crowdfunding goals, whereas those in the bottom 10% achieved just 20%. Moreover, while the amount of donations received by an individual in need decreased over time in all brackets, this decrease was far more significant for individuals of mid to low socioeconomic status than for their relatively better-off peers.
In other words, our data suggests that the success of a crowdfunding initiative is closely related to an individual’s offline social networks. The higher the socioeconomic status of help-seekers, the greater the size and diversity of their social networks, as well as the mobilizable resources embedded within these networks. This affects the dissemination of crowdfunding campaigns, resulting in better crowdfunding outcomes.
Interestingly, even when help-seekers of low socioeconomic status do have better-off contacts, these contacts often don’t share the fundraising campaign on their social media accounts. Rather, to save face, they’re more likely to donate privately.
In recent years, the stubborn persistence of the digital divide — that is, unequal access to the internet — has received widespread attention in China. For example, during the pandemic, many elderly Chinese have been unable to use health codes or shop online. But whether the internet reduces or reinforces social inequality has rarely been discussed.
Our research demonstrates that mobile internet technology reinforces inequality when it comes to healthcare crowdfunding. However, the way that platforms are designed and organized may limit the generalizability of our findings. In particular, the majority of the fundraising campaigns we examined were shared primarily through WeChat, the largest social networking tool in China, and one that mostly acts as an online duplicate of real-life acquaintance networks.
If requests for donations can spread beyond these circles to reach online spaces frequented by a greater diversity of people, inequalities in crowdfunding outcomes would likely decrease. Internet platforms that operate differently from WeChat, such as the short video app Douyin and microblogging service Weibo — both of which are less tethered to an individual’s real-life networks than WeChat — may allow for a more equal distribution of resources among people of different socioeconomic status.
To achieve more equitable results, crowdfunding and philanthropic platforms should optimize their promotion of crowdfunding initiatives to help those launched by comparatively disadvantaged individuals reach a broader section of the public, rather than being limited to private social circles. Not only do platforms need to fine-tune their own promotional algorithms, but they also must find ways of collaborating with other online platforms, beyond WeChat, to connect different communities and elevate the voices of those most in need.
Ultimately, no matter how healthcare crowdfunding improves, true equality will require China to commit to improving public healthcare infrastructure and bolstering its safety net. Our study suggests that certain stopgap measures, such as targeted policies aimed at reducing the incidence of disease-induced poverty and keeping minor illnesses from developing into more serious conditions, are necessary. Yet, the fact that disadvantaged people can benefit from medical crowdfunding, but are unable to do so in proportion to their need, prompts us to reconsider how social resources could be reallocated, and to work harder toward fostering a more cohesive, equitable society.
Ren Yifei of the Department of Sociology of Zhejiang University also contributed to this article.
Translator: Lewis Wright; editors: Lu Hua and Kilian O’Donnell.
(Header image: IC)