China is now one of the world’s most digitally advanced societies and is rapidly moving toward global leadership in artificial intelligence. Despite the stark contrast in political systems, Europe has much to learn from this “innovation tiger”, including in healthcare, says Genia Kostka, Professor of Chinese Politics at Freie Universität Berlin.
Over the past decade, China has transformed into one of the most digital-savvy societies. What key policies, cultural, or institutional factors made this digital acceleration possible?
Many factors are driving China’s digital transformation but let me highlight three major ones.
First, China is a one-party state led by the Communist Party, which has developed strategies and plans explicitly focused on digital growth. The belief is that digitalization and innovation are essential for improving the quality of economic development.
Second, the government has emphasized not just digital development but also diffusion. It’s not enough to have cutting-edge research; technology must be adopted and widely used to deliver tangible benefits. The country has invested vast sums in 3G, 4G, and 5G technologies, electric vehicles, and data centers. This growth was often debt-fueled, but it’s necessary if you want to be a front player in technology.
And third, China has backed these strategies with substantial funding. For example, as early as the 2000s, there was a medium- and long-term plan for science and technology development. Later came the Made in China 2025 strategy in 2015, which identified key high-tech industries and set clear targets for industrial upgrading. These targets were passed down to local governments, ensuring alignment across all levels.
Since then, we’ve seen multiple initiatives: the 2017 AI plan, the dual circulation strategy, and the latest five-year plan, where technology is one of the most frequently mentioned priorities.
As you see, clear goals, concrete incentives, and significant financial backing are the ingredients of this unprecedented, rapid digital transformation.
China’s population seems to have embraced digitalization with surprising trust and optimism. It’s driven partly by a political agenda, but not only. What explains this high level of public acceptance toward AI technologies and digital innovation?
There is indeed more technological optimism in China and across much of Asia. Part of this may be political and cultural. But it’s also pragmatic. In my comparative research on technologies like contact-tracing apps, facial recognition, and social credit systems in China, the U.S., the U.K., and Germany, I found that while Chinese citizens are aware of risks – especially privacy concerns – they emphasize the benefits. They value efficiency and convenience: paying for groceries or collecting pensions with facial recognition, for instance. The perceived benefits often outweigh the potential risks, which encourages experimentation and adoption.
Let’s elaborate on the comparative studies you did. What lessons could European policymakers draw from China’s experience in building digital infrastructure and public acceptance of emerging technologies?
One lesson is not to be afraid of a more top-down approach when building infrastructure. Digital transformation requires significant state investment, even if it means taking on debt. China did exactly that.
The government also created strong incentives for both public and private actors, from fiscal subsidies and tax breaks to funding for tech companies. At the same time, it maintained oversight through regulation, ensuring that private companies aligned with national goals.
Europe, of course, operates within a very different system, so it cannot replicate China’s model directly. But Europe can invest more heavily in digital infrastructure and balance the debate around technology. Too often, the focus is on risks rather than on opportunities, on regulation instead of experimentation and implementation. Keep in mind that in China, there is a lot of propaganda pushing the benefits of technology. We don’t want this in Europe, but we could promote the benefits of digital technologies for society. When people don’t know what AI or blockchain is, it's no surprise they feel unsure. A more informed and balanced public dialogue about risks and benefits would help increase acceptance.
Beijing has made clear its ambition to lead globally in AI. How close is China to achieving that goal, and how does its strategy differ from the U.S. and Europe?
China is catching up quickly, though leadership depends on which technologies you’re looking at. The U.S. still has an edge in frontier research, but China is advancing fast, particularly in diffusion and application.
The U.S. export bans on advanced chips have challenged China, yet Beijing has responded by investing heavily in domestic chip development. While Chinese large language models are not yet on par with American ones, they’re closing the gap, and many are open source.
Some argue that the future of AI leadership will depend less on who achieves the next breakthrough and more on who achieves broader diffusion. From that perspective, China’s wide adoption of AI gives it long-term advantages. In reality, both the U.S. and China are leading in different ways, even if some, including NVIDIA’s CEO Jensen Huang, believe China is winning the race.
You’ve also studied how digital technologies are integrated into local governance in China. What did you find?
We analyzed thousands of digital initiatives at the local level. Every local government now operates digital platforms for administrative services, from car registration to marriage licenses, so citizens rarely need to visit offices in person.
AI and digital tools are also used in environmental governance, traffic monitoring, and citizen participation. For example, citizens can report polluted rivers and other issues via an app. In Beijing, there’s a digital hotline, 12345, where residents can submit complaints, raise concerns, or share anything they are unhappy with. AI filters these messages by urgency, and citizens receive responses. There are digital ID cards and facial recognition systems to monitor society. Digitalization is now embedded in nearly every policy area.
During the COVID-19 pandemic, China quickly deployed digital tools like social distancing apps. How is AI being used today to address healthcare challenges such as doctor shortages, an aging population, and rural access to medical services?
You’ve just mentioned three key challenges China is also facing: an aging society, talent shortages, and underdeveloped healthcare in rural areas. Thus, the country is experimenting with AI to improve healthcare provision, including diagnostic capacity, automate triage, and support clinical decisions.
For example, Tsinghua University partnered with a Beijing hospital to develop an “agent hospital” system with digital admissions, diagnostics, and mobile nursing stations. Another example is Ping An, one of China’s largest insurance companies, which launched an AI medical avatar offering 24/7 consultations. According to the latest available data, the Ping An Good Doctor app already has over 400 million registered users.
Another example is an AI-assisted ultrasound diagnostics system implemented in over 100 healthcare institutions. There is also a system for digital admissions in the hospitals, and “mobile nursing stations” which connect nurses with at-home patients. These projects scale rapidly once proven effective, but also because China lacks strong privacy protection laws. Since 2021, there has been a new personal data law, the PIPL (Personal Information Protection Law of the People's Republic of China), that requires consent for the collection of medical and biometric data. But bureaucratic hurdles are lower than in Europe, where GDPR compliance slows experimentation. Last but not least, it’s much easier to scale a solution in a population of over 1,4 billion people than in Europe. The biggest country in Europe, Germany, has “only” 84 million citizens.
Are Chinese patients aware of or concerned about algorithmic decision-making in healthcare?
There are debates about algorithmic bias and ethics, but they’re not as prominent as in the West. Generally, trust in government and medical institutions is higher, so there’s less pushback.
Interestingly, older people in China are now more digitally literate, partly because the use of contact-tracing apps during the pandemic was mandatory. The government offers training courses and has designed “elderly-friendly” app versions. This means that digital healthcare pilots can reach broader demographics than they might in Europe. Overall, people remain quite trusting toward medical AI, even if their understanding of how it works is limited.
Your latest research focuses on people’s emotional relationships with AI chatbots. What were your most surprising findings?
One striking finding is the extent to which users become emotionally attached. In our survey across four countries, 48% of chatbot users considered chatbots their friends, and 35% said they missed them after several days without use.
People value the non-judgmental nature of chatbots. They can ask questions or share feelings freely. They also experience a sense of privacy, paradoxically, because they feel safe confiding in a machine. Talking to chatbots often provides emotional support.
Interestingly, people with larger social networks were more likely to form attachments to chatbots. We expected the opposite, that lonely people would rely on them more. But it seems that those already socially active seek additional interaction through AI.
That’s fascinating. It also ties to healthcare. Many studies show that patients perceive AI-generated answers as more empathetic than those of doctors. What do you think this means for our future interactions with AI?
We need to recognize that chatbots can fulfill some of the same social functions as human conversation, at least in the short term. People see them as safe spaces that listen without judgment.
But we must also consider long-term effects. Chatbots are created by companies that profit from user engagement and can manipulate users, intentionally or not. In China, certain content is censored. Bias and accuracy are also serious concerns.
AI can shape opinions and even influence politics. Our research shows that users often prefer chatbots developed in their own country, which suggests these technologies carry political weight. Regulation will therefore be crucial.
We’ve seen examples, such as the Replika app, where users have become emotionally dependent. Regulation indeed seems urgent. Do you think we could learn from China’s approach?
Absolutely. China already regulates many aspects of AI more strictly, for example, banning deepfakes that mock politicians and controlling online communications. There’s much to learn, both positive and negative.
Because diffusion and experimentation happen so rapidly in China, it serves as a proper testing ground. Studying these developments can help other countries anticipate challenges and avoid mistakes.
You’ve been to China many times. What has impressed you most about its digitalization and use of AI?
The first impression is that technology controls every area of life. But if you ask about positives, what impressed me most is how deeply digitalization has penetrated everyday life and how inclusive many efforts are.
The government actively trains elderly citizens and designs technologies to be accessible to all.
That inclusiveness is remarkable. Of course, there are problems: data leaks, insufficient attention to privacy, and other risks. But overall, the systematic effort to make digital tools widely beneficial is impressive.
