On June 2, General Secretary Xi Jinping chaired a symposium attended by experts and scholars, and made important remarks. He called for better coordination among medical and health institutions across regions to mobilize resources and personnel in collective response to public health emergencies. It is imperative to establish and improve a graded, tiered and category-based treatment system for major epidemic crises. The Yangtze River Delta to is in an advantageous position to explore and practice cross-regional coordination, and there is especially great room for the improvement of coordination among medical and health institutions. The integrated development of the Yangtze River Delta has been elevated to a national strategy, which provides a key opportunity for the coordinated development of medical services in the region. This will directly improve people’s sense of happiness and gain, and thus attract more high-level talent to settle down in the region and contribute to its development. Moreover, this will optimize the comprehensive carrying capacity of core cities, and make city clusters undertake the functions of megacities, effectively solving the problems of megacities, addressing uneven regional development, avoiding concentration of medical resources in megacities, and improving the basic public service system of the entire region. The top priority now is to figure out how to make full use of and integrate the medical resources of the three provinces (Zhejiang, Jiangsu and Anhui) and one city (Shanghai), draw on each other’s strength, and jointly promote the coordinated development of medical care. The establishment and improvement of online medical care may be an effective solution to this problem. New Infrastructure Construction becomes new engines for online medical care IT development and regional collaboration are the key factors to promote the integration of medical and health resources. The integration of medical services in the Yangtze River Delta wouldn’t have been possible without the inter-connectivity of infrastructure. In the past, due to limited investment from hospitals and lack of government financial support, primary medical institutions couldn’t afford to build telemedicine consultation platforms, making it difficult to achieve infrastructure inter-connectivity in the region. The introduction of the “new infrastructure” policy has stimulated the development of new formats and new models such as 5G, artificial intelligence and big data, and promoted the IT construction of medical institutions of various levels and types in the Yangtze River Delta region. Regional barriers have been completely smashed down, enabling uninterrupted electronic health files and medical records, and sharing of medical information, imaging and test data. The construction of new medical and health infrastructure will bring about a breakthrough in the coordinated development of medical care and inject a “new engine” into the digital transformation of medical care in the Yangtze River Delta. The establishment of online medical care system should also focus on improving medical informatization, exploring an integrated standard system for medical information and formulating unified basic standards for data security, privacy information protection and information sharing, thus ensuring effective sharing of medical and health information in the Yangtze River Delta. Online medical care ushers in a “new way” for inter-connectivity in the Yangtze River Delta The Yangtze River Delta region has achieved cross-administrative area connectivity in terms of transportation. Online medical care has also built an “invisible highway” with its advantages in offering real-time, convenient and economical services, breaking the time and space restrictions and effectively promoting the free flow of medical resources in the Yangtze River Delta. It has helped address the uneven distribution of medical resources in the region, enhanced the integration of medical and health services, and promoted high-quality development of medical services. During the spread of COVID-19, online medical application scenarios such as telemedicine, remote diagnosis, online consultation, electronic prescription and medicine distribution have profoundly changed the traditional medical treatment model, which not only helps avoid cross-infection, but also optimizes business process reengineering and improves the efficiency of medical services. IT-based means are used to extend offline medical resources to online and expand the space and scope of medical services, so that patients can enjoy the same services at home. After the outbreak of the epidemic, many national departments have issued a series of policies and guidance documents on using information technology to contain the virus, and the online medical industry has been given substantial policy support. In the post-epidemic era, online medical care will embrace golden development opportunities. Combining with medical consortiums and promoting regional integrated development will become one of the future trends of online medical care. Online medical care provides a “new model” for sharing high-quality public services The coordinated development of medical care in the Yangtze River Delta needs to give consideration to “both sides” and strive for “vertical-horizontal” integration. In terms of vertical integration, we should explore cross-area medical consortiums, specialist alliances and telemedicine collaboration network to establish a hierarchical diagnosis and treatment system of “first consultation at primary hospitals and two-way patient transfer.” Primary medical and health institutions mainly provide preventive health care, health education, disease management, diagnosis and treatment of common diseases and frequently-occurring diseases, receive rehabilitation patients transferred from higher-level hospitals, and transfer to higher-level hospitals patients that they are unable to treat. The second- and third- level hospitals mainly provide diagnosis and treatment of diseases, especially acute, severe and complicated cases, emergency medical treatment and rescue, and engage themselves in medical education & training, medical scientific research and guidance for primary medical and health institutions. In terms of horizontal integration, National Medical Center and regional medical centers should give play to their roles in demonstration, guidance and driving force. We should use the construction of clinic specialties as the starting point and telemedicine as a means to effectively address the structural contradictions caused by unbalanced distribution of medical resources in the region, reduce the number of patients seeking medical treatment in other places, and promote the coordinated development of local clinical diagnosis and treatment capacity. Through the “internet + medical consortiums” model, we will promote telemedicine services to cover all medical consortiums and county-level hospitals in the region, and gradually community health service institutions, township health centers and village clinics, thus improving local medical service level and medical treatment efficiency. We should adhere to the coordinated development of human resources to promote regional coordinated development, and strengthen the expertise and management abilities of medical care professionals. The “online + offline” model is taken to recommend core physicians to advanced hospitals in the Yangtze River Delta for further training, and management personnel and professional technicians to areas with advanced medical service in the region for exchange. Additionally, seminars and exchange activities for coordinated medical development of the region are organized to strengthen the construction of the Yangtze River Delta Regional Medical Care Think Tank and multi-center clinical research, so as to cultivate more local high-quality health talent and increase its support for and contribution to the medical development of the region. Online medical care facilitates “cloud handling” of direct settlement of cross-province medical expenses In recent years, the cross-province social security system in the Yangtze River Delta has become more convenient for people. Currently, insured patients in the three provinces (Zhejiang, Jiangsu and Anhui) and one city (Shanghai) of the region can enjoy offline direct settlement of cross-province medical expenses, but the formalities and procedures are complicated and time-consuming. Besides, due to different medical security levels in different areas, different medicine catalogs in medical institutions of different levels, inconsistent time limits for medical insurance settlement, and incomplete medicine catalogs in primary medical institutions, availability of the same medicines cannot be guaranteed for patients transferred to lower-level hospitals, which is one of the obstacles to promoting two-way patient transfer. The COVID-19 crisis has accelerated the link-up of online medical care with medical insurance, and online payment of local medical insurance has initially realized. In Shanghai, Zhejiang, Jiangsu, Tianjin, Sichuan, Guangdong, etc., online further consultation of common and chronic diseases of designated medical institutions and online purchase of medicines are covered by medical insurance. The electronic certificate of medical insurance issued by the national medical insurance information platform is officially launched, which will further facilitate direct settlement of cross-province medical insurance in the future. People can scan the QR code to buy medicine with medical insurance from over 10,000 pharmacies and hospitals in Shandong, Fujian, Hebei, Heilongjiang and Jilin. Recently, China has successively issued relevant policies, while the price management mechanism for online medical care and the medical insurance payment policies are taking shape. Realizing direct settlement of cross-province medical insurance is undoubtedly a gesture to promote the flow of talent in the Yangtze River Delta region, as well as a feasible way to achieve the equalization of public services. Strategies for the coordinated development of medical services in the Yangtze River Delta against the backdrop of online medical care As a new format, online medical care is quite different from the traditional medical service model in terms of policy supervision, diagnosis & treatment, operation, doctor behavior and patient management, and is bound to encounter many difficulties and pain points in its operation. In this regard, we can further explore and improve the following aspects, and continue to promote cross-area coordination of medical services against the backdrop of online medical treatment. First, we should encourage doctors to practice medicine in multiple institutions. Currently, there is an urgent need to realize electronic and regional registration of physicians, and expand the registration at local medical institutions to that in the Yangtze River Delta region, so as to break the administrative jurisdictional restrictions. To allow doctors to work in multiple institutions is an exploratory measure proposed according to the requirements of the new medical reform, which helps revitalize medical resources and encourage healthy competition among various hospitals. It fully embodies the principle of public hospitals, namely serving the public, and can actively motivate the medical staff. Second, we should push ahead with medical insurance payment reform. It is recommended to implement online payment of cross-province medical insurance, optimize the software and hardware of the settlement platform, cover the “last mile” of online medical care, and form a cross-province medical insurance settlement mechanism for patients transferred to different hospitals in the Yangtze River Delta region. We should give full play to the leverage of medical insurance on the rational allocation of medical resources, and improve the differentiated payment policy for medical insurance at medical institutions of different levels and types. Besides, it’s necessary to promote the reform of payment methods such as medical insurance package payment in medical consortiums, establish a mechanism to rationally share the overspending while the surplus medical income can be used to carry out work and improve the benefits of medical staff, so that the hospitals can form a community of mutual benefits with “shared risks and profits.” This can motivate medical staff to make two-way patient transfers and actively control medical cost, and guide the hospitals within medical consortiums to actively standardize diagnosis and treatment. Third, we should promote cross-province acceptance of electronic prescriptions. It is recommended to build an integrated platform for regional pharmaceutical management in the Yangtze River Delta to realize the functions of connecting medicine catalogs, sharing procurement data, free flow of prescriptions, and integrated distribution and payment in the region. Finally, patients that make a second visit will have electronic prescriptions through online hospitals, and the medicines will be directly delivered to their houses or pharmacies near their houses where they can pick up the medicines, thus meeting the basic medical service needs of patients in the Yangtze River Delta.  Fourth, we should promote the quality-based performance evaluation mechanism. The coordinated development of medical care not only encourages institutions to provide proper services, but also emphasizes cooperation between institutions. We should establish a salary system suitable for the characteristics of the medical and health industry and meets the requirements for coordinated development, gradually increase the proportion of technical personnel’s income in medical services, compensate medical staff for the value of medical services, and motivate medical institutions and medical staff. It’s necessary to give public hospitals certain autonomy in medical pricing so as to give incentives to all parties. The medical staff’s salary depends on the quality-based performance evaluation mechanism, and their performance will be evaluated through establishing the standard medical quality management system and the single disease quality control standard. Ultimately, the quality and level of medical care in the region will be greatly improved. (Originally published in Shanghai Observer on June 11, 2020. Yu Guangjun is the dean of Shanghai Children’s Hospital and the director of the Institute of Medical Information, Development Research Institute of China Hospital, Shanghai Jiaotong University; Shi Jingjin is a Ph.D. of School of Public Health, Shanghai Jiaotong University)