Analyzing national telemedicine policies in China from the perspective of policy instrument (1997-2020)

Willingness of healthcare professionals in China to continue participating in and recommend telemedicine post COVID-19 pandemic

Sustained engagement and promotion by healthcare professionals are essential for the advancement of telemedicine. Post coronavirus disease 2019 (COVID-19) pandemic, the preference for in-person care highlights the need for research on healthcare professionals' sustained telemedicine attitudes. This study assessed healthcare professionals' continued willingness to participate in and recommend telemedicine post-pandemic and identified factors influencing their decisions. From September to October 2023, a cross-sectional study was conducted among 560 healthcare professionals, with samples recruited from 230 hospitals across 11 provinces in China using a multi-stage sampling method. Overall, 518 (92.5%) of 560 respondents expressed their willingness to continue participating in telemedicine, and nearly all respondents (93.5%) displayed a willingness to recommend telemedicine to those in need. The results showed that perceived usefulness, subjective norms, patient coverage, and satisfaction were positively associated with healthcare professionals' willingness to continue participating in and recommend telemedicine. Satisfaction and subjective norms play a partial mediating role in the effect of usefulness on willingness to continue participating in and recommend telemedicine. Patient coverage partially mediates relationship between usefulness and willingness to recommend telemedicine. Chinese healthcare professionals exhibited a generally high level of willingness to continue participating in and to recommend telemedicine. To further enhance this willingness, it is essential to improve their perceptions of telemedicine's usefulness, increase their satisfaction with the technology, and emphasize the roles of subjective norms. Moreover, broadening patient access to telemedicine services will be crucial in promoting healthcare professionals' recommendations.

Correlation Between the Online Visiting Time and Frequency Increase in Telemedicine Services Offered by Health Care Providers Before, During, and After the COVID-19 Pandemic in China: Cross-Sectional Study

BACKGROUND

China has changed its COVID-19 prevention and control status since 2023. However, what role telemedicine will play post-COVID-19 is still uncertain.

OBJECTIVE

We aimed to determine the frequency change in health care providers offering telemedicine services before, during, and after COVID-19, as well as the correlation between the frequency change and telemedicine visit time.

METHODS

The Telemedicine Informationization Professional Committee of China (TIPC) carried out a nationwide questionnaire survey. We adopted data from part of the questionnaires that answered questions regarding the frequency of offering telemedicine services before, during, and after the COVID-19 explosion. Chi-square tests were applied to compare general differences in the between-group telemedicine frequency. Regression models were performed to analyze correlations between the frequency change and the time spent in online versus in-person visits.

RESULTS

Questionnaires from 428 providers were included. As reported, 39 (9.11%) providers often and 159 (37.15%) always offered telemedicine services before COVID-19 exploded. The component ratio increased to 12.38% (n=53) of providers often and 45.79% (n=196) always offering telemedicine during COVID-19 explosion and 12.62% (n=54) often and 50% (n=214) always offering telemedicine after pandemic control was relaxed. The increase in frequency shown as a difference between the before and during groups (χ2=17.21, P.002) and between the before and after groups (χ2=30.17, P<.001) was significant, while it was insignificant between the during and after groups (χ2=2.89, P.57). Senior professional titles (odds ratio [OR] 4.38, 95% CI 1.72-11.6) and longer (OR 3.87, 95% CI 1.95-7.89) and shorter (OR 2.04, 95% CI 1.11-3.87) online visits were correlated with the increase in frequency during versus before COVID-19. In addition, senior professional titles (OR 3.47, 95% CI 1.46-8.49), longer (OR 3.14, 95% CI 1.64-6.11) and shorter (OR=2.27, 95% CI 1.31-4.07) online visits, and using third-party telemedicine platforms (OR 0.51, 95% CI 0.29-0.86) were correlated with the increase in frequency after versus before COVID-19. No factor was significantly correlated with the frequency change after versus during COVID-19. In stratified analysis, longer online visits were correlated with both during versus before (OR 3.84, 95% CI 1.73-8.83) and after versus before (OR 3.40, 95% CI 1.61-7.34) groups for providers using hospital-run platforms, while shorter online visits were correlated with both during versus before (OR 8.16, 95% CI 1.39-68.3) and after versus before (OR 5.70, 95% CI 1.22-33.6) groups for providers using third-party platforms.

CONCLUSIONS

The frequency of telemedicine has increased since the COVID-19 pandemic exploded and is correlated with the time spent in online versus in-person visits. The correlation is different for providers using hospital-run and third party platforms. On a hospital-run platform, providers with longer online visits have a higher frequency of offering telemedicine, while on a third-party platform, providers with shorter online visits are more likely to offer telemedicine.

Community emergency management policy in China using a policy text tool

Systematically analyzing the current status and problems of the Community Emergency Management Policy (CEMP) system in China and proposing practical suggestions that are conducive to subsequent policy formulation and improvement are important for improving community emergency management capabilities and levels and promoting sustainable community development. Based on the two-dimensional analysis framework of "policy tools-policy objectives", this paper draws from content analysis and social network analysis, quantitatively analyzing the CEMP texts at the national level from 2004 to 2024. The results show that the CEMP system in China has essentially taken shape, but there are still some problems, such as the uneven use of policy tools, the unbalanced internal structure of policy tools, the large distribution gap of policy objective elements, and the adaptability between policy tools and policy objectives, which needs to be improved. Given these results, we suggest 1) Appropriately increasing the frequency of using demand-type policy tools and effectively optimizing the internal structure of the three main types of policy tools; 2) Comprehensively deepening the reform of CEMP objectives; and 3) Reasonably improving the adaptability between policy tools and objectives.

Pathways to Sustainable Health Care Development: Study on the Carbon Reduction Potential of Telemedicine in China

BACKGROUND

Carbon emissions are a global concern due to their significant greenhouse effect. The health care sector's greenhouse gas (GHG) emissions must be controlled. Telemedicine in China continued to grow between 2020 and 2022, offering a promising solution for reducing carbon emissions in the country's health sector.

OBJECTIVE

This study explores the potential of telemedicine for reducing GHG emissions and saving energy through a life cycle assessment.

METHODS

This study used the Chinese Environmentally Extended Input-Output database, which is based on input-output models, to quantify the GHG emissions and energy consumption associated with care outpatient and telemedicine from a life cycle perspective. Data collected from the West China Second University Hospital of Sichuan University between 2020 and 2022 were incorporated into the analyses.

RESULTS

The findings indicated that telemedicine could reduce GHG emissions by 36 tCO2e. The GHG emissions per telemedicine session were only 19.14 kgCO2e and are expected to decrease from 2025 to 2030. Replacing in-person treatments with telemedicine can lead to an average reduction of 85.51 kgCO2e emissions.

CONCLUSIONS

In the future, the widespread adoption of telemedicine could help achieve carbon neutrality in the health care sector. Telemedicine is crucial for establishing the sustainable development of the health care sector.

Worldwide research performance on telemedicine for newborns and neonatal intensive care units: A bibliometric and visualization study

Background

Telemedicine uses videoconferencing technology to enable real-time audio and visual communication, linking on-site healthcare providers with specialists at remote locations. Over the past decade, telemedicine has grown significantly within the field of neonatology. This study seeks to deepen the understanding of telemedicine applications for newborns and neonatal intensive care units (NICUs) through a detailed bibliometric analysis.

Methods

Publications on telemedicine in newborns and NICUs from January 1, 2004, to October 22, 2024, were retrieved from the Web of Science Core Collection. Using Microsoft Excel, CiteSpace, the R package "bibliometrix," and VOSviewer, we analyzed the data to examine the number of publications, contributing countries/regions, institutions, authors, journals, references, and keywords.

Results

Since 2004, 1177 publications have been included, reflecting a rapid increase in research on telemedicine in newborns and NICUs over the past decade. These studies originated from 55 countries/regions and 139 institutions. The United States, the United Kingdom, and India were the primary contributors in terms of publication volume. Among the 405 authors analyzed, Jennifer L. Fang had the highest number of publications, while James P. Marcin received the most co-citations. BMC Pregnancy and Childbirth published the most articles, and Pediatrics had the highest citation count. The most frequently used keywords included "accuracy," "depression," "digital health," "mobile health," and "parents," highlighting key research areas. Emerging research frontiers such as "palliative care," "low-income populations," "artificial intelligence," and "parents with high-risk infants" indicate rapidly advancing topics in this field.

Conclusions

This study is the first to perform a comprehensive bibliometric analysis of publications on telemedicine in newborns and NICUs. In the previous 20 years, global interest in teleneonatology research has significantly increased. Our bibliometric findings offer valuable insights for researchers, helping them understand essential information, recognize current research hotspots, identify potential collaborators, and explore future research frontiers in this field.

Embracing the Future of Health Care: Investigating Medical Students' Willingness to Become Online Doctors

Purpose: With the rapid advancement of technology, online health care services are becoming increasingly prominent. This study aims to investigate medical students' perceptions, attitudes, and readiness to adopt online health care services. Methods: Based on a literature review, this study constructed a conceptual model describing the relationships among medical students' perception, personality traits, and usage intention, grounded in the Technology Acceptance Model and Technology Readiness Index (TRI). The data for this study were collected from January to February 2023 through a questionnaire survey at Wenzhou Medical University, China. The proposed hypotheses were tested using structural equation modeling through AMOS software. Results: Out of the 340 respondents, 281 (82.6%) validly responded. Among these, 58.4% of medical students agreed and strongly agreed with the intention to become an online doctor. Within the TRI's motivational factors, optimism positively and significantly affected perceived usefulness (PU) and perceived ease of use (PEOU). Innovativeness also significantly enhanced PEOU. Among the inhibitory factors, insecurity was found to have a negative and statistically significant influence on PU. The rest of the dimensions did not have a significant effect on either PU or PEOU. Importantly, both PU and PEOU demonstrated a direct and substantial effect on usage intention. Conclusions: This study emphasizes the significance of comprehending medical students' readiness to adopt the role of online doctors in shaping the future of health care. By equipping medical students with the necessary skills and competencies, health care institutions can effectively leverage the full potential of online health care services while ensuring the provision of high-quality, accessible, and patient-centered care in the digital era.

Matching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents

China is home to the second largest population of children and adolescents in the world. Yet demographic shifts mean that the government must manage the challenge of fewer children with the needs of an ageing population, while considering the delicate tension between economic growth and environmental sustainability. We mapped the health problems and risks of contemporary school-aged children and adolescents in China against current national health policies. We involved multidisciplinary experts, including young people, with the aim of identifying actionable strategies and specific recommendations to promote child and adolescent health and wellbeing. Notwithstanding major improvements in their health over the past few decades, contemporary Chinese children and adolescents face distinct social challenges, including high academic pressures and youth unemployment, and new health concerns including obesity, mental health issues, and sexually transmitted infections. Inequality by gender, geography, and ethnicity remains a feature of health risks and outcomes. We identified a mismatch between current health determinants, risks and outcomes, and government policies. To promote the health of children and adolescents in China, we recommend a set of strategies that target government-led initiatives across the health, education, and community sectors, which aim to build supportive and responsive families, safe communities, and engaging and respectful learning environments. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Governing cross-border healthcare in mainland China: a scoping review of national policies from 2002 to 2022

This study reviews national-level policies regulating cross-border healthcare in mainland China after it acceded to the World Trade Organization (WTO). Policy documents from official websites of the State Council and 19 ministries were screened, from which 487 policy documents were analyzed. WTO's five modes of trade and WHO's six building blocks of healthcare system were used to guide the analysis of policymaking patterns, charting of policy evolution process, identification of key policy areas, differentiation of 29 detailed policy themes, and identification of major countries/regions involved in cross-border healthcare. The findings lead to four policy recommendations: (1) to establish a national-level committee to govern cross-border healthcare, (2) to build an information system to comprehensively integrate various information on cross-border healthcare consumption and provision, (3) to take more proactive policy actions in healthcare internationalization, and (4) to carry out reform experiments in key sub-national regions to fully explore various possibilities in developing and regulating cross-border healthcare.

Key Factors Influencing the Operationalization and Effectiveness of Telemedicine Services in Henan Province, China: Cross-Sectional Analysis

BACKGROUND

Telemedicine has demonstrated its potential in alleviating the unbalanced distribution of medical resources across different regions. Henan, a province in China with a population of approximately 100 million, is especially affected by a health care divide. The province has taken a proactive step by establishing a regional collaborative platform for telemedicine services provided by top-tier provincial hospitals.

OBJECTIVE

We aim to identify the key factors that influence the current operationalization and effectiveness of telemedicine services in Henan province. The insights gained from this study will serve as valuable references for enhancing the efficient operation of telemedicine platforms in low- and middle-income regions.

METHODS

We analyzed service reports from the performance management system of telemedicine services in Henan province throughout 2020. Using descriptive statistics and graphical methods, we examined key influencing factors, such as management competency; device configuration; and hospital capability, capacity, and service efficacy, across hospitals at 2 different tiers. In addition, we used generalized linear models and multiple linear regression models to identify key operational factors that significantly affect the service volume and efficacy of 2 major telemedicine services, namely teleconsultation and tele-education.

RESULTS

Among the 89 tier 3 hospitals and 97 tier 2 hospitals connected to the collaborative telemedicine platform, 65 (73%) and 55 (57%), respectively, have established standardized management procedures for telemedicine services. As the primary delivery method for telemedicine services, 90% (80/89) of the tier 3 hospitals and 94% (91/97) of the tier 2 hospitals host videoconferencing consultations through professional hardware terminals rather than generic computers. Teleconsultation is the dominant service type, with an average annual service volume per institution of 173 (IQR 37-372) and 60 (IQR 14-271) teleconsultations for tier 3 and tier 2 hospitals, respectively. Key factors influencing the service volume at each hospital include available funding, management competency, the number of connected upper tiers, and the number of professional staff. After receiving teleconsultations from tier 3 (65/89, 73%) and tier 2 (61/97, 63%) hospitals, patients reported significant improvements in their medical conditions. In addition, we observed that service efficacy is positively influenced by management competency, financial incentives, the number of connected upper or lower tiers, and the involvement of participating medical professionals.

CONCLUSIONS

Telemedicine has become increasingly popular in Henan province, with a notable focus on teleconsultation and tele-education services. Despite its popularity, many medical institutions, especially tier 2 hospitals, face challenges related to management competency. In addition to enhancing the effectiveness of existing telemedicine services, health care decision-makers in Henan province and other low- and middle-income regions should consider expanding the service categories, such as including remote emergency care and telesurgery, which have promise in addressing crucial health care needs in these regions.

Analysis of the influencing factors and spatiotemporal evolution characteristics of telemedicine service supply: Empirical evidence from pilot cities in China

Background

Telemedicine is one of the major trends in the evolution of modern medicine. Telemedicine encompasses a wide range of services with different characteristics. Healthcare organisations know limited information on developing and utilising different types of telemedicine service programmes as well as factors and spatial and temporal characteristics that influence their development.

Objective

To analyse the factors influencing the development of telemedicine, and to explore the priority order of different telemedicine services carried out by healthcare institutions, as well as the spatiotemporal evolution characteristics.

Methods

This study selected Zunyi City, a national pilot city for telemedicine in China, and employed multinomial logistic regression to analyse factors influencing the provision of different types of telemedicine service programmes by healthcare institutions and evaluate the spatial and temporal evolutionary characteristics of spatially visualised telemedicine service programmes.

Results

When the price of services increased, providers were more inclined to conduct teleconsultation (OR: 1.023) and telepathology (OR: 1.058) than tele-imaging, and the willingness to conduct telecardiology (OR: 0.775) and telemetry (OR: 0.997) was relatively low. Patients' out-of-pocket payments increased, and providers' willingness to conduct teleconsultations (OR: 49.401) and telepathology (OR: 5.039) increased. Healthcare organisations at higher level were more willing to carry out teleconsultation (OR: 14.052), telepathology (OR: 8.071) and telemetry (OR: 13.113). Compared with private hospitals, public hospitals were 17.760, 12.248 and 87.860 times more likely to conduct teleconsultations, telecardiology and telepathology than tele-imaging. The effectiveness of telemedicine development may be related to the level of local economic development.

Conclusion

Medical institutions carry out telemedicine service programmes with a certain order of priority. Their decisions are often influenced by various factors such as price, out-of-pocket payment ratio and level and attribute of the healthcare organisation. The development of telemedicine may follow an inverted 'U' pattern with the level of regional economic development.

Implications for implementation and adoption of telehealth in developing countries: a systematic review of China's practices and experiences

The rapid advancement of telehealth technologies has the potential to revolutionize healthcare delivery, especially in developing countries and resource-limited settings. Telehealth played a vital role during the COVID-19 pandemic, supporting numerous healthcare services. We conducted a systematic review to gain insights into the characteristics, barriers, and successful experiences in implementing telehealth during the COVID-19 pandemic in China, a representative of the developing countries. We also provide insights for other developing countries that face similar challenges to developing and using telehealth during or after the pandemic. This systematic review was conducted through searching five prominent databases including PubMed/MEDLINE, Embase, Scopus, Cochrane Library, and Web of Science. We included studies clearly defining any use of telehealth services in all aspects of health care during the COVID-19 pandemic in China. We mapped the barriers, successful experiences, and recommendations based on the Consolidated Framework for Implementation Research (CFIR). A total of 32 studies met the inclusion criteria. Successfully implementing and adopting telehealth in China during the pandemic necessitates strategic planning across aspects at society level (increasing public awareness and devising appropriate insurance policies), organizational level (training health care professionals, improving workflows, and decentralizing tasks), and technological level (strategic technological infrastructure development and designing inclusive telehealth systems). WeChat, a widely used social networking platform, was the most common platform used for telehealth services. China's practices in addressing the barriers may provide implications and evidence for other developing countries or low-and middle- income countries (LMICs) to implement and adopt telehealth systems.