Abstract
The increasing concerns of the geographical maldistribution of medical resources have sparked worldwide interests in exploring the potential of telemedicine in the rural health system. This study aimed to investigate the application and effect of telemedicine as well as their regional heterogeneity in the primary care centres in rural China. Based on the stratified multistage cluster sampling, a cross-sectional study was conducted among 358 township health centres (THCs) from eastern, central and western China. A self-administered questionnaire was used and the data of the Health Statistical Annual Reports in 2017 were collected to investigate the implication of telemedicine as well as the performance and other characteristics of each THCs. Propensity score matching was used to estimate the effect of telemedicine application on the bed occupancy rate and the number of annual outpatient visits of the THCs, with comparison among the regions. The overall prevalence of telemedicine application was 58.66% in 2017, and it was found to increase the bed occupancy rate of the THCs in the national range (p < 0.1). When divided into different regions, telemedicine was found to improve the number of annual outpatient visits in western China (p < 0.05) and the bed occupancy rate in eastern China (p < 0.1). Disparities in the degree of remoteness and the capability of THCs among the regions were also found in this study, which may be the reasons for the regional heterogeneous effects of telemedicine. These findings suggested the potential of telemedicine in improving the utilization of primary care centres in rural areas. Further studies were needed to investigate the underlying reasons for its regional heterogeneous effects.
Highlights
Due to the increasing needs of medical care, insufficient medical resources and their unbalanced allocation has become a worldwide problem [1]
Given the number of counties was twice that of districts in China, two counties and one district were randomly selected in each city [47]
As for the outpatient service, we found that telemedicine application could increase the utilization of the outpatient service of township health centres (THCs) in the western region, but no significant effect was found in the eastern and central regions
Summary
Due to the increasing needs of medical care, insufficient medical resources and their unbalanced allocation has become a worldwide problem [1]. The majority of health workers tend to work in urban areas, leaving a shortage of health workers in remote and rural areas, especially in the rural primary care system [2,3]. Due to the shortage of skilled doctors and limited laboratory services, some patients in remote areas suffered from misdiagnosis and delay of treatment [4]. Some other patients in rural areas tend to travel to the tertiary hospitals in urban areas, leading to the underutilization of health care facilities in rural areas and overloading in the tertiary hospitals in urban areas [5]. Increasing concerns about poor access to high-quality medical care and sustainability of primary care facilities in rural areas have sparked the worldwide interest in exploring the potential of telemedicine in the rural health system [6]. Public Health 2020, 17, 4531; doi:10.3390/ijerph17124531 www.mdpi.com/journal/ijerph
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