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.