Abstract
OBJECTIVE: The scarcity of healthcare resources and inadequate access to medical services in rural and remote areas are pervasive challenges many countries face, particularly in the developing world. Telemedicine, with its capacity to overcome geographical barriers and provide patients with real-time medical services, has shown considerable potential in addressing these issues, attracting widespread attention. Compact medical communities and family doctor systems play important roles in improving healthcare accessibility. However, despite the critical nature of patients' perceptions of healthcare accessibility, research in this domain is sparse. This study aimed to explore the impact of telemedicine on rural residents' perceived healthcare accessibility in China, analyze the mechanisms underpinning this relationship, and elucidate the roles of compact medical communities and the family doctor system. METHODS: Survey data from 3311 rural residents were analyzed using a probit model, instrumental variables, and subgroup regression analyses to ascertain causal effects, perform heterogeneity analysis, examine mechanisms, and ascertain the robustness of the findings. RESULTS: Telemedicine significantly enhanced rural residents' perceived healthcare accessibility, with particularly notable benefits for those in sparsely populated areas, regions with high-speed internet access, within the purview of compact healthcare consortiums, and those with access to family doctor services. Furthermore, telemedicine improved rural residents' perceived healthcare accessibility by encouraging the use of primary care services. CONCLUSION: Telemedicine in China has played a significant role in improving the perceived healthcare accessibility among rural residents and aiding in the reduction of disparities in accessibility across different demographic groups. This is consistent with the broader objective of achieving universal health coverage. However, the efficacy of telemedicine in enhancing healthcare accessibility is contingent upon certain preconditions. Policymakers must confront local infrastructure challenges, particularly regarding internet connectivity, when expanding telemedicine services to ensure their effective operation. The synergistic interaction observed between telemedicine, the family doctor system, and compact medical communities highlights the importance of integrating telemedicine into existing healthcare systems. Such integration could enhance collaboration with current healthcare frameworks, ensuring the provision of safe, accessible, and affordable healthcare services, and promoting the health and well-being of local populations.