Department of Public Administration, Graduate School of Law and Politics, University of Tokyo, Tokyo, Japan.
Department of Health and Social Behavior, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Telemed J E Health. 2024 Feb;30(2):563-569. doi: 10.1089/tmj.2023.0221. Epub 2023 Aug 16.
COVID-19 has reportedly resulted in disparities in the use of telemedicine due to several socioeconomic factors. While telemedicine was developed to overcome geographical distance, under COVID-19 telemedicine conversely might have deepened the urban-rural telemedicine divide. Especially in Japan, the authority has virtually regulated distant telemedicine use, which favored telemedicine providers who are located in close proximity to patients. This study aimed to quantify the urban-rural disparity in access to telemedicine and investigate heterogeneity between devices (phone and video visits). We used two nationally comprehensive data sources in Japan. One was a municipality-level telemedicine provider database. Municipality-provider-level analysis intended to measure the uneven distribution of telemedicine providers compared to usual health care providers as well as the difference among clinical departments. The second source was prefecture-level telemedicine utilization data. Prefecture-utilization-level analysis aimed to quantify how the use of telemedicine converged in urban areas. We investigated the heterogeneity between types of devices and time periods. To measure inequality, this study used the Lorenz Curve and Gini coefficients. Ethical review was not required. The data included 16,927 providers (14,111 clinics and 2,816 hospitals) and 88,952 first visits throughout Japan. The main findings were the geographically converged distribution of telemedicine providers compared with overall providers who were not limited to telemedicine and, possibly as a result of it, the geographically unequal utilization of telemedicine compared with in-person visits. Furthermore, video visits were more unequally utilized than phone visits, let alone in-person visits. The disparity was not resolved over time, which implied a systematic cause. Using comprehensive nationwide data, this study revealed geographical inequality relating to access to telemedicine under the COVID-19 special deregulation in Japan. While telemedicine initially aimed to provide access to care for people in rural areas, several factors, including the digital divide, COVID-19, and the Japanese policy, paradoxically could have caused this disparity.
据报道，由于多种社会经济因素，COVID-19 的出现导致远程医疗的使用存在差异。虽然远程医疗的发展旨在克服地理距离的限制，但在 COVID-19 期间，远程医疗反而可能加深了城乡远程医疗的差距。特别是在日本，当局实际上已经规范了远程医疗的使用，这有利于那些靠近患者的远程医疗提供者。本研究旨在量化远程医疗的城乡获取差距，并研究设备之间的异质性（电话和视频访问）。我们使用了日本的两个全国性综合数据源。一个是市级远程医疗提供者数据库。市级提供者分析旨在衡量与常规医疗提供者相比，远程医疗提供者的分布不均，以及临床科室之间的差异。第二个来源是县市级远程医疗利用数据。县市级利用分析旨在量化远程医疗在城市地区的使用如何趋同。我们研究了不同设备类型和时间段之间的异质性。为了衡量不平等，本研究使用了洛伦兹曲线和基尼系数。不需要伦理审查。该数据包括日本各地的 16927 名提供者（14111 家诊所和 2816 家医院）和 88952 次首次就诊。主要发现是远程医疗提供者的地理分布与不受远程医疗限制的总体提供者相比趋于集中，可能因此，与面对面就诊相比，远程医疗的地理利用不平等。此外，视频访问的使用不平等程度高于电话访问，更不用说面对面访问了。这种差距并没有随着时间的推移而得到解决，这暗示着存在系统性的原因。利用全面的全国性数据，本研究揭示了 COVID-19 特殊放宽管制下日本远程医疗获取方面的地理不平等。虽然远程医疗最初旨在为农村地区的人们提供医疗服务，但包括数字鸿沟、COVID-19 和日本政策在内的几个因素，可能会导致这种差距。
