Assessment of Utilization and Cost-Effectiveness of Telemedicine Program in Western Regions of China: A 12-Year Study of 249 Hospitals Across 112 Cities.
The imbalance in healthcare between urban and rural areas is still a problem in China. In recent decades, China has aimed to develop telemedicine. We assessed the implementation, utilization, and cost-effectiveness of a large telemedicine program across western China.



In 2002-2013, a government-sponsored major telemedicine program was established by West China Hospital of Sichuan University (hub), covering 249 spoke hospitals in 112 cities throughout western China and in 40 medical expertise areas. We analyzed the cross-sectional data from 11,987 consultations conducted at West China Hospital using the telemedicine network over a 12-year period. The types of diseases as well as the diagnosis and treatment changes were assessed. We also performed a cost-savings analysis and a one-way sensitivity analysis.



Of the 11,987 teleconsultations, we noted that neoplasms (19.4%), injuries (13.9%), and circulatory diseases (10.3%) were the three most common diagnoses. Teleconsultations resulted in a change of diagnosis in 4,772 (39.8%) patients, and 3,707 (77.7%) of them underwent major diagnosis changes. Moreover, it led to a change of treatment in 6,591 (55.0%) patients, including 3,677 (55.8%) changes not linked to diagnosis changes. The telemedicine network resulted in an estimated net saving of $2,364,525 (if the patients traveled to the hub) or $3,759,014 (if the specialists traveled to the spoke hospitals).



The introduction of telemedicine in China, linking highly specialized major hospitals (hub) with hundreds of small rural hospitals (spoke), can greatly improve the quality, efficiency, and cost-effectiveness of healthcare delivery and utilization. This new Internet-based healthcare model should be utilized more widely in developing countries.
1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China .
Ting-Ting
TT
Wang
1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China .
Jin-Mei
JM
Li
2 Department of Health Statistics, West China School of Public Health, Sichuan University , Chengdu, Sichuan, China .
Cai-Rong
CR
Zhu
1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China .
Zhen
Z
Hong
1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China .
Dong-Mei
DM
An
1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China .
Hong-Yu
HY
Yang
1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China .
Jie-Chuan
JC
Ren
1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China .
Xue-Mei
XM
Zou
1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China .
Cheng
C
Huang
1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China .
Xiao-Sa
XS
Chi
1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China .
Jia-Ni
JN
Chen
3 Department of Neurology, Huashan Hospital, Fudan University , Shanghai, China .
Zhen
Z
Hong
4 Department of Neuroepidemiology, Beijing Neurosurgical Institute, Capital Medical University , Beijing, China .
Wen-Zhi
WZ
Wang
5 Department of Hematology and Research Laboratory of Hematology, West China Hospital, Sichuan University , Chengdu, Sichuan, China .|6 Department of Public Affairs Development, West China Hospital, Sichuan University , Chengdu, Sichuan, China .
Cai-Gang
CG
Xu
1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China .
Li
L
He
7 Department of Respiratory Medicine, West China Hospital, Sichuan University , Chengdu, Sichuan, China .
Wei-Min
WM
Li
1 Department of Neurology, West China Hospital, Sichuan University , Chengdu, Sichuan, China .
Dong
D
Zhou
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002681:China; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019114:Remote Consultation / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D017216:Telemedicine / Q000458:organization & administration / Q000706:statistics & numerical data; D055815:Young Adult
Western China; cost-effectiveness; tele-consultation; telehealth; telemedicine