Abstract：
Background: 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). Methods: 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. Results: 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. Conclusion: 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.
摘要：
背景：据报道，由于多种社会经济因素，COVID-19导致远程医疗的使用差异。虽然远程医疗是为了克服地理距离而开发的，在COVID-19下，远程医疗可能会加深城乡远程医疗鸿沟。尤其是在日本,当局实际上已经规范了远程远程医疗的使用，这有利于远程医疗提供者谁是位于靠近患者。这项研究旨在量化城乡在远程医疗方面的差距，并调查设备之间的异质性（电话和视频访问）。方法：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。市政提供者级别的分析旨在衡量远程医疗提供者与普通医疗保健提供者相比的分布不均以及临床部门之间的差异。第二个来源是地级远程医疗利用数据。地区利用水平分析旨在量化城市地区远程医疗的使用方式。我们调查了设备类型和时间段之间的异质性。为了衡量不平等，这项研究使用了洛伦兹曲线和基尼系数。不需要道德审查。结果：数据包括整个日本的16,927个提供者（14,111个诊所和2,816个医院）和88,952个首次访问。主要发现是与不限于远程医疗的整体提供者相比，远程医疗提供者在地理上的融合分布，可能是它的结果，与面对面就诊相比，远程医疗在地理上的利用不平等。此外，视频访问比电话访问更不平等地利用，更不用说亲自拜访了。随着时间的推移，差距并没有得到解决，这意味着一个系统的原因。结论：利用全国综合数据，这项研究揭示了日本在COVID-19特别放松管制下与获得远程医疗有关的地理不平等。虽然远程医疗最初旨在为农村地区的人们提供护理，几个因素,包括数字鸿沟，COVID-19和日本的政策，矛盾的是可能造成这种差距。
